1.

All of the following are benefits of traditional management style except: Correct Answer: subordinates always obey superiors.

2.

As a nurse manager achieves a higher management position in the organization, there is a need for what type of skills? Correct Answer: Conceptual and interpersonal skills

3.

The contingency theory of management moves the manager away from which of the following approaches? Correct Answer: One size fits all

4.

Transformational leadership is characterized by all of the following elements except: Correct Answer: incentives to promote loyalty and performance.

5.

The characteristics of an effective leader include: Correct Answer: sound problem-solving skills and strong people skills.

6.

Which nursing delivery model is based on a production and efficiency model and stresses a task-oriented approach? Your Answer: Case management Correct Answer: Functional method

7.

What are essential competencies for today's nurse manager? Your Answer: A vision and goals Correct Answer: Communication and teamwork

8.

What are the leadership challenges confronting nurses in the U.S. health care system? Your Answer: Limited resources of providing care Correct Answer: All of the above

9.

What is the most important issue confronting nurse managers using situational leadership? Your Answer: Leaders can choose one of the four leadership styles when faced with a new situation. Correct Answer: Value is placed on the accomplishment of tasks and on interpersonal relationships between leader and group members

10.

When group members are unable and unwilling to participate in making a decision, which leadership style should the nurse manager use? Your Answer: Laissez-faire Correct Answer: Authoritarian

1. Ms. Castro is newly-promoted to a patient care manager position. She updates her knowledge on the theories in management and leadership in order to become effective in her new role. She learns that some managers have low concern for services and high concern for staff. Which style of management refers to this? a. Organization Man b. Impoverished Management c. Country Club Management d. Team Management 2. Her former manager demonstrated passion for serving her staff rather than being served. She takes time to listen, prefers to be a teacher first before being a leader, which is characteristic of a. Transformational leader b. Transactional leader c. Servant leader d. Charismatic leader 3. On the other hand, Ms. Castro notices that the Chief Nurse Executive has charismatic leadership style. Which of the following behaviors best describes this style? a. Possesses inspirational quality that makes followers gets attracted of him and regards him with reverence b. Acts as he does because he expects that his behavior will yield positive results c. Uses visioning as the core of his leadership d. Matches his leadership style to the situation at hand. 4. Which of the following conclusions of Ms. Castro about leadership characteristics is TRUE? a. There is a high correlation between the communication skills of a leader and the ability to get the job done. b. A manager is effective when he has the ability to plan well. c. Assessment of personal traits is a reliable tool for predicting a managers potential. d. There is good evidence that certain personal qualities favor success in managerial role. 5. She reads about Path Goal theory. Which of the following behaviors is manifested by the leader who uses this theory? a. Recognizes staff for going beyond expectations by giving them citations b. Challenges the staff to take individual accountability for their own practice c. Admonishes staff for being laggards. d. Reminds staff about the sanctions for non performance.

1. Answer: (C) Country Club Management Country club management style puts concern for the staff as number one priority at the expense of the delivery of services. He/she runs the department just like a country club where every one is happy including the manager.

2. Answer: (C) Servant leader Servant leaders are open-minded, listen deeply, try to fully understand others and not being judgmental

3. Answer: (A) Possesses inspirational quality that makes followers gets attracted of him and regards him with reverence Charismatic leaders make the followers feel at ease in their presence. They feel that they are in good hands whenever the leader is around.

4. Answer: (C) Assessment of personal traits is a reliable tool for predicting a managers potential. It is not conclusive that certain qualities of a person would make him become a good manager. It can only predict a managers potential of becomin g a good one.

5. Answer: (A) Recognizes staff for going beyond expectations by giving them citations Path Goal theory according to House and associates rewards good performance so that others would do the same

6. One leadership theory states that leaders are

born and not made, which refers to which of the following theories? a. Trait b. Charismatic c. Great Man d. Situational 7. She came across a theory which states that the leadership style is effective dependent on the situation. Which of the following styles best fits a situation when the followers are self-directed, experts and are matured individuals? a. Democratic b. Authoritarian c. Laissez faire d. Bureaucratic 8. She surfs the internet for more information about leadership styles. She reads about shared leadership as a practice in some magnet hospitals. Which of the following describes this style of leadership? a. Leadership behavior is generally determined by the relationship between the leaders personality and the specific situation b. Leaders believe that people are basically good and need not be closely controlled c. Leaders rely heavily on visioning and inspire members to achieve results d. Leadership is shared at the point of care. 9. Ms. Castro learns that some leaders are transactional leaders. Which of the following does NOT characterize a transactional leader? a. Focuses on management tasks b. Is a caretaker c. Uses trade-offs to meet goals d. Inspires others with vision 10. She finds out that some managers have benevolent-authoritative style of management. Which of the following behaviors will she exhibit most likely? a. Have condescending trust and confidence in their subordinates b. Gives economic or ego awards c. Communicates downward to the staff d. Allows decision making among subordinates 11. Harry is a Unit Manager I the Medical Unit. He is not satisfied with the way things are going in his unit. Patient satisfaction rate is 60% for two consecutive months and staff morale is at its lowest. He decides to plan and initiate changes that will push for a turnaround in the condition of the unit. Which of the following actions is a priority for Harry? a. Call for a staff meeting and take this up in the agenda.

6. Answer: (C) Great Man Leaders become leaders because of their birth right. This is also called Genetic theory or the Aristotelian theory

7. Answer: (C) Laissez faire Laissez faire leadership is preferred when the followers know what to do and are experts in the field. This leadership style is relationship-oriented rather than task-centered.

8. Answer: (D) Leadership is shared at the point of care. Shared governance allows the staff nurses to have the authority, responsibility and accountability for their own practice.

9. Answer: (D) Inspires others with vision Inspires others with a vision is characteristic of a transformational leader. He is focused more on the day-to-day operations of the department/unit.

10. Answer: (A) Have condescending trust and confidence in their subordinates Benevolent-authoritative managers pretentiously show their trust and confidence to their followers

11. Answer: (A) Call for a staff meeting and take this up in the agenda. This will allow for the participation of every staff in the unit. If they contribute to the solutions of the problem, they will own the solutions; hence the chance for compliance would be greater.

b. Seek help from her manager. c. Develop a strategic action on how to deal with these concerns. d. Ignore the issues since these will be resolved naturally. 12. She knows that there are external forces that influence changes in his unit. Which of the following is NOT an external force? a. Memo from the CEO to cut down on electrical consumption b. Demands of the labor sector to increase wages c. Low morale of staff in her unit d. Exacting regulatory and accreditation standards 13. After discussing the possible effects of the low patient satisfaction rate, the staff started to list down possible strategies to solve the problems head-on. Should they decide to vote on the best change strategy, which of the following strategies is referred to this? a. Collaboration b. Majority rule c. Dominance d. Compromise 14. One staff suggests that they review the pattern of nursing care that they are using, which is described as a: a. job description b. system used to deliver care c. manual of procedure d. rules to be followed 15. Which of the following is TRUE about functional nursing? a. Concentrates on tasks and activities b. Emphasizes use of group collaboration c. One-to-one nurse-patient ratio d. Provides continuous, coordinated and comprehensive nursing services 16. Functional nursing has some advantages, which one is an EXCEPTION? a. Psychological and sociological needs are emphasized. b. Great control of work activities. c. Most economical way of delivering nursing services. d. Workers feel secure in dependent role 17. He raised the issue on giving priority to patient needs. Which of the following offers the best way for setting priority? a. Assessing nursing needs and problems b. Giving instructions on how nursing care needs are to be met c. Controlling and evaluating the delivery of nursing 12. Answer: (C) Low morale of staff in her unit Low morale of staff is an internal factor that affects only the unit. All the rest of the options emanate from the top executive or from outside the institution.

13. Answer: (B) Majority rule Majority rule involves dividing the house and the highest vote wins.1/2 + 1 is a majority.

14. Answer: (B) system used to deliver care A system used to deliver care. In the 70s it was termed as methods of patient assignment; in the early 80s it was called modalities of patient care then patterns of nursing care in the 90s until recently authors called it nursing care systems.

15. Answer: (A) Concentrates on tasks and activities Functional nursing is focused on tasks and activities and not on the holistic care of the patients

16. Answer: (A) Psychological and sociological needs are emphasized. When the functional method is used, the psychological and sociological needs of the patients are neglected; the patients are regarded as tasks to be done

17. Answer: (A) Assessing nursing needs and problems This option follows the framework of the nursing process at the same time applies the management process of planning, organizing, directing and controlling

care d. Assigning safe nurse: patient ratio 18. Which of the following is the best guarantee that the patients priority needs are met? a. Checking with the relative of the patient b. Preparing a nursing care plan in collaboration with the patient c. Consulting with the physician d. Coordinating with other members of the team 19. When Harry uses team nursing as a care delivery system, he and his team need to assess the priority of care for a group of patients, which of the following should be a priority? a. Each patient as listed on the worksheet b. Patients who needs least care c. Medications and treatments required for all patients d. Patients who need the most care 20. She is hopeful that her unit will make a big turnaround in the succeeding months. Which of the following actions of Harry demonstrates that he has reached the third stage of change? a. Wonders why things are not what it used to be b. Finds solutions to the problems c. Integrate the solutions to his day-to-day activities d. Selects the best change strategy 21. Julius is a newly-appointed nurse manager of The Good Shepherd Medical Center, a tertiary hospital located within the heart of the metropolis. He thinks of scheduling planning workshop with his staff in order to ensure an effective and efficient management of the department. Should he decide to conduct a strategic planning workshop, which of the following is NOT a characteristic of this activity? a. Long-term goal-setting b. Extends to 3-5 years in the future c. Focuses on routine tasks d. Determines directions of the organization 22. Which of the following statements refer to the vision of the hospital? a. The Good Shepherd Medical Center is a trendsetter in tertiary health care in the Philippines in the next five years Goal b. The officers and staff of The Good Shepherd Medical Center believe in the unique nature of the human person c. All the nurses shall undergo continuing competency training program. d. The Good Shepherd Medical Center aims to provide a patient-centered care in a total healing environment.

18. Answer: (B) Preparing a nursing care plan in collaboration with the patient The best source of information about the priority needs of the patient is the patient himself. Hence using a nursing care plan based on his expressed priority needs would ensure meeting his needs effectively.

19. Answer: (D) Patients who need the most care In setting priorities for a group of patients, those who need the most care should be number-one priority to ensure that their critical needs are met adequately. The needs of other patients who need less care ca be attended to later or even delegated to assistive personnel according to rules on delegation.

20. Answer: (C) Integrate the solutions to his day-to-day activities Integrate the solutions to his day-to-day activities is expected to happen during the third stage of change when the change agent incorporate the selected solutions to his system and begins to create a change.

21. Answer: (C) Focuses on routine tasks Strategic planning involves options A, B and D except C which is attributed to operational planning

22. Answer: (A) The Good Shepherd Medical Center is a trendsetter in tertiary health care in the Philippines in the next five years A vision refers to what the institution wants to become within a particular period of time.

23. The statement, The Good Shepherd Medical Center aims to provide patient-centered care in a total healing environment refers to which of the following? a. Vision b. Goal c. Philosophy d. Mission 24. Julius plans to revisit the organizational chart of the department. He plans to create a new position of a Patient Educator who has a coordinating relationship with the head nurse in the unit. Which of the following will likely depict this organizational relationship? a. Box b. Solid line c. Broken line d. Dotted line 25. He likewise stresses the need for all the employees to follow orders and instructions from him and not from anyone else. Which of the following principles does he refer to? a. Scalar chain b. Discipline c. Unity of command d. Order 26. Julius orients his staff on the patterns of reporting relationship throughout the organization. Which of the following principles refer to this? a. Span of control b. Hierarchy c. Esprit d corps d. Unity of direction 27. He emphasizes to the team that they need to put their efforts together towards the attainment of the goals of the program. Which of the following principles refers to this? a. Span of control b. Unity of direction c. Unity of command d. Command responsibility 28. Julius stresses the importance of promoting esprit d corps among the members of the unit. Which of the following remarks of the staff indicates that they understand what he pointed out? a. Lets work together in harmony; we need to be supportive of one another b. In order that we achieve the same results; we must all follow the directives of Julius and not from other managers. c. We will ensure that all the resources we need are available when needed. d. We need to put our efforts together in order to raise the bar of excellence in the care we provide to

23. Answer: (B) Goal B

24. Answer: (C) Broken line This is a staff relationship hence it is depicted by a broken line in the organizational structure

25. Answer: (C) Unity of command The principle of unity of command means that employees should receive orders coming from only one manager and not from two managers. This averts the possibility of sowing confusion among the members of the organization

26. Answer: (B) Hierarchy Hierarchy refers to the pattern of reporting or the formal line of authority in an organizational structure.

27. Answer: (B) Unity of direction Unity of direction means having one goal or one objective for the team to pursue; hence all members of the organization should put their efforts together towards the attainment of their common goal or objective.

28. Answer: (A) Lets work together in harmony; we need to be supportive of one another The principle of esprit d corps refers to promoting harmony in the workplace, which is essential in maintaining a climate conducive to work.

all our patients. 29. He discusses the goal of the department. Which of the following statements is a goal? a. Increase the patient satisfaction rate b. Eliminate the incidence of delayed administration of medications c. Establish rapport with patients. d. Reduce response time to two minutes. 30. He wants to influence the customary way of thinking and behaving that is shared by the members of the department. Which of the following terms refer to this? a. Organizational chart b. Cultural network c. Organizational structure d. Organizational culture 31. He asserts the importance of promoting a positive organizational culture in their unit. Which of the following behaviors indicate that this is attained by the group? a. Proactive and caring with one another b. Competitive and perfectionist c. Powerful and oppositional d. Obedient and uncomplaining 32. Stephanie is a new Staff Educator of a private tertiary hospital. She conducts orientation among new staff nurses in her department. Joseph, one of the new staff nurses, wants to understand the channel of communication, span of control and lines of communication. Which of the following will provide this information? a. Organizational structure b. Policy c. Job description d. Manual of procedures 33. Stephanie is often seen interacting with the medical intern during coffee breaks and after duty hours. What type of organizational structure is this? a. Formal b. Informal c. Staff d. Line 34. She takes pride in saying that the hospital has a decentralized structure. Which of the following is NOT compatible with this type of model? a. Flat organization b. Participatory approach c. Shared governance d. Tall organization

29. Answer: (A) Increase the patient satisfaction rate Goal is a desired result towards which efforts are directed. Options AB, C and D are all objectives which are aimed at specific end.

30. Answer: (D) Organizational culture An organizational culture refers to the way the members of the organization think together and do things around them together. Its their way of life in that organization

32. Answer: (A) Organizational structure Organizational structure provides information on the channel of authority, i.e., who reports to whom and with what authority; the number of people who directly reports to the various levels of hierarchy and the lines of communication whether line or staff.

33. Answer: (B) Informal This is usually not published and oftentimes concealed.

34. Answer: (D) Tall organization Tall organizations are highly centralized organizations where decision making is centered on one authority level.

35. Centralized organizations have some advantages. Which of the following statements are TRUE? 1. 2. 3. 4. Highly cost-effective Makes management easier Reflects the interest of the worker Allows quick decisions or actions.

35. Answer: (A) 1 & 2 Centralized organizations are needs only a few managers hence they are less expensive and easier to manage

a. 1 & 2 b. 2 & 4 c. 2, 3& 4 d. 1, 2, & 4 36. Stephanie delegates effectively if she has authority to act, which is BEST defined as: a. having responsibility to direct others b. being accountable to the organization c. having legitimate right to act d. telling others what to do 37. Regardless of the size of a work group, enough staff must be available at all times to accomplish certain purposes. Which of these purposes is NOT included? a. Meet the needs of patients b. Provide a pair of hands to other units as needed c. Cover all time periods adequately. d. Allow for growth and development of nursing staff. 38. Which of the following guidelines should be least considered in formulating objectives for nursing care? a. Written nursing care plan b. Holistic approach c. Prescribed standards d. Staff preferences 39. Stephanie considers shifting to transformational leadership. Which of the following statements best describes this type of leadership? a. Uses visioning as the essence of leadership. b. Serves the followers rather than being served. c. Maintains full trust and confidence in the subordinates d. Possesses innate charisma that makes others feel good in his presence. 40. As a manager, she focuses her energy on both the quality of services rendered to the patients as well as the welfare of the staff of her unit. Which of the following management styles does she adopt? a. Country club management b. Organization man management c. Team management d. Authority-obedience management

36. Answer: (C) having legitimate right to act Authority is a legitimate or official right to give command. This is an officially sanctioned responsibility

37. Answer: (B) Provide a pair of hands to other units as needed Providing a pair of hands for other units is not a purpose in doing an effective staffing process. This is a function of a staffing coordinator at a centralized model.

38. Answer: (D) Staff preferences Staff preferences should be the least priority in formulating objectives of nursing care. Individual preferences should be subordinate to the interest of the patients.

39. Answer: (A) Uses visioning as the essence of leadership. Transformational leadership relies heavily on visioning as the core of leadership.

