nursing research questions and answers

Nursing Research Nursing Test Bank and Practice Questions (60 Items)

Welcome to your nursing test bank and practice questions for nursing research.

Nursing Research Test Bank

Nursing research has a great significance on the contemporary and future professional nursing practice, thus rendering it an essential component of the educational process. Research is typically not among the traditional responsibilities of an entry-level nurse . Many nurses are involved in either direct patient care or administrative aspects of health care. However, nursing research is a growing field in which individuals within the profession can contribute a variety of skills and experiences to the science of nursing care. Nursing research is critical to the nursing profession and is necessary for continuing advancements that promote optimal nursing care. Test your knowledge about nursing research in this 60-item nursing test bank.

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Saunders Comprehensive Review for the NCLEX-RN Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.

Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.

Saunders Q & A Review for the NCLEX-RN® Examination This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.

NCLEX-RN Prep Plus by Kaplan The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.

Illustrated Study Guide for the NCLEX-RN® Exam The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.

NCLEX RN Examination Prep Flashcards (2023 Edition) NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.

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Thanks for the well prepared questions and answers. It will be of a great help for those who look up your contributions.

Hi Zac, we’re having some performance issues with the quizzes so we’re forced to change their settings in the meantime. We are working on a solution and will revert the changes once we’re sure that the problem is resolved. Thanks for the understanding!

Identifying and defining research questions

25 January, 2016

Many nursing students do not know where to begin with their research project

Successful clinical research depends on a properly constructed research question on a topic that is relevant for study. Discover the best process of developing one

Research is vital to improving nursing practice and patient outcomes, and therefore a key aspect of nursing degree programmes. All student nurses must show they can undertake an independent learning project before they can graduate and become registered nurses. This article outlines processes that can be followed to select a research area and narrow it down to generate a specific research question. Methodologies and models can then be used to compile a list of search terms that can be used to get the research underway.

Citation: Khodabux R (2015) Identifying and defining research questions. Nursing Times ; 112: 3/4, 16-19

Author: Raouf Khodabux is senior lecturer, module leader for Approaches to Health and Social Care Research, Middlesex University, London.

This article has been double-blind peer reviewed
Scroll down to read the article or download a print-friendly PDF here

Introduction

In 2011, pre-registration education in England became an all-degree programme (Nursing and Midwifery Council, 2010), so student nurses in their final year must carry out an independent learning project. In addition, many qualified nurses are returning to university to do their dissertation and complete their degree (Aveyard, 2014). These projects vary in scope and nature, from literature reviews or extended essays to small research projects.

For many students, the dissertation is a “nightmare” they have to endure to gain a degree (Lundgren and Halvarsson, 2009). This module can be challenging for a number of reasons such as:

The requirement to be on placement;
Long days and/or night duty;
Working part-time to make ends meet;
Family commitments.

However, perhaps the biggest challenge is the fact that this is an independent module in which a lot depends on students’ motivation and willingness – they have to determine the focus and direction of their work. This is usually carried out on an individual basis, although some tutor support, supervision and direction is provided.

The module is also demanding because there is typically a substantial research component to the project requiring primary data to be collected and secondary or existing data to be analysed. Furthermore, students are expected to have a more prolonged engagement with the chosen subject than they do with standard coursework, such as essays or reports; the work is consequently required to be more in-depth than students are accustomed to (Todd et al, 2004).

Many students struggle to start their project because they simply do not know where to begin. The most critical question for many is “What should I study?” Deciding between a research project and a literature review depends on the type of degree course being undertaken. However, for most undergraduate nursing courses, students are required to carry out a literature review.

Pole and Lampard (2002) stated that curiosity is, or at least should be, the driving force behind the conduct of any research. Research questions are an attempt to “tame” curiosity, so they are not asked in a haphazard manner but in relation to what is already known about the topic of interest (White 2013). The process of framing, developing and refining these questions allows researchers to make connections with existing theories and previous empirical findings; this helps avoid unnecessary repetition of, or overlap with, previous work (White, 2009). In the final analysis, a researchable question is an uncertainty about a problem that can be challenged, examined and analysed to provide useful information (Ellis, 2013). A clearly defined research problem is the fuel that drives the scientific process, and is the foundation of any research method and experimental design, from true experiment to case study (Shuttleworth 2008).

