Chapter 1: Professional Nursing Practice
1. A nurse has been offered a position on an obstetric unit and has learned that the
unit offers therapeutic abortions, a procedure that contradicts the nurse's personal
beliefs. What is the nurse's ethical obligation to these clients?
A. The nurse should adhere to professional standards of practice and offer service
to these clients.
B. The nurse should make the choice to decline this position and pursue a different
nursing role.
C. The nurse should decline to care for the clients considering abortion.
D. The nurse should express alternatives to women considering terminating their
pregnancy.
ANS: B
Rationale: To avoid facing the ethical dilemma of providing care that contradicts the
nurse’s personal beliefs, the nurse should consider working in an area of nursing
that would not pose this dilemma. The nurse should not provide care to the client
because it is a conflict of personal values. The nurse should not deny care to these
clients as this would be a breach in the Code of Ethics for nurses. If the client is not
requesting information for alternatives to abortions, then the nurse should not be
providing this information.
PTS: 1 REF: p. 27
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Caring
BLM: Cognitive Level: Apply NOT: Multiple Choice
2. An 80-year-old client is admitted with a diagnosis of community-acquired
pneumonia. During admission the client states, "I have a living will." What
implication of this should the nurse recognize?
A. This document is always honored, regardless of circumstances.
B. This document specifies the client's wishes before hospitalization.
C. This document is binding for the duration of the client's life.
D. This document has been drawn up by the client's family to determine DNR
status.
ANS: B
Rationale: A living will is one type of advance directive. In most situations, living
wills are limited to situations in which the client's medical condition is deemed
terminal. The other answers are incorrect because living wills are not always
honored in every circumstance, they are not binding for the duration of the client's
life, and they are not drawn up by the client's family.
PTS: 1 REF: p. 29
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Communication and Documentation BLM: Cognitive
Level: Analyze
NOT: Multiple Choice
3. A nurse has been providing ethical care for many years and is aware of the need
to maintain the ethical principle of nonmaleficence. Which of the following actions
would be considered a violation of this principle?
A. Discussing a DNR order with a terminally ill client
B. Assisting a semi-independent client with ADLs
C. Refusing to administer pain medication as prescribed
D. Providing more care for one client than for another
ANS: C
Rationale: The duty not to inflict as well as prevent and remove harm is termed
nonmaleficence. Discussing a DNR order with a terminally ill client and assisting a
client with ADLs would not be considered contradictions to the nurse's duty of
nonmaleficence. Some clients justifiably require more care than others.
PTS: 1 REF: p. 25
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
4. A nurse has begun creating a client's plan of care shortly after the client's
admission. The nurse knows that it is important that the wording of the chosen
nursing diagnoses falls within the taxonomy of nursing. Which organization is
responsible for developing the taxonomy of a nursing diagnosis?
A. American Nurses Association (ANA)
B. North American Nursing Diagnosis Association (NANDA)
C. National League for Nursing (NLN)
D. Joint Commission
ANS: B
Rationale: NANDA International is the official organization responsible for
developing the taxonomy of nursing diagnoses and formulating nursing diagnoses
acceptable for study. The ANA, NLN, and Joint Commission are not charged with the
task of developing the taxonomy of nursing diagnoses.
PTS: 1 REF: p. 15
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
5. A medical nurse has obtained a new client's health history and has completed the
admission assessment. The nurse followed this by documenting the results and
creating a care plan for the client. Which of the following is the most important
rationale for documenting the client's care?
A. It provides continuity of care.
B. It creates a teaching log for the family.
C. It verifies appropriate staffing levels.
D. It keeps the client fully informed.
ANS: A
Rationale: This record provides a means of communication among members of the
health care team and facilitates coordinated planning and continuity of care. It
serves as the legal and business record for a health care agency and for the
professional staff members who are responsible for the client's care.
Documentation is not primarily a teaching log; it does not verify staffing; and it is
not intended to provide the client with information about treatments.
PTS: 1 REF: p. 14
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Communication and Documentation BLM: Cognitive
Level: Understand
NOT: Multiple Choice
6. The nurse has been assigned to care for a client admitted with an opportunistic
infection secondary to AIDS. The nurse informs the clinical nurse leader that the
nurse refuses to care for a client with AIDS. The nurse has an obligation to this
client under which of the following?