40. Answer: (C) Team management Team management has a high concern for services and high concern for staff.

FOR K PART 2

FOR K PART 2

1. Katherine is a young Unit Manager of the Pediatric Ward. Most of her staff nurses are senior to her, very articulate, confident and sometimes aggressive. Katherine feels uncomfortable believing that she is the scapegoat of everything that goes wrong in her department. Which of the following is the best action that she must take? A. Identify the source of the conflict and understand the points of friction B. Disregard what she feels and continue to work independently C. Seek help from the Director of Nursing D. Quit her job and look for another employment. 2. As a young manager, she knows that conflict occurs in any organization. Which of the following statements regarding conflict is NOT true?

1. Answer: (A) Identify the source of the conflict and understand the points of friction This involves a problem solving approach, which addresses the root cause of the problem.

A. Can be destructive if the level is too high B. Is not beneficial; hence it should be prevented at all times C. May result in poor performance D. May create leaders 3. Katherine tells one of the staff, I dont have time to discuss the matter with you now. See me in my office later when the latter asks if they can talk about an issue. Which of the following conflict resolution strategies did she use? A. Smoothing B. Compromise nnnnb .C. Avoidance D. Restriction 4. Kathleen knows that one of her staff is experiencing burnout. Which of the following is the best thing for her to do? A. Advise her staff to go on vacation. B. Ignore her observations; it will be resolved even without intervention C. Remind her to show loyalty to the institution. D. Let the staff ventilate her feelings and ask how she can be of help. 5. She knows that performance appraisal consists of all the following activities EXCEPT: A. Setting specific standards and activities for individual performance. B. Using agency standards as a guide. C. Determine areas of strength and weaknesses D. Focusing activity on the correction of identified behavior. 6. Which of the following statements is NOT true about performance appraisal? A. Informing the staff about the specific impressions of their work help improve their performance. B. A verbal appraisal is an acceptable substitute for

2. Answer: (B) Is not beneficial; hence it should be prevented at all times Conflicts are beneficial because it surfaces out issues in the open and can be solved right away. Likewise, members of the team become more conscientious with their work when they are aware that other members of the team are watching them.

3. Answer: (C) Avoidance This strategy shuns discussing the issue head-on and prefers to postpone it to a later time. In effect the problem remains unsolved and both parties are in a loselose situation.

4. Answer: (D) Let the staff ventilate her feelings and ask how she can be of help. Reaching out and helping the staff is the most effective strategy in dealing with burn out. Knowing that someone is ready to help makes the staff feel important; hence her self-worth is enhanced.

5. Answer: (D) Focusing activity on the correction of identified behavior. Performance appraisal deal with both positive and negative performance; is not meant to be a fault-finding activity

6. Answer: (C) Patients are the best source of information regarding personnel appraisal. The patient can be a source of information about the performance of the staff but it is never the best source. Directly observing the staff is the best source of information for personnel appraisal.

a written report C. Patients are the best source of information regarding personnel appraisal. D. The outcome of performance appraisal rests primarily with the staff. 7. There are times when Katherine evaluates her staff as she makes her daily rounds. Which of the following is NOT a benefit of conducting an informal appraisal?
7. Answer: (C) The evaluation is focused on objective data systematically. Collecting objective data systematically can not be achieved in an informal appraisal. It is focused on what actually happens in the natural work setting.

A. The staff member is observed in natural setting. B. Incidental confrontation and collaboration is allowed. C. The evaluation is focused on objective data systematically. D. The evaluation may provide valid information for compilation of a formal report. 8. She conducts a 6-month performance review session with a staff member. Which of the following actions is appropriate? A. She asks another nurse to attest the session as a witness. B. She informs the staff that she may ask another nurse to read the appraisal before the session is over. C. She tells the staff that the session is managercentered. D. The session is private between the two members. 9. Alexandra is tasked to organize the new wing of the hospital. She was given the authority to do as she deems fit. She is aware that the director of nursing has substantial trust and confidence in her capabilities, communicates through downward and upward channels and usually uses the ideas and opinions of her staff. Which of the following is her style of management? A. Benevolent authoritative B. Consultative C. Exploitive-authoritative D. Participative 10. She decides to illustrate the organizational structure. Which of the following elements is NOT included? A. Level of authority B. Lines of communication C. Span of control D. Unity of direction 11. She plans of assigning competent people to fill the roles designed in the hierarchy. Which process refers to this? A. Staffing B. Scheduling C. Recruitment D. Induction
11. Answer: (A) Staffing Staffing is a management function involving putting the best people to accomplish tasks and activities to attain the goals of the organization. 10. Answer: (D) Unity of direction Unity of direction is a management principle, not an element of an organizational structure. 8. Answer: (D) The session is private between the two members. The session is private between the manager and the staff and remains to be so when the two parties do not divulge the information to others.

9. Answer: (B) Consultative A consultative manager is almost like a participative manager. The participative manager has complete trust and confidence in the subordinate, always uses the opinions and ideas of subordinates and communicates in all directions.

12. She checks the documentary requirements for the applicants for staff nurse position. Which one is NOT necessary? A. Certificate of previous employment B. Record of related learning experience (RLE) C. Membership to accredited professional organization D. Professional identification card 13. Which phase of the employment process includes getting on the payroll and completing documentary requirements? A. Orientation B. Induction C. Selection D. Recruitment 14. She tries to design an organizational structure that allows communication to flow in all directions and involve workers in decision making. Which form of organizational structure is this? A. Centralized B. Decentralized C. Matrix D. Informal 15. In a horizontal chart, the lowest level worker is located at the A. Left most box B. Middle C. Right most box D. Bottom 16. She decides to have a decentralized staffing system. Which of the following is an advantage of this system of staffing? A. greater control of activities B. Conserves time C. Compatible with computerization D. Promotes better interpersonal relationship 17. Aubrey thinks about primary nursing as a system to deliver care. Which of the following activities is NOT done by a primary nurse? A. Collaborates with the physician B. Provides care to a group of patients together with a group of nurses C. Provides care for 5-6 patients during their hospital stay. D. Performs comprehensive initial assessment 18. Which pattern of nursing care involves the care given by a group of paraprofessional workers led by a professional nurse who take care of patients with the same disease conditions and are located geographically near each other?

12. Answer: (B) Record of related learning experience (RLE) Record of RLE is not required for employment purposes but it is required for the nurses licensure examination.

13. Answer: (B) Induction This step in the recruitment process gives time for the staff to submit all the documentary requirements for employment.

14. Answer: (B) Decentralized Decentralized structures allow the staff to make decisions on matters pertaining to their practice and communicate in downward, upward, lateral and diagonal flow.

15. Answer: (C) Rightmost box The leftmost box is occupied by the highest authority while the lowest level worker occupies the rightmost box.

16. Answer: (D) Promotes better interpersonal relationship Decentralized structures allow the staff to solve decisions by themselves, involve them in decision making; hence they are always given opportunities to interact with one another.

17. Answer: (B) Provides care to a group of patients together with a group of nurses This function is done in team nursing where the nurse is a member of a team that provides care for a group of patients.

18. Answer: (B) Modular nursing Modular nursing is a variant of team nursing. The

A. Case method B. Modular nursing C. Nursing case management D. Team nursing 19. St. Raphael Medical Center just opened its new Performance Improvement Department. Ms. Valencia is appointed as the Quality Control Officer. She commits herself to her new role and plans her strategies to realize the goals and objectives of the department. Which of the following is a primary task that they should perform to have an effective control system? A. Make an interpretation about strengths and weaknesses B. Identify the values of the department C. Identify structure, process, outcome standards & criteria D. Measure actual performances 20. Ms. Valencia develops the standards to be followed. Among the following standards, which is considered as a structure standard? A. The patients verbalized satisfaction of the nursing care received B. Rotation of duty will be done every four weeks for all patient care personnel. C. All patients shall have their weights taken recorded D. Patients shall answer the evaluation form before discharge 21. When she presents the nursing procedures to be followed, she refers to what type of standards? A. Process B. Outcome C. Structure D. Criteria

difference lies in the fact that the members in modular nursing are paraprofessional workers.

19. Answer: (B) Identify the values of the department Identify the values of the department will set the guiding principles within which the department will operate its activities

20. Answer: (B) Rotation of duty will be done every four weeks for all patient care personnel. Structure standards include management system, facilities, equipment, materials needed to deliver care to patients. Rotation of duty is a management system.

21. Answer: (A) Process Process standards include care plans, nursing procedure to be done to address the needs of the patients.

22. The following are basic steps in the controlling process of the department. Which of the following is NOT included? A. Measure actual performance B. Set nursing standards and criteria C. Compare results of performance to standards and objectives D. Identify possible courses of action 23. Which of the following statements refers to criteria? A. Agreed on level of nursing care B. Characteristics used to measure the level of nursing care C. Step-by-step guidelines D. Statement which guide the group in decision making and problem solving

22. Answer: (D) Identify possible courses of action This is a step in a quality control process and not a basic step in the control process.

23. Answer: (B) Characteristics used to measure the level of nursing care Criteria are specific characteristics used to measure the standard of care.

24. She wants to ensure that every task is carried out as planned. Which of the following tasks is NOT included in the controlling process? A. Instructing the members of the standards committee to prepare policies B. Reviewing the existing policies of the hospital C. Evaluating the credentials of all nursing staff D. Checking if activities conform to schedule 25. Ms. Valencia prepares the process standards. Which of the following is NOT a process standard? A. Initial assessment shall be done to all patients within twenty four hours upon admission. B. Informed consent shall be secured prior to any invasive procedure C. Patients reports 95% satisfaction rate prior to discharge from the hospital. D. Patient education about their illness and treatment shall be provided for all patients and their families. 26. Which of the following is evidence that the controlling process is effective? A. The things that were planned are done B. Physicians do not complain. C. Employees are contended D. There is an increase in customer satisfaction rate. 27. Ms. Valencia is responsible to the number of personnel reporting to her. This principle refers to: A. Span of control B. Unity of command C. Carrot and stick principle D. Esprit d corps 28. She notes that there is an increasing unrest of the staff due to fatigue brought about by shortage of staff. Which action is a priority? A. Evaluate the overall result of the unrest B. Initiate a group interaction C. Develop a plan and implement it D. Identify external and internal forces. 29. Kevin is a member of the Nursing Research Council of the hospital. His first assignment is to determine the level of patient satisfaction on the care they received from the hospital. He plans to include all adult patients admitted from April to May, with average length of stay of 3-4 days, first admission, and with no complications. Which of the following is an extraneous variable of the study? A. Date of admission B. Length of stay C. Age of patients D. Absence of complications 30. He thinks of an appropriate theoretical

24. Answer: (A) Instructing the members of the standards committee to prepare policies Instructing the members involves a directing function.

25. Answer: (C) Patients reports 95% satisfaction rate prior to discharge from the hospital. This refers to an outcome standard, which is a result of the care that is rendered to the patient.

26. Answer: (A) The things that were planned are done Controlling is defined as seeing to it that what is planned is done.

27. Answer: (A) Span of control Span of control refers to the number of workers who report directly to a manager.

28. Answer: (B) Initiate a group interaction Initiate a group interaction will be an opportunity to discuss the problem in the open.

29. Answer: (C) Age of patients An extraneous variable is not the primary concern of the researcher but has an effect on the results of the study. Adult patients may be young, middle or late adult.

30. Answer: (B) Sr. Callista Roy Sr. Callista Roy developed the Adaptation Model which

framework. Whose theory addresses the four modes of adaptation? A. Martha Rogers B. Sr. Callista Roy C. Florence Nightingale D. Jean Watson 31. He opts to use a self-report method. Which of the following is NOT TRUE about this method? A. Most direct means of gathering information B. Versatile in terms of content coverage C. Most accurate and valid method of data gathering D. Yields information that would be difficult to gather by another method 32. Which of the following articles would Kevin least consider for his review of literature? A. Story-Telling and Anxiety Reduction Among Pediatric Patients B. Turnaround Time in Emergency Rooms C. Outcome Standards in Tertiary Health Care Institutions D. Environmental Manipulation and Client Outcomes 33. Which of the following variables will he likely EXCLUDE in his study? A. Competence of nurses B. Caring attitude of nurses C. Salary of nurses D. Responsiveness of staff 34. He plans to use a Likert Scale to determine A. degree of agreement and disagreement B. compliance to expected standards C. level of satisfaction D. degree of acceptance 35. He checks if his instruments meet the criteria for evaluation. Which of the following criteria refers to the consistency or the ability to yield the same response upon its repeated administration? A. Validity B. Reliability C. Sensitivity D. Objectivity 36. Which criteria refer to the ability of the instrument to detect fine differences among the subjects being studied? A. Sensitivity B. Reliability C. Validity D. Objectivity

involves the physiologic mode, self-concept mode, role function mode and dependence mode

31. Answer: (C) Most accurate and valid method of data gathering The most serious disadvantage of this method is accuracy and validity of information gathered

32. Answer: (B) Turnaround Time in Emergency Rooms The article is for pediatric patients and may not be relevant for adult patients.

33. Answer: (C) Salary of nurses Salary of staff nurses is not an indicator of patient satisfaction, hence need not be included as a variable in the study.

34. Answer: (A) degree of agreement and disagreement Likert scale is a 5-point summated scale used to determine the degree of agreement or disagreement of the respondents to a statement in a study.

35. Answer: (B) Reliability Reliability is repeatability of the instrument; it can elicit the same responses even with varied administration of the instrument

36. Answer: (A) Sensitivity Sensitivity is an attribute of the instrument that allow the respondents to distinguish differences of the options where to choose from

37. Which of the following terms refer to the degree to which an instrument measures what it is supposed to be measure? A. Validity B. Reliability C. Meaningfulness D. Sensitivity 38. He plans for his sampling method. Which sampling method gives equal chance to all units in the population to get picked? A. Random B. Accidental C. Quota D. Judgment 39. Raphael is interested to learn more about transcultural nursing because he is assigned at the family suites where most patients come from different cultures and countries. Which of the following designs is appropriate for this study? A. Grounded theory B. Ethnography C. Case study D. Phenomenology 40. The nursing theorist who developed transcultural nursing theory is A. Dorothea Orem B. Madeleine Leininger C. Betty Newman D. Sr. Callista Roy

37. Answer: (A) Validity Validity is ensuring that the instrument contains appropriate questions about the research topic

38. Answer: (A) Random Random sampling gives equal chance for all the elements in the population to be picked as part of the sample.

39. Answer: (B) Ethnography Ethnography is focused on patterns of behavior of selected people within a culture

40. Answer: (B) Madeleine Leininger Madeleine Leininger developed t

FOR K PART 3
1. Angelina, an R.N., reports to work looking unkempt. Maegan, another R.N., approaches when she notices her using uncoordinated movements. Angelinas breath reeks of peppermints and Maegan suspects Angelina may be intoxicated. What is the best initial nursing action for Maegan to take? a. Call the supervisor and report Angelina. b. Confront Angelina, saying that she feels she is intoxicated, and relieve her of her nursing duties immediately. c. Ignore the situation. d. Give Angelina a lecture about substance abuse and do nothing else. 2. Carol has a nasogastric tube after colon surgery. Which one of these tasks can be safely delegated to an unlicensed assistive personnel (UAP)? a. To observe the type and amount of nasogastric tube drainage b. Monitor the client for nausea or other complications c. Irrigate the nasogastric tube with the ordered irrigant

1. Answer B. Calling the supervisor is a secondary measure after confronting the nurse and relieving the nurse of her duties. You cannot always assume the supervisor will be immediately available, and client safety should be addressed first. When another nurse is unable to perform her nursing duties due to substance abuse, she should not be allowed to continue them, as client safety is a primary concern. Ignoring the situation is against the professional code of conduct for nurses. Angelina needs to be relieved of her duties. She probably would not benefit from a lecture in her condition.

2. Answer D. Skin care around a nasogastric tube is a routine task that is appropriate for UAPs. The other tasks would be appropriate for a PN or RN to do since they are advanced skills or require evaluation.

d. Perform nostril and mouth care 3. Lana is admitted with a diagnosis of schizophrenia. The client refuses to take medication and states I dont think I need those medications. They make me too sleepy and drowsy. I insist that you explain their use and side effects. The nurse should understand that: a. a referral is needed to the psychiatrist who is to provide the client with answers b. the client has a right to know about the prescribed medications c. such education is an independent decision of the individual nurse whether or not to teach clients about their medications d. clients with schizophrenia are at a higher risk of psychosocial complications when they know about their medication side effects 4. James with a diagnosis of bipolar disorder has been referred to a local boarding home for consideration for placement. The social worker telephoned the hospital unit for information about the clients mental status and adjustment. Th e appropriate response of the nurse should be which of these statements? a. "I am sorry. Referral information can only be provided by the clients providers" b. "I can never give any information out by telephone. How do I know who you are?" c. "Since this is a referral, I can give you this information" d. "I need to get the clients written consent before I release any information to you" 5. A client tells the nurse, "I have something very important to tell you if you promise not to tell." The best response by the nurse is: a. "I must document and report any important information." b. "I cant make such a promise." c. "That depends on what you tell me." d. "I must report everything to the treatment team." 6. Helen, a nurse from the maternity unit is floated to the critical care unit because of staff shortage on the evening shift. Which client would be appropriate to assign to this nurse? A client with: a. Dopamine drip IV with vital signs monitored every 5 minutes b. a myocardial infarction that is free from pain and dysrhythmias c. a tracheotomy of 24 hours in some respiratory distress d. a pacemaker inserted this morning with intermittent capture 7. A client asks the nurse to call the police and states: I need to report that I am being abused by a nurse. The nurse should first: 5. Answer B. Secrets are inappropriate in therapeutic relationships and are counterproductive to the therapeutic efforts of the interdisciplinary team. Secrets may be related to risk for harm to self or others. The nurse honors and helps clients to understand rights, limitations, and boundaries regarding confidentiality. 3. Answer B. Clients have a right to informed consent which includes information about medications, treatments, and diagnostic studies.

