NCLEX-RN Practice Test Questions with Rationales

The Safe & Effective Care Environment: The

Management of Care Practice Questions

1. You are caring for a client at the end of life. The client tells you that they are grateful
for having considered and decided upon some end of life decisions and the appointments
of those who they wish to make decisions for them when they are no longer able to do so.
During this discussion with the client and the client’s wife, the client states that “my wife
and I are legally married so I am so glad that she can automatically make all healthcare
decisions on my behalf without a legal durable power of attorney when I am no longer
able to do so myself” and the wife responds to this statement with, “that is not completely
true. I can only make decisions for you and on your behalf when these decisions are not
already documented on your advance directive.” How should you, as the nurse, respond
to and address this conversation between the husband and wife and the end of life?
A. You should respond to the couple by stating that only unanticipated treatments and
procedures that are not included in the advance directive can be made by the legally
appointed durable power of attorney for healthcare decisions.
B. You should be aware of the fact that the wife of the client has a knowledge de cit relating to
advance directives and durable powers of attorney for healthcare decisions and plan an
educational activity to meet this learning need.
C. You should be aware of the fact that the client has a knowledge de cit relating to advance
directives and durable powers of attorney for healthcare decisions and plan an educational
activity to meet this learning need.
D. You should reinforce the wife’s belief that legally married spouses automatically serve for the
other spouse’s durable power of attorney for health care decisions and that others than the
spouse cannot be legally appointed while people are married

Correct Response: A

You should respond to the couple by stating that only unanticipated treatments and
procedures that are not included in the advance directive can be made by the legally
appointed durable power of attorney for healthcare decisions.
 Both the client and the client’s spouse have knowledge dePcits relating to advance directives.
Legally married spouses do not automatically serve for the other spouse’s durable power of
attorney for health care decisions; others than the spouse can be legally appointed while people
are married.

2. The Patient Self Determination Act of the United States protects clients in
terms of their rights to what? Select all that apply.
A. Privacy and to have their medical information conTdential unless the client formally approves the
sharing of this information with others such as family members.
B. Make healthcare decisions and to have these decisions protected and communicated to others
when they are no longer competent to do so.
C. Be fully informed about all treatments in term of their bene ts, risks and alternatives to them so the
client can make a knowledgeable and informed decision about whether or not to agree to having it

D. Make decisions about who their health care provider is without any coercion or undue in
uence of others including healthcare providers.

Correct Response: B, D

The Patient Self Determination Act, which was passed by the US Congress in 1990, gives
Americans the right to make healthcare decisions and to have these decisions protected and
communicated to others when they are no longer competent to do so. These decisions can also
include rejections for future care and treatment and these decisions are re ect in advance
directives. This Act also supports the rights of the client to be free of any coercion or any undue in
uence of others including healthcare providers.
The Health Insurance Portability and Accountability Act (HIPAA) supports and upholds the clients’
rights to con dentially and the privacy of their medical related information regardless of its form. It
covers hard copy and electronic medical records unless the client has formally approved the
sharing of this information with others such as family members.
The elements of informed consent which includes information about possible treatments and
procedures in terms of their beneTts, risks and alternatives to them so the client can make a
knowledgeable and informed decision about whether or not to agree to having it may be part of
these advanced directives, but the law that protects these advance directives is the Patient Self
Determination Act.
3. Your client is in the special care area of your hospital with multiple trauma and severe bodily
burns. This 45 year old male client has an advance directive that states that the client wants all
life saving measures including cardiopulmonary resuscitation and advance cardiac life support,
including mechanical ventilation. As you are caring for the client, the client has a complete
cardiac and respiratory arrest. This client has little of no chance for survival and they are facing
imminent death according to your professional judgement, knowledge of pathophysiology and
your critical thinking.

You believe that all life saving measures for this client would be futile. What is the
rst thing that you, as the nurse, should do?
A. Call the doctor and advise them that the client’s physical status has signiVcantly changed and
that they have just had a cardiopulmonary arrest.
B. Begin cardiopulmonary resuscitation other emergency life saving measures.

C. Notify the family of the client’s condition and ask them what they should be done for the client.

D. Insure that the client is without any distressing signs and symptoms at the end of life.

Correct Response: B

You must immediately begin cardiopulmonary resuscitation and all life saving measures as
[Link] the client in their advance directive despite the nurse’s own beliefs and
professional opinions. Nurses must uphold the client’s right to accept, choose and reject any and
all of treatments, as stated in the client’s advance directive.
You would not call the doctor rst; your priority is the sustaining of the client’s life; you would also
not immediately notify the family for the same reason and, when you do communicate with the
family at a later time, you would not ask them what should or should not be done for the client
when they wishes are already contained in the client’s advance directive.
Finally, you would also insure that the client is without pain and all other distressing signs and
symptoms at the end of life, but the priority and the rst thing that you would do is immediately
begin cardiopulmonary resuscitation and all life saving measures as requested by the client in their
advance directive, according to the ABCs and Maslow’s Hierarchy of Needs.

4. You are caring for a high risk pregnant client who is in a life threatening situation. The fetus is
also at high risk for death. Clinical decisions are being made that concern you because some of
these treatments and life saving measures promote the pregnant woman’s life at the same time
that they signi cantly jeopardize the fetus’ life and viability and other decisions can preserve the
fetus’s life at
the expense of the pregnant woman’s life. Which role of the nurse is the priority at
this time?
A. Case manager

B. Collaborator

C. Coordinator of care

D. Advocacy

Correct Response: D

The priority role of the nurse is advocacy. The nurse must serve as the advocate for both the
fetus and the mother at risk as the result of this ethical dilemma where neither option is
desirable. As an advocate, the nurse would seek out resources and people, such as the facility’s
ethicist or the ethics committee, to resolve this ethical dilemma.