A. Good Samaritan Act
B. Nursing Interventions Classification (NIC)
C. The nurse practice act in the nurse's jurisdiction
D. International Council of Nurses (ICN) Code of Ethics for Nurses
ANS: D
Rationale: The ethical obligation to care for all clients is included in the Code of
Ethics for Nurses. The Good Samaritan Act relates to lay people helping others in
need. The NIC is a standardized classification of nursing treatment that includes
independent and collaborative interventions. Nurse practice acts primarily address
scope of practice.
PTS: 1 REF: p. 27
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
7. The nurse, in collaboration with the client's family, is determining priorities
related to the care of the client. The nurse explains that it is important to consider
the urgency of specific problems when setting priorities. What should the nurse
adopt as the best framework for prioritizing client problems?
A. Availability of hospital resources
B. Family member statements
C. Maslow hierarchy of needs
D. The nurse's skill set
ANS: C
Rationale: The Maslow hierarchy of needs provides a useful framework for
prioritizing problems, with the first level given to meeting physical needs of the
client. Availability of hospital resources, family member statements, and nursing
skill do not provide a framework for prioritization of client problems, though each
may be considered.
PTS: 1 REF: p. 6
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
8. A medical nurse is caring for a client who is receiving palliative care following
cancer metastasis. The nurse is aware of the need to uphold the ethical principle of
beneficence. How can the nurse best exemplify this principle in the care of this
client?
A. The nurse tactfully regulates the number and timing of visitors as per the client's
wishes.
B. The nurse stays with the client during their death.
C. The nurse ensures that all members of the care team are aware of the client's
DNR order.
D. The nurse collaborates with members of the care team to ensure continuity of
care.
ANS: A
Rationale: Beneficence is the duty to do good and the active promotion of
benevolent acts. Enacting the client's wishes regarding visitors is an example of
this. Each of the other nursing actions is consistent with ethical practice, but none
directly exemplifies the principle of beneficence.
PTS: 1 REF: p. 25
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Caring
BLM: Cognitive Level: Apply NOT: Multiple Choice
9. In the process of planning a client's care, the nurse has identified a nursing
diagnosis of Ineffective Health Maintenance related to alcohol use. What must
precede the determination of this nursing diagnosis?
A. Establishing of a plan to address the underlying problem
B. Assigning a positive value to each consequence of the diagnosis
C. Collecting and analyzing data that corroborate the diagnosis
D. Evaluating the client's chances of recovery
ANS: C
Rationale: In the diagnostic phase of the nursing process, the client's nursing
problems are defined through analysis of client data. Establishing a plan comes
after collecting and analyzing data; evaluating a plan is the last step of the nursing
process; and assigning a positive value to each consequence is not done.
PTS: 1 REF: p. 16
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
10. The provider has recommended an amniocentesis for an 18-year-old
primiparous client. The client is at 34 weeks' gestation and does not want this
procedure, but the health care provider arranges for the amniocentesis to be
performed. The nurse should recognize that the provider is in violation of which
ethical principle?
A. Veracity
B. Beneficence
C. Nonmaleficence
D. Autonomy
ANS: D
Rationale: The principle of autonomy specifies that individuals have the ability to
make a choice free from external constraints. The provider's actions in this case
violate this principle. This action may or may not violate the principle of
beneficence. Veracity centers on truth-telling, and nonmaleficence is avoiding the
infliction of harm.
PTS: 1 REF: p. 25
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
11. During a discussion with the client and the client's spouse, the nurse discovers
that the client has a living will. How does the presence of a living will influence the
client's care?
A. The client is legally unable to refuse basic life support.
B. The health care provider can override the client's desires for treatment if desires
are not evidence based.
C. The client may nullify the living will during the hospitalization.
D. Power of attorney may change while the client is hospitalized.
ANS: C
Rationale: Because living wills are often written when the person is in good health,
it is not unusual for the client to nullify the living will during illness. A living will does
not make a client legally unable to refuse basic life support. The health care
provider may disagree with the client's wishes but is ethically bound to carry out
those wishes. A power of attorney is not synonymous with a living will.