Framework for a literature review

Formulation of a research-focused question underpins any type of literature review, whether it is for a:

Dissertation for a systematic or traditional/narrative review;
Primary research project;
Research proposal.

A literature review is an account of what has been published on a topic by accredited scholars and researchers. It is an objective, thorough summary and critical analysis of the relevant available research and non-research literature on the topic being studied (Hart 2012).

Conducting a literature review can be a daunting and confusing prospect. Wakefield (2015) identifies seven steps in the process (Box 1), at the top of which is formulating a research question. Aveyard (2010) argued that in order to write a robust evaluative literature review, it is essential to start with a sound research question. Even in the context of the research process, Gelling (2015) identified the development of a research question as the first stage, while Offredy and Vickers (2010) said the first step in writing a research proposal is to choose a topic and then to develop research questions.

Ionesco (1969) stated that it is not the answer that enlightens, but the question. According to Graziano and Raulin (2004): “Questions are everywhere; all you have to do is observe and be curious”.

To carry out a literature review, it is necessary to:

Have a basic knowledge of research processes and methodologies;
Understand the origins of the evidence, primary and secondary sources;
Understand the terminology used;
Know how the various types of literature reviews vary (Conner, 2014).

It is well documented that student nurses tend to disengage with the research module (Ax and Kincade, 2001). Undergraduates find research boring, and may have difficulty understanding the language and experience cognitive shutdown (Porter et al, 2006); this may come back to haunt them in the final year when they attempt the literature review for their dissertation. Since the literature review is an integral part of the research process, it is crucial for students to engage with the research module.

Box 1. Conducting a literature review

There are seven steps to follow when conducting a literature review:

Formulate a research question
Identify a term/terms that will be used to search the literature
Create robust inclusion and exclusion criteria to select the most appropriate literature
Select the most relevant databases to interrogate the literature
Search the literature from a global perspective
Analyse, synthesise and critique the research articles
Present the findings

Source: Wakefield (2015)

Choosing a research topic

The starting point for any research project begins with the choice of topic. This should be a subject the student finds interesting, stimulating and worthwhile, as this will make the process more enjoyable and, ultimately, more rewarding. While the initial topic selected may be broad, it must be narrowed down to a focused question (Playle, 2000).

The topic should already have been researched by others so it is possible to search for relevant literature to review. The most interesting topic in the world will not create a successful literature review if nothing has previously been written about it. Sometimes it is a good idea to come up with a few alternative ideas and carry out some preliminary research on each – that way, if there has only been limited exploration of the first choice, there is an alternative to fall back on.

Most research projects start with an idea that arises from clinical practice (Gelling, 2015). However, it is generally agreed that research topics narrowed into focused questions arise from three basic sources:

The literature;
Experience (Springett and Campbell, 2006).

Using the literature

Sometimes studies raise far more questions than they answer so, when reading the literature on a particular topic, you may find new ideas are recommended for further investigation. For example, there may be observational studies that explain what is happening but not necessarily why. When reading the literature it is useful to bear in mind that:

It is possible to replicate a study – this not only ensures its reliability but also provides additional information;
Any recommendations made at the end of research articles may be followed up with another investigation;
Sometimes there may be flaws in the original method used in a study, and the same question can be asked in a different way – this may then reinforce or challenge the findings of the earlier study.

Theoretical concepts that may be tested in practice are the second major source of research questions. Theories such as the promotion of continence and self-care as a framework for nursing or mentorship, and student nurses’ performance, can be tested in practice. An example of a theory is: “Promotion of continence will result in better quality of life for patients”. Like many other theories in nursing, this can be investigated inductively or deductively. A quantitative experimental design uses deductive reasoning to arrive at a testable hypothesis. According to Coates (2011), this approach focuses on replicability, objectivity, prediction and control; the distinguishing feature is a collection of numerical data that can be subjected to statistical analysis. Qualitative research designs use inductive reasoning to propose a research statement about how people interpret and structure their lives. This kind of research is used to explore, understand and interpret experiences, feelings and beliefs (Gelling, 2015).