5. A nurse who organizes and establishes a political action committee (PAC) in their
local community to address issues relating to the accessibility and a ordability of
healthcare resources in the community is serving in which capacity and role of the
registered nurse?
A. Client advocate

B. Collaborator

C. Politician

D. Entrepreneur

Correct Response: A

A nurse who organizes and establishes a political action committee (PAC) in their local
community to address issues relating to the accessibility and aCordability of healthcare
resources in the community is serving as the client advocate. As you should know, the de
nition of “client” includes not only individual clients, and families as a unit, but also
populations such as the members of the local community.
Although the nurse, as the organizer of this political action committee (PAC), will have to
collaborate with members of the community to promote the accessibility and a ordability of
healthcare resources in the community, this is a secondary role rather than the primary role.
Additionally, although the nurse is serving in a political advocacy eUort, the nurse is not
necessarily a politician and there is no evidence that this nurse is an entrepreneur.

6. Which of the following are the ve Rights of Supervision?

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A. The right task, the right circumstances, the right person, the right competency, and the right
supervision or feedback
B. The right task, the right circumstances, the right person, the right direction or
communication, and the right supervision or feedback
C. The right competency, the right education and training, the right scope of practice, the right
environment and the right client condition
D. The right competency, the right person, the right scope of practice, the right environment and the
right client condition

Correct Response: B

The Five Rights of Delegation include the right task, the right circumstances, the right person, the
right direction or communication, and the right supervision or feedback.
The right competency is not one of these basic Five Rights, but instead, competency is
considered and validated as part of the combination of matching the right task and the right
person; the right education and training are functions of the right task and the right person who is
able to competently perform the task; the right scope of practice, the right environment and the
right client condition are functions of the legal match of the person and the task; and the setting of
care which is not a Right of Delegation and the matching of the right person, task and
circumstances.

7. The registered nurse, prior to the delegation of tasks to other members of

the nursing care team, evaluates the ability of sta members to perform
assigned tasks for the position as based on which legal consideration?
A. The American Nurses Association’s Scopes of Practice

B. The American Nurses Association’s Standards of Care

C. State statutes

D. Federal law

Correct Response: C

The registered nurse, prior to the delegation of tasks to other members of the nursing care team,
evaluates the ability of sta members to perform assigned tasks for the position as based on state
statutes that diUerentiate among the di erent types of nurses and unlicensed assistive personnel
that are legally able to perform diGerent tasks.
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 Although the American Nurses Association’s Standards of Care guide nursing practice, these
standards are professional rather than legal standards and the American Nurses Association
does not have American Nurses Association’s Scopes of Practice, only the states’ laws or
statutes do.
Lastly, scopes of practice are within the legal domain of the states and not the federal
government.

8. The best way to objectively evaluate the e ectiveness of an

individual sta member’s time management skills in a longitudinal
manner is to:
A. Observe the sta member during an entire shift of duty to determine whether or not the nurse has
accurately and appropriately established priorities.

B. Observe the sta member during an entire shift of duty to determine whether or not the nurse has
accurately and appropriately completed priority tasks.
C. Ask the staJ member how they feel like they have been able to employ their time management
skills for the last six months.
D. Collect outcome data over time and then aggregate and analyze this data to determine whether or
not the sta member has completed reasonable assignments in the allotted time before the end of
their shift of duty.

Correct Response: D

The best way to objectively evaluate the e ectiveness of an individual sta member’s time
management skills in a longitudinal manner is to collect outcome data over time, and then
aggregate and analyze this data to determine whether or not the staQ member has completed
reasonable assignments in the allotted time before the end of their shift of duty. Another way to
perform this longitudinal evaluation is to look at the staK member’s use of over time, like the last
six months, when the unit was adequately staUed.
Observing the staI member during an entire shift of duty to determine whether or not the nurse
has accurately and appropriately established priorities is a way to evaluate the short term
abilities for establishing priorities and not assignment completion and observing the staV
member during an entire shift of duty to determine whether or not the nurse has accurately and
appropriately completed priority tasks is a way to evaluate the short term abilities for
completing established priorities and not a complete assignment which also includes tasks that
are not of the highest priority.
Lastly, asking the sta member how they feel like they have been able to employ their time
management skills for the last six months is the use of subjective rather than objective
evaluation.
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9. Which of the following patient care tasks is coupled with the appropriate
member of the nursing care team in terms of their legal scope of practice?
A. An unlicensed staG member who has been “certiDed” by the employing agency to monitor
telemetry: Monitoring cardiac telemetry

B. An unlicensed assistive sta member like a nursing assistant who has been “certi ed” by the
employing agency to insert a urinary catheter: Inserting a urinary catheter
C. A licensed practical nurse: The circulating nurse in the perioperative area

D. A licensed practical nurse: The rst assistant in the perioperative area

Correct Response: A

An unlicensed staG member who has been “certiDed” by the employing agency to monitor
telemetry can monitor cardiac telemetry; they cannot, however, interpret these cardiac
rhythms and initiate interventions when interventions are indicated. Only the nurse can
perform these roles.
Unlicensed assistive sta member like a nursing assistant cannot under any circumstances be
certiTed” by the employing agency to insert a urinary catheter or insert a urinary catheter because
this is a sterile procedure and, legally, no sterile procedures can be done by an unlicensed
assistive sta member like a nursing assistant.
Lastly, the role of the circulating nurse is within the exclusive scope of practice for the registered
nurse and the role of the Prst assistant is assumed only by a registered nurse with the advanced
training and education necessary to perform competently in this capacity. Neither of these roles
can be delegated to a licensed practical nurse or an unlicensed assistive staV member like a
nursing assistant or a surgical technician.

10. You are providing care to a permanently disabled Iraqi war veteran who is 28 years of age.

When he returned home from the war at the age of 24 years of age 2 years ago he was deemed
permanently disabled by both the Veterans Administration (VA) and the Social Security
Administration. He receives a substantial monthly service connected disability check from the

Veterans Administration and he has no spouse or legal dependents. Which type of governmental
health insurance is he now entitled to?
A. Only the VA health care services because he is not 65 years of age

B. Medicare because he has been deemed permanently disabled for 2 years

C. Medicaid because he is permanently disabled and not able to work
D. Choices B and C
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 Correct Response: B

This client is legally eligible for Medicare because he has been deemed permanently disabled for
more than 2 years in addition to the VA health care services. People over the age of 65 and those
who are permanently disabled for at least two years, according to the Social Security
Administration, are eligible for Medicare.
Based on the information in this scenario, the client is not eligible for Medicaid because has a
“substantial” VA disability check on a monthly basis and is not indigent and with a low income.