PTS: 1 REF: p. 29
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Communication and Documentation BLM: Cognitive
Level: Apply
NOT: Multiple Choice
12. The nurse is providing care for a client who has a diagnosis of pneumonia due
to Streptococcus pneumonia infection. What aspect of nursing care would
constitute part of the planning phase of the nursing process?
A. Achieve SaO2 92% at all times.
B. Auscultate chest q4h.
C. Administer oral fluids q1h and PRN.
D. Avoid overexertion at all times.
ANS: A
Rationale: The planning phase entails specifying the immediate, intermediate, and
long-term goals of nursing action, such as maintaining a certain level of oxygen
saturation in a client with pneumonia. Providing fluids and avoiding overexertion
are parts of the implementation phase of the nursing process. Chest auscultation is
an assessment.
PTS: 1 REF: p. 12
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
13. A recent nursing graduate is aware of the differences between nursing actions
that are independent and nursing actions that are interdependent. A nurse
performs an interdependent nursing intervention when performing which of the
following actions?
A. Auscultating a client's apical heart rate during an admission assessment
B. Providing mouth care to a client who is unconscious following a cerebrovascular
accident
C. Administering an IV bolus of normal saline to a client with hypotension
D. Providing discharge teaching to a postsurgical client about the rationale for a
course of oral antibiotics
ANS: C
Rationale: Although many nursing actions are independent, others are
interdependent, such as carrying out prescribed treatments; administering
medications and therapies; collaborating with other health care team members to
accomplish specific, expected outcomes; and to monitor and manage potential
complications. Irrigating a wound, administering pain medication, and
administering IV fluids are interdependent nursing actions and require a health care
provider's order. An independent nursing action occurs when the nurse assesses a
client's heart rate, provides discharge education, or provides mouth care.
PTS: 1 REF: p. 19
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
14. A hospital audit reveals that four clients in the hospital have current orders for
restraints. The nurse knows that restraints are an intervention of last resort, and
that it is inappropriate to apply restraints to which of the following clients?
A. A postlaryngectomy client who is attempting to pull out the tracheostomy tube
B. A client in hypovolemic shock trying to remove the dressing over a central
venous catheter
C. A client with urosepsis who is ringing the call bell incessantly to use the bedside
commode
D. A client with depression who has just tried to commit suicide and whose
medications are not achieving adequate symptom control
ANS: C
Rationale: Restraints should never be applied for staff convenience. The client with
urosepsis who is frequently ringing the call bell is requesting assistance to the
bedside commode; this is appropriate behavior that will not result in client harm.
The other described situations could plausibly result in client harm; therefore, it is
more appropriate to apply restraints in these instances.
PTS: 1 REF: p. 28
NAT: Client Needs: Safe, Effective Care Environment: Safety and Infection Control
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
15. A client agreed to be a part of a research study involving migraine headache
management. The client asks the nurse if a placebo was given for pain
management or if the new drug that is undergoing clinical trials was given. After
discussing the client's distress, it becomes evident to the nurse that the client did
not fully understand the informed consent document that was signed at the start of
the research study. What is the best response by the nurse?
A. "The research study is in place and there is no way to know now."
B. "I have no idea what is being given for your migraine."
C. "What difference does it make? How is your headache?"
D. "You signed the informed consent documents prior to the treatment."
ANS: A
Rationale: Telling the truth (veracity) is one of the basic principles of nursing
culture. Three ethical dilemmas in clinical practice that can directly conflict with this
principle are the use of placebos (nonactive substances used for treatment), not
revealing a diagnosis to a client, and revealing a diagnosis to persons other than
the client with the diagnosis. The nurse is following the guidelines of the research
study, so re-educating the client about the study is the best the nurse can do.
Saying "What difference does it make?" or "You signed informed consent
documents" is not helpful because these statements are not supportive. While it is
true that the nurse does not know what treatment the client received, this
statement is also not supportive.
PTS: 1 REF: p. 28
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Communication and Documentation | Integrated Process:
Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
16. A care conference has been organized for a client with complex medical and
psychosocial needs. When applying the principles of critical thinking to this client's
care planning, the nurse should most exemplify what characteristic?