4. Answer D. In order to release information about a client there must be a signed consent form with designation of to whom information can be given, and what information can be shared.

6. Answer B. This client is the most stable with minimal risk of complications or instability. The nurse can utilize basic nursing skills to care for this client.

7. Answer C. Obtain more details of the clients claim of abuse. The advocacy role of the

a. focus on reality orientation to place and person b. assist with the report of the clients complaint to the police c. obtain more details of the clients claim of abuse d. document the statement on the clients chart with a report to the manager 8. John, a client frequently admitted to the locked psychiatric unit repeatedly compliments and invites one of the nurses to go out on a date. The nurses response should be to: a. ask to not be assigned to this client or to work on another unit b. tell the client that such behavior is inappropriate c. inform the client that hospital policy prohibits staff to date clients d. discuss the boundaries of the therapeutic relationship with the client 9. A client continuously calls out to the nursing staff when anyone passes the clients door and asks them to do something in the room. The best response by the charge nurse would be to: a. keep the clients room door cracked to minimize the distractions b. assign 1 of the nursing staff to visit the client regularly c. reassure the client that 1 staff person will check frequently if the client needs anything d. arrange for each staff member to go into the clients room to check on needs every hour on the hour 10. The nurse is responsible for several elderly clients, including a client on bed rest with a skin tear and hematoma from a fall 2 days ago. What is the best care assignment for this client? a. Assign an RN to provide total care of the client b. Assign a nursing assistant to help the client with self-care activities c. Delegate complete care to an unlicensed assistive personnel d. Supervise a nursing assistant for skin care 11. A 24-year-old woman had surgery today. Her father, a physician but not her surgeon, enters the nursing station and asks for her chart. The best action for the nurse to take is: a. to give him the chart as requested. b. not to allow him to read the chart. c. to ask the attending surgeon if it is permissible for him to read the chart. d. to ask the client if she wants him to read her chart. 12. When assessing a client, it is important for the nurse to be informed about cultural issues related to the clients background because: a. Normal patterns of behavior may be labeled as

professional nurse as well as the legal duty of the reasonable prudent nurse requires the investigation of claims of abuse or violation of rights. The nurse is legally accountable for actions delegated to others. The application of the nursing process requires that the nurse gather more information, further assessment, before documentation or the reporting of the complaint.

8. Answer D. The nurse-client relationship is one with professional not social boundaries. Consistent adherence to the limits of the professional relationship builds trust.

9. Answer B. Assign 1 of the nursing staff to visit the client regularly. Regular, frequent, planned contact by 1 staff member provides continuity of care and communicates to the client that care will be available when needed.

10. Answer D. Supervise a nursing assistant for skin care. The nursing assistant can inspect the skin while giving hygiene care, but the nurse should supervise skin care since assessment and analysis are needed.

11. Answer B. The nurse must maintain the clients right of confidentiality. Since he is not the clients physician and does not have a medical need to see her chart, he should not be allowed to read the chart without written permission from the client, who is above the age of majority. Since he is not the clients physician and does not have a medical need to see her chart, he should not be allowed to read the chart without written permission from the client, who is above the age of majority. It is not the attending surgeon who can give permission for him to review the chart, it is the client. The client must 12. Answer A. Culture is an important variable in the assessment of individuals. To work effectively with clients, the nurse must be aware of a cultural distinctive qualities

deviant, immoral, or insane b. The meaning of the clients behavior can be derived from conventional wisdom c. Personal values will guide the interaction between persons from 2 cultures d. The nurse should rely on her knowledge of different developmental mental stages 13. Robin, an adult male is scheduled for exploratory surgery this morning. After he is premedicated for surgery the nurse reviews his chart and discovers that he has not signed a consent form. The nurses action is based on which of the following understandings? a. Since the client came to the hospital consent is implied even if the consent for the surgery has not been signed. b. All invasive procedures require a consent form. c. The nurse should have him sign a consent form immediately d. The nurse should have the next of kin sign the necessary consent form 14. Zantac is ordered for an adult client. The nurse mistakenly administered Xanax. What is the most appropriate action for the nurse to take? a. Notify the physician and document in the nurses notes that the physician was notified of the error. b. Notify the supervisor, complete a medication error incident report, and document in the nurses notes that an incident report was completed c. Notify the house supervisor, assess client carefully, and document only if adverse or untoward effects occur. d. Notify the physician, complete an incident report, and document the notification of the physician and any assessments made. 15. A client with Guillain-Barr syndrome has been on a ventilator for three weeks, and can communicate only with eye blinks because of quadriplegia. The intensive care nursing staff sometimes have no time for this tedious communication process. The clients family comes infrequently since they run a family-owned restaurant that does not close until visiting hours are over. How should the nurse respond to the familys request for exemption from visiting hours? a. Arrange for a volunteer to stay with the client during the day to provide for socialization needs and to facilitate communication with staff. b. Explain to the family that consistency in enforcing rules is important to prevent complaints from the families of other clients. c. Suggest that the family visit in shifts during the normal visiting hours, since the client needs to sleep at night. d. Make an exception to visiting regulations because of the long-term nature of the clients recovery and the need for family support. 16. An adult client has continued slow bleeding from the graft after repair of an abdominal aortic

13. Answer B. It cannot be legally assumed that the client consents to a procedure for which he has not given consent. This is not legally defensible. All invasive procedures require informed consent. The surgery is prescheduled and described as exploratory and therefore is not an emergency. If the client is an adult and has not been declared incompetent the client must sign the form. This client should not have surgery performed without written consent. The nurse must notify the physician immediately. The client has been premedicated for surgery and is not alert. He

14. Answer D. In addition to notifying the physician and documenting it, the nurse should complete an incident report. The physician must be notified. An incident report should be completed. However, no record of the incident report should appear in the nurses notes. The physician must be notified. An incident report should be completed. However, no record of the incident report should appear in the nurses notes. The physician must be notified of the medication error. An incident report should be completed. However, no record of the incident report should appear in the nurses notes. The nurse should document that the physician was notified and any assessments completed. 15. Answer D. The need for family support is vital to prevent discouragement and depression. A volunteer will not take the place of family. The need for family support is vital to prevent discouragement and depression, even at the risk of offending the families of other patients. Loss of a breadwinner during the lengthy recovery process may add financial problems for the family. GuillainBarr syndrome is characterized by the onset of ascending paralysis, which may include respiratory muscles. Persons with Guillain-Barr syndrome may remain ventilator-dependent for weeks, but have full consciousness. The prognosis for recovery from Guillain-Barr syndrome is good, but is very much dependent upon the level of supportive care during the acute stage.

16.

Answer D. The clients spiritual needs must

aneurysm. Because of the clients unstable condition, he is in the intensive care unit where visitors are limited to the family. The client insists on having a visit from a medicine man whom the family visits regularly. How should the nurse interpret this request? a. The principle of justice prohibits giving one client a privilege that other clients are not permitted. b. Faith healers do not meet the standards for clergy exemption from visitation rules. c. Medicine men are not approved by the hospital as legitimate health care providers. d. Provision of holistic care requires that the clients belief system is honored. 17. Flo Rida is an 88-year-old client at a long-term care facility. Prior to administering any medication or treatment to this client the nurse must confirm identity by: a. asking the client if she is Flo Rida. b. reading the clients identification bracelet c. reading the clients medical record. d. asking the roommate to state the client s name. 18. After working with a very demanding client, a nursing assistant tells the nurse, "I have had it with that client. I just cant do anything that pleases him. Im not going in there again." The nurses BEST response is: a. "He has a lot of problems. You need to be patient with him." b. "I will talk with him and try to figure out what to do." c. "He is scared and taking it out on you. Lets try to figure out what to do." d. "Ignore him and get the rest of your work done. Someone else can take care of him tomorrow." 19. A client frequently compliments and invites the nurse to go out. The nurse should: a. Minimize further contact with the client b. Tell the client that his/her behavior is inappropriate c. Tell the client that hospital policy prohibits dating clients d. Discuss the boundaries of the relationship with the client 20. Which one of the following could be safely delegated by the nurse to the nursing assistant? a. Observe a clients self-administration of insulin b. Cleanse and dress a small decubitus ulcer c. Monitor a clients response to physical therapy d. Apply and care for a clients rectal pouch

be met within the framework of his personal belief systems, even if those beliefs differ from those of the nursing staff. The clients spiritual needs must be met within the framework of his personal belief systems, even if those beliefs differ from those of the nursing staff. The clients spiritual needs must be met within the framework of his personal belief systems, even if those beliefs differ from those of the nursing staff. The clients spiritual needs must be met within the framework of his personal belief systems, even if those beliefs differ from those of the nursing staff.

17. Answer B. An alert, oriented client should be asked to state her full name so that there is no confusion in identity. The ID bracelet will confirm identity when the client is not alert or oriented to person. Reading the name on the clients ID bracelet is the most accurate way to confirm identity. Reading the clients medical record will not confirm identity. The roommate is not an accurate source for client identification.

18. Answer C. This response explains the clients behavior without belittling the nursing assistants feelings. The nursing assistant is encouraged to help solve the problem with the nurse.

19. Answer D. The nurse-client relationship is one with professional not social boundaries. Consistent adherence to the limits of the professional relationship builds trust.

20. Answer D. The RN may delegate the application and care of rectal pouches to a nursing assistant, who should be capable of performing this task . 1. D. Bathing an infant with eczema can be safely delegated to an aide; this task is basic and can competently performed by an aid.

1. The registered nurse is planning to delegate tasks to unlicensed assistive personnel (UAP). Which of the following task could the registered nurse safely assigned to a UAP?

A) Monitor the I&O of a comatose toddler client with salicylate poisoning B) Perform a complete bed bath on a 2-year-old with multiple injuries from a serious fall C) Check the IV of a preschooler with Kawasaki disease D) Give an outmeal bath to an infant with eczema 2. A nurse manager assigned a registered nurse from telemetry unit to the pediatrics unit. There were three patients assigned to the RN. Which of the following patients should not be assigned to the floated nurse? A) A 9-year-old child diagnosed with rheumatic fever B) A young infant after pyloromyotomy C) A 4-year-old with VSD following cardiac catheterization D) A 5-month-old with Kawasaki disease 3. A nurse in charge in the pediatric unit is absent. The nurse manager decided to assign the nurse in the obstetrics unit to the pediatrics unit. Which of the following patients could the nurse manager safely assign to the float nurse? A) A child who had multiple injuries from a serious vehicle accident B) A child diagnosed with Kawasaki disease and with cardiac complications C) A child who has had a nephrectomy for Wilms tumor D) A child receiving an IV chelating therapy for lead poisoning 4. The registered nurse is planning to delegate task to a certified nursing assistant. Which of the following clients should not be assigned to a CAN? A) A client diagnosed with diabetes and who has an infected toe B) A client who had a CVA in the past two months C) A client with Chronic renal failure D) A client with chronic venous insufficiency 5. The nurse in the medication unit passes the medications for all the clients on the nursing unit. The head nurse is making rounds with the physician and coordinates clients activities with other departments. The nurse assistant changes the bed lines and answers call lights. A second nurse is assigned for changing wound dressings; a licensed practitioner nurse takes vital signs and bathes theclients. This illustrates of what method of nursing care? A) Case management method B) Primary nursing method C) Team method D) Functional method 6. A registered nurse has been assigned to six clients on the 12-hour shift. The RN is responsible

2. B. The RN floated from the telemetry unit would be least prepared to care for a young infant who has just had GI surgery and requires a specific feeding regimen.

3. C. RN floated from the obstetrics unit should be able to care for a client with major abdominal surgery, because this nurse has experienced caring for clients with cesarean births.

4. A. The patient is experiencing a potentially serious complication related to diabetes and needs ongoing assessment by an RN

5. D. It describes functional nursing. Staff is assigned to specific task rather than specific clients.

6. B. Case management. The nurse assumes total responsibility for meeting the needs of the client

for every aspect of care such as formulating the care of plan, intervention and evaluating the care during her shift. At the end of her shift, the RN will pass this same task to the next RN in charge. This nursing care illustrates of what kind of method? A) primary nursing method B) case method C) team method D) functional method 7. A newly hired nurse on an adult medicine unit with 3 months experience was asked to float to pediatrics. The nurse hesitates to perform pediatric skills and receive an interesting assignment that feels overwhelming. The nurse should: A) resign on the spot from the nursing position and apply for a position that does not require floating B) Inform the nursing supervisor and the charge nurse on the pediatric floor about the nurses lack of skill and feelings of hesitations and request assistance C) Ask several other nurses how they feel about pediatrics and find someone else who is willing to accept the assignment D) Refuse the assignment and leave the unit requesting a vacation a day 8. An experienced nurse who voluntarily trained a less experienced nurse with the intention of enhancing the skills and knowledge and promoting professional advancement to the nurse is called a: A) mentor B) team leader C) case manager D) change agent 9. The pediatrics unit is understaffed and the nurse manager informs the nurses in the obstetrics unit that she is going to assign one nurse to float in the pediatric units. Which statement by the designated float nurse may put her job at risk? A) I do not get along with one of the nurses on the pediatrics unit B) I have a vacation day coming and would like to take that now C) I do not feel competent to go and work on that area D) I am afraid I will get the most serious clients in the unit 10. The newly hired staff nurse has been working on a medical unit for 3 weeks. The nurse manager has posted the team leader assignments for the following week. The new staff knows that a major responsibility of the team leader is to: A) Provide care to the most acutely ill client on the team B) Know the condition and needs of all the patients on the team C) Document the assessments completed by the team members

during her entire duty.

7. B. The nurse is ethically obligated to inform the person responsible for the assignment and the person responsible for the unit about the nurses skill level. The nurse therefore avoids a situation of abandoningclients and exposing them to greater risks

8. A. This describes a mentor

9. B. This action demonstrates a lack of responsibility and the nurse should attempt negotiation with the nurse manager.

10. B. The team leader is responsible for the overall management of all clients and staff on the team, and this information is essential in order to accomplish this

D) Supervise direct care by nursing assistants 11. C. Even though the mother is a minor, she is legally able to sign consent for her own child. 11. A 15-year-old girl just gave birth to a baby boy who needs emergency surgery. The nurse prepared the consent form and it should be signed by: A) The Physician B) The Registered Nurse caring for the client C) The 15-year-old mother of the baby boy D) The mother of the girl 12. A nurse caring to a client with Alzheimers disease overheard a family member say to the client, if you pee one more time, I wont give you any more food and drinks. What initial action is best for the nurse to take? A) Take no action because it is the family member saying that to the client B) Talk to the family member and explain that what she/he has said is not appropriate for the client C) Give the family member the number for an Elder Abuse Hot line D) Document what the family member has said 13. Which is true about informed consent? A) A nurse may accept responsibility signing a consent form if the client is unable B) Obtaining consent is not the responsibility of the physician C) A physician will not subject himself to liability if he withholds any facts that are necessary to form the basis of an intelligent consent D) If the nurse witnesses a consent for surgery, the nurse is, in effect, indicating that the signature is that of the purported person and that the persons condition is as indicated at the time of signing 14. A mother in labor told the nurse that she was expecting that her baby has no chance to survive and expects that the baby will be born dead. The mother accepts the fate of the baby and informs the nurse that when the baby is born and requires resuscitation, the mother refuses any treatment to her baby and expresses hostility toward the nurse while the pediatric team is taking care of the baby. The nurse is legally obligated to: A) Notify the pediatric team that the mother has refused resuscitation and any treatment for the baby and take the baby to the mother B) Get a court order making the baby a ward of the court C) Record the statement of the mother, notify the pediatric team, and observe carefully for signs of impaired bonding and neglect as a reasonable suspicion of child abuse D) Do nothing except record the mothers statement in the medical record 15. The hospitalized client with a chronic cough is scheduled for bronchoscopy. The nurse is tasks to bring the informed consent document into the clients room for a signature. The client asks the 15. C. It best explains what informed consent is and provides for legal rights of the patient 13. D. The nurse who witness a consent for treatment or surgery is witnessing only that the client signed the form and that the clients condition is as indicated at the time of signing. The nurse is not witnessing that the client is informed.

12. B. This response is the most direct and immediate. This is a case of potential need for advocacy and patients rights.

