Health Care Quality

Which event is an example of negligence?

Which nursing intervention will be most effective in preventing the spread of Clostridium difficile between patients?

Which patient is at the highest risk for falls?

The patient is pale and dizzy following a gunshot wound to the groin. Minimal bleeding is noted at the site. Vital signs are notable for a heart rate of 125 bpm and a blood pressure of 73/39 mm Hg. Two unsuccessful attempts have been made to establish an IV site. He loses consciousness. Which action does the nurse take next?

A person in the hospital pulls out a firearm and starts shooting patients and staff at random in the emergency department. Which action by the nurse is most appropriate?

A patient with a documented Do Not Resuscitate (DNR) order suddenly develops pulseless ventricular tachycardia. Which intervention by the nurse is most appropriate?

Which interventions does the nurse implement for the patient diagnosed with Clostridium difficile? Select all that apply.

A patient with a signed Do Not Resuscitate (DNR) order suddenly becomes unresponsive and goes into cardiac arrest. His wife, who is his healthcare power of attorney, starts yelling hysterically, “Do everything you can! Save him! I don’t care that he didn’t want to be resuscitated, he would want to live for me!” Which action by the nurse is best?

The nurse is counseling the parents of a 7-year-old child who are concerned because of a strong family history of type 2 diabetes mellitus. The nurse instructs the parents that the initial screening for type 2 diabetes mellitus will occur at which time? 

The nurse instructs parents on which type of diet to decrease the risk for lead poisoning in their children? 

The nurse is assessing the patient in the emergency room who is complaining of severe joint pain. Which term does the nurse use to document this complaint?

The nurse is caring for a 48-year-old female diagnosed with acute kidney injury. Laboratory results reveal that the patient is experiencing mild hyperkalemia. Which independent nursing action is appropriate to manage the patient's hyperkalemia?

The nurse uses which technique to counsel a patient with chronic obstructive pulmonary disorder (COPD) about quitting smoking? 

The nurse is caring for a 71-year-old who was recently diagnosed with age-related macular degeneration (AMD) in the left eye. The nurse encourages the patient to increase dietary intake of which substances? 

The patient with persistent shoulder pain with associated numbness of the hand is scheduled for a magnetic resonance imaging (MRI) scan. The patient tells the nurse, "I'm terrified of enclosed spaces. I just don't know if I'll survive this test." After relaying the patient's concerns to the provider, which response does the nurse expect from the provider? 

The nurse is supervising the student nurse passing medications on the medical surgical floor. The nurse allows the patient to continue after which verbalization to the patient? 

The parents of a 12-year-old girl with severe anemia decline a blood transfusion because it is against their religion. When responding to the parent's decision, the nurse utilizes which ethical principle?

The patient with bipolar disorder is verbally threatening the staff and other patients in the medical surgical unit. Which initial action is most appropriate? 

The nurse is preparing a 56-year-old male for a surgery that will take several hours. The nurse performs which intervention to decrease the patient's risk of pressure injury during the procedure?

The patient with chronic pain and generalized anxiety disorder has been prescribed alprazolam. Which medication, if also prescribed to the patient, prompts the nurse to clarify the order with the provider?

Which question does the nurse ask to determine the patient's risk for suicide in the patient with major depressive disorder? 

The nurse is caring for a 22-year-old patient who is experiencing sickle-cell crisis. Which is the priority nursing consideration?

The nurse is caring for a patient receiving total parenteral nutrition (TPN). After morning rounds, the nurse notices the rate of TPN infusion is slower than what is ordered for the patient and is three hours behind schedule. There are no nursing notes, and the rate was not mentioned on sign-out. Which initial action is most appropriate?

The nurse is assigned to a 4-year-old patient admitted with a vaso-occlusive crisis secondary to sickle cell anemia. The boy is in agonizing pain. He has apparently taken off his hospital wristband. Before administering the pain medication, the nurse should perform which of the following actions?

The nurse is caring for a patient admitted for nephrolithiasis. The patient is experiencing severe pain and the provider writes the following order: “5 mg MSO4.” Which action by the nurse is most appropriate?