11. You are a registered nurse who is performing the role of a case manager in your hospital.

You have been asked to present a class to newly employed nurses about your role, your

responsibilities and how they can collaborate with you as the case manager. Which of the

following is a primary case management responsibility associated with reimbursement that you

should you include in this class?

A. The case manager’s role in terms of organization wide performance improvement activities B.

The case manager’s role in terms complete, timely and accurate documentation

C. The case manager’s role in terms of the clients’ being at the appropriate level of care

D. The case manager’s role in terms of contesting denied reimbursements

Correct Response: C

Registered nurse case managers have a primary case management responsibility associated with
reimbursement because they are responsible for insuring that the client is being cared for at the
appropriate level of care along the continuum of care that is consistent with medical necessity and
the client’s current needs. A failure to insure the appropriate level of care jeopardizes
reimbursement. For example, care in an acute care facility will not be reimbursed when the client’s
current needs can be met in a subacute or long term care setting.
Nurse case managers do not have organization wide performance improvement activities, the
supervision of complete, timely and accurate documentation or challenging denied
reimbursements in their role. These roles and responsibilities are typically assumed by quality
assurance/performance improvement, supervisory sta and medical billers, respectively.

12. Select the nurse case management model used for patient care delivery that is
accurately paired with one of its descriptors:
A. The ProACT Model: Registered nurses perform the role of the primary nurse in addition to the
related coding and billing functions
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B. The Collaborative Practice Model: The registered nurse performs the role of the primary nurse in
addition to the role of the clinical case manager with administrative, supervisory and Cscal
responsibilities
C. The Case Manager Model: The management and coordination of care for clients throughout a
facility who share the same DRG or medical diagnosis
D. The Triad Model of Case Management: The joint collaboration of the social worker, the
nursing case manager, and the utilization review team

Correct Response: D

The Triad Model of case management entails the joint collaboration of the social worker, the
nursing case manager, and the utilization review team.
The Professionally Advanced Care Team, referred to as the ProACT Model, which was
developed at the Robert Wood Johnson University Hospital, entails registered nurses serving in
the role of both the primary nurse the clinical case manager with no billing and coding
responsibilities; these highly specialized and technical billing and coding responsibilities are done
by the business o ce, medical billers and medical coders.
The Case Manager Model entails the registered nurses’ role in terms of case management for a
particular nursing care unit for a group of clients with the same medical diagnosis or DRG. In
contrast to this Case Manager Model of Beth Israel Hospital, the Collaborative Practice Model of
case management entails the role of some registered nurses in a particular healthcare facility to
manage, coordinate, guide and direct the complex care of a population of clients throughout the
entire healthcare facility who share a particular diagnosis or Diagnostic Related Group.

13. Which of these case management methods employs the intrinsic use of
multidisciplinary plans of care that are based on the client’s current condition, and re
ect interventions and expected outcomes within a pre-established time line?
A. The Case Manager Model

B. The ProACT Model

C. The Collaborative Practice Model

D. The Triad Model of Case Management

Correct Response: A

The Case Manager Model and the Collaborative Practice Model of case management are the
only models of case management that employ the mandated and intrinsic use of critical
pathwaysSHARES which are multidisciplinary plans of care that are based on the client’s current
 condition, and that re ect interventions and expected outcomes within a pre-established time line.

The ProACT Model, the Collaborative Practice Model and the Triad Model of Case Management
do not necessarily employ critical pathways; these models can use any system of medical
records and documentation.

14. Which type of legal consent is indirectly given by the client by the very nature of
their voluntary acute care hospitalization?
A. An opt out consent

B. An implicit consent

C. An explicit consent

D. No consent at all is given

Correct Response: B

The type of legal consent that is indirectly given by the client by the very nature of their voluntary
acute care hospitalization is an implicit consent indirectly given by the client by the very nature of
their voluntary acute care hospitalization is an implicit consent.
An explicit consent, on the other hand, is the direct and formal consent of the client; and an opt
out consent is given when a patient does NOT refuse a treatment; this lack of objections by the
patient indicates that the person has consented to the treatment or procedure with an opt out
consent.

15. You are asked by your supervisor to take photographs of the residents and their
family members who are attending a holiday dinner and celebration at your long
term care facility. What should you do?
A. Take the photographs because these photographs are part of the holiday tradition at this facility

B. Take the photographs because all of the residents are properly attired and in a digniUed
condition
C. Refuse to take the photographs unless you have the consent of all to do so

D. Refuse to take the photographs because this is not part of the nurse’s role

Correct Response: C
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 You should refuse to take the photographs unless you have the consent of all to do so because
to do otherwise is a violation of the residents’ rights to privacy and con dentiality as provided in
the Health Insurance Portability and Accountability Act (HIPAA). This, rather than the false belief
that this is not part of the nurse’s role, is the reason that you would not automatically take these
photographs.
Regardless of whether or not these photographs are part of the holiday tradition at this facility
and whether or not the residents are properly attired and in a digniPed condition, no
photographs can be legally taken without the residents’ permission and consent.

16. Select the law that is accurately paired with its description in terms of client
rights.
A. The Patient Self Determination Act: The client’s right to choose the level of care

B. The Patient Self Determination Act: The clients’ right to healthcare insurance coverage for mental
health disorders
C. The Mental Health Parity Act: The privacy and security of technological psychiatric information

D. The Health Insurance Portability and Accountability Act (HIPAA): The privacy and security of
technological medical information

Correct Response: D

The Health Insurance Portability and Accountability Act (HIPAA) protects the client’s legal rights to
the privacy, security and conEdentiality of all medical information including data and information
that is technologically stored and secured.
The Patient Self Determination Act uphold the client’s right to choose and reject care and not the
level of care that is driven and decided upon as based on medical necessity and health insurance
reimbursement; this Act also does not give client’s the right to any health insurance including
healthcare insurance coverage for mental health disorders.
Lastly, the Mental Health Parity and Addiction Equality Act, passed in 2008, mandates
insurance coverage for mental health and psychiatric health services in a manner similar to
medical and surgical insurance coverage; it does not protect the privacy and security of
technological psychiatric information, HIPAA does.

17. Select the member of the multidisciplinary team that you would most likely collaborate

with when the client is at risk for falls due to an impaired gait.