14. C. Although the statements by the mother may not create a suspicion of neglect, when they are coupled with observations about impaired bonding and maternal attachment, they may impose the obligation to report child neglect. The nurse is further obligated to notify caregivers of refusal to consent to treatment

nurse for details of the procedure and demands an explanation why the process of informed consent is necessary. The nurse responds that informed consent means: A) The patient releases the physician from all responsibility for the procedure. B) The immediate family may make decision against the patients will. C) The physician must give the client or surrogates enough information to make health care judgments consistent with their values and goals. D) The patient agrees to a procedure ordered by the physician even if the client does not understand what the outcome will be. 16. A hospitalized client with severe necrotizing ulcer of the lower leg is schedule for an amputation. The client tells the nurse that he will not sign the consent form and he does not want any surgery or treatment because of religious beliefs about reincarnation. What is the role of the RN? A) call a family meeting B) discuss the religious beliefs with the physician C) encourage the client to have the surgery D) inform the client of other options 17. While in the hospital lobby, the RN overhears the three staff discussing the health condition of her client. What would be the appropriate nursing action for the RN to take? A) Tell them it is not appropriate to discuss the condition of the client B) Ignore them, because it is their right to discuss anything they want to C) Join in the conversation, giving them supportive input about the case of the client D) Report this incident to the nursing supervisor 18. A staff nurse has had a serious issue with her colleague. In this situation, it is best to: A) Discuss this with the supervisor B) Not discuss the issue with anyone. It will probably resolve itself C) Try to discuss with the colleague about the issue and resolve it when both are calmer D) Tell other members of the network what the team member did 19. The nurse is caring to a client who just gave birth to a healthy baby boy. The nurse may not disclose confidential information when: A) The nurse discusses the condition of the client in a clinical conference with other nurses B) The client asks the nurse to discuss the her condition with the family C) The father of a woman who just delivered a baby is on the phone to find out the sex of the baby D) A researcher from an institutionally approved research study reviews the medical record of a patient 20. A. The priority is to let the surgeon know, who 17. A. The behavior should be stopped. The first step is to remind the staff that confidentiality may be violated

16. B. The physician may not be aware of the role that religious beliefs play in making a decision about surgery.

18. C. Waiting for emotions to dissipate and sitting down with the colleague is the first rule of conflict resolution.

19. C. The nurse has no idea who the person is on the phone and therefore may not share the information even if the patient gives permission

in turn may ask the husband to sign the consent. 20. A 17-year-old married client is scheduled for surgery. The nurse taking care of the client realizes that consent has not been signed after preoperative medications were given. What should the nurse do? A) Call the surgeon B) Ask the spouse to sign the consent C) Obtain a consent from the client as soon as possible D) Get a verbal consent from the parents of the client 21. A 12-year-old client is admitted to the hospital. The physician ordered Dilantin to the client. In administering IV phenytoin (Dilantin) to a child, the nurse would be most correct in mixing it with: A) Normal Saline B) Heparinized normal saline C) 5% dextrose in water D) Lactated Ringers solution 22. The nurse is caring to a client who is hypotensive. Following a large hematemesis, how should the nurse position the client? A) Feet and legs elevated 20 degrees, trunk horizontal, head on small pillow B) Low Fowlers with knees gatched at 30 degrees C) Supine with the head turned to the left D) Bed sloped at a 45 degree angle with the head lowest and the legs highest 23. The client is brought to the emergency department after a serious accident. What would be the initial nursing action of the nurse to the client? A) assess the level of consciousness and circulation B) check respirations, circulation, neurological response C) align the spine, check pupils, check for hemorrhage D) check respiration, stabilize spine, check circulation 24. A nurse is assigned to care to a client with Parkinsons disease. What interventions are important if the nurse wants to improve nutrition and promote effective swallowing of the client? A) Eat solid food B) Give liquids with meals C) Feed the client D) Sit in an upright position to eat 25. During tracheal suctioning, the nurse should implement safety measures. Which of the following should the nurse implements? A) limit suction pressure to 150-180 mmHg B) suction for 15-20 seconds C) wear eye goggles D) remove the inner cannula

21. A. Phenytoin (Dilantin) can cause venous irritation due to its alkalinity, therefore it should be mixed with normal saline.

22. A. This position increases venous return, improves cardiac volume, and promotes adequate ventilation and cerebral perfusion

23. D. Checking the airway would be a priority, and a neck injury should be suspected

24. D. Client with Parkinsons disease are at a high risk for aspiration and undernutrition. Sitting upright promotes more effective swallowing.

25. C. It is important to protect the RNs eyes from the possible contamination of coughed-up secretions

26. The nurse is conducting a discharge instructions to a client diagnosed with diabetes. What sign of hypoglycemia should be taught to a client? A) warm, flushed skin B) hunger and thirst C) increase urinary output D) palpitation and weakness 27. A client admitted to the hospital and diagnosed with Addisons disease. What would be the appropriate nursing action to the client? A) administering insulin-replacement therapy B) providing a low-sodium diet C) restricting fluids to 1500 ml/day D) reducing physical and emotional stress 28. The nurse is to perform tracheal suctioning. During tracheal suctioning, which nursing action is essential to prevent hypoxemia? A) aucultating the lungs to determine the baseline data to assess the effectiveness of suctioning B) removing oral and nasal secretions C) encouraging the patient to deep breathe and cough to facilitate removal of upper-airway secretions D) administering 100% oxygen to reduce the effects of airway obstruction during suctioning. 29. An infant is admitted and diagnosed with pneumonia and suspicious-looking red marks on the swollen face resembling a handprint. The nurse does further assessment to the client. How would the nurse document the finding? A) Facial edema with ecchymosis and handprint mark: crackles and wheezes B) Facial edema, with red marks; crackles in the lung C) Facial edema with ecchymosis that looks like a handprint D) Red bruise mark and ecchymosis on face 30. On the evening shift, the triage nurse evaluates several clients who were brought to the emergency department. Which in the following clients should receive highest priority? A) an elderly woman complaining of a loss of appetite and fatigue for the past week B) A football player limping and complaining of pain and swelling in the right ankle C) A 50-year-old man, diaphoretic and complaining of severe chest pain radiating to his jaw D) A mother with a 5-year-old boy who says her son has been complaining of nausea and vomited once since noon 31. A 80-year-old female client is brought to the emergency department by her caregiver, on the nurses assessment; the following are the

26. D. There has been too little food or too much insulin. Glucose levels can be markedly decreased (less than 50 mg/dl). Severe hypoglycemia may be fatal if not detected

27. D. Because the clients ability to react to stress is decreased, maintaining a quiet environment becomes a nursing priority. Dehydration is a common problem in Addisons disease, so close observation of the clients hydration level is crucial.

28. D. Presuctioning and postsuctioning ventilation with 100% oxygen is important in reducing hypoxemia which occurs when the flow of gases in the airway is obstructed by the suctioning catheter.

29. B. This is an example of objective data of both pulmonary status and direct observation on the skin by the nurse.

30. C. These are likely signs of an acute myocardial infarction (MI). An acute MI is a cardiovascular emergency requiring immediate attention. Acute MI is potentially fatal if not treated immediately.

31. D. Assessment and more data collection are needed. The client may have gastrointestinal or neurological problems that account for the

manifestations of the client: anorexia, cachexia and multiple bruises. What would be the best nursing intervention? A) check the laboratory data for serum albumin, hematocrit, and hemoglobin B) talk to the client about the caregiver and support system C) complete a police report on elder abuse D) complete a gastrointestinal and neurological assessment 32. The night shift nurse is making rounds. When the nurse enters a clients room, the client is on the floor next to the bed. What would be the initial action of the nurse? A) chart that the patient fell B) call the physician C) chart that the client was found on the floor next to the bed D) fill out an incident report 33. The nurse on the night shift is about to administer medication to a preschooler client and notes that the child has no ID bracelet. The best way for the nurse to identify the client is to ask: A) The adult visiting, The childs name is ____________________? B) The child, Is your name____________? C) Another staff nurse to identify this child D) The other children in the room what the childs name is 34. The nurse caring to a client has completed the assessment. Which of the following will be considered to be the most accurate charting of a lump felt in the right breast? A) abnormally felt area in the right breast, drainage noted B) hard nodular mass in right breast nipple C) firm mass at five clock, outer quadrant, 1cm from right nipple D) mass in the right breast 4cmx1cm 35. The physician instructed the nurse that intravenous pyelogram will be done to the client. The client asks the nurse what is the purpose of the procedure. The appropriate nursing response is to: A) outline the kidney vasculature B) determine the size, shape, and placement of the kidneys C) test renal tubular function and the patency of the urinary tract D) measure renal blood flow 36. A client visits the clinic for screening of scoliosis. The nurse should ask the client to: A) bend all the way over and touch the toes B) stand up as straight and tall as possible C) bend over at a 90-degree angle from the waist

symptoms. The anorexia could result from medications, poor dentition, or indigestion, and the bruises may be attributed to ataxia, frequent falls, vertigo or medication.

32. B. This is closest to suggesting actionassessment, rather than paperwork- and is therefore the best of the four.

33. C. The only acceptable way to identify a preschooler client is to have a parent or another staff member identify the client.

34. C. It describes the mass in the greatest detail.

35. C. Intravenous pyelogram tests both the function and patency of the kidneys. After the intravenous injection of a radiopaque contrast medium, the size, location, and patency of the kidneys can be observed by roentgenogram, as well as the patency of the urethra and bladder as the kidneys function to excrete the contrast medium.

36. C. This is the recommended position for screening for scoliosis. It allows the nurse to inspect the alignment of the spine, as well as to compare both shoulders and both hips.

D) bend over at a 45-degree angle from the waist 37. A client with tuberculosis is admitted in the hospital for 2 weeks. When a clients family members come to visit, they would be adhering to respiratory isolation precautions when they: A) wash their hands when leaving B) put on gowns, gloves and masks C) avoid contact with the clients roommate D) keep the clients room door open 38. An infant is brought to the emergency department and diagnosed with pyloric stenosis. The parents of the client ask the nurse, Why does my baby continue to vomit? Which of t he following would be the best nursing response of the nurse? A) Your baby eats too rapidly and overfills the stomach, which causes vomiting B) Your baby cant empty the formula that is in the stomach into the bowel C) The vomiting is due to the nausea that accompanies pyloric stenosis D) Your baby needs to be burped more thoroughly after feeding 39. A 70-year-old client with suspected tuberculosis is brought to the geriatric care facilities. An intradermal tuberculosis test is schedule to be done. The client asks the nurse what is the purpose of the test. Which of the following would be the best rationale for this? A) reactivation of an old tuberculosis infection B) increased incidence of new cases of tuberculosis in persons over 65 years old C) greater exposure to diverse health care workers D) respiratory problems are characteristic in this population 40. The nurse is making a health teaching to the parents of the client. In teaching parents how to measure the area of induration in response to a PPD test, the nurse would be most accurate in advising the parents to measure: A) both the areas that look red and feel raised B) The entire area that feels itchy to the child C) Only the area that looks reddened D) Only the area that feels raised 41. A community health nurse is schedule to do home visit. She visits to an elderly person living alone. Which of the following observation would be a concern? A) Picture windows B) Unwashed dishes in the sink C) Clear and shiny floors D) Brightly lit rooms 42. After a birth, the physician cut the cord of the baby, and before the baby is given to the mother, 40. D. Parents should be taught to feel the area that is raised and measure only that. 37. A. Handwashing is the best method for reducing cross-contamination. Gowns and gloves are not always required when entering a clients room.

38. B. Pyloric stenosis is an anomaly of the upper gastrointestinal tract. The condition involves a thickening, or hypertrophy, of the pyloric sphincter located at the distal end of the stomach. This causes a mechanical intestinal obstruction, which leads to vomiting after feeding the infant. The vomiting associated with pyloric stenosis is described as being projectile in nature. This is due to the increasing amounts of formula the infant begins to consume coupled with the increasing thickening of the pyloric sphincter.

39. B. Increased incidence of TB has been seen in the general population with a high incidence reported in hospitalized elderly clients. Immunosuppression and lack of classic manifestations because of the aging process are just two of the contributing factors of tuberculosis in the elderly.

41. C. It is a safety hazard to have shiny floors because they can cause falls.

what would be the initial nursing action of the nurse? A) examine the infant for any observable abnormalities B) confirm identification of the infant and apply bracelet to mother and infant C) instill prophylactic medication in the infants eyes D) wrap the infant in a prewarmed blanket and cover the head 43. A 2-year-old client is admitted to the hospital with severe eczema lesions on the scalp, face, neck and arms. The client is scratching the affected areas. What would be the best nursing intervention to prevent the client from scratching the affected areas? A) elbow restraints to the arms B) Mittens to the hands C) Clove-hitch restraints to the hands D) A posey jacket to the torso 44. The parents of the hospitalized client ask the nurse how their baby might have gotten pyloric stenosis. The appropriate nursing response would be: A) There is no way to determine this preoperatively B) Their baby was born with this condition C) Their baby developed this condition during the first few weeks of life D) Their baby acquired it due to a formula allergy 45. A male client comes to the clinic for check-up. In doing a physical assessment, the nurse should report to the physician the most common symptom of gonorrhea, which is: A) pruritus B) pus in the urine C) WBC in the urine D) Dysuria 46. Which of the following would be the most important goal in the nursing care of an infant client with eczema? A) preventing infection B) maintaining the comfort level C) providing for adequate nutrition D) decreasing the itching 47. The nurse is making a discharge instruction to a client receiving chemotherapy. The client is at risk for bone marrow depression. The nurse gives instructions to the client about how to prevent infection at home. Which of the following health teaching would be included? A) Get a weekly WBC count B) Do not share a bathroom with children or pregnant woman C) Avoid contact with others while receiving chemotherapy

42. D. The first priority, beside maintaining a newborns patent airway, is body temperature.

43. B. The purpose of restraints for this child is to keep the child from scratching the affected areas. Mittens restraint would prevent scratching, while allowing the most movement permissible.

44. C. Pyloric stenosis is not a congenital anatomical defect, but the precise etiology is unknown. It develops during the first few weeks of life.

45. B. Pus is usually the first symptom, because the bacteria reproduce in the bladder.

46. A. Preventing infection in the infant with eczema is the nurses most important goal. The infant with eczema is at high risk for infection due to numerous breaks in the skins integrity. Intact skin is always the infants first line of defense against infection. 47. D. Frequent hand washing and good hygiene are the best means of preventing infection.

D) Do frequent hand washing and maintain good hygiene 48. The nurse is assigned to care the client with infectious disease. The best antimicrobial agent for the nurse to use in handwashing is: A) Isopropyl alcohol B) Hexachlorophene (Phisohex) C) Soap and water D) Chlorhexidine gluconate (CHG) (Hibiclens) 49. The mother of the client tells the nurse, Im not going to have my baby get any immunization. What would be the best nursing response to the mother? A) You and I need to review your rationale for this decision B) Your baby will not be able to attend day care without immunizations C) Your decision can be viewed as a form of child abuse and neglect D) You are needlessly placing other people at risk for communicable diseases 50. The nurse is teaching the client about breast self-examination. Which observation should the client be taught to recognize when doing the examination for detection of breast cancer? A) tender, movable lump B) pain on breast self-examination C) round, well-defined lump D) dimpling of the breast tissue 1. A new nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice? a) a task approach method is used to provide care to clients b) managed care concepts and tools are used in providing client care c) an RN leads nursing personnel in providing care to a group of clients d) a single RN is responsible for providing nursing care to a group of clients 2. The nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. A nursing assistant is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following is the best approach in dealing with the nursing assistant? a) ignore the resistance b) exert coercion with the nursing assistant c) provide a positive reward system for the nursing assistant d) confront the nursing assistant to encourage verbalization of feelings regarding the change 3. A nurse is giving a report to a nursing assistant who will be caring for a client who has hand restraints. The nurse instructs the nursing assistant to assess the skin integrity of the restrained hands every: a) 2 hours b) 3 hours c) 4 hours d) 30 minutes 4. Fibrinolysin and desoxyribonuclease (Elase) is prescribed to treat a skin ulcer, and the nurse is observing a nursing student perform the treatment. The nurse intervenes if the nursing student is observed doing which of the following? a) applies a thin layer of medication b) cleans the wound with a sterile solution c) places petrolatum gauze over the fibrinolysin and desoxyribonuclease d) applies a thick layer of medication and covers with a dry sterile dressings 48. D. CHG is a highly effective antimicrobial ingredient, especially when it is used consistently over time.

49. A. The mother may have many reasons for such a decision. It is the nurses responsibility to review this decision with the mother and clarify any misconceptions regarding immunizations that may exist.

50. D. The tumor infiltrates nearby tissue, it can cause retraction of the overlying skin and create a dimpling appearance.