Research ideas can also stem from experience in clinical areas where nurses observe practice that may be a source of concern or simply “interest”. The research question need not be about something that is “wrong” but something that could be done better or has not been thought about before. Student nurses are taught critical analysis to encourage them to ask:

Why is this being done in this particular way?
What will happen if this is done differently?

These are important ways to explore more about nursing inductively as they stem from the real world of nursing.

From a clinical practice perspective, when a research question is carefully composed it aims to close the gaps between what is known and what needs to be known about nursing care, and resolve the discrepancy between the way things are and how they ought to be to result in better patient care. However, research does not always lead to definitive answers.

Composing the research question

Deciding on the research question is challenging, but is one of the most critical aspects of the research process. A carefully constructed research question helps to guide the project to hit its scholarly target. Research is only as good as the question and plan on which it is based; this is relevant to healthcare research because new knowledge comes from having asked answerable questions (Haynes, 2006).

Beitz (2006) defined research questions as “an explicit query about a problem or issue that can be challenged, examined and analysed, and that will yield useful new information”.

The question is the fundamental core of a research project, study or literature review. It focuses the study, determines the methodology and guides all stages of inquiry, analysis and reporting. It also acts as an aide memoire, and helps keep the researcher focused on the specific area of enquiry, which is particularly helpful when searching the literature (Lahlafi, 2007).

Blaikie (2007) argued that the use of research questions in the design and conduct of research is often neglected. The key to defining a research question is focus. If it is too broad (for example, “Does regular exercise prevent heart disease in adult men?”), the search strategy will become unstructured and many important articles may be overlooked (Wakefield, 2015). The end product should be a specific query that is explicit in what it is looking for. However, Denney and Tewksbury (2013) have also argued against having a research question that is too narrow (for example, “Do daily 30-minute exercise sessions reduce the incidence of myocardial infarction in 40-60-year-old Asian men?”) as it can limit the search strategy. An appropriate question on the topic in the examples above might be, “Does daily exercise reduce the incidence of myocardial infarction in men over 40 years of age?”

Framing the research question

The development of the research question is important as it sets the parameters of the research. It provides opportunities for a wide range of research methodologies as well as a structure and direction for the student. Hanson (2006) argued that there are three important phases of developing a study question destined for success:

Defining the research question(s);
Refining the research question(s);
Converting the research question(s) into a specific aim(s).

Similarly, Lipowski (2008) proposed three steps in the formulation of a great research question:

Ask interesting questions;
Select the best question for research;
Transform the research question into a testable hypothesis.

There are three types of research question:

Descriptive: describing something, using a descriptive approach that can simply be an observation of something, with the researcher taking the role of the “witness” and answering the basic question of “what happened?”;
Relational: a relational or correlational study exploring relationships between two or more variables using statistical analysis, and asking the question: “how are these linked?”;
Causal: exploring cause and effect to determine whether one or more variables causes or affects one or more outcomes using an experimental approach (Trochim, 2006).

Table 1 (attached) indicates some broad research topics and specific research questions; students should be able to identify which type of question each one is. Research questions should be:

Manageable in terms of research and in terms of the individual’s own academic abilities;
Substantial and with originality: rather than previously addressed topics, students should use their imagination and come up with ground-breaking ideas that can be turned into research issues or developed into a dissertation;
Able to confirm or refute previous findings, extend or build on previous findings or provide new findings;
Consistent with the requirements of the assessment;
Clear and simple;
Interesting and worthwhile;
Feasible or able to be answered.