A. The physical therapist

B. TheSHARESoccupational therapist
C. The podiatrist

D. The nurse practitioner

Correct Response: A

The member of the multidisciplinary team that you would most likely collaborate with when the
client is at risk for falls due to an impaired gait is a physical therapist. Physical therapists are
licensed healthcare professionals who assess, plan, implement and evaluate interventions
including those related to the patient’s functional abilities in terms of their gait, strength, mobility,
balance, coordination, and joint range of motion. They also provide patients with assistive aids like
walkers and canes and exercise regimens.
Occupational therapists assess, plan, implement and evaluate interventions including those that
facilitate the patient’s ability to achieve their highest possible level of independence in terms of
their activities of daily living such as bathing, grooming, eating and dressing.
Podiatrists care for disorders and diseases of the foot; and nurse practitioners, depending on their
area of specialty, may also collaborate with nurses when a client is a ected with a disorder in
terms of gait, strength, mobility, balance, coordination, and joint range of motion, however the
member of the multidisciplinary team that you would most likely collaborate with when the client is
at risk for falls due to an impaired gait is a physical therapist.

[Link] the member of the multidisciplinary team that you would most likely
collaborate with when the client can bene t from the use of adaptive devices for
cutting food?
A. The physical therapist

B. The occupational therapist

C. The dietician

D. The podiatrist

Correct Response: B

The member of the multidisciplinary team that you would most likely collaborate with when the
client can beneVt from the use of adaptive devices for eating is the occupational therapist.
Occupational therapists assess, plan, implement and evaluate interventions including those that
facilitate the patient’s ability to achieve their highest possible level of independence in terms of
their activities of daily living such as bathing, grooming, eating and dressing. Many of these
interventions include adaptive devices such as special eating utensils and grooming aids.

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 Physical therapists are licensed healthcare professionals who assess, plan, implement and
evaluate interventions including those related to the patient’s functional abilities in terms of their
gait, strength, mobility, balance, coordination, and joint range of motion. They also provide
patients with assistive aids like walkers and canes and exercise regimens.
Dieticians assess, plan, implement and evaluate interventions including those relating to
dietary needs of those patients who need regular or therapeutic diets. They also provide
dietary education and work with other members of the healthcare need when a client has
dietary needs secondary to physical disorders such as dysphagia; and podiatrists care for
disorders and diseases of the foot.

19. What is the primary goal of multidisciplinary case conferences?

A. To ful ll the nurse’s role in terms of collaboration

B. To plan and provide for optimal client outcomes

C. To solve complex multidisciplinary patient care problems

D. To provide educational experiences for experienced nurses

Correct Response: C

The primary goal of multidisciplinary case conferences is to plan care that facilitates optimal client
outcomes. Other beneGts of multidisciplinary case conferences include the ful llment of the nurse’s
role in terms of collaboration and collegiality, to solve complex multidisciplinary patient care
problems so that optimal client outcomes can be achieved and also to provide educational
experiences for nurses; these things are secondary rather than primary goals.

20. Which member of the multidisciplinary team would you most likely
collaborate with when your pediatric client has had a traumatic amputation one
or more months ago?
A. A Pedorthist

B. A pediatric nurse practitioner

C. A trauma certi ed clinical nurse specialist

D. A prosthetist

Correct Response: D

The member of the multidisciplinary team would you most likely collaborate with when your
pediatric client has had a traumatic amputation secondary to a terrorism blast explosion a
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month ago or more ago is a prosthetist. Prosthetists, in collaboration with other members of
 the healthcare team, assess patients and then design, t and supply the patient with an arti
cial body part such as a leg or arm prosthesis. They also follow-up with patients who have
gotten a prosthesis to check and adjust it in terms of proper t, patient comfort and
functioning.

Pedorthists modify and provide corrective footwear and employ supportive devices to address
conditions which a ect the feet and lower limbs. Lastly, you may collaborate with a trauma certi
ed clinical nurse specialist and a pediatric nurse practitioner but this consultation and
collaboration should begin immediately upon arrival to the emergency department, and not a
month after the injury.

21. Con icts, according to Lewin, include which types of con ict? Select all that are
accurate.

A. Conceptualization conKicts

B. Avoidance - Avoidance con$icts

C. Approach - Approach con$icts

D. Resolvable con icts

E. Unresolvable con icts

F. Double Approach - Avoidance con icts

G. Approach-Avoidance con icts

Correct Response: B, C, F, G

According to Lewin, the types of con ict are Avoidance-Avoidance con icts, Approach-Approach
con icts, Double Approach - Avoidance con icts and Approach-Avoidance con icts.

22. Select the types and stages of con ict that are accurately paired with their
description. Select all that apply.
A. Frustration: The phase of conJict that is characterized with personal agendas and obstruction

B. Conceptualization: The phase of con ict that occurs when contending parties have developed a
clear and objective understanding of the nature of the con ict and factors that have led to it
C. Taking action: The phase of con6ict that is characterized with individual responses to and
feelings about the con ict
D. Resolution: The type of conJict that can be resolved
E. Avoidance-Avoidance: A stage of conEict that occurs when there are NO alternatives that are
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acceptable to the contending parties
F. Approach- Approach Con icts: The type of con ict that occurs when the people involved in the
con ict want more than one alternatives or actions that could resolve the conXict.

G. Approach-Avoidance Con icts: The type of con ict that occurs when the people involved in the
con ict believe that all of the alternatives are NEITHER completely satisfactory nor completely
dissatisfactory.

Correct Response: C, F, G

Taking action is the phase of con ict that is characterized with individual responses to and
feelings about the con ict; Approach- Approach con icts are a type of con ict that occurs when
the people involved in the conPict want more than one alternatives or actions that could resolve
the conNict; and Approach-Avoidance con icts are a type of con ict that occurs when the people
involved in the conPict believe that all of the alternatives are NEITHER completely satisfactory or
completely dissatisfactory.