5. A nursing student is caring for a client with a brain attack (stroke) who is experiencing unilateral neglect. The nurse would intervene if the student plans to use which of the following strategies to help the client adapt to this deficit? a) tells the client to scan the environment b) approaches the client from the unaffected side c) places the bedside articles on the affected side d) moves the commode and cahir to the affected side

NCLEX for RN - Leadership and Management: ANSWERS AND RATIONALE 1) C - In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option A identifies functional nursing. Option B identifies a component of case management. Option D identifies primary nursing. 2) D - Confrontation is an important strategy to meet resistance head on. Face-to-face meetings to confront the issue at hand will allow verbalization of feelings, identification of problems and issues, and development of strategies to solve the problem. Option A will not address the problem. Option B may produce additional resistance. Option C may provide a temporary solution to the resistance but will not address the concern 3) D - The nurse should instruct the nursing assistant to assess restraints and skin integrity every 30 minutes. Agency guidelines regarding the use of restraints should always be followed. 4) D - The wound should be cleansed with a sterile solution and gently patted dry. A thin layer of fibrinolysin and desoxyribonuclease (Elase) is applied and covered with petrolatum gauze. If a dry powder preparation is used, for best effects, the solution should be prepared just before use. 5) B - Unilateral neglect is an unawareness of the paralyzed side of the body, which increases the clients risk for injury. The nurses role is to refocus the clients attention to the affected side. The nurse moves personal care items and belongings to the affected side, as well as the bedside chair and commode. The nurse teaches the client to scan the environment to become aware of that half of the body and approaches the client from the affected side to increase awareness further. 6. A nursing instructor asks the nursing student to describe the definition of a critical path. Which of the following statements, if made by the student, indicates a need for further understanding regarding critical paths? a) they are developed through the collaborative efforts of all members of the health care team b) they provide an effective way of monitoring care and for reducing or controlling the length of hospital stay for the client c) they are developed based on appropriate standards of care d) they are nursing care plans and use the steps of the nursing process 7. A community health nurse is working with a disaster relief following a tornado. The nurse's goal for the community is to prevent as much injury and death as possible from the uncontrollable event. Finding safe housing for survivors, providing support to families, organizing counseling, and securing physical care when needed all examples of which type of prevention? a) primary level of prevention b) secondary level of prevention c) tertiary level of prevention d) aggregate care prevention 8. The nurse manager is planning to implement a change in the nursing unit from team nursing to primary nursing. The nurse anticipates that there will be resistance to the change during the change process. The primary technique that the nurse would use in implementing this change is which of the following? a) introduce the change gradually b) confront the individuals involved in the change process c) use coercion to implement the change d) manipulate the participants in the change process 9. A nurse manager is providing an educational session to nursing staff members about the phases of viral hepatitis. The nurse manager tells the staff that which clinical manifestation(s) are primarily characteristic of preicteric phase? a) right upper quadrant pain b) fatigue, anorexia and nausea c) jaundice, dark-colored urine, and clay-colored stools d) pruritus

10. A nurse is preparing a plan of care for a client who will be hospitalized for insertion of an internal cervical radiation implant. Which nursing intervention should the nurse implement in preparation for the arrival of the client? a) prepare a private room at the end of the hallway b) place a sign on the door that indicates that visitors are limited to 60-minute visits c) assign one primary nurse to care for the client during the hospital stay d) place a linen bag outside of the client's room for discarding linens after morning care

NCLEX for RN - Leadership and Management: ANSWERS AND RATIONALE 6) D - Use the process of elimination and knowledge regarding the definition and purpose of critical paths to direct you to option D. Note the strategic words in the question, a need for further understanding. These words indicate a negative event query and ask you to select an option that is incorrect. If you had difficulty with this question, review critical paths. 7) C - Tertiary prevention involves the reduction of the amount and degree of disability, injury, and damage following a crisis. Primary prevention means keeping the crisis from occurring, and secondary prevention focuses on reducing the intensity and duration of a crisis during the crisis itself. There is no known aggregate care prevention level. 8) A - The primary technique that can used to handle resistance to change during the change process is to introduce the change gradually. Confrontation is an important strategy used to meet resistance when it occurs. Coercion is another strategy that can be used to decrease resistance to change but is not always a successful technique for managing resistance. Manipulation usually involves a covert action, such as leaving out pieces of vital information that the participants might receive negatively. It is not the best method of implementing a change. 9) B - In the preicteric phase, the client has nonspecific complaints of fatigue, anorexia, nausea, cough, and joint pain. Options A, C, and D are clinical manifestations that occur in the icteric phase. In the posticteric phase, jaundice decreases, the color of urine and stool return to normal, and the clients appetite improves. 10) A - The client with an internal cervical radiation implant should be placed in a private room at the end of the hall because this location provides less of a chance of exposure of radiation to others. The clients room should be marked with appropriate signs that indicate the presence of radiation. Visitors should be limited to 30-minute visits. Nurses assigned to this client should be rotated so that one nurse is not consistently caring for the client and exposing him or herself to excess amounts of radiation. All linens should be kept in the clients room until the implant is removed in case the implant has dislodged and needs to be located. 11. A nursing student is developing a plan of care for a client with a chest tube that is attached to a Pleur-Evac drainage system. The nurse intervenes if the student writes which incorrect intervention in the plan? a) position the client in semi-fowler's position b) add water to the suction chamber as it evaporates c) tape the connection sites between the chest tube and the drainage system d) instruct the client to avoid coughing and deep breathing 12. A nurse is caring for a client who has just had a plaster leg cast applied. The nurse would plan to prevent the development of compartment syndrome is instructing the licensed practical nurse assigned to care for the client to: a) elevate the limb and apply ice to the affected leg b) elevate the limb and cover the limb with bath blankets c) place the leg in a slightly dependent position and apply ice to the affected leg d) keep the leg horizontal and apply ice to the affected leg 13. A registered nurse (RN) is supervising a licensed practical nurse (LPN) administering an intramuscular (IM) injection of iron to an assigned client. The RN would intervene if the LPN is observed to perform which of the following? a) changing the needle after drawing up the dose and before injection b) preparing an air lock when drawing up the medication c) using a Z-track method for injection d) massaging the injection site after injection 14. A nursing student develops a plan of care for a client with paraplegia who has a risk for injury related to spasticity of the leg muscles. On reviewing the plan, the co-assigned nurse identifies which of the following as an incorrect

intervention. a) use of padded restraints to immobilize the limb b) performing range of motion to the affected limbs c) removing potentially harmful objects near the spastic limbs d) use of prescribed muscle relaxants as needed 15. A registered nurse (RN) is observing a licensed practical nurse (LPN) preparing a client for treatment with a continuous passive motion (CPM) machine. Which observation by the RN would indicate that the LPN is performing an incorrect action? a) places the client's knee in a slightly externally rotated position b) keeps the client's knee at the hinged joint of the machine c) assesses the client for pressure areas at the knee and the groin d) checks the degree of extension and flexion and the speed of the CPM machine per the physician's orders

NCLEX for RN - Leadership and Management: ANSWERS AND RATIONALE 11) D - It is important to encourage the client to cough and deep breathe when a chest tube drainage system is in place. This will assist in facilitating appropriate lung re-expansion. Water is added to the suction chamber as it evaporates to maintain the full suction level prescribed. Connections between the chest tube and the drainage system are taped to prevent accidental disconnection. The client is positioned in semi-Fowlers to facilitate ease in breathing. 12) A - Compartment syndrome is prevented by controlling edema. This is achieved most optimally with the use of elevation and application of ice. Options B, C, and D are incorrect. 13) D - The site should not be massaged after injection because massaging could cause staining of the skin. Proper technique for administering iron by the IM route includes changing the needle after drawing up the medication and before giving it. An air lock and Z-track technique both should be used. The medication should be given in the upper outer quadrant of the buttock, not in an exposed area such as the arms or thighs. 14) A - Range-of-motion exercises are beneficial in stretching muscles, which may diminish spasticity. Removing potentially harmful objects is a good safety measure. Use of muscle relaxants also is indicated if the spasms cause discomfort to the client or pose a risk to the clients safety. Use of limb restraints will not alleviate spasticity and could harm the client. 15) A - In the use of a CPM machine, the leg should be kept in a neutral position and not rotated either internally or externally. The knee should be positioned at the hinge joint of the machine. The nurse should monitor for pressure areas at the knee and the groin and should follow the physicians orders and institutional protocol regarding extension and flexion and speed of the CPM machine. 16. A client who is mouth breathing is receiving oxygen by face mask. The nursing assistant asks the registered nurse (RN) why a water bottle is attached to the oxygen tubing near the wall oxygen outlet. The RN responds that the primary purpose of this feature is to: a) prevent fluid loss from the lungs during mouth breathing b) give the client added fluid via the respiratory rate c) humidify the oxygen that is bypassing the client's nose d) prevent the client from getting nosebleed 17. A nurse and a nursing assistant are assisting the respiratory therapist to position a client for postural drainage. The nursing assistant asks the nurse how the respiratory therapists selects the position used for the procedure. The nurse responds that a position is chosen that will use gravity to help drain secretions from which of the following areas? a) trachea b) main bronchi c) lobes d) alveoli 18. A registered nurse (RN) is observing a licensed practical nurse (LPN) caring for a deceased client whose eyes will be donated. The RN intervenes if the LPN performs which action? a) elevates the head of the bed b) closes the client's eyes c) places wet saline gauze pads and ice pack on the eyes

d) closes the client's eyes and places a dry sterile dressing over the eyes 19. The nurse has recently been assigned to manage a pulmonary progressive unit at a large urban hospital. The nurse's leadership style is participative, with the belief that all staff members assist in decision making and the development of the unit's goals. The nurse is implementing which leadership style? a) democratic b) laissez faire c) auticratic d) situational 20. A physician has written an order for a vest restraint to be applied on a client from 10:00 pm to 7:00 am because the client becomes disoriented during the night and is at risk for falls. At 11:00 pm, the charge nurse makes rounds on all of the clients with the vest restraint, which observation by the charge nurse would indicate that the nurse who cared for this client performed an unsafe action in the use of the restraint? a) a safety knot was used to secure the restraint b) the client's record indicates that the restraint will be released every 2 hours c) the restraint was applied tightly d) the call light was placed within reach of the client

Nursing Questions about Leadership and Management: Answers and Rationale 16) C - The purpose of the water bottle is to humidify the oxygen that is bypassing the nose during mouth breathing. The humidified oxygen may help keep mucous membranes moist but will not substantially alter fluid balance (options A and B). A client who is breathing through the mouth is not at risk for nosebleeds. 17) C - Postural drainage uses specific client positions that vary depending on the affected lobe(s). The positions usually involve having the head lower than the affected lung segment(s) to facilitate drainage of secretions. Postural drainage often is done in conjunction with chest percussion for maximum effectiveness. The other options are incorrect. 18) C - When a corneal donor dies, the eyes are closed and gauze pads wet with saline are placed over them with a small ice pack. Within 2 to 4 hours, the eyes are enucleated. The cornea is usually transplanted with 24 to 48 hours. The head of the bed should also be elevated. Placing dry sterile dressings over the eyes serves no useful purpose. 19) A - Democratic leadership is defined as participative with a focus on the belief that all members of the group have input into the decision making process. This leader acts as a resource person and facilitator. Laissez faire leaders assume a passive approach, with the decision making left to the group. Autocratic leadership dominates the group, with maintenance of strong control over the group. Situational leadership is based on the current events of the day. 20) C - Restraints should never be applied tightly because that could impair circulation. The restraint should be applied securely (not tightly) to prevent the client from slipping through the restraint and endangering himself or herself. A safety knot should be used because it can easily be released in an emergency. Restraints, especially limb restraints, must be released every 2 hours (or per agency policy) to inspect the skin for abnormalities. The call light must always be within the clients reach in case the client needs assistance. 21. A nursing student prepares a postoperative plan of care for a client scheduled for hypophysectomy. The registered nurse reviews the plan and informs the nursing student that the plan needs to be corrected if which of the following was noted? a) obtain daily weights b) administer mouth care c) monitor intake and output d) encourage coughing and deep breathing 22. A nurse manager is reviewing with the nursing staff the purposes for applying wrist and ankle restraints (security devices) to a client. The nurse manager determines that further review is necessary when a nursing staff member states that an indication for the use of a restraint is to: a) limit movement of a limb b) keep the client in bed at night c) prevent the violent client from injuring self and others

d) prevent the client from pulling out intravenous lines and catheters 23. A hospitalized client with a diagnosis of anorexia nervosa and in a state of starvation is in two-bed hospital room. A newly admitted client will be assigned to this client's room. Which client would be inappropriate to assign to this two-bed room? a) a client with pneumonia b) a client who can perform self-care c) a client with a fractured leg that is casted d) a client who is scheduled for a diagnostic test 24. A multidisciplinary health care team is planning care for a client with hyperparathyroidism. The nurse identifies which client outcome to the health care team? a) describes how to take antacids b) restricts fluids to 1000 ml per day c) describes how to take antidiarrheal medications d) walks down the hall for 15 minutes, three times a day 25. A clinic nurse wants to develop a diabetic teaching program. In order to meet the client's needs, the nurse must first: a) assess the client's functional abilities b) ensure that insurance will pay for participation in the program c) discuss the focus of the program with the multidisciplinary team d) include everyone who comes into the clinic in the teaching sessions

Nursing Questions about Leadership and Management Answers and Rationale 21) D - Toothbrushing, sneezing, coughing, nose blowing, and bending are activities that should be avoided postoperatively in the client who underwent a hypophysectomy. These activities interfere with the healing of the incision and can disrupt the graft. Options A, B, and C are appropriate postoperative interventions. 22) B - Wrist and ankle restraints are devices used to limit the client's movement in situations when it is necessary to immobilize a limb. They are applied to prevent the client from injuring self or others; from pulling out intravenous lines, catheters, or tubes; or from removing dressings. Restraints also may be used to keep children still and from injuring themselves during treatments and diagnostic procedures. Restraints are not applied to keep a client in bed at night and should never be used as a form of punishment. 23) A - The client in a state of starvation has a compromised immune system. Having a roommate with pneumonia would place the client at risk for infection. Options B, C, and D are appropriate roommates. 24) D - Mobility of the client with hyperparathyroidism should be encouraged as much as possible because of the calcium imbalance that occurs in this disorder and the predisposition to the formation of renal calculi. Fluids should not be restricted. Options A and C are not specifically associated with this disorder. 25) A - Nurse-managed clinics focus on individualized disease prevention and health promotion and maintenance. Therefore the nurse must first assess the clients and their needs in order to effectively plan the program. Options B, C, and D do not address the clients' needs. 26. A nurse notes that a postoperative client has not been obtaining relief from pain with the prescribed opioid analgesics when a particular licensed practical nurse (LPN) is assigned to the client. The appropriate action for the nurse to take is to: a) reassign the LPN to the care of clients not receiving opioids b) notify the physician that the client needs an increase in opioid dosage c) review the client's medication administration record immediately and discuss the observations with the nursing supervisor d) confront the LPN with the information about the client having pain control problems and ask if the LPN is using the opioids personally 27. A medication nurse is supervising a newly hired licensed practical nurse (LPN) during the administration of oral

pyridostigmine bromide (Mestinon) to a client with myasthenia gravis. Which observation by the medication nurse would indicate safe practice by the LPN? a) asking the client to take sips of water b) asking the client to lie down on his right side c) asking the client to look up at the ceiling for 30 seconds d) instructing the client to void before taking the medication 28. During orientation, a graduate nurse learns that the nursing model of practice implemented in the facility is a primary nursing approach. When the nurse attends report on the medical unit, the nurse will verify with the staff which of the following characteristics of primary nursing? a) critical paths are used when providing client care b) the nurse manager assigns tasks to the staff members c) a registered nurse (RN) leads nursing staff in providing care to a group of clients d) a single RN is responsible for planning and providing individualized nursing care to clients 29. A clinical nurse manager conducts an inservice educational session for the staff nurses about case management. The clinical nurse manager determines that a review of the material needs to be done if a staff nurse stated that case management: a) manages client care by managing the client care environment b) maximizes hospital revenues while providing for optimal client care c) is designed to promote appropriate use of hospital personnel and material resources d) represents a primary health prevention focus managed by a single case manager 30. A nurse manager is reviewing the critical paths of the clients on the nursing unit. The nurse manager collaborates with each nurse assigned to the clients and performs a variance analysis. Which of the following would indicate the need for further action and analysis? a) a client is performing his own colostomy care b) purulent drainage is noted from a postoperative wound incision c) a 1-day postoperative client has a temperature of 98.8F d) a client newly diagnosed with diabetes mellitus is preparing his own insulin for injection

Nursing Questions about Leadership and Management Answers and Rationale 26) C - In this situation, the nurse has noted an unusual occurrence, but before deciding what action to take next, the nurse needs more data than just suspicion. This can be obtained by reviewing the client's record. State and federal labor and opioid regulations, as well as institutional policies and procedures, must be followed. It is therefore most appropriate that the nurse discuss the situation with the nursing supervisor before taking further action. The client does not need an increase in opioids. To reassign the LPN to clients not receiving opioids ignores the issue. A confrontation is not the most advisable action because it could result in an argumentative situation. 27) A - Myasthenia gravis can affect the client's ability to swallow. The primary assessment is to determine the client's ability to handle oral medications or any oral substance. Options B and C are not appropriate. Option B could result in aspiration and option C has no useful purpose. There is no specific reason for the client to void before taking this medication. 28) D - Primary nursing is concerned with keeping the nurse at the bedside actively involved in direct care while planning goaldirected, individualized client care. Option A identifies a component of case management. Option B identifies functional nursing. Option C identifies team nursing. 29) D - Case management represents an interdisciplinary health care delivery system to promote appropriate use of hospital personnel and material resources to maximize hospital revenues while providing for optimal client care. It manages client care by managing the client care environment. 30) C - Variances are actual deviations or detours from the critical paths. Variances can be either positive or negative, or avoidable or unavoidable and can be caused by a variety of things. Positive variance occurs when the client achieves maximum benefit and is discharged earlier than anticipated. Negative variance occurs when untoward events prevent a timely discharge. Variance analysis occurs continually in order to anticipate and recognize negative variance early so that appropriate action can be taken. Option B is the only option that identifies the need for further action.