Framing models

Having selected a broad topic, the next step is to narrow it down. There are several frameworks that can be used to structure a sound research question in a strategic manner (Bettany-Saltikov, 2010); two models are PICO and SPICE (Box 2). Offredy and Vickers (2010) mentioned four stages in the research question formulation process, illustrating the process of narrowing the topic by focusing on surgery.

Broad topic area – surgery;
Narrow broad topic area – surgery and pain relief;
Focused topic area – surgery, pain relief and patient-controlled analgesia;
Research question.

In the fourth stage, when the focused topic area is converted into a research question, PICO or SPICE is used. According to Ellis (2013), PICO is useful when generating quantitative questions, whereas SPICE is most commonly applied to research aimed at exploring qualitative phenomena. However, not all components may be relevant when formulating a question.

Box 2. Framing models for research questions

P – Population I – Intervention C – Comparison O – Outcome

S – Setting P – Perspective I – Intervention C – Comparison E – Evaluation

Generating search terms

Once the question has been composed, it is essential to generate several key search terms or words, from which synonyms are identified, that can be entered into one or more databases. These key terms are combined using Boolean Operators such as “OR”, “AND” and “NOT”.

Fig 1 (attached) indicates the process by which search terms have been generated from the research question using the PICO model. These terms are entered in the databases for a comprehensive literature search and a number of articles will be found. Wakefield (2014) suggests that establishing and adhering to inclusion and exclusion criteria will ensure the most appropriate literature is selected, which addresses the research question.

Clinical practice is the main arena from which nurses can seek ideas for research, but those ideas can stem from experience, theories and the literature. With the advent of the internet and the increasing volume of articles being published, students can spend a lot of time sifting through the resources. Developing a research question, therefore, is an important systematic activity that provides a “road map” for a successful literature search.

Tools such as PICO or SPICE can be used to structure a sound research question. Not only is valuable time saved but the most appropriate articles are selected for review. Formulating a focused question is a disciplined method to beginning a research project.

Students must complete an independent learning project as part of their nursing degree
Before conducting research, students must have some knowledge of research process and methodologies
Many issues encountered in clinical practice form the basis of research projects
Once a broad topic has been selected, it should be narrowed down until a specific research question has been framed
Research models can help generate relevant search terms from a research question

Related files

270116_identifying-and-defining-research-questions.pdf, table 1 research question types.pdf, fig 1 generating search terms from a research question.pdf.

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Nursing Research NCLEX Practice Quiz #1 (10 Questions)

All questions are shown, but the results will only be given after you’ve finished the quiz. You are given 1 minute per question, a total of 10 minutes in this quiz.

What should be included in “scholarly literature”? Select all that apply.

Research reports reported in primary sources only

Conceptual and theoretical literature from primary sources only

Published and unpublished reports of research

Primary and secondary sources

Rate this question:

Reviews of the literature are conducted for PURPOSES OF RESEARCH as well as for the CONSUMER OF RESEARCH. How are these reviews similar? Select all that apply.

Amount of literature required to be reviewed

Degree of critical reading required

Importance of conceptual literature

Purpose of the review

What are characteristics of the literature review required for a quantitative research study? Select all that apply.

The review is exhaustive and must include all studies conducted in the area

Doctoral dissertations and masters’ theses are excellent sources of information

Computer-accessed materials are acceptable

Primary sources are not as important as secondary sources

Which of the following is an example of a primary source in a research study?

A published commentary on the findings of another study

A doctoral dissertation that critiques all research in the area of attention deficit disorder

A textbook of medical-surgical nursing

A journal article about a study that used large

What is the best source to use when conducting a level I systematic meta-analysis of the literature?

An electronic database

Doctoral dissertations

The Cochrane Statistical Methods

An electronic database and Doctoral dissertations

What is a characteristic of an audio recording of an unpublished research study reported at a professional conference?

Databased literature

Secondary Sources

Are more difficult to analyze than written reports.

Are not useful because they are not published

What is the first step in the qualitative research process?

Data analysis

Review of literature

Study design

Which mode of clinical application for qualitative research is considered to be the sharing of qualitative findings with the patient?