A. Willingness to observe behaviors
B. A desire to utilize the nursing scope of practice fully
C. An ability to base decisions on what has happened in the past
D. Openness to various viewpoints
ANS: D
Rationale: Willingness and openness to various viewpoints are inherent in critical
thinking; these allow the nurse to reflect on the current situation. An emphasis on
the past, willingness to observe behaviors, and a desire to utilize the nursing scope
of practice fully are not central characteristics of critical thinkers.
PTS: 1 REF: p. 11 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
17. The nurse cites a list of skills that support critical thinking in clinical situations.
The nurse should describe skills in which of the following domains? Select all that
apply.
A. Self-esteem
B. Self-regulation
C. Inference
D. Autonomy
E. Interpretation
ANS: B, C, E
Rationale: Skills needed in critical thinking include interpretation, analysis,
evaluation, inference, explanation, and self-regulation. Self-esteem and autonomy
would not be on the list because they are not skills.
PTS: 1 REF: p. 11 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Select
18. The nurse is providing care for a client with chronic obstructive pulmonary
disease (COPD). The nurse's most recent assessment reveals an SaO2 of 89%. The
nurse is aware that part of critical thinking is determining the significance of data
that have been gathered. What characteristic of critical thinking is used in
determining the best response to this assessment finding?
A. Extrapolation
B. Inference
C. Characterization
D. Interpretation
ANS: D
Rationale: Nurses use interpretation to determine the significance of data that are
gathered. This specific process is not described as extrapolation, inference, or
characterization.
PTS: 1 REF: p. 11 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
19. A nurse is admitting a new client to the medical unit. During the initial nursing
assessment, the nurse has asked many supplementary open-ended questions while
gathering information about the new client. What is the nurse achieving through
this approach?
A. Interpreting what the client has said
B. Evaluating what the client has said
C. Assessing what the client has said
D. Validating what the client has said
ANS: D
Rationale: Critical thinkers validate the information presented to make sure that it
is accurate (not just supposition or opinion), that it makes sense, and that it is
based on fact and evidence. The nurse is not interpreting, evaluating, or assessing
the information the client has given.
PTS: 1 REF: p. 15 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Communication and Documentation BLM: Cognitive
Level: Understand
NOT: Multiple Choice
20. A nurse provides care on an orthopedic reconstruction unit and is admitting two
new clients, both status post knee replacement. What would be the best
explanation why their care plans may be different from each other?
A. Clients may have different qualifications for government subsidies.
B. Individual clients are seen as unique and dynamic, with individual needs.
C. Nursing care may be coordinated by members of two different health disciplines.
D. Clients are viewed as dissimilar according to their attitude toward surgery.
ANS: B
Rationale: Regardless of the setting, each client situation is viewed as unique and
dynamic. Differences in insurance coverage and attitude may be relevant, but
these should not fundamentally explain the differences in their nursing care.
Nursing care should be planned by nurses, not by members of other disciplines.
PTS: 1 REF: p. 12
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
21. The nurse is caring for a client whose family members are in a bitter conflict
about the best course of treatment for the client. How should the nurse best
address this challenging situation?
A. Seek guidance from the client's primary health care provider.
B. Offer to act as a mediator in the family's conflict.
C. Involve the institution's ethics committee.
D. Educate the client about the need for assertiveness skills.
ANS: C
Rationale: Challenging ethical or moral situations often benefit from the
involvement of the ethics committee. Acting independently in the role of mediator
likely goes beyond the nurse's skill and scope of practice. The primary health care
provider likely cannot resolve this issue independently. Assertiveness on the part of
the client may or may not be beneficial.
PTS: 1 REF: p. 29
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
22. The nurse is caring for a client with cancer who is undergoing genetic testing.
The nurse explains that genetic testing will affect which aspects of the client's care?
Select all that apply.
A. Screening for genetic mutations
B. Diagnosing the specific type of cancer
C. Providing information on prognosis
D. Choosing specific treatments
E. Predicting lifespan
ANS: A, C, D
Rationale: Advances in genetic testing have improved the process of screening for
genetic mutations in cancer cells, diagnosing specific types of cancer, and choosing
specific treatments for certain types of cancers. Genetic testing does not provide
information on prognosis nor does it predict lifespan.