31. Based upon a request made by the client's spouse and children, a physician asks a nurse to discontinue the feeding tube in a client who is in chronic debilitated and comatose state. The nurse understands the legal basis for carrying out the order and first checks the client's record for documentation of: a) a court approval to discontinue the treatment b) approval by the institutional Ethics Committee c) a written order by the physician to remove the tube d) authorization by the family to discontinue the treatment 32. A nurse plans to carry out a multidisciplinary research project on the effects of immobility on client's stress levels. Of the following statements, which principle is most important when planning this project? a) any client has the right to refuse to participate in research studies b) collaboration with other disciplines is essential to the successful practice of nursing c) the cooperation of the physicians on staff must be ensured in order for the project to succeed d) the corporate nurse executive should be consulted, because the project will take nursing time 33. A nurse manager has identified a problem on the nursing unit and holds unit meetings for all shifts. The nurse manager presents an analysis of the problem and proposals for actions to team members and invites the team members to comment and provide input. Which style of leadership is the nurse manager specifically employing? a) situational b) laissez-faire c) participative d) authoritarian 34. A charge nurse observes that a staff nurse is not able to meet client needs in a reasonable time frame, does not problem-solve situations, and does not prioritize nursing care. The charge nurse has the responsibility to: a) supervise the staff nurse more closely so that tasks are completed b) ask other staff members to help the staff nurse get the work done c) provide support and identify the underlying cause of the staff nurse's problem d) report the staff nurse to the supervisor so that something is done to resolve the problem 35. A registered nurse is preceptor for a new nursing graduate and is observing the new nursing graduate organize the client assignment and daily tasks. The registered nurse intervenes if the new nursing graduate does which of the following? a) provide time for unexpected tasks b) lists the supplies needed for a task c) prioritizes client needs and daily tasks d) plans to document task completion at the end of the day

Nursing Leadership NCLEX Questions Answers and Rationale 31) D - The family or a legal guardian can make treatment decisions for the client who is unable to do so. Once the decision is made, the physician writes the order. Generally, the family makes decisions in collaboration with physicians, other health care workers, and other trusted advisors. Although a written order by the physician is necessary, the nurse first checks for documentation of the family's request. Unless special circumstances exist, a court order is not necessary. Although some health care agencies may require reviewing such requests via the Ethics Committee, this is not the nurse's first action. 32) A - The proposed project is research and includes human subjects. Although options B, C, and D need to be considered, they are all secondary to the overriding principle of the legal and ethical practice of nursing that any client has the right to refuse to participate in research using human subjects. 33) C - Participative leadership demonstrates an "in-between" style, neither authoritarian nor democratic style. In participative leadership, the manager presents an analysis of problems and proposals for actions to team members, inviting critique and comments. The participative leader then analyzes the comments and makes the final decision. A laissez-faire leader abdicates leadership and responsibilities, allowing staff to work without assistance, direction, or supervision. The autocratic style of leadership is task oriented and directive. The situational leadership style utilizes a style depending on the situation and events. 34) C

Option C empowers the charge nurse to assist the staff nurse while trying to identify and reduce the behaviors that make it difficult for the staff nurse to function. Options A, B, and D are punitive actions, shift the burden to other workers, and do not solve the problem. 35) D - The nurse should document task completion continuously throughout the day. Options A, B, and C identify accurate components of time management. 36. A registered nurse is a preceptor for a new nursing graduate an is describing critical paths and variance analysis to the new nursing graduate. The registered nurse instructs the new nursing graduate that a variance analysis is performed on all clients: a) continuously b) daily during hospitalization c) every third day of hospitalization d) every other day of hospitalization 37. When a nurse manager makes a decisions regarding the management of the nursing unit without input from the staff, the type of leadership style that the nurse manager is demonstrating is: a) autocratic b) situational c) democratic d) laissez-faire 38. A charge nurse knows that drug and alcohol use by nurses is a reason for the increasing numbers of disciplinary cares by the Board of Nursing. The charge nurse understands that when dealing with a nurse with such an illness, it is most important to assess the impaired nurse to determine: a) the magnitude of drug diversion over time b) if falsification of clients records occurred c) the types of illegal activities related to the abuse d) the physiological impact of the illness on practice 39. A nurse manager is planning to implement a change in the method of the documentation system for the nursing unit. Many problems have occurred as a result of the present documentation system, and the nurse manager determines that a change is required. The initial step in the process of change for the nurse manager is which of the following? a) plan strategies to implement the change b) set goals and priorities regarding the change process c) identify the inefficiency that needs improvement or correction d) identify potential solutions and strategies for the change process 40. A nurse receives a telephone call from the emergency department and is told that a child with a diagnosis of tonicclonic seizures will be admitted to the pediatric unit. The nurse prepares for the admission of the child and instructs assistant to place which items at the bedside? a) a tracheostomy set and oxygen b) suction apparatus and an airway c) an endotracheal tube and an airway d) an emergency cart and laryngoscope

Nursing Leadership NCLEX Questions Answers and Rationale 36) A - Variance analysis occurs continually as the case manager and other caregivers monitor client outcomes against critical paths. The goal of critical paths is to anticipate and recognize negative variance early so that appropriate action can be taken. A negative variance occurs when untoward events preclude a timely discharge and the length of stay is longer than planned for a client on a specific critical path. Options B, C and D are incorrect. 37) A - The autocratic style of leadership is task oriented and directive. The leader uses his or her power and position in an authoritarian manner to set and implement organizational goals. Decisions are made without input from the staff. Democratic styles best empower staff toward excellence because this style of leadership allows nurses to provide input regarding the decision-making process and an opportunity to grow professionally. The situational leadership style utilizes

a style depending on the situation and events. The laissez-faire style allows staff to work without assistance, direction, or supervision. 38) D - A nurse must be able to function at a level that does not affect the ability to provide safe, quality care. The highest priority is to determine how the illness affects the nurse's ability to practice. The other options will be addressed if an investigation is carried out. 39) C - When beginning the change process, the nurse should identify and define the problem that needs improvement or correction. This important first step can prevent many future problems, because, if the problem is not correctly identified, a plan for change may be aimed at the wrong problem. This is followed by goal setting, prioritizing, and identifying potential solutions and strategies to implement the change. 40) B - Tonic-clonic seizures cause tightening of all body muscles followed by tremors. Obstructed airway and increased oral secretions are the major complications during and following a seizure. Suction is helpful to prevent choking and cyanosis. Options A and C are incorrect because inserting an endotracheal tube or a tracheostomy is not done. It is not necessary to have an emergency cart (which contains a laryngoscope) at the bedside, but a cart should be available in the treatment room or on the nursing unit. 41. When assessing the client with the vest restraint (security device) at the beginning of day shift, which observation by the charge nurse would indicate that the nurse who placed the vest restraint on the client failed to follow safety guidelines? a) a hitch was used to secure the restraint b) the call light was placed within reach of the client c) the restraint was applied tightly across the client's chest d) the client's record indicates that the restraint will be released every 2 hours 42. A male client who is admitted to the hospital for an unrelated medical problem is diagnosed with urethritis caused by chlamydial infection. The nursing assistant assigned to the client asks the nurse what measures are necessary to prevent contraction of the infection during care. The nurse tells the nursing assistant that: a) enteric precautions should be instituted for the client b) gloves and mask should be used when the in client's room c) contact isolation should be initiated, because the diseases is highly contagious d) standard precautions are sufficient, because the disease is transmitted sexually 43. A nursing assistant is caring for an older male client with cystits who has an indwelling urinary catheter. The registered nurse provides directions regarding urinary catheter care and ensures that the nursing assistant: a) loops the tubing under the client's leg b) places the tubing below the client's knee c) uses soap and water to cleanse the perineal area d) keeps the drainage bag above the level of the bladder 44. A nurse is planning care for a client with acute glomerulonephritis. The nurse instructs the nursing assistant to do which of the following in the care of the client? a) ambulate the client frequently b) monitor the temperature every 2 hours c) encourage a diet that is high in protein d) remove the water pitcher from the bedside 45. A nurse watches a second nurse perform hemodialysis on a client. The second nurse is drinking coffee and eating doughnut next to the hemodialysis machine while talking with the client about the client's week. The first nurse should: a) get a cup of coffee and join in on the conversation b) determine whether or not the client would like a cup of coffee c) admire the therapeutic relationship the second nurse has with the client d) ask the second nurse to refrain from eating and drinking in the client area

Nursing Leadership NCLEX Questions: Answers and Rationale 41) C

- A vest restraint should never be applied tightly because it could impair respirations. A hitch knot may be used on the client because it can easily be released in an emergency. The call light must always be within the client's reach in case the client needs assistance. The restraint needs to be released every 2 hours (or per agency policy) to provide movement. 42) D - Chlamydia is a sexually transmitted disease. Caregivers cannot acquire the disease during administration of care, and standard precautions are the only measure that needs to be used. 43) C - Proper care of an indwelling urinary catheter is especially important to prevent prolonged infection or reinfection in the client with cystitis. The perineal area is cleansed thoroughly using mild soap and water at least twice a day and following a bowel movement. The drainage bag is kept below the level of the bladder to prevent urine from being trapped in the bladder, and, for the same reason, the drainage tubing is not placed or looped under the client's leg. The tubing must drain freely at all times. 44) D - A client with acute glomerulonephritis commonly experiences fluid volume excess and fatigue. Interventions include fluid restriction as well as monitoring weight and intake and output. The client may be placed on bed rest or at least encouraged to rest, because a direct correlation exists between proteinuria, hematuria, edema, and increased activity levels. The diet is high in calories but low in protein. It is unnecessary to monitor the temperature as frequently as every 2 hours. 45) D - A potential complication of hemodialysis is the acquisition of dialysis-associated hepatitis B. This is a concern for clients (who may carry the virus), client families (at risk from contact with the client and with environmental surfaces), and staff (who may acquire the virus from contact with the client's blood). This risk is minimized by the use of standard precautions, appropriate handwashing and sterilization procedures, and the prohibition of eating, drinking, or other hand-to-mouth activity in the hemodialysis unit. The first nurse should ask the second nurse to stop eating and drinking in the client area. 46. A nurse is working in the emergency department of a small local hospital when a client with multiple gunshot wounds arrives by ambulance. Which of the following actions by the nurse is contraindicated in the handling legal evidence? a) initiate a chain of custody log b) give clothing and wallet to the family c) cut clothing along seams, avoiding bullet holes d) place personal belongings in a labeled, sealed paper bag 47. A registered nurse (RN) is orienting a nursing assistant to the clinical nursing unit. The RN would intervene if the nursing assistant did which of the following during a routine handwashing procedure? a) kept hands lower than elbows b) dried from forearm down to fingers c) washed continuously for 10 to 15 seconds d) used 3 to 5 ml of soap from the dispenser 48. A registered nurse (RN) on the night shift assists a staff member in completing an incident report for a client who was found sitting on the floor. Following completion of the report, the RN intervenes if the staff member prepares to: a) notify the nursing supervisor b) ask the secretary to telephone the physician c) document in the nurse's notes that an incident report was filed d) forward incident report to the Continuous Quality Improvement Department 49. A physician visiting a client on the nursing unit is paged and notified that the monthly physician's breakfast meeting is about to start. The physician states to the nurse : "I'm in a hurry. Can you write an order t decrease the atenolol (Tenormin) to 25mg daily?" Which of the following is the appropriate nursing action? a) write the order b) call the nursing supervisor to write the order c) inform the client of the change of medication d) ask the physician to return to the nursing unit to write the order 50. A registered nurse suspects that a colleague is substance impaired and notes signs of alcohol intoxication in the colleague. The Nurse Practice Act requires the registered nurse do which of the following? a) talk with the colleague b) call the impaired nurse organization c) report the information to a nursing supervisor d) ask the colleague to go to the nurse's lounge to sleep for a while

Nursing Leadership Programs Answers and Rationale 46) D - Basic rules for handling evidence include limiting the number of people with access to the evidence, initiating a chain of custody log to track handling and movement of evidence, and carefully removing of clothing to avoid destroying evidence. This usually includes cutting clothes along seams, while avoiding areas where there are obvious holes or tears. Potential evidence is never released to the family to take home. 47) B - Proper handwashing procedure involves wetting the hands and wrists and keeping the hands lower than the forearms so that water flows toward the fingertips. The nurse uses 3 to 5 mL of soap and scrubs for 10 to 15 seconds, using rubbing and circular motions. The hands are rinsed and then dried, moving from the fingers to the forearms. The paper towel is then discarded, and a second one is used to turn off the faucet to avoid hand contamination. 48) C - Nurses are advised not to document the filing of an incident report in the nurses' notes for legal reasons. Incident reports inform the facility's administration of the incident so that risk management personnel can consider changes that might prevent similar occurrences in the future. Incident reports also alert the facility's insurance company to a potential claim and the need for further investigation. Options A, B, and D are accurate interventions. 49) D - Nurses are encouraged not to accept verbal orders from the physician because of the risks of error. The only exception to this may be in an emergency situation, and then the nurse must follow agency policy and procedure. Although the client will be informed of the change in the treatment plan, this is not the appropriate action at this time. The physician needs to write the new order. It is inappropriate to ask another individual other than the physician to write the order. 50) C - Nurse Practice Acts require reporting the suspicion of impaired nurses. The Board of Nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision. This suspicion needs to be reported to the nursing supervisor, who will then report to the Board of Nursing. Confronting the colleague may cause conflict. Asking the colleague to go to the nurses' lounge to sleep for awhile does not safeguard clients. 51. A cooling blanket is prescribed for a child with a fever. A nurse caring for the child has never used this type of equipment, and the charge nurse provides instructions and observes the nurse using the cooling blanket. The charge nurse intervenes if the nurse: a) keeps the child uncovered to assist in reducing the fever b) places the cooling blanket on the bed and covers the blanket with a sheet c) keeps the child dry while on the cooling blanket to reduce the risk of frostbite d) checks the skin condition of the child before, during, and after the use of the cooling blanket 52. A nursing instructor asks a nursing student to identify situations that indicate a secondary level of prevention in health care. Which situation, if identified by the student, would indicate the need for further study of the levels of prevention? a) teaching s stroke client how to use a walker b) screening for hypertension in a community group c) screening for hyperlipidemia in a community group d) encouraging a woman who is more than 40 years old to obtain periodic mammograms 53. A charge nurse is supervising a new registered nurse (RN) who is providing care to a client with end-stage heart failure. The client is withdrawn and reluctant to talk, and she shows little interest in participating in hygienic care or activities. Which statement, if made by the new RN to the client, indicates that the new RN requires further teaching regarding the use of therapeutic communication techniques? a) what are your feelings right now? b) why don't you feel like getting up for your bath? c) these dreams you mentioned, what are they like? d) many clients with end-stage heart failure fear death 54. A nurse is observing a nursing assistant talking to a client who is hearing impaired. The nurse would intervene if which of the following is performed by the nursing assistant during communication with the client? a) the nursing assistant is speaking in a normal tone

b) the nursing assistant is speaking clearly to the client c) the nursing assistant is facing the client when speaking d) the nursing assistant is speaking directly into the impaired ear 55. A charge nurse reviews the plan of care formulated by a new nursing graduate for a child returning from the operating room after a tonsillectomy. The charge nurse assists the new nursing graduate with changing the plan if which incorrect intervention is documented? a) suction whenever necessary b) offer clear, cool liquids when awake c) monitor for bleeding from the surgical site d) eliminate milk or milk products from the diet

Leadership NCLEX Questions Answers and Rationale 51) A - While on a cooling blanket, the child should be covered lightly to maintain privacy and reduce shivering. Options B, C, and D are important interventions to prevent shivering, frostbite, and skin breakdown. 52) A - Secondary prevention focuses on the early diagnosis and prompt treatment of disease. Tertiary prevention is represented by rehabilitation services. Options B, C, and D identify screening procedures. Option A identifies a rehabilitative service. 53) B - When the nurse asks a "why" question of the client, the nurse is requesting an explanation for feelings and behaviors when the client may not know the reason. Requesting an explanation is a nontherapeutic communication technique. In option A, the nurse is encouraging the verbalization of emotions or feelings, which is a therapeutic communication technique. In option C, the nurse is using the therapeutic communication technique of exploring, which involves asking the client to describe something in more detail or to discuss it more fully. In option D, the nurse is using the therapeutic communication technique of giving information. Identifying the common fear of death among clients with end-stage heart failure may encourage the client to voice concerns. 54) D - When communicating with a hearing-impaired client, the nurse should speak in a normal tone to the client and should not shout. The nurse should talk directly to the client while facing the client, and he or she should speak clearly. If the client does not seem to understand what is being said, the nurse should express the statement differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse needs to avoid talking directly into the impaired ear. 55) A - After tonsillectomy, suction equipment should be available, but suctioning is not performed unless there is an airway obstruction. Clear, cool liquids are encouraged. Milk and milk products are avoided initially because they coat the throat; this causes the child to clear the throat, thereby increasing the risk of bleeding. Option C is an important intervention after any type of surgery. 1. A registered nurse is planning for the client assignment for the day. Which of the following is the most appropriate assignment for a nursing assistant? A. a client requires tap water enemas B. a client requiring colostomy irrigation C. a client requiring continuous tube feeding D. a client with difficulty swallowing food and fluid 2. A registered nurse employed in long-term care facility is planning assignments for the clients on a nursing unit. The RN needs to assign four clients and has a licensed practical (vocational) nurse and three nursing assistants on a nursing team. Which of the following clients would the nurse most appropriately assign to LPN A. a client who requires a 24-hour urine collection B. an elderly client requiring assistance with bed bad and frequent ambulation C. a client who requires a fleet and an oil retention enema

D. a client with an abdominal wound that requires irrigation and dressing changes every 3 hours 3. A registered nurse has received the assignment for the day shift. After making initial rounds and checking all the assigned clients, which will the RN plan to care for first? A. a client who is ambulatory B. a client who has fever and who is diaphoretic and restless C. a client scheduled for physical therapy at 1:00 pm D. a post-operative client who has received pain medications 4. A nurse is assigned to care for four clients. In planning client rounds, which client would the nurse assess first? A. a client receiving oxygen via nasal cannula who had difficulty breathing the previous shift B. a post-operative client for discharge C. a client scheduled for x-ray D. a client requiring daily dressing changes

ANSWERS AND RATIONALE 1) A - The nursing assistant can perform enema. Option B, C, and D will be done by the LVN/LPN 2) D - the LVN can perform more complicated procedures like wound care. Option A, B, and C tasks done by nursing assistants 3) B - patients with unstable condition should be given highest priority by the nurse. The client who has fever, and who is diaphoretic and restless is with unstable condition 4) A - the client with problem with airways and whose condition is unstable should be given first priority by the nurse. "ABC" is a priority.

