PROFESSIONAL ADJUSTMENT AND NURSING CARE

MANAGEMENT PRACTICE EXAM

1. The nurse is explaining the Bill of Rights for psychiatric patients to a
client who has voluntarily sought admission to an inpatient psychiatric facility.
Which of the following rights should the nurse include in the discussion? Select all
that apply:

__Right to select health care team members

__Right to refuse treatment
__Right to a written treatment plan
__Right to obtain disability
__Right to confidentiality
__Right to personal mail

2. In the emergency department, a client reveals to the nurse a lethal

plan for committing suicide and agrees to a voluntary admission to the psychiatric
unit. Which information will the nurse discuss with the client to answer the
question, "How long do I have to stay here?" Select all that apply:

__"You may leave the hospital at any time unless you are suicidal."
__"Let's talk more after the health team has assessed you."
__"Once you've signed the papers, you have no say."
__"Because you could hurt yourself, you must be safe before being discharged."
__"You need a lawyer to help you make that decision."
__"There must be a court hearing before you leave the hospital."

3. The nurse has developed a relationship with a client who has an

addiction problem. Which information would indicate that the therapeutic
interaction is in the working stage? Select all that apply:

__The client addresses how the addiction has contributed to family distress.
__The client reluctantly shares the family history of addiction.
__The client verbalizes difficulty identifying personal strengths.
__The client discusses the financial problems related to the addiction.
__The client expresses uncertainty about meeting with the nurse.
__The client acknowledges the addiction's effects on the children.

4. If parents or legal guardians aren't available to give consent for

treatment of a life-threatening situation in a minor child, which of the following
statements is most accurate?

A. onsent may be obtained from a neighbor or close friend of the family.

B. Consent may not be needed in a life-threatening situation.
C. Consent must be in the form of a signed document; therefore, parents or
guardians must be contacted.
D. Consent may be given by the family physician.

5. You're admitting a 15-month-old boy who has bilateral otitis media

and bacterial meningitis. Which room arrangements would be best for this client?

A. In isolation off a side hallway

B. A private room near the nurses' station
C. A room with another child who also has meningitis
D. A room with two toddlers who have croup

6. Which of the following points should a team leader consider when

delegating work to team members in order to conserve time?
 A. Assign unfinished work to other team members.
B. Explain to each team member what needs to be done.
C. Relinquish responsibility for the outcome of the work.
D. Assign each team member the responsibility to obtain dietary trays.

7. The nurse is caring for a client admitted to the emergency

department after a motor vehicle accident. Under the law, the nurse must obtain
informed consent before treatment unless:

A. the client is mentally ill.

B. the client refuses to give informed consent.
C. the client is in an emergency situation.
D. the client asks the nurse to give substituted consent.

8. The nurse is assigned to care for an elderly client who is confused and
repeatedly attempts to climb out of bed. The nurse asks the client to lie quietly
and leaves her unsupervised to take a quick break. While the nurse is away, the
client falls out of bed. She sustains no injuries from the fall. Initially, the nurse
should treat this occurrence as:

A. a quality improvement issue.

B. an ethical dilemma.
C. an informed consent problem.
D. a risk-management incident.

9. The nurse receives an assignment to provide care to 10 clients. Two of

them have had kidney transplantation surgery within the last 36 hours. The nurse
feels overwhelmed with the number of clients. In addition, the nurse has never
cared for a client who has undergone recent transplantation surgery. What's the
appropriate action for the nurse to take?

A. Speak to the manager and document in writing all concerns related to the
assignment.
B. Refuse the assignment.
C. Ignore the assignment and leave the unit.
D. Trade assignments with another nurse.

10. The nurse works with a colleague who consistently fails to use
standard precautions or wear gloves when caring for clients. The nurse calls the
colleague's attention to these oversights. The colleague tells the nurse that
standard precautions and gloves aren't necessary unless the client is known to
have tested positive for the human immunodeficiency virus. What's the most
appropriate action for the nurse to take?

A. Ignore it because it isn't directly the nurse's problem.

B. Document the problem in writing for the manager.
C. Talk to other staff members to ascertain their practices.
D. Instruct the clients to remind this colleague to wear gloves.

11. An adult client is diagnosed with acquired immunodeficiency

syndrome. The nurse who is caring for the client is also his friend. The nurse tells
the client's parents about the diagnosis; after all, they know their son is the
nurse's friend. Several weeks later, the nurse receives a letter from the client's
attorney stating that the nurse has committed an intentional tort. Which
intentional tort has this nurse committed?