PTS: 1 REF: p. 8
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Apply
NOT: Multiple Select
23. A group of students have been challenged to prioritize ethical practice when
working with a marginalized population. How should the students best understand
the concept of ethics?
A. The formal, systematic study of moral beliefs
B. The informal study of patterns of ideal behavior
C. The adherence to culturally rooted, behavioral norms
D. The adherence to informal personal values
ANS: A
Rationale: In essence, ethics is the formal, systematic study of moral beliefs,
whereas morality is the adherence to informal personal values.
PTS: 1 REF: p. 24
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
24. While developing the plan of care for a new client on the unit, the nurse must
identify expected outcomes that are appropriate for the new client. What resource
should the nurse prioritize for identifying these appropriate outcomes?
A. Community Specific Outcomes Classification (CSO)
B. Nursing Outcomes Classification (NOC)
C. State Specific Nursing Outcomes Classification (SSNOC)
D. Department of Health and Human Services Outcomes Classification (DHHSOC)
ANS: B
Rationale: Resources for identifying appropriate expected outcomes include the
NOC and standard outcome criteria established by health care agencies for people
with specific health problems. The other options are incorrect because they do not
exist.
PTS: 1 REF: p. 18
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember
NOT: Multiple Choice
25. The public health nurse is presenting a health promotion class to a group of new
mothers. How should the nurse best define health?
A. Being disease free or having existing diseases stabilized
B. The state of having fulfillment in all domains of life
C. Possessing psychological and physiologic harmony
D. The state of being connected in body, mind, and spirit
ANS: D
Rationale: The World Health Organization (WHO) defines health in the preamble to
its constitution as a "state of complete physical, mental, and social well-being and
not merely the absence of disease and infirmity." The concept goes beyond
psychology and physiology to include social considerations. It does not depend on
having an absence of disease. Fulfillment is consistent with health, but the concepts
are not synonymous.
PTS: 1 REF: p. 6 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Apply
NOT: Multiple Choice
26. The nurse has been asked to speak to members of a self-care education
program. What topic would the nurse most likely address?
A. Adequate prenatal care
B. Government advocacy and lobbying
C. Judicious use of online communities
D. Management of illness
ANS: D
Rationale: Organized self-care education programs emphasize health promotion,
disease prevention, management of illness, self-care, and judicious use of the
professional health care system. Prenatal care, lobbying, and Internet activities are
secondary.
PTS: 1 REF: p. 6 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
27. The nurse is preparing a wellness program for seniors at a community center.
Which concept of wellness should the nurse utilize when planning the program?
A. Wellness is the absence of sickness.
B. A person needs to be proactive in achieving wellness.
C. Each person views wellness in the same way.
D. Wellness is static and unchanging.
ANS: B
Rationale: Wellness is a proactive state involving self-care activities aimed at
physical, psychological, social, and spiritual well-being. Wellness exists on a
continuum and is not merely the absence of sickness. Wellness is subjective and,
therefore, is not the same for each person. Because wellness is the ability to adjust
and adapt to varying situations, the definition of wellness can change for a person
over time.
PTS: 1 REF: p. 6 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
28. A nurse on a medical–surgical unit has asked to represent the unit on the
hospital's quality committee. When describing quality improvement programs to
nursing colleagues and members of other health disciplines, what characteristic
should the nurse cite?
A. These programs establish consequences for health care professionals' actions.
B. These programs emphasize the need for evidence-based practice.
C. These programs identify specific incidents related to quality.
D. These programs seek to justify health care costs and systems.
ANS: B
Rationale: Numerous models seek to improve the quality of health care delivery. A
commonality among them is a focus on the importance of evidence-based practice.
Consequences, a focus on incidents, and justification for health care costs are not
universal characteristics of quality improvement efforts.
PTS: 1 REF: p. 9
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Communication and Documentation BLM: Cognitive
Level: Understand
NOT: Multiple Choice
29. The nurse is admitting a client to the medical unit after the client has been
transferred from the emergency department. What is the nurse's priority action at
this time?
A. Meeting the urgent needs of the client
B. Checking the admitting health care provider's prescriptions
C. Obtaining a baseline set of vital signs
D. Allowing the family to be with the client
ANS: A
Rationale: Among the nurse's functions in health care delivery, identifying the
client's urgent needs and working in concert with the client to address them is most
important. The other nursing functions are important, but they are not the most
important functions.