1. Theory X and theory Y was proposed by A. William Ouchi B. Frederick Taylor C. Mary Follett D. Douglas McGregor Answer Key 2. The famous 14 Principles of Management was first defined by A. Elton Mayo B. Henri Fayol C. Adam Smith D. James Watt Answer Key 3. "Management by objective works - if you know the objectives. Ninety percent of the time you don't. " This was stated by A. Peter Drucker B. Frederick Taylor C. Henri Fayol D. Henry L. Gantt Answer Key 4. Scientific Management Theory was developed by A. Max Weber B. Frederick Taylor C. Adam Smith D. Rensis Likert Answer Key 5. Which management theory states " when managers make a decision, they must take into account all aspects of the current situation and act on those aspects that are key to the situation at hand"? A. Systems theory B. Chaos Theory C. Contingency Theory D. Bureaucratic Management Theory

Answer Key 6. Motivation-Hygiene theory (two-factor theory) of management was proposed by A. Elton Mayo B. W. Edwards Deming C. Kurt Lewin D. Frederick Herzberg Answer Key 7. Which of the following concept is NOT related to Frederick Taylor's theory of modern management A. Management is a true science. B. The selection of workers is a science. C. Workers are to be developed and trained. D. Scientific management is a collaboration of workers and managers. E. The average human being prefers to be directed, wishes to avoid responsibility, has relatively little ambition, wants security above all. Answer Key 8. The famous Hawthorne experiments were conducted by A. Elton Mayo B. Max Weber C. Henry Ford D. F.W Taylor Answer Key 9. Which type of leadership theories consider people inherit certain qualities that make them better suited to leadership? A. Contingency Theories B. Behavioral theories C. Trait Theories D. Situational theories E. "Great Man" Theories Answer Key 10. Which of the following characteristics is NOT related to Laissez-faire leadership? A. Very little guidance from leaders B. Complete freedom for followers to make decisions C. Leaders provide the tools and resources needed D. There is little time for group decision-making E. Group members are expected to solve problems on their own
1. D 6. D 2. B 7. E 3. A 8. A 4. B 9. C 5. C 10. D

1. Hygiene factors and motivational factors are key concepts in A. Maslows hierarchy of needs B. Expectancy Theory C. Goal Setting Theory D. Herzbergs two factor theory Answer Key 2. Bhore Committee is also known as A. Health Survey and Development Committee B. Health Survey and Planning Committee C. Hospital review committee D. Mudaliar Committee Answer Key

3. Which of the following is an Indian Health Care Accrediting Agency? A. Joint Commission International (JCI) B. Joint Commission On Accreditation Of Healthcare (JCAHO) C. National Accreditation Board for Hospitals & Healthcare Providers (NABH) D. QHA Trent Accreditation E. International Society for Quality in Healthcare (ISQua) Answer Key 4. The basis of ABC analysis in inventory control is A. Annual consumption value B. Criticality of items C. Unit cost of item D. Procurement difficulty, market availability Answer Key 5. Which of the following is method of inventory control in which the items are classified on the basis of rate/speed of consumption? A. ABC analysis B. VED analysis C. HML analysis D. FSN analysis Answer Key 6. In material management, the period in days that elapses between placing an order and receiving the stores is termed as A. Lead time B. Economic Order Quantity C. Quantity survey D. Reorder time Answer Key 7. Theory of bureaucracy in management was proposed by A. Henry Gantt B. Max Weber C. Henry Fayol D. Peter Ducker Answer Key 8. W. Edward Deming is known for his contribution in modern management for

introducing A. Application of psychology in advertisement and marketing B. Time and motion studies C. Quality control D. PERT Technique Answer Key 9. A broad statement by which the organization specifies how it will achieve its goals is A. Vision Statement B. Mission Statement C. Policy statement D. Protocol Answer Key 10. Management by objectives (MBO) as an organization tool was first explained by A. Robert Owen B. Hugo Munsterberg C. Henry Towne D. Peter F. Ducker Answer Key
ANSWER KEY 1. D 6. A 2. B 7. B 3 .C 8. C 4. A 9. B 5. D 10. D

Question 1 WRONG Which of the following describes an inductive form of reasoning? Separation anxiety is common in children. Children whose parents are not in the hospital room will manifest anxious behavior. Most patients are irritable. Unpredictable moods and irritability behaviors of patients are caused by their underlying illnesses that alter their activities of daily living. Mild anxiety sharpens ones perception and cognitive function. Most students who take examination with mild anxiety have high scores. All of the above Question 1 Explanation: Keyword: INDUCTIVE FORM Rationale: inductive reasoning moves from specific observations to broader generalizations and theories. A) Separation anxiety is common in children (generalization/theory). Children whose parents are not in the hospital room manifest anxious behavior (specific observation). = deductive

reasoning B) Most patients are irritable (specific observation). Unpredictable moods and irritability behaviors of patients are caused by their underlying illnesses that alter their activities of daily living (generalization/theory). = inductive reasoning C) Mild anxiety sharpens ones perception and cognitive function (generalization/theory). Most students who take examination with mild anxiety have high scores (specific observation). = deductive reasoning Question 2 WRONG Which paradigm of nursing research responds to the human inquiry How should the inquirer obtain knowledge? Ontologic Epistemologic Axiologic Methodologic Question 2 Explanation: Keyword: OBTAIN KNOWLEDGE Rationale: Paradigm is a general perspective on the complexities of the real world. Paradigms for human inquiry are often characterized in terms of the ways in which they respond to basic philosophical questions: Ontologic: What is the nature of reality? Epistemologic: What is the relationship between the inquirer and that being studied? Axiologic: What is the role of values in the inquiry? Methodologic: How should the inquirer obtain knowledge? (Source: Nursing Research: Principles and Methods by Polit and Beck) Question 3 CORRECT The following are characteristics of a clinical nursing problem apart from: It reflects something that could be improved in clinical practice It has a potential to change how nursing care is delivered in the unit It is value-laden and involves feelings and perceptions It is a problem that occurs frequently in a particular group Question 3 Explanation: Keyword: EXCEPT Rationale: Characteristics of a research problem general applicability and use Researchable Feasible and measurable Factors of a feasible research : time, money, experience of the researcher, instruments, population importance to nursing profession novelty/originality (Plagiarism/illegal replication unauthorized use of anothers literary work without any consent or permission) significance to nursing Question 4 CORRECT The head nurse in the unit is consistent in her decisions and compels the group to follow her. She performs decision making without asking or getting any inputs from her members. Which type of leadership is the head nurse following? Laissez-faire Democratic Autocratic Ultra-liberal Question 4 Explanation:

Keyword: CONSISTENT, COMPELS, PERFORMS DECISION MAKING WITHOUT ASKING Rationale: Autocratic/Authoritarian/dictatorial/hard leader - unilateral style of leadership. Only the leader here performs the decision making without getting the inputs from his members. One sided style of leadership Behavior : A apathy insensitive to others B Boisterous speech C consistency D Dominating E Exploitative behavior F ferocious behavior, to coerce or compel the group to follow him Question 5 CORRECT Which of the following leadership is best used during an emergency or intensive crisis? Laissez-faire Democratic Autocratic Ultra-liberal Question 5 Explanation: Keyword: BEST DURING EMERGENCY OR INTESIVE CRISIS Rationale: Autocratic style is leadership is best style during emergency or intensive crisis. Question 6 WRONG The charisma and charm of a leader is referred to as which power of a leader? Expert power Referent power Exclusive power Reward power Question 6 Explanation: Keyword: CHARISMA AND CHARM Rationale: 5 Powers of a Good Leader Legitimate/ Formal/ exclusive Power o Exercise because you are appointed to a higher position Expert Power o You acquire ext ra ordinary skills, talent or ability Referent Power o Charisma and charm Reward Power o + power for the part of the leader o gives rewards, bonus, promotion, compensation Coercive Power o power on the part of the leader o reprimand, suspend, terminate Question 7 WRONG No deposit policy during emergency cases only is stated in which law? RA 7305 RA 7160 PD 825 RA 8344 Question 7 Explanation: Keyword: NO DEPOSIT POLICY Rationale:a. RA 7305 magna carta law b. RA 7160 local government code c. PD 825 environmental sanitation law of the Phils d. RA 8344 - No deposit policy during emergency cases only Question 8 CORRECT Attributes of a good leader involves which of the following? Holds his member accountable for their wrongdoing and

negligence Aware of the members strengths and weaknesses Confident in his leadership skills All of these Question 8 Explanation: Keyword: INVOLVES Rationale: attributes of a good leader 1. Self awareness 2. Self confidence 3. Advocacy 4. Accountability Question 9 WRONG A variable that comes between dependent and independent variable is called: Extraneous variable Polychomotous variable Dichomotous variable Intervening variable Question 9 Explanation: Keyword: COMES BETWEEN Rationale: Kinds of variable Independent variable - use this to stimulate a target population Dependent variable/Effectual variable - results of the effects of the study Intervening Variable - Comes between dependent and independent o Example: orghanism variable, internal factor, sex, gender, color Extraneous Variable - External infuences that can be changed o Example: citizenship, educational status Dichotomous Variable - 2 choices/ 2 results o Example: Male/ Female Polychotomous Variable - Multiple choices o Example: Preferred foods Chinese, Japanese, American. . . . . Question 10 CORRECT To be a good manager, there should be a good interpersonal relationship between the leader and follower. This leadership theory is called: Scientific Management theory Motivational Theory Human Relations Theory Bureaucratic Theory Question 10 Explanation: Keyword: GOOD INTERPERSONAL RELATIONSHIP Rationale: Human Relations theory to be a good manager, there should be a good interpersonal relationship between the leader and follower Douglas Mc Gregors Motivational theory Theory X o Negative workers o negligence, inefficient, ineffective workers Theory Y o Positive workers o diligent, effective, efficient worker theory X should be given focus because they are prone to negligence and malpractice.Max Webers Bureaucratic/ authoritarian Theory whoever is on the top would perform the management function centralized Frederick Taylors Scientific Management Theory Elements o choosing the appropriate person (TAO) o choosing the appropriate team o choosing the appropriate training o choosing the appropriate tools Question 11 CORRECT The leadership is exercised because of the appointment to a higher position is referred to as: Expert power Referent power Exclusive power

Reward power Question 11 Explanation: Keyword: APPOINTMENT Rationale: Legitimate/ Formal/ exclusive Power o Exercise because you are appointed to a higher position Question 12 WRONG Which of the following characteristics do not describe a scientific investigation? They are conducted to test or develop theories and study advance knowledge Empirical data are not necessarily gathered through human sense but must be based on theories It is planned and conducted in a systematic and orderly manner External factors which may influence the relationship among phenomena is controlled Question 12 Explanation: Keyword: DO NOT Rationale: Characteristics of a Good Research Systematic - conduct research in a step by step process or procedure Empirical - objective data should be observable/measurable or readily collected using your senses Controlled/ manipulated - Methods/tool of controlling is research design Critical investigation/fact finding investigation - In order to answer the data is by using facts. Looking for human beings who can give us facts Question 13 WRONG Sources of a research problem could either be the following except: Concepts Issues Theories Research Question 13 Explanation: Keyword: EXCEPT Rationale: Sources of a research problem are the following: (C-L-I-E-N-T) C Concepts L Literature, essays, books, journals I Issues E Experiences N Nursing problems T Theories Question 14 WRONG The loose style of nursing leadership is: Laissez-faire Democratic Autocratic None of these Question 14 Explanation: Keyword: LOOSE Rationale: Permissive, ultra-liberal, laissez faire, free-rein o Loose style of nursing leadership. o Giving excess freedom or liberality towards your subordinates if to lenient in your subordinates, there will be control and power = negligence Question 15

WRONG Which of the following characteristics do not describe a research problem? Used unauthorized from anothers literary work The topic itself is researchable Generally applicable for use in practice None of these Question 15 Explanation: Keyword: DO NOT Rationale: Characteristics of a research problem general applicability and use Researchable Feasible and measurable Factors of a feasible research : time, money, experience of the researcher, instruments, population importance to nursing profession novelty/originality (Plagiarism/illegal replication unauthorized use of anothers literary work without any consent or permission) significance to nursing Question 16 WRONG Research designed to generate knowledge to guide nursing practice and to improve the health and quality of life of nurses clients is termed as: Nursing Research Clinical Nursing Research Research Ethics Question 16 Explanation: Keyword: GUIDE NURSING PRACTICE Rationale: Clinical Nursing Research is a research designed to generate knowledge to guide nursing practice and to improve the health and quality of life of nurses clients. A) Nursing research is a systematic inquiry designed to develop knowledge about issues of importance to the nursing profession, including nursing practice, education, administration and informatics. B) Correct answer C) Research is a systematic inquiry that uses disciplined methods to answer questions or solve problems. (Source: Nursing Research: Principles and Methods by Denise Polit and Cheryl Beck) Question 17 WRONG Telling the truth is the practice of which ethical principle? Non-maleficence Veracity Beneficence Justice Question 17 Explanation: Keyword: TELLING THE TRUTH Rationale: Ethical Principles o Principle of Autonomy independent judgment or decision making in all situation the pt himself is the one who should decide for his own care Consent respect the decision of the pt explain the risk to the patient/SO waiver - a legal doc when the pt refuse for treatment. o Principle of Veracity telling the truth to the patient #1 the patient has the right to know from the PHYSICIAN (not the nurse) o Principle of Double Effects if the pt is made to choose between 2 equal danger and he only needs to choose one, choose the one that will produce one good effect and less evil effect. o Principle of Beneficence doing good to the patient (eg. providing therapeutic communication, providing privacy) o Principle of Non-Maleficence do no harm 3 types of Harm Physical negligence by commission Mental assault and battery Moral slander and libel o Principle of Justice Prioritize the needs of the patient. To be able to provide nursing care to the patient, provide the nursing process. Nursing Process characteristics : A acceptable universally B - based patients assessment needs C client focused

D dynamics base on the ever changing needs of the pt E equitable care F familiarity/rapport to the patient G goal directed towards solving the assess needs of the patient (SMART) o Principle of Respect/Inviolability of life Suicide and abortion is violation of this principle Question 18 CORRECT Which theory of nursing leadership states that a leader becomes the head because of his charm? Great-Man theory Situational theory Charismatic theory Trait theory Question 18 Explanation: Keyword: CHARM Rationale: Theories of Nursing Leadership Great -Man theory born as a leader Trait theory develop characteristics or born with the characteristics o 3 traits of a leader P personality (adaptability, independence, creative/assertive, advocate) ability to adjust to the need of the pt I intelligence (proper judgment, proper decision making, proper communication) A ability (influence others, respect others, participate and cooperate) Proper way to influence is thru health teaching Charismatic theory becomes a leader because of the charm Situational theory/case to case basis o a person can be a leader in one situation but only a follower in another situation. (eg. becomes a leader in where he specializes) Question 19 CORRECT Which of the following elements is not included in Frederick Taylors scientific management theory? Appropriate person Appropriate team Appropriate goals Appropriate tools Question 19 Explanation: Keyword: NOT INCLUDED Rationale: Frederick Taylors Scientific Management Theory Elements o choosing the appropriate person (TAO) o choosing the appropriate team o choosing the appropriate training o choosing the appropriate tools Question 20 WRONG Principles of effective leadership least likely involves: One group commanded by one leader One group should always have an objective Patient first policy is applied Accountability is delegated to the members of the team Question 20 Explanation: Keyword: LEAST LIKELY Rationale: Responsibility can be delegated by a team leader but not the accountability. Command responsibility or Respondent Superior states the master or the superior answers for the negligence of his subordinates in half of his patient who suffer from injury or death. Question 21 WRONG