Insight or empathy

Anticipatory guidance

Assessment of status or progress

Which research process steps may be noted in an article’s abstract? Select all that apply.

Identifying the phenomenon

Research question study purpose

Literature review

What does a level-of-evidence model use to evaluate the strength of a research study and its findings? Select all that apply.

Consistency

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Nursing Research Guide: Clinical Question Types

Quick Access
Intro to EBP
Clinical Question Types
Using PICO(T)
Study Designs

Types of Clinical Questions

Clinical questions may be categorized as either background or foreground. Why is this important?

Determining the type of question will help you to select the best resource to consult for your answer.

Background questions ask for general knowledge about an illness, disease, condition, process or thing. These types of questions typically ask who, what, where, when, how & why about things like a disorder, test, or treatment, etc.

Background questions are best answered by medical textbooks, which are available from platforms such as AccessMedicine and ClinicalKey Nursing

Foreground questions ask for specific knowledge to inform clinical decisions. These questions typically concern a specific patient or particular population, and tend to be more specific and complex compared to background questions. Quite often, foreground questions investigate comparisons, such as two drugs, two treatments, two diagnostic tests, etc.

Foreground questions are best answered by consulting medical databases such as Medline (via PubMed or OvidSP), Cochrane Library, and CINAHL.

All of these resources are available from Miner Library and Williams Library ; many are listed in the "Quick Links" section of the homepage.

You can also access an alphabetic list of Evidence-Based Resources at Miner's website, or a webpage of available Evidence-Based Health Care resources at Williams' website.

It's useful to check the page for your workplace as some resources are only licensed for access at specific locations.

Branch Librarian at URMC

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Examples of Research Questions

Phd in nursing science program, examples of broad clinical research questions include:.

Does the administration of pain medication at time of surgical incision reduce the need for pain medication twenty-four hours after surgery?
What maternal factors are associated with obesity in toddlers?
What elements of a peer support intervention prevent suicide in high school females?
What is the most accurate and comprehensive way to determine men’s experience of physical assault?
Is yoga as effective as traditional physical therapy in reducing lymphedema in patients who have had head and neck cancer treatment?
In the third stage of labor, what is the effect of cord cutting within the first three minutes on placenta separation?
Do teenagers with Type 1 diabetes who receive phone tweet reminders maintain lower blood sugars than those who do not?
Do the elderly diagnosed with dementia experience pain?
How can siblings’ risk of depression be predicted after the death of a child?
How can cachexia be prevented in cancer patients receiving aggressive protocols involving radiation and chemotherapy?

Examples of some general health services research questions are:

Does the organization of renal transplant nurse coordinators’ responsibilities influence live donor rates?
What activities of nurse managers are associated with nurse turnover? 30 day readmission rates?
What effect does the Nurse Faculty Loan program have on the nurse researcher workforce? What effect would a 20% decrease in funds have?
How do psychiatric hospital unit designs influence the incidence of patients’ aggression?
What are Native American patient preferences regarding the timing, location and costs for weight management counseling and how will meeting these preferences influence participation?
What predicts registered nurse retention in the US Army?
How, if at all, are the timing and location of suicide prevention appointments linked to veterans‘ suicide rates?
What predicts the sustainability of quality improvement programs in operating rooms?
Do integrated computerized nursing records across points of care improve patient outcomes?
How many nurse practitioners will the US need in 2020?

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PICOT Question Examples for Nursing Research

Are you looking for examples of nursing PICOT questions to inspire your creativity as you research for a perfect nursing topic for your paper? You came to the right place.

We have a comprehensive guide on how to write a good PICO Question for your case study, research paper, white paper, term paper, project, or capstone paper. Therefore, we will not go into the details in this post. A good PICOT question possesses the following qualities:

A clinical-based question addresses the nursing research areas or topics.
It is specific, concise, and clear.
Patient, problem, or population.
Intervention.
Comparison.
Includes medical, clinical, and nursing terms where necessary.
It is not ambiguous.