PTS: 1 REF: p. 17
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
NOT: Multiple Choice
BLM: Cognitive Level: Apply
30. A nurse has accepted a position at a health care facility that embraces
interprofessional collaboration as its model of practice. Which competency should
the nurse recognize as being key to interprofessional collaboration? Select all that
apply.
A. Client-centered care
B. Evidence-based practice
C. Managing care
D. Safety
E. Informatics
ANS: A, B, D, E
Rationale: According to the Interprofessional Collaborative Practice, the core
competencies of interdisciplinary collaboration include client-centered care,
evidence-based practice, safety, and informatics. Other core competencies are
interdisciplinary teamwork and collaboration and quality improvement. Managing
care is not a core competency of interdisciplinary collaboration. It is a function of
the role of the manager.
PTS: 1 REF: p. 9
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Select
31. The nurse is engaging in critical thinking while caring for a group of clients.
Which situation is an example of critical thinking by the nurse?
A. Following unit policy when administering pain medication
B. Administering an analgesic according to the health care provider's prescription
C. Working with the client to find a nonpharmacologic pain relief measure
D. Assessing the level of pain before administering pain medication
ANS: C
Rationale: Critical thinking involves the formulation of options that are most
appropriate for a situation and that are client-centered. By working with the client
to find a pain relief measure for that client’s specific situation, the nurse is
exhibiting critical thinking. Following unit policy, administering medication
according to a prescription by the health care provider, and assessing level of pain
before administering a pain medication are examples of safe care but not critical
thinking that is client-centered.
PTS: 1 REF: p. 11
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
32. A hospice nurse is caring for a client who is dying of lymphoma. According to the
Maslow hierarchy of needs, what dimension of care should the nurse consider
primary in importance when caring for a dying client?
A. Spiritual
B. Social
C. Physiologic
D. Emotional
ANS: C
Rationale: Maslow ranked human needs as follows: physiologic needs; safety and
security; sense of belonging and affection; esteem and self-respect; and
self-actualization, which includes self-fulfillment, desire to know and understand,
and aesthetic needs.
PTS: 1 REF: p. 6 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Caring
BLM: Cognitive Level: Understand NOT: Multiple Choice
33. A medical–surgical nurse is aware of the scope of practice as defined in the
jurisdiction where the nurse provides care. When exploring the legal basis for the
scope of practice, the nurse should consult:
A. codes of ethics.
B. a code of nursing conduct.
C. the nurse practice act in the nurse's jurisdiction.
D. client preferences and norms within the profession.
ANS: C
Rationale: Nurses have a responsibility to comply with the nurse practice act of the
jurisdiction in which they practice. A nurse's scope of practice is not determined by
codes of ethics, codes of conduct, or client preferences.
PTS: 1 REF: p. 5
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
34. The nurse is caring for a client who has developed heart failure. Which
intervention is a primary nursing focus in treating this collaborative problem?
A. Administering a diuretic
B. Monitoring intake and output
C. Restricting fluid intake
D. Inserting an indwelling urinary catheter
ANS: B
Rationale: Collaborative problems are physiologic complications that the nurse
monitors to detect changes or complications. By monitoring intake and output, the
nurse is monitoring the client's fluid status to detect fluid volume overload. While
the nurse administers a diuretic, it is prescribed by the health care provider.
Likewise, the nurse restricts the intake of fluids or inserts an indwelling urinary
catheter in the client, but the interventions are prescribed by the heath care
provider.
PTS: 1 REF: p. 16
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
35. A nurse is involved in a program that aims to increase the use of health
informatics. What is the most likely outcome of this program if it is successful?
A. Rapid access to client information by everyone involved in the client's care
B. Increased participation by clients in their care
C. Centralization of care into centers where there are more health professionals
D. Increased interprofessional collaboration
ANS: A
Rationale: The essence of health informatics is rapid and comprehensive access to
client information. This can allow for a decentralization of care and it may or may
not cause clients to become more involved in their care. Health informatics alone
will not result in interprofessional collaboration.