A. Fraud
B. Defamation of character
C. Assault and battery
D. Breach of confidentiality
 12. A nurse accidentally administers 40 mg of propranolol (Inderal) to a
client instead of 10 mg. Although the client exhibits no adverse reactions to the
larger dose, the nurse should:

A. call the facility's attorney.

B. inform the client's family.
C. complete an incident report.
D. do nothing because the client's condition is stable.

13. The nurse is assigned to care for a postoperative client who has
diabetes mellitus. During the assessment interview, the client reports that he's
impotent and says that he's concerned about its effect on his marriage. In
planning this client's care, the most appropriate intervention would be to:

A. encourage the client to ask questions about personal sexuality.

B. provide time for privacy.
C. provide support for the spouse or significant other.
D. suggest referral to a sex counselor or other appropriate professional.

14. The nurse is assigned to care for eight clients. Two nonprofessionals
are assigned to work with the nurse. Which statement is valid in this situation?

A. The nurse may assign the two nonprofessionals to work independently with a
client assignment.
B. The nurse is responsible to supervise assistive personnel.
C. Nonprofessionals aren't responsible for their own actions.
D. Nonprofessionals don't require training before they work with clients.

15. Each state has guidelines that regulate the different levels of
nursing : licensed practical or vocational nurse, registered nurse, or advanced
practice nurse. Legal guidelines outlining the scope of practice for nurses are
known as:

A. consent to treatment.
B. client's bill of rights.
C. nurse practice acts.
D. licensure requirements.

16. A client is dissatisfied with his hospitalization. He decides to leave

against medical advice and refuses to sign the paperwork. The nurse's next
course of action is to:

A. detain him until he signs the paperwork.

B. detain him until his physician arrives.
C. call security for assistance.
D. let him leave.

17. A nurse needs assistance transferring an elderly, confused client to

bed. The nurse leaves the client to find someone to assist her with the transfer.
While the nurse is gone, the client falls and hurts herself. The nurse is at fault
because she hasn't:

A. properly educated this client about safety measures.

B. restrained the client.
C. documented that she left the client.
D. arranged for continual care of the client.
 18. When prioritizing a client's care plan based on Maslow's hierarchy of
needs, the nurse's first priority would be:

A. allowing the family to see a newly admitted client.

B. ambulating the client in the hallway.
C. administering pain medication.
D. placing wrist restraints on the client.

19. When developing a therapeutic relationship with a client, the nurse

should begin preparing the client for termination of the relationship:

A. at discharge.
B. during the first meeting.
C. at the midpoint of the relationship.
D. when the client demonstrates the ability to function independently.

20. To be effective, a clinical nurse-manager in a managed care

environment must:

A. expect all staff to accept change.

B. go along with a proposed change.
C. be a catalyst for change.
D. document staff nurses' reactions to change.

21. In community-based nursing, primary responsibility for decisions

related to health care belongs to the:

A. nurse.
B. client.
C. health care team.
D. physician.

22. A client became seriously ill after a nurse gave him the wrong
medication. After his recovery, he files a lawsuit. Who is most likely to be held
liable?

A. No one because it was an accident

B. The hospital
C. The nurse
D. The nurse and the hospital

23. The nurse is providing care for a client who underwent mitral valve
replacement. The best example of a measurable client outcome goal is to:

A. change his own dressing.

B. walk in the hallway.
C. walk from his room to the end of the hall and back before discharge.
D. eat a special diet.

24. A client with end-stage liver cancer tells the nurse he doesn't want
extraordinary measures used to prolong his life. He asks what he must do to make
these wishes known and legally binding. How should the nurse respond to the
client?

A. Tell him that it's a legal question beyond the scope of nursing practice.
B. Give him a copy of the client's bill of rights.
C. Provide information on active euthanasia.
D. Discuss documenting his wishes in an advance directive.
 25. While admitting a client with pneumonia, the nurse notes multiple
bruises in various stages of healing. The client has Alzheimer's disease and a
history of multiple fractures. Legally, the most important action for the nurse to
take is to:

A. document findings thoroughly.

B. question the client about the bruising.
C. inform appropriate local authorities.
D. tell the client's physician.

26. The nurse is providing care for a client with multiple myeloma, a
disorder characterized by episodes of remissions and exacerbations. Which
resource can best help the client adapt to the disease?

A. The client's family

B. Pastoral care
C. Support group
D. Hospice care

27. A client with brain cancer is deteriorating and the prognosis is poor.
The client meets brain-death criteria. Which nursing intervention is most
appropriate at this time?