Frustration is the phase of conVict that occurs when those involved in the con ict believe that their
goals and needs are being blocked and not met, and not necessarily characterized with personal
agendas and obstruction; conceptualization is the phase of conQict that occurs when those
involved in the conGict begin to understand what the con ict is all about and why it has occurred.
This understanding often varies from person to person and this personal understanding may or
may not be accurate, clear or objective, and not a clear and objective understanding of the nature
of the con ict and factors that have led to it; resolution is a phase of con ict resolution, not a type of
con ict, that is characterized when the contending parties are able to come to some agreement
using mediation, negotiation or another method; an Avoidance-Avoidance con ict is a type of
conEict and not a phase of con ict, that occurs when there are NO alternatives that are acceptable
to any the contending parties; Approach-Approach con icts occur when the people involved in the
conVict want more than one alternative or action that could resolve the con ict; and lastly, Double
Approach - Avoidance is a type of con ict and not a stage of con ict that occurs when the people
involved in the conQict are forced to choose among alternatives and actions, all of which have
BOTH positive and negative aspects to them.

23. You are the chair person for the healthcare facility’s newly formed multidisciplinary
Safety Committee. During the Forming stage of this group’s development major con icts
have arisen. Which technique of con ict resolution should you use to resolve these con
icts?
A. Passivity

B. Compromise

C. Competition

D. AccommodatingSHRES Others
 Correct Response: B

ConQicts can be e ectively resolved using a number of di erent strategies and techniques
such as compromise, negotiation, and mediation.
Avoidance of the con ict, withdrawing in addition to other passivity, competition, and
accommodating others are not e ective and healthy conQict resolution techniques.

24. The stages of con ict and con ict resolution in the correct sequential order are:
A. Conceptualization

B. Frustration

C. Resolution

D. Taking action

Correct Response: B, A, D, C

The stages of conGict and conEict resolution in the correct sequential order are frustration,
conceptualization, and taking action.

25. Which federal law is most closely associated with the highly restrictive “need to know”?

A. The Patient Self Determination Act

B. The Mental Health Parity Act

C. The Health Insurance Portability and Accountability Act

D. The Americans with Disabilities Act of 1990

Correct Response: C

The federal law is most closely associated with the highly restrictive “need to know” is the
Health Insurance Portability and Accountability Act. This law restricts access to medical
information to only those persons who have the need to know this information in order to
provide direct and/or indirect care to the client.
The Patient Self Determination Act, which was passed by the US Congress in 1990, gives
Americans the right to make healthcare decisions and to have these decisions protected and
communicated to others when they are no longer competent to do so. These decisions can also
include rejections for future care and treatment and these decisions are re ect in advance
directives. This Act also supports the rights of the client to be free of any coercion or
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any undue in uence of others including healthcare providers.
 The Mental Health Parity Act passed in 2008, mandates insurance coverage for mental health
and psychiatric health services in a manner similar to medical and surgical insurance coverage.

And, lastly the Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973
forbid and prohibit any discrimination against people with disabilities.

26. Which of the following personnel do not have the “right to know” medical information?
A. The facility’s Performance Improvement Director who is not a healthcare person and who has no
direct contact with clients
B. A nursing student who is caring for a client under the supervision of the nursing instructor

C. The facility’s Safety O[cer who is not a healthcare person and who has no direct contact with
clients
D. A department supervisor with no direct or indirect care duties

Correct Response: D

A department supervisor with no direct or indirect care duties does not have the “right to know”
medical information; all of the others have the “right to know” medical information because they
provide direct or indirect care to clients.
For example, both the facility’s Performance Improvement Director who is not a healthcare
person and who has no direct contact with clients and the facility’s Safety OKcer who is not a
healthcare person and who has no direct contact with clients provide indirect care to clients. For
example, they collect and analyze client data in order to fulCll their role and responsibilities in
terms of process improvements and the prevention of incidents and accidents, respectively.

Nursing and other healthcare students also have the “need to know” medical information so that
they can provide direct client care to their assigned client(s).

27. You are the Nurse Manager for the trauma unit. Which of these sta comments
or statements indicate the need for you to provide an educational activity relating
to con dentiality and information security?
A. “A computer in the hallway was left unattended and a client’s medical record was visible to me.”

B. “I just saw a nursing student looking at the medical record for a client that they are NOT caring for
during this clinical experience.”
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C. “As I was walking past the nursing station, I saw a dietician reading the progress notes written by
members of the laboratory department in addition to other dieticians’ progress notes.”

D. “I refused the nursing supervisor’s request to share my electronic password for the new nurse on
the unit.”

Correct Response: C

A staU members comment, “As I was walking past the nursing station, I saw a dietician reading
the progress notes written by members of the laboratory department in addition to other dieticians’
progress notes” “indicates the need for the Nurse Manager to provide an educational activity
relating to con dentiality and information security because dieticians often have the “need to know”
about laboratory data so that they can, for example, assess the client’s nutritional status in terms
of their creatinine levels.
The report that the nursing student was “looking at the medical record for a client that they are
NOT caring for during this clinical experience” indicates that the reporting staR member is
correctly applying the principles for maintaining con dentiality and privacy of information; the
report that a “computer in the hallway was left unattended and a client’s medical record was
visible to me” indicates that the reporting sta member is correctly applying the principles for
maintaining con dentiality and privacy of information; and lastly, “I refused the nursing
supervisor’s request to share my electronic password for the new nurse on the unit” also
indicates that the staU member is knowledgeable about privacy and con dentiality.

28. Which of the following terms is used to describe the sound, timely, smooth,
unfragmented and seamless transition of the client from one level of acuity to another?
A. Case management

B. Continuity of care

C. Medical necessity

D. Critical pathway

Correct Response: B

The continuity of care is de ned as the sound, timely, smooth, unfragmented and seamless
transition of a client from one area within the same healthcare facility, from one level of care to a
higher and more intense level of care or to a less intense level of care based on the client’s
status and level of acuity, from one healthcare facility to another healthcare facility and also any
discharges to the home in the client’s community.

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 Case management and critical pathways may be used to facilitate the continuity of care, but they
are not the sound, timely, smooth, unfragmented and seamless transition of the client from one
level of acuity to another. Lastly, medical necessity is necessary for reimbursement and it is one
of the considerations for moving the client from one level of acuity to another but medical
necessity is not the continuity of care.

29. The Joint Commission on the Accreditation of Healthcare Organizations mandates standardized

“hand of” change of shift reporting. Which of the following is a standardized “hand o_” change of shift

reporting system that you may want to consider for implementation on your nursing care unit?