PTS: 1 REF: p. 8
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Communication and Documentation BLM: Cognitive
Level: Apply
NOT: Multiple Choice
36. The nurse is developing a plan of care for a client admitted with chronic
obstructive pulmonary disease. Using the Maslow hierarchy of needs, which nursing
diagnosis should the nurse give the highest priority?
A. Activity intolerance
B. Situational low self-esteem
C. Toileting self-care deficit
D. Ineffective airway clearance
ANS: D
Rationale: After nursing diagnoses have been developed, the nurse assigns
priorities based on the urgency of the problem. The Maslow hierarchy of needs is
one framework the nurse can utilize to prioritize needs. Using the Maslow hierarchy
of needs, maintaining a patent airway would have the highest priority since it
satisfies a basic physiologic need. Activity intolerance, self-esteem, and inability to
toilet oneself are all important problems but would be handled after clearing the
airway has been addressed and oxygenation and perfusion have been assured.
PTS: 1 REF: p. 6
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Choice
37. Over the past several decades, nursing roles have changed and expanded in
many ways. Which of the following needs has most contributed to this change?
A. The need to decrease the cost of health care
B. The need to improve the quality of nursing education
C. The need to increase the number of nursing jobs available
D. The need to increase the public awareness of nursing
ANS: A
Rationale: The role of the nurse has expanded to improve the distribution of health
care services and to decrease the cost of health care. The other answers are
incorrect because the expansion of roles in nursing did not occur to improve
education, increase the number of nursing jobs, or increase public awareness.
PTS: 1 REF: p. 7
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand
NOT: Multiple Choice
38. The nurse is developing nursing interventions for a nursing diagnosis related to
mobility in a surgical client. Which statement is an example of a nursing
intervention?
A. Ambulate with the client twice a day.
B. Ask nursing assistant to ambulate client in the hall twice a day.
C. Client will walk in hall twice a day.
D. Client has limited mobility due to surgery.
ANS: A
Rationale: A nursing intervention is performed to help the client achieve expected
outcomes. Nursing interventions are client-centered and always start with a verb.
The intervention “ambulate the client twice a day” is client-centered and begins
with a verb. Asking a nursing assistant to ambulate the client is not client-focused.
“Client will walk in hall twice a day” does not start with a verb and is written in the
form of an outcome rather than an intervention. The statement “client has limited
mobility due to surgery” is written as a problem statement, rather than an
intervention, and does not start with a verb.
PTS: 1 REF: p. 19
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
39. A nurse is aware that an increasing emphasis is being placed on health, health
promotion, wellness, and self-care. Which of the following activities would best
demonstrate the principles of health promotion?
A. A discharge planning initiative between acute care and community care nurses
B. Collaboration between several schools of nursing in an urban area
C. Creation of a smoking prevention program undertaken in a middle school
D. Establishment of a website where clients can check emergency department
wait-times
ANS: C
Rationale: Smoking prevention is a clear example of health promotion. Each of the
other listed activities has the potential to be beneficial, but none is considered
health promotion.
PTS: 1 REF: p. 6 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Communication and Documentation | Integrated Process:
Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
40. The nurse is evaluating the plan of care for a client who had a total hip
replacement. Which action(s) will the nurse perform during this step of the nursing
process? Select all that apply.
A. Add additional nursing diagnoses to address new problems.
B. Change expected outcomes if they are not realistic.
C. Check that pain assessments are being performed with vital signs.
D. Determine whether priorities need to be reordered.
E. Discontinue nursing interventions that are no longer needed.
ANS: A, B, D, E
Rationale:
During the evaluation step of the nursing process, the nurse
determines whether new actual or potential health problems have developed that
need to be added to the plan of care. The nurse also checks the outcomes to
determine whether they have been resolved, need modification, or whether new
outcomes need to be developed. The nurse evaluates the priorities for care to see
whether they need to be reordered. As the client’s health conditions change,
nursing interventions may also need to be added or discontinued. A chart audit to
determine whether pain assessments have been completed is not part of the
nursing process.
PTS: 1 REF: p. 14
NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 1: Professional Nursing Practice
KEY: Integrated Process: Nursing Process
NOT: Multiple Response
BLM: Cognitive Level: Apply