A. Approach the client's family about organ donation.

B. Make the decision to withdraw life support.
C. Sedate the client.
D. Talk to the staff about their feelings.

28. A client is scheduled to have a descending colostomy. He's very

anxious and has many questions concerning the surgical procedure, care of a
stoma, and lifestyle changes. It would be most appropriate for the nurse to make
a referral to which member of the health care team?

A. Social worker
B. Registered dietitian
C. Occupational therapist
D. Enterostomal nurse therapist

29. A 92-year-old client with prostate cancer and multiple metastases is

in respiratory distress and is admitted to a medical unit from a skilled nursing
facility. His advance directive states that he doesn't want to be placed on a
ventilator or receive cardiopulmonary resuscitation. Based on the client's advance
directive, which intervention should the nursing care plan include?

A. Check on the client once per shift.

B. Provide mouth and skin care only if the family requests it.
C. Turn the client only if he's uncomfortable.
D. Provide emotional support and pain relief.

30. The registered nurse has an unlicensed assistant working with her
for the shift. When delegating tasks, the registered nurse understands that the
unlicensed assistant:

A. interprets clinical data.

B. collects clinical data.
C. is trained in the nursing process.
D. can function independently.
 31. A nurse on a medical-surgical floor is making assignments for an 8-
hour shift. Which of the following considerations has the highest priority?

A. Complexity of care required

B. Age of the clients
C. Skills of the assigned personnel
D. The number of clients

32. The nurse is caring for a homeless client with active tuberculosis.
The client is almost ready for discharge; however, the nurse is concerned about
the client's ability to follow the medical regimen. Which intervention will best
ensure that the client complies with treatment?
A. Referring the client to a social worker for discharge planning
B. Providing individualized client education
C. Having the client attend a formal education session
D. Attempting to contact a member of the client's family to provide
assistance

33. The nurse is following a critical pathway to help a client who

underwent hip replacement surgery meet specific objectives. What's a critical
pathway?

A. A nursing care plan that helps the nurse to decide which intervention to
perform first
B. A multidisciplinary care plan that helps the nurse to use a variety of critical
interventions
C. A standardized care plan that lists basic interventions for the nurse to use
with every client
D. A clinical management tool that organizes the major interventions for a
multidisciplinary health care team

34. A train accident sends a large number of injured passengers to the

hospital. The hospital's disaster plan is put into effect. Which one of the following
nursing actions will best serve the hospital in a disaster situation?

A. The nurse should know the hospital's disaster plan and what's expected of
her during a disaster.
B. During a disaster, the nurse should volunteer to help where she thinks
assistance is most needed.
C. The nurse should offer advice about how to keep the operation running
smoothly.
D. If told to do so, the nurse should perform tasks that are beyond her scope
of practice.

35. The nurse-manager of a hospital unit holds monthly staff meetings.

During these meetings, she maintains control over the meeting and agenda,
resists consensus decision making, and uses discipline and coercion to elicit
desired behavior from staff. This manager uses what type of leadership style?

A. Autocratic
B. Democratic
C. Participative
D. Laissez-faire

36. The registered nurse of a hospital unit is acting as charge nurse. The
charge nurse's responsibility is to delegate client care appropriately to the
licensed practical nurse (LPN) and the nurse's aide. Delegation of activities should
be primarily based on which factors?
A. Whether the LPN or nurse's aide provided care for the client before
B. The staff member whose turn it is to perform certain, less pleasant tasks
C. The job description and experience level of the LPN and the aide
 D. The staff member who volunteers to perform the various tasks

37. A task force is formed to analyze institutional problems, such as

inadequate staffing and a rise in the number of negative evaluations from clients.
During the meeting, members express their concerns, disagree over the most
significant factors contributing to these problems, and compete for influence over
the group. Which of the following four stages of group development does their
behavior represent?

A. Forming
B. Storming
C. Norming
D. Performing

38. A client in the final stages of terminal cancer tells his nurse, "I wish I
could just be allowed to die. I'm tired of fighting this illness. I've lived a good life.
I continue my chemotherapy and radiation treatments only because my family
wants me to." What's the nurse's best response?

A. "Would you like to talk to a psychologist about your thoughts and

feelings?"
B. "Would you like to talk to your minister about the significance of death?"
C. "Would you like to meet with your family and your physician about this
matter?"
D. "I know you are tired of fighting this illness, but death will come in due
time."

39. The nurse works in a managed-care environment. The nurse is

expected to be oriented to which of the following criteria?