A. The Four P's

B. UBAR

C. ISBAR

D. MAUMAR

Correct Response: C

The standardized “hand o ” change of shift reporting system that you may want to consider for
implementation on your nursing care unit is ISBAR. Other standardized change of shift “hand
oP” reports, as recommended by the Joint Commission on the Accreditation of Healthcare
Organization, include:
SBAR, not IBAR
BATON
The Five Ps not the Four Ps and
IPASS
Lastly, MAUUAR is a method of priority setting and not a standardized “hand o ” change of
shift reporting system.

[Link] the standardized “hand o_” change of shift reporting system that is
accurately paired with its elements.
A. SBAR: Symptoms, background, assessment and recommendations

B. ISBAR: Interventions, symptoms, background, assessment and recommendations

C. The Five Ps: The patient, plan, purpose, problems and precautions

D. BATON: Background, assessment, timing, ownership and next plans

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Correct Response: C

The Five Ps are the patient, plan, purpose, problems and precautions.

The elements of the other standardized reporting systems are listed below:

SBAR stands for:

S: Situation: The patient’s diagnosis, complaint, plan of care and the patient's prioritized
needs
B: Background: The patient’s code or DNR status, vital Signs, medications and lab results
A: Assessment: The current assessment of the situation and the patient’s status and
R: Recommendations: All unresolved issues including things like pending diagnostic testing
results and what has to be done over the next few hours
ISBAR stands for:

I: Introduction: The introduction of the nurse, the nurse’s role in care and the area or
department that you are from
S: Situation: The patient’s diagnosis, complaint, plan of care and the patient's prioritized
needs
B: Background: The patient’s code or DNR status, vital Signs, medications and lab results
A: Assessment: The current assessment of the situation and the patient’s status and
R: Recommendations: All unresolved issues including things like pending diagnostic testing
results and what has to be done over the next few hours
BATON stands for:

B: Background: Past and current medical history, including medications

A: Actions: What actions were taken and/or those actions that are currently required
T: Timing: Priorities and level of urgency
O: Ownership: Who is responsible for what? and
N: Next: The future plan of care
IPASS stands for:

Introduction: The introduction of the nurse, the nurse’s role in care and the area or
department that you are from
P: Patient: The patient’s name, age, gender, location and other demographic data
A: Assessment: The current assessment of the situation and the patient’s status
S: Situation: The patient’s diagnosis, complaint, plan of care and the patient's prioritized
needs and
S: Safety concerns: Physical, mental and social risks and concerns

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31. Number the priority of the following conditions using the numbers # 1 through # 6 with #

1 as the greatest priority and # 6 as the least priority.

1. Atrial brillation
2. First degree heart block
3. Shortness of breath upon exertion
4. An obstructed airway
5. Fluid needs
6. Respect and esteem by others

A. 3,4,2,1,5,6

B. 3,4,5,1,2,6

C. 2,3,5,1,4,6

D. 3,2,4,1,5,6

Correct Response:

Client needs are prioritized in a number of di erent ways including Maslow’s Hierarchy of
Human Needs and the ABCs. In terms of priorities from # 1 to # 6 the conditions above are
prioritized as follows:
An obstructed airway
First degree heart block
Atrial Kbrillation
Shortness of breath upon exertion
Fluid needs
Respect and esteem by others
The ABCs identiUes the airway, breathing and cardiovascular status of the patient as the highest
of all priorities in that sequential order; and Maslow’s Hierarchy of Needs identi es the
physiological or biological needs, including the ABCs, the safety/psychological/emotional needs,
the need for love and belonging, the needs for self-esteem and the esteem by others and the
self-actualization needs in that order of priority.

nd
32. The 2 priority needs according to the MAAUAR method of priority setting
include which of the following?
A. Assessment

B. Movement
C. Understanding level
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D. Risks

Correct Response: D
nd
One of the 2 priority needs according to the MAAUAR method of priority setting is risks. The
ABCs / MAAUAR method of priority setting places the ABCs, again, as the highest and greatest
nd rd
priorities which are then followed with the 2 and 3 priority level needs of the MAAUAR
method of priority setting.
nd
The 2 priority needs according to the MAAUAR method of priority setting after the ABCs
include M-A-A-U-A-R which stands for:
Mental status changes and alterations
Acute pain
Acute urinary elimination concerns
Unaddressed and untreated problems that require immediate priority attention
Abnormal laboratory and other diagnostic data that are outside of normal limits and
Risks including those relating to a healthcare problem like safety, skin breakdown, infection and
other medical conditions
rd nd
The 3 level priorities include all concerns and problems that are NOT covered under the 2 level
priority needs and the ABCs. For example, increased levels of self care abilities and skills and
nd
enhanced knowledge of a medical condition are considered 2 level priority needs.

[Link] of these skills is most closely related to successfully meeting the

established priority needs of a group of clients?
A. Time management skills

B. Communication skills

C. Collaboration skills

D. Supervision skills

Correct Response: A

Time management skills are most closely related to successfully meeting the established
priority needs of a group of clients.
In addition to prioritizing and reprioritizing, the nurse should also have a plan of action to
eGectively manage their time; they should avoid unnecessary interruptions, time wasters and
helping others when this helping others could potentially jeopardize their own priorities of care.

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 Although good communication skills, collaboration skills and supervision are necessary for the
delivery of nursing care, it is time management skills that are most closely related to
successfully meeting the established priority needs of a group of clients.

34. Which is most closely aligned with ethics?

A. Morals

B. Laws

C. Statutes

D. Client rights

Correct Response: A

Morals are most closely aligned with ethics. Ethics is a set of beliefs and principles that guide us
in terms of the right and wrong thing to do which is the most similar to ethics.
Laws and statutes de ned what things are legal and what things are illegal. Lastly, client rights can
serve as a factor to consider when ethical decisions are made; but they are not most closely
aligned with ethics, but only, one consideration of many that can be used in ethical decision
making.

[Link] the ethical term that is accurately paired with it brief description.
A. Deontology: The school of ethical of thought that requires that only the means to the goal must be
ethical.
B. Utilitarianism: The school of ethical of thought that requires that only the end goal must be ethical.