The nurse is assigned to a 55-year-old patient admitted for diabetic ketoacidosis. The provider writes the patient’s insulin regimen on the admission orders as follows, - “insulin NPH 25 IU.” Which action by the nurse is most appropriate? 

The nurse discovers a fire in an empty patient room. Where does the nurse aim the fire extinguisher discharge to eradicate the flame?

The nurse discovers a fire coming from a computer in the staff computer room. After sounding the alarm and ensuring nearby patients are being moved to safety, which is the best action for the nurse to take?

Following nephrectomy surgery, the patient is groggy and continuously pulls at the IV inserted in the right arm. Which intervention is most appropriate to protect the IV?

The nurse is assigned to a 52-year-old patient who is admitted for elective cholecystectomy. While undergoing preoperative evaluation, the patient mentions to the nurse an allergy that is not documented in the health record. Which action by the nurse is most appropriate?

The nurse is evaluating a 9-month-old male infant who presents for a routine checkup. In obtaining the patient’s history from his mother, the nurse discovers they live in a home built in 1975. The nurse instructs the mother on which health screening schedule?

The 17-year-old pregnant female patient presents for her first prenatal visit. The nurse plans care based on which understanding of recommended screening?

The 28-year-old female patient presents to the clinic after missing her usual monthly menstrual cycle. A urine hCG level confirms that she is pregnant; further questioning estimates a gestational age of 11 weeks. The patient asks about the possibility of getting an abortion in the next few weeks. Which response by the nurse is appropriate? 

At a well-child visit, the mother of a 2-year-old child states, "My child is not keeping up with the other kids." Further evaluation reveals the patient can stack 6 cubes, walk backwards, and copy a line. The child exhibits separation anxiety and has a vocabulary of 10 words but cannot use symbols or use pronouns. Which assessment does the nurse make about the child's development?

The nurse instructs the mother at her child's 9-month well-child visit that patient will be screened for developmental delays and disabilities at which visits?

The nurse informs the parent of an 18-month-old patient at the well-child visit that screening for an autism spectrum disorder at which time(s)?

The patient with major depressive disorder who has been off medication for a couple of years has been prescribed fluoxetine (Zoloft) again. The patient states, "I'm concerned about starting this medication again. I'm a taxi driver and it always used to make me so sleepy." Which instruction from the nurse is appropriate?

The older adult patient with dementia wants her eldest son to make healthcare decisions on her behalf when her condition worsens. The nurse instructs the patient to complete which form? 

The patient brought to the emergency department following a motor vehicle accident is found to be brain dead. An organ donor card is found on this person and the organ procurement team is contacted. Which medical history, if found in the patient’s chart, would prompt the nurse to stop the line in the organ procurement process?

The patient with schizophrenia tells the nurse of his plans to initiate a fire in the kitchen of the psychiatric department. Which action does the nurse take first?

The surgeon is obtaining informed consent from the parents of a child in preparation for a bone biopsy. The nurse anticipates the surgeon to include which information in the discussion? Select all that apply.

The student nurse accidentally administered morphine sulfate (Avinza) to the wrong patient. Who is directly accountable for the student nurse's medication error?

Which component of quality improvement in medical institutions requires the institution provides standard care for all patients?

The provider is obtaining consent from the patient in preparation for a laparoscopic ureterolithotomy. The nurse witnesses the provider dismissing the patient’s questions and repeatedly asking the patient to sign the consent form. The nurse reports which violation to the charge nurse for further management?

Which element of informed consent refers to the patient's appreciation of the relevance of surgery to the present and future conditions?

The 15-year-old patient with anorexia nervosa has been prescribed nasogastric tube feeding for malnutrition. Which intervention is helpful in promoting the patient’s autonomy?

In response to a possible mass admission of injured individuals who were involved in a bombing incident nearby, the nurse supervisor is arranging the discharge of several patients who have recuperated already. Which is the operating principle of this situation?

The nurse has been instructed by the nurse manager to report to an affiliate hospital in the neighboring city because of an imbalance in staffing needs between the two hospitals. Which action by the nurse is most appropriate?

The patient speaks Chinese and very little English. Which action by the nurse is appropriate?

Which term refers to a feeling of indifference towards the patient for whom the nurse is providing care?