Which paradigm of nursing research responds to the human inquiry What is the relationship between the inquirer and that being studied? Ontologic Epistemologic Axiologic Methodologic Question 21 Explanation: Keyword: RELATIONSHIP Rationale: Paradigm is a general perspective on the complexities of the real world. Paradigms for human inquiry are often characterized in terms of the ways in which they respond to basic philosophical questions: Ontologic: What is the nature of reality? Epistemologic: What is the relationship between the inquirer and that being studied? Axiologic: What is the role of values in the inquiry? Methodologic: How should the inquirer obtain knowledge? (Source: Nursing Research: Principles and Methods by Polit and Beck) Question 22 WRONG Quantitative research uses which type of reasoning to generate hunches that are tested in the real world? Deductive reasoning Inductive reasoning Informal logic All of the above Question 22 Explanation: Keyword: GENERATE HUNCHES; TESTED IN THE REAL WORLD Rationale: Deductive reasoning works from a generalization or theory to a specific observation (tested in the real world). Quantitative research uses deductive reasoning to generate hunches that are tested in the real world. Question 23 WRONG The statement of the future purpose of the future organization that is involved in the planning stage of the management process is called: Mission Vision Goal Philosophy Question 23 Explanation: Keyword: STATEMENT OF THE FUTURE PURPOSE Rationale: Mission present reason when established your organization Vision - statement of your future purpose of your future organization Philosophy set of values and beliefs of your organization Goal general statement of your purpose Objectives more specific statement of your purpose Question 24 WRONG This theory states that a person becomes a leader because he is born to be one: Great-Man theory Situational theory Charismatic theory

Trait theory Question 24 Explanation: Keyword: BORN TO BE A LEADER Rationale: Theories of Nursing Leadership Gr eat-Man theory born as a leader Trait theory develop characteristics or born with the characteristics o 3 traits of a leader P personality (adaptability, independence, creative/assertive, advocate) ability to adjust to the need of the pt I intelligence (proper judgment, proper decision making, proper communication) A ability (influence others, respect others, participate and cooperate) Proper way to influence is thru health teaching Charismatic theory becomes a leader because of the charm Situational theory/case to case basis o a person can be a leader in one situation but only a follower in another situation. (eg. becomes a leader in where he specializes) Question 25 WRONG Which of the following leadership styles will be having more risk of negligence of the members? Laissez-faire Democratic Autocratic None of these Question 25 Explanation: Keyword: MORE RISK OF NEGLIGENCE Rationale: Giving excess freedom or liberality towards your subordinates if to lenient in your subord inates, there will be control and power = negligence
Situation 11 Management of nurse practitioners is done by qualified nursing leaders who had clinical experience and management experience. 51. An example of a management function of a nurse is: A. Teaching patient do breathing and coughing exercises B. Preparing for a surprise party for a client C. Performing nursing procedures for clients D. Directing and evaluating the staff nurses 52. Your head nurse in the unit believes that the staff nurses are not capable of decision making so she makes the decisions for everyone without consulting anybody. This type of leadership is: A. Laissez faire leadership B. Democratic leadership C. Autocratic leadership D. Managerial leadership 53. When the head nurse in your ward plots and approves your work schedules and directs your work, she is demonstrating: A. Responsibility B. Delegation C. Accountability D. Authority 54. The following tasks can be safely delegated by a nurse to a non-nurse health worker EXCEPT: A. Transfer a client from bed to chair B. Change IV infusions C. Irrigation of a nasogastric tube D. Take vital signs 55. You made a mistake in giving the medicine to the wrong client. You notify the clients doctor and write an incident report. You are demonstrating: A. Responsibility B. Accountability C. Authority D. Autocracy

Situation 12 Mr. Dizon, 84 years old, brought to the Emergency Room for complaint of hypertension, flushed face, severe headache, and nausea. You are doing the initial assessment of vital signs.

56. You are to measure the clients initial blood pressure reading by doing all of the following EXCEPT: A. Take the blood pressure reading on both arms for comparison B. Listen to and identify the phases of Korotkoffs sound C. Pump the cuff to around 50 mmHg above the point where the pulse is obliterated D. Observe procedures for infection control 57. A pulse oximeter is attached to Mr. Dizons finger to: A. Determine if the clients hemoglobin level is low and if he needs blood transfusion B. Check level of clients tissue perfusion C. Measure the efficacy of the clients anti-hypertensive medications D. Detect oxygen saturation of arterial blood before symptoms of hypoxemia develops 58. After a few hours in the Emergency Room, Mr. Dizon is admitted to the ward with an order of hourly monitoring of blood pressure. The nurse finds that the cuff is too narrow and this will cause the blood pressure reading to be: A. inconsistent B. low systolic and high diastolic C. higher than what the reading should be D. lower than what the reading should be 59. Through the clients health history, you gather that Mr. Dizon smokes and drinks coffee. When taking the blood pressure of a client who recently smoked or drank coffee, how long should the nurse wait before taking the clients blood pressure for accurate reading? A. 15 minutes B. 30 minutes C. 1 hour D. 5 minutes 60. While the client has pulse oximeter on his fingertip, you notice that the sunlight is shining on the area where the oximeter is. Your action will be to: A. Set and turn on the alarm of the oximeter B. Do nothing since there is no identified problem C. Cover the fingertip sensor with a towel or bedsheet D. Change the location of the sensor every four hours Situation 13 The nurses understanding of ethico-legal responsibilities will guide his/her nursing practice. 61. The principles that govern right and proper conduct of a person regarding life, biology and the health professionals is referred to as: A. Morality B. Religion C. Values D. Bioethics 62. The purpose of having a nurses code of ethics is: A. Delineate the scope and areas of nursing practice B. Identify nursing action recommended for specific health care situations C. To help the public understand professional conduct expected of nurses D. To define the roles and functions of the health care givers, nurses, clients 63. The most important nursing responsibility where ethical situations emerge in patient care is to: A. Act only when advised that the action is ethically sound B. Not takes sides, remain neutral and fair C. Assume that ethical questions are the responsibility of the health team D. Be accountable for his or her own actions 64. You inform the patient about his rights which include the following EXCEPT: A. Right to expect reasonable continuity of care

B. Right to consent to or decline to participate in research studies or experiments C. Right to obtain information about another patient D. Right to expect that the records about his care will be treated as confidential 65. This principle states that a person has unconditional worth and has the capacity to determine his own destiny: A. Bioethics B. Justice C. Fidelity D. Autonomy Situation 14 Your director of nursing wants to improve the quality of health care offered in the hospital. As a staff nurse in that hospital you know that this entails quality assurance programs. 66. The following mechanisms can be utilized as part of the quality assurance program of your hospital EXCEPT: A. Patient satisfaction surveys B. Peer review to assess care provided C. Review of clinical records of care of client D. Use of Nursing Interventions Classification 67. The use of the Standards of Nursing Practice is important in the hospital. Which of the following statements best describes what it is? A. These are statements that describe the maximum or highest level of acceptable performance in nursing practice B. It refers to the scope of nursing practice as defined in Republic Act 9173 C. It is a license issued by the Professional Regulation Commission to protect the public from substandard nursing practice D. The Standards of Care includes the various steps of the nursing process and the standards of professional performance 68. you are taking care of critically ill client and the doctor in charge calls to order a DNR (do not resuscitate) for the client. Which of the following is the appropriate action when getting DNR order over the phone? A. Have the registered nurse, family spokesperson, nurse supervisor and doctor sign B. Have 2 nurse validate the phone order, both nurses sign the order and the doctor should sign his order within 24 hours C. Have the registered nurse, family and doctor sign the order D. Have 1 nurse take the order and sign it and have the doctor sign it within 24 hours 69. To ensure client safety before starting blood transfusions the following are needed before the procedure can be done EXCEPT: A. take baseline vital signs B. blood should be warmed to room temperature for 30 minutes before blood transfusions is administered C. have two nurses verify client identification, blood type, unit number and expiration date of blood D. get consent signed for blood transfusion 70. Part of standards of care has to do with the use of restraints. Which of the following statements is NOT true? A. Doctors order for restraints should be signed within 24 hours B. Remove and reapply restraints every 2 hours C. Check clients pulse, blood pressure and circulation every 4 hours D. Offer food and toileting every 2 hours Situation 15 During the NUTRITION EDUCATION class discussion a 58 year old man, Mr. Bruno, shows increased interest. 71. Mr. Bruno asks what the normal allowable salt intake is. Your best response to Mr. Bruno is: A. 1 tsp of salt/day with iodine and sprinkle of MSG B. 5 gms per day or 1 tsp of table salt/day C. 1 tbsp of salt/day with some patis and toyo D. 1 tsp of salt/day but no patis and toyo

72. Your instructions to reduce or limit salt intake include all the following EXCEPT: A. eat natural food with little or no salt added B. limit use of table salt and use condiments instead C. use herbs and spices D. limit intake of preserved or processed food 73. Teaching strategies and approaches when giving nutrition education is influenced by age, sex and immediate concerns of the group. Your presentation for a group of young mothers would be best if you focus on: A. diets limited in salt and fat B. harmful effects of drugs and alcohol intake C. commercial preparation of dishes D. cooking demonstration and meal planning 74. Cancer cure is dependent on A. use of alternative methods of healing B. watching out for warning signs of cancer C. proficiency in doing breast self-examination D. early detection and prompt treatment 75. The role of the health worker in health education is to A. report incidence of non-communicable diseases to community health center B. educate as many people about warning signs of non-communicable diseases C. focus on smoking cessation projects D. monitor clients with hypertension Situation 16 You are assigned to take care of 10 patients during the morning shift. The endorsement includes the IV infusion and medications for these clients. 76. Mr. Felipe, 36 years old is to be given 2700 ml of D5LR to infuse for 18 hours starting at 8 am. At what rate should the IV fluid be flowing hourly? A. 100 ml per hour B. 210 ml per hour C. 150 ml per hour D. 190 ml per hour 77. Mr. Atienza is to receive 150 ml/hour of D% W IV infusion for 12 hours for a total of 1800ml. He is also losing gastric fluid which must be replaced every two hours. Between 8 am and 10 am, Mr. Atienza has lost 250 ml of gastric fluid. How much fluid should he receive at 11 am? A. 350 ml/hour B. 275 ml/hour C. 400 ml/hour D. 200 ml/hour 78. You are to apply a transdermal patch of nitoglycerin to your client. The following are important guidelines to observe EXCEPT: A. Apply to hairless clean area of the skin not subject to much wrinkling B. Patches may be applied to distal part of the extremities like forearm C. Change application and site regularly to prevent irritation of the skin D. Wear gloves to avoid any medication on your hand 79. You will be applying eye drops to Miss Romualdez. After checking all the necessary information and cleaning the affected eyelid and eyelashes, you administer the ophthalmic drops by instilling the eye drops: A. directly onto the cornea B. pressing the lacrimal duct C. into the outer third of the lower conjunctival sac D. from the inner canthus going towards the side of the eye 80. When applying eye ointment, the following guidelines apply EXCEPT: A. squeeze about 2 cm of ointment and gently close but not squeeze the eye B. apply the ointment from the inner canthus going outward of the affected eye C. discard the first bead of the eye ointment before application because the

tube is likely to expel more than desired amount of ointment D. hold the tube above the conjunctival sac, do not let tip touch the conjunctiva Situation 17 The staff nurse supervisor requests all the staff nurses to brainstorm and learn ways to instruct diabetic clients on self-administration of insulin. She wants to ensure that there are nurses available daily to do health education classes. 81. The plan of the nurse supervisor is an example of A. in service education process B. efficient management of human resources C. increasing human resources D. primary prevention 82. When Mrs. Guevarra, a nurse, delegates aspects of the clients care to the nurse-aide who is an unlicensed staff, Mrs. Guevarra A. makes the assignment to teach the staff member B. is assigning the responsibility to the aide but not the accountability for those tasks C. does not have to supervise or evaluate the aide D. most know how to perform task delegated 83. Connie, the new nurse, appears tired and sluggish and lacks the enthusiasm she had six weeks ago when she started the job. The nurse supervisor should A. empathize with the nurse and listen to her B. tell her to take the day off C. discuss how she is adjusting to her new job D. ask about her family life 84. Process of formal negotiations of working conditions between a group of registered nurses and employer is A. grievance B. arbitration C. collective bargaining D. strike 85. You are attending a certification on cardiopulmonary resuscitation (CPR) offered and required by the hospital employing you. This is A. professional course towards credits B. inservice education C. advance training D. continuing education Situation 18 There are various developments in health education that the nurse should know about: 86. The provision of health information in the rural areas nationwide through television and radio programs and video conferencing is referred to as: A. Community health program B. Telehealth program C. Wellness program D. Red Cross program 87. A nearby community provides blood pressure screening, height and weight measurement, smoking cessation classes and aerobics class services. This type of program is referred to as A. outreach program B. hospital extension program C. barangay health program D. wellness program 88. Part of teaching client in health promotion is responsibility for ones health. When Danica states she needs to improve her nutritional status this means: A. Goals and interventions to be followed by client are based on nurses priorities B. Goals and intervention developed by the nurse and client should be approved by the doctor C. Nurse will decide goals and interventions needed to meet client goals D. Client will decide the goals and interventions required to meet her goals

89. Nurse Beatrice is providing tertiary prevention to Mrs. De Villa. An example of tertiary provision is A. Marriage counseling B. Self-examination for breast cancer C. Identifying complication of diabetes D. Poison Control 90. Mrs. Ostrea has a schedule for Pap Smear. She has a strong family history of cervical cancer. This is an example of A. tertiary prevention B. secondary prevention C. health screening D. primary prevention Situation 19 Ronnie was in a vehicular accident where he sustained injury to his left ankle. In the Emergency Room, you notice how anxious he looks. 91. You establish rapport with him and to reduce his anxiety you initially: A. Take him to the radiology section for X-ray of affected extremity B. Identify yourself and state your purpose in being with the client C. Talk to the physician for an order of Valium D. Do inspection and palpation to check extent of his injuries 92. While doing your assessment, Ronnie asks you Do I have a fracture? I dont want to have a cast. The most appropriate nursing response would be: A. You have to have an x ray first to know if you have a fracture. B. Why do you sound so scared? It is just a cast and its not painful. C. You seem to be concerned about being in a cast. D. Based on my assessment, there doesnt seem to be a fracture. 93. Ronnie is very anxious and is unaware of the extent of his injury. The nurse can best assist him by: A. Asking the doctor to give an order for a sedative to call him down B. Informing him that he is being treated by a very competent health team so he has nothing to worry about C. Identifying his level of anxiety to determine how much information he can understand D. Allaying his anxiety by telling him that he only sustained a minor injury 94. After cleaning the abrasions and applying antiseptic, the nurse applies cold compress to the swollen ankle as ordered by the physician. This statement shows that the nurse has correct understanding of the use of cold compress: A. Cold compress reduces blood viscosity in the affected area B. It is safer to apply than hot compress C. Cold compress prevents edema and reduces pain D. It eliminates toxic waste products due to vasodilation 95. After receiving prescription for pain medication, Ronnie is instructed to continue applying 30 minute cold at home and start 30 minute hot compress the next day. You explain that the use of hot compress: A. Produces anesthetic effect B. Increases nutrition in the blood to promote wound healing C. Increase oxygenation to the injured tissues for better healing D. Induces vasoconstriction to prevent infection Situation 20 A nursing professor assigns a group of students to do data gathering by interviewing their classmates as subjects. 96. She instructed the interviewees not to tell the interviewees that the data gathered are for her own research project for publication. This teacher has violated the students right to: A. Not be harmed B. Disclosure C. Privacy D. Self-determination

97. A nurse preceptor observes that many clients are being readmitted in the ward for postoperative infections. She suggests to the students that they do a research on this topic. What research activity is this? A. Sharing research results with colleagues B. Identifying clinical problem C. Developing guidelines for patient care D. Data collection 98. Quantitative research involves numerical data. Which of the following is based on quantitative research? A. A study on the effects of the white uniform of hospital personnel on pediatric patients B. The effects of regular nurse visits to clients bedside on the number of clients calls to the nurse C. A study on benefits of pre-operative health instructions to clients feeling of anxiety D. A study on the effects of touch on the clients feelings of isolation 99. Before the nurse researcher starts her study, she analyzes how much time, money, materials and people she will need to complete the research project. This analysis prior to beginning the study is called: A. Validity B. Feasibility C. Reliability D. Researchability 100. Data analysis is to be done and the nurse researcher wants to include variability. These include the following EXCEPT: A. Variance B. Range C. Standards of Deviation D. Mean