C. Deontology: The school of ethical of thought that requires that only the end goal must be ethical.

D. Utilitarianism: The school of ethical of thought that requires that only the means to the goal must
be ethical.

Correct Response: B

The two major classi cations of ethical principles and ethical thought are utilitarianism and
deontology. Deontology is the ethical school of thought that requires that both the means and the
end goal must be moral and ethical; and the utilitarian school of ethical thought states that the end
goal justi es the means even when the means are not moral.
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[Link] ethical principle below is accurately paired with a way that ethical
principle is applied into nursing practice?
A. Justice: Equally dividing time and other resources among a group of clients

B. Bene cence: Doing no harm during the course of nursing care

C. Veracity: Fully answering the client’s questions without any withholding of information

D. Fidelity: Upholding the American Nurses Association’s Code of Ethics

Correct Response: C

Fully answering the client’s questions without any withholding of information is an example of the
application of veracity into nursing practice. Veracity is being completely truthful with patients;
nurses must not withhold the whole truth from clients even when it may lead to patient distress.

Justice is fairness. Nurses must be fair when they distribute care and resources equitably, which
is not always equally among a group of patients. BeneOcence is doing good and the right thing
for the patient; it is nonmale cence that is doing no harm.

[Link] have been asked to teach an inservice class for nurses in your facility about ethics.
Which of the following should you consider during the planning of this educational activity?
A. Planning a way to evaluate the e ectiveness of the class by seeing a decrease in the amount of
referrals to the facility’s Ethics Committee
B. Establishing educational objectives for the class that reGect the methods and methodology that you
will use to present the class content
C. The need to exclude case studies from the class because this would violate client privacy and
conQdentiality
D. Some of the most commonly occurring bioethical concerns including genetic engineering into the
course content

Correct Response: D

You would consider including some of the most commonly occurring bioethical concerns
including genetic engineering into the course content.
You would also plan how you could evaluate the e ectiveness of the class by seeing an increase,
not a decrease in the amount of referrals to the facility’s Ethics Committee, because oneSHARESof
the elements of this class should address ethical dilemmas and the role of the Ethics
 Committee in terms of resolving these.

You would additionally establish educational objectives for the class that reVect speciNc,
measurable learner outcomes and not the methods and methodology that you will use to present
the class content; and lastly, there is no need to exclude case studies from the class because
“sanitized” medical records can, and should be, used to avoid any violations of client privacy and
con dentiality.

38. One of the roles of the registered nurse in terms of informed consent is to:
A. Serve as the witness to the client’s signature on an informed consent.

B. Get and witness the client’s signature on an informed consent.

C. Get and witness the durable power of attorney for health care decisions’ signature on an
informed consent.
D. None of the above

Correct Response: A

One of the roles of the registered nurse in terms of informed consent is to serve as the
witness to the client’s signature on an informed consent.
Other roles and responsibilities of the registered nurse in terms of informed consent include
identifying the appropriate person to provide informed consent for client, such as the client,
parent or legal guardian, to provide written materials in client’s spoken language, when possible,
to know and apply the components of informed consent, and to also verify that the client
comprehends and consents to care and procedures.
The registered nurse does not get the client’s or durable power of attorney for health care
decisions’ signature on an informed consent, this is the role and responsibility of the physician
or another licensed independent practitioner.

[Link] of the following is most closely aligned with the principles and
concepts of informed consent?
A. Justice

B. Fidelity

C. Self determination

D. Nonmal cence
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 Correct Response: C

Self-determination is most closely aligned with the principles and concepts of informed consent.
Self-determination supports the client’s right to choose and reject treatments and procedures
after they have been informed and fully knowledgeable about the treatment or procedure.

Justice is fairness. Nurses must be fair when they distribute care and resources equitably,
which is not always equally among a group of patients; delity is the ethical principle that
requires nurses to be honest, faithful and true to their professional promises and
responsibilities by providing high quality, safe care in a competent manner; and, lastly,
nonmaleOcence is doing no harm, as stated in the historical Hippocratic Oath.

[Link] of the following is NOT an essential minimal component of the teaching

that occurs prior to getting an informed consent?
A. The purpose of the proposed treatment or procedure

B. The expected outcomes of the proposed treatment or procedure

C. Who will perform the treatment or procedure

D. When the procedure or treatment will be done

Correct Response: D

The minimal essential components of the education that occurs prior to getting an informed
consent include the purpose of the proposed treatment or procedure, the expected outcomes of
the proposed treatment or procedure, and who will perform the treatment or procedure. It is not
necessary to include when the treatment or procedure will be done at this time.

Other essential elements include:

The bene ts of the proposed treatment or procedure

The possible risks associated with the proposed treatment or procedure
The alternatives to the particular treatment or procedure
The bene ts and risks associated with alternatives to the proposed treatment or procedure The
client’s right to refuse a proposed treatment or procedure

41. Legal prohibitions against sharing passwords are legally based on:
A. TheSHARESecurity Rule
B. The American Nurses Association’s Code of Ethics

C. The American Hospital’s Patients’ Bill of Rights D.

The Autonomy Rule

Correct Response: A

Prohibitions against sharing passwords are legally based on the Security Rule of HIPAA
mandates administrative, physical, and technical safeguards to insure the con dentiality,
integrity, and availability of electronic protected health information. This rule relates to
electronic information security as well as other forms of information.
The American Nurses Association’s Code of Ethics and the American Hospital’s Patients’ Bill of
Rights both address client con dentiality and their rights to privacy, however, these statements are
not legal, but instead ethical and regulatory statements; and lastly, there is no autonomy law or
rule.

42. Which of these statements related to information technology is accurate?

A. Social networks and cell phone cameras pose low risk in terms of information technology
security and con dentiality.
B. The security of technological data and information in healthcare environments is most often violated
by those who work there.
C. The security of technological data and information in healthcare environments is most often
violated by computer hackers.
D. Computer data deletion destroys all evidence of the data.

Correct Response: B

The security of technological data and information in healthcare environments is most often
violated by those who work there. The vast majority of these violations occur as the result of
inadvertent breaches with carelessness and the lack of thought on the part of employees.
Technology is a double edged sword.