A. Performing tasks in the shortest time possible

B. Adhering to client preferences
C. Problem solving and time management
D. Quality of care and cost-containment

40. A client asks to be discharged from the health care facility against
medical advice (AMA). What should the nurse do?

A. Take measures to prevent the client from leaving.

B. Ask the client to sign an AMA form.
C. Call a security guard to help detain the client.
D. Notify the physician.

41. The nurse is caring for a client with renal failure who requires
peritoneal dialysis. The nurse doesn't feel comfortable performing the procedure.
What would be the most appropriate action for the nurse to take?

A. Omit the procedure and tell the next nurse in report that she'll need to
perform the dialysis.
B. Ask the nursing supervisor for assistance in using the equipment.
C. Ask the client how to use the equipment.
D. Perform the procedure to the best of her ability, utilizing her knowledge of
basic health principles.

42. A registered nurse suspects that another nurse has been drinking.
She smells alcohol on the nurse's breath and notes slurred speech. What's the
best course of action for the registered nurse to take?

A. Cover for the nurse because the profession depends on loyalty from
colleagues.
 B. Call the police and ask them to arrest the nurse because she's
endangering the lives of clients.
C. Tell the nurse she has one more chance, but if she drinks on duty again
she'll be reported.
D. Immediately notify the nursing supervisor.

43. When documenting care in a client's medical record, the nurse

should:

A. record the nurse's interpretation of data.

B. correct a mistake using a correcting fluid.
C. record the time and date for all entries.
D. leave blank spaces to record information at a later time, if necessary.

44. The nurse is completing a change-of-shift report. Which statement

wouldn't be appropriate for a nurse to include in the report?

A. The client was admitted with a diagnosis of myocardial infarction.

B. The client lives at home with his wife and two children.
C. The client had chest pain relieved with one sublingual nitroglycerin tablet.
D. The client is scheduled for a cardiac catheterization in the morning and will
be nothing by mouth after midnight.

45. A 19-year-old male client is diagnosed with prostate cancer. Which

nursing action constitutes an invasion of the client's privacy?

A. Covering the client with a blanket before transporting him through the
hospital corridors
B. Pulling a curtain around the bed before performing a prostate examination
C. Refusing to discuss the details of the young man's condition with
coworkers in an elevator filled with staff
D. Telling the family that the client has cancer without the client's knowledge

46. The parents of a 4-year-old with sickle cell anemia tell the nurse that
they would like to have other children, but they're concerned about passing sickle
cell anemia on to them. Which health care team member would be the most
appropriate person for the nurse to refer them to?

A. Clergy
B. Social worker
C. Certified nurse midwife
D. Genetic counselor

47. The family of a child dying from leukemia asks the nurse about
organ donation. Who must give consent for the child's organs to be donated?

A. Member of the clergy

B. Physician
C. Parents
D. Court-appointed surrogate, as designated under the Uniform Anatomical
Gift Act

48. Parents whose first child has celiac disease ask the nurse if all of
their children will have the disease. To whom should the nurse refer them?

A. Registered dietitian
B. Genetic counselor
C. Certified nurse midwife
D. Social worker
 49. The nurse is caring for a school-age child with cerebral palsy. The
child has difficulty eating using regular utensils and requires a lot of assistance.
Which of the following referrals is most appropriate?

A. Registered dietitian
B. Physical therapist
C. Occupational therapist
D. Nurse's aide

50. An 18-year-old pregnant woman tells the nurse that she's concerned
that she may not be able to take care of herself during her pregnancy. She states
that prenatal care is expensive and her job doesn't provide insurance. The nurse
should recognize that she:

A. may not take care of herself.

B. may not be fit to take care of a child.
C. needs to take up a second job.
D. should be referred to community resources available for pregnant women.

51.The nurse is caring for a client with hyperemesis gravidarum who will
need close monitoring at home. When should the nurse begin discharge planning?

A. On the day of discharge

B. When the client expresses readiness to learn
C. When the client's vomiting has stopped
D. On admission to the hospital

52. The parents of a 5-year-old call the clinic to tell the nurse that they
think their child has been abused by her day-care provider. What should the nurse
advise them to do?

A. Take the child to the emergency department of the local hospital.

B. Schedule an immediate appointment with their health care provider.
C. Call the child protective services to file a complaint.
D. Talk to their attorney to file charges against the accused.

53. The nurse is concerned about another nurse's relationship with the
members of a family and their ill preschooler. Which of the following behaviors
would be most worrisome and should be brought to the attention of the nurse-
manager?

A. The nurse keeps communication channels open among herself, the family,
physicians, and other health care providers.
B. The nurse attempts to influence the family's decisions by presenting her
own thoughts and opinions.
C. The nurse works with the family members to find ways to decrease their
dependence on health care providers.
D. The nurse has developed teaching skills to instruct the family members so
they can accomplish tasks independently.