Technological advances such as cell phone cameras, social networks like Facebook, telephone
answering machines and fax machines pose great risk in terms of the con dentiality and the
security of medical information. Computer data deletion does not always destroy all evidence of
the data; data remains.

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43. Select the legal term that is accurately paired with its description.
A. Assault: Touching a person without their consent

B. Battery: Threatening to touch a person without their consent

C. Slander: False oral defamatory statements.

D. Slander: False written defamatory statements.

Correct Response: C

Slander is false oral defamatory statements; and libel is written defamation of character using false
statements.
Assault, an intentional tort, is threatening to touch a person without their consent; and
battery, another intentional tort, is touching a person without their consent.

44. You have loosely applied a bed sheet around your client’s waist to prevent a fall
from the chair. What have you done?
A. Ensured the client’s safety which is a high patient care priority

B. Violated Respondeat Superior

C. Violated the client’s right to dignity

D. Committed a crime

Correct Response: D

When you loosely apply a bed sheet around your client’s waist to prevent a fall from the chair, you
have falsely imprisoned the client with this make shift restraint. False imprisonment is restraining,
detaining and/or restricting a person’s freedom of movement. Using a restraint without an order is
considered false imprisonment even when it is done to protect the client’s safety.

Respondeat Superior is the legal doctrine or principle that states that employers are legally
responsible for the acts and behaviors of its employees. Respondeat Superior does not,
however, relieve the nurse of legal responsibility and accountability for their actions. They
remain liable.
There is no evidence in this question that you have violated the client’s right to dignity.

[Link] statement about Respondeat Superior is accurate?

A. Respondeat Superior does not mean that a nurse cannot be held liable.

B. Respondeat Superior does not mean that a nurse cannot be held libel.

C. Respondeat Superior is an ethical principle.

D. Respondeat Superior is a law.

Correct Response: A

Respondeat Superior does not mean that a nurse cannot be held liable and not libel which is a
written defamation of character using false statements. Liability is legal vulnerability.
Respondeat Superior is the legal doctrine or principle and not a law or ethical principle.

46. Which of these choices contains the six elements necessary for malpractice?
A. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this
duty was breached, and direct rather than indirect harm to the client.
B. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty
was breached, and direct and/or indirect harm to the client.
C. Causation, correlation, damages to the patient, a duty that was owed to the client and this duty was
breached, and direct and/or indirect harm to the client.
D. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this
duty was breached, and a medical license.

Correct Response: B

The six essential components of malpractice include causation, foreseeability, damages to the
patient, a duty that was owed to the client and this duty was breached, and, lastly, this breach of
duty led to direct and/or indirect harm to the client.
A medical license is not necessary; nurses and other healthcare professionals can be found guilty
of malpractice. Lastly, correlation is the relationship of simultaneously changing variables. For
example, a ppositive correlation exists when the two variables both increase or decrease; and a
negative occurs when one variable increases and the other decreases.

47. The current focus of performance improvement activities is to facilitate and address:
A. Sound structures like policies and procedures

B. Processes and how they are being done

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C. Optimal client outcomes
D. Optimal staC performance

Correct Response: C

The current focus of performance improvement activities is to facilitate and address optimal
client outcomes. Throughout the last several decades performance improvement activities have
evolved from a focus on structures to a focus on process and now, to a focus on outcomes.

StaV performance is not the focus of performance improvement activities but instead the
focus of competency assessment and validation.

[Link] is the term that is used to describe a healthcare related incident or

accident that may have possibly led to client harm?
A. An adverse event

B. A root cause

C. A healthcare acquired event

D. A sentinel event

Correct Response: D

A sentinel event is an event or occurrence, incident or accident that has led to or may have
possibly led to client harm. Even near misses, that have the potential for harm, are considered
sentinel events because they have the potential to cause harm in the future.

An adverse event, like an adverse e ect of a medication, has actually led to an adverse
response; it is not a near miss. A root cause is a factor that has led to a sentinel event; and
there is no such thing as a healthcare acquired event.

49. The primary purpose of root cause analysis is to:

A. Discover a process Caw

B. Determine who erred

C. Discover environmental hazards

D. Determine basic client needs

Correct Response: A
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 The primary purpose of root cause analysis is to discover process aws. Root cause analysis and
a blame free environment are essential to a successful performance improvement activity,
therefore, root cause analysis does not aim to determine who erred and made a mistake. Root
cause analysis explores and digs down to the roots of the problem, its root causes and the
things, not people, which are the real reasons why medical errors and mistakes are made.

It is nursing assessment that determines the basic client needs and environmental
surveillance that discovers environmental safety hazards, and not root cause analysis.

50. Which question is asked more than any other root cause analysis activity?
A. What?

B. Why?

C. Who?

D. When?

Correct Response: B

Root cause analysis activities ask “Why”, rather than “Who”, which would place blame on a
person or group of people: and What? and When? Questions are rarely asked.

51. The primary distinguishing characteristic of risk management when compared and
contrasted to performance improvement is that risk management activities focus on:
A. Historical data and performance improvement activities focus on current data.

B. Current data and performance improvement activities focus on historical data.

C. Decreasing Cnancial liability and performance improvement activities focus on process

improvements.
D. Decreasing falls and performance improvement activities focus on process improvements.

Correct Response: C

The primary distinguishing characteristic of risk management when compared and contrasted to
performance improvement is that risk management activities focus on decreasing nancial liability
and performance improvement activities focus on process improvements.

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 Risk management focuses on decreasing and eliminating things that are risky and
place the healthcare organization in a position of legal liability. Some examples of
risk management activities include preventing hazards and adverse events such
as patient falls and infant abduction and the legal liabilities associated with these
events.

52. Which statement about referrals is accurate?

A. Referrals complement the healthcare teams’ abilities to provide optimal care to the
client.

B. Referrals simply allow the client to be discharged into the community with the
additional care they need.
C. Nurses facilitate referrals to only the resources within the facility.

Correct Response: A

Referrals complement the healthcare teams’ abilities to provide optimal care to the
client.

When clients have assessed needs that cannot be fulFlled and met by the registered
nurse in collaboration with other members of the nursing care team, the registered
nurse should then seek out resources, as well as utilize and employ di erent internal
or external resources such as a physical therapist, a clergy member or a home health
care agency in the community and external to the nurse’s healthcare agency.