54. When meeting with parents who will learn that their 3-year-old is
seriously ill, which action demonstrates the nurse's role as collaborator of care?

A. Provide the parents with information about financial assistance programs.

B. Inform the family of the diagnosis and recently discovered findings.
C. Coordinate the multidisciplinary services and provide information about
them.
D. Refer and consult with other specialties to help in treating the diagnosis.

55. In planning a presentation that advocates a decrease in the client-

to-nurse ratio from 8:1 to 6:1, a nurse should emphasize its effect on:
 A. institutional resources.
B. standards of practice.
C. client-care quality.
D. nursing recruitment.

56. The employer of a client on the psychiatric unit calls the nursing
station inquiring about the client's progress. The nurse doesn't know if the client
has given consent to allow the staff to give information out to callers on the
phone. Which of the following would be the nurse's best response?

A. "I'm not permitted to discuss her progress."

B. "I'll give you the name and telephone number of her physician."
C. "I'll have her call you."
D. "I can't confirm whether your employee is a client here."

57.Based on multiple referrals, the nurse determines that childhood

injuries are increasing in the community in which she practices. The first step the
nurse would take in developing an educational program is:

A. assessing for a decrease in referrals following a pediatric safety class.

B. assessing the strengths and needs of the community while identifying
barriers to learning.
C. choosing a health promotion or health belief model as a framework.
D. developing and implementing a specific plan to decrease childhood
injuries.

58. A registered nurse who usually works on a medical-surgical unit is

told to report to the cardiac care unit (CCU) for the day because the CCU is short
staffed and needs additional help to care for the clients. The nurse has never
worked in the CCU. Which of the following responses is the most appropriate
nursing action?

A. Call the hospital lawyer.

B. Report to the CCU and identify tasks that she feels she can safely perform.
C. Speak to the nursing supervisor.
D. Refuse to go to the CCU.

59. A nurse-manager is explaining the unit's performance improvement

(PI) program to a newly hired nurse. Which of the following should she include as
one of the primary purposes of the PI program?

A. Evaluation of client outcomes

B. Evaluation of staff member performance
C. Improvement in the efficiency of care
D. Preparation for accreditation

60. Two family members are arguing in a child's room. They start to hit
each other and the child is crying. What's the most appropriate nursing action?

A. Call security to come and intervene.

B. Remove the child from the room.
C. Ask one of the family members to leave the room.
D. Try to reason with both family members.

61. The nursing supervisor is called to the emergency department to

assist with a 10-month-old infant with injuries consistent with child abuse. The
nursing supervisor confers with the emergency department physician. To whom
must she report the incident?
 A. A social worker
B. The medical director of the emergency department
C. A Children's Protective Services (CPS) representative
D. A public health nurse

62. The nurse-manager has noticed a sharp increase in the mediation

errors with I.V. antibiotics over the last month. She discusses the situation with
each nurse involved. What other action should she take?

A. Document it on their evaluation.

B. Ask them to attend inservice training for administration of I.V. medications.
C. Report them to the supervisor.
D. Report the incidents to the hospital attorney.

63. When reporting to the surgeon that a chest tube is malfunctioning,

the nurse is ordered to reposition the tube and obtain a chest radiograph. The
nurse should:

A. inform the surgeon this isn't within her scope of practice.

B. report the surgeon to the Ethics Committee.
C. report the surgeon to the nursing supervisor.
D. follow the order as requested by the surgeon.

64. An Iranian mother and father admit their 14-month-old son to the
pediatric unit for treatment of leukemia. When the female pediatric oncologist,
who isn't Muslim, introduces herself, they became uncooperative and refused
treatment. The nurse should be aware that this change of behavior is probably
related to:

A. the gender of the physician.

B. fear of being accused of child abuse and neglect by an authority figure.
C. religious barriers that prevent the family from accepting care from
someone who isn't of their religion.
D. aggressiveness of Middle Easterners.

65. Which of the following clients would be a priority for the nurse to
evaluate when assuming responsibility for their care at the beginning of the day
shift?

A. The client who had a total laryngectomy the previous day

B. The client with diabetes who had a fasting blood glucose of 150 mg/dl
C. An elderly client who has Alzheimer's disease and periods of confusion
D. A client with a pneumothorax who had a chest tube inserted earlier in the
day

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PROFESSIONAL ADJUSTMENT AND NURSING CARE
MANAGEMENT PRACTICE EXAM

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