For more information, read our comprehensive PICOT Question guide . You can use these questions to inspire your PICOT choice for your evidence-based papers , reports, or nursing research papers.

If you are stuck with assignments and want some help, we offer the best nursing research assignment help online. We have expert nursing writers who can formulate an excellent clinical, research, and PICOT question for you. They can also write dissertations, white papers, theses, reports, and capstones. Do not hesitate to place an order.

List of 180 Plus Best PICOT Questions to Get Inspiration From

Here is a list of nursing PICO questions to inspire you when developing yours. Some PICOT questions might be suitable for BSN and MSN but not DNP. If you are writing a change project for your DNP, try to focus on PICOT questions that align to process changes.

Among healthy newborn infants in low- and middle-income countries (P), does early skin-to-skin contact of the baby with the mother in the first hour of life (I) compared with drying and wrapping (C) have an impact on neonatal mortality, hypothermia or initiation/exclusivity/ duration of breastfeeding (O)?
Is it necessary to test blood glucose levels 4 times daily for a patient suffering from Type 1 diabetes?
Does raising the head of the bed of a mechanically ventilated patient reduce the chances of pneumonia?
Does music therapy is an effective mode of PACU pain management for patients who are slowly coming out from their anesthesia?
For all neonates (P), should vitamin K prophylaxis (I) be given for the prevention of vitamin K deficiency bleeding (O)?
For young infants (0-2 months) with suspected sepsis managed in health facilities (P), should third generation cephalosporin monotherapy (I) replace currently recommended ampicillin-gentamicin combination (C) as first line empiric treatment for preventing death and sequelae (O)?
In low-birth-weight/pre-term neonates in health facilities (P), is skin-to-skin contact immediately after birth (I) more effective than conventional care (C) in preventing hypothermia (O)?
In children aged 2–59 months (P), what is the most effective antibiotic therapy (I, C) for severe pneumonia (O)?
Is skin-to-skin contact of the infant with the mother a more assured way of ensuring neonatal mortality compared to drying and wrapping?
Are oral contraceptives effective in stopping pregnancy for women above 30 years?
Is spironolactone a better drug for reducing the blood pressure of teenagers when compared to clonidine?
What is the usefulness of an LP/spinal tap after the beginning of antivirals for a pediatric population suffering from fever?
In children aged 2–59 months in developing countries (P), which parenteral antibiotic or combination of antibiotics (I), at what dose and duration, is effective for the treatment of suspected bacterial meningitis in hospital in reducing mortality and sequelae (O)?
Does the habit of washing hands third-generation workers decrease the events of infections in hospitals?
Is the intake of zinc pills more effective than Vitamin C for preventing cold during winter for middle-aged women?
In children with acute severe malnutrition (P), are antibiotics (I) effective in preventing death and sequelae (O)?
Among, children with lower respiratory tract infection (P), what are the best cut off oxygen saturation levels (D), at different altitudes that will determine hypoxaemia requiring oxygen therapy (O)?
In infants and children in low-resource settings (P), what is the most appropriate method (D) of detecting hypoxaemia in hospitals (O)?
In children with shock (P), what is the most appropriate choice of intravenous fluid therapy (I) to prevent death and sequelae (O)?
In fully conscious children with hypoglycaemia (P) what is the effectiveness of administering sublingual sugar (I)?
Is using toys as distractions during giving needle vaccinations to toddlers an effective pain response management?
What is the result of a higher amount of potassium intake among children with low blood pressure?
Is cup feeding an infant better than feeding through tubes in a NICU setup?
Does the intervention of flushing the heroin via lines a more effective way of treating patients with CVLs/PICCs?
Is the use of intravenous fluid intervention a better remedy for infants under fatal conditions?
Do bedside shift reports help in the overall patient care for nurses?
Is home visitation a better way of dealing with teen pregnancy when compared to regular school visits in rural areas?
Is fentanyl more effective than morphine in dealing with the pain of adults over the age of 50 years?
What are the health outcomes of having a high amount of potassium for adults over the age of 21 years?
Does the use of continuous feed during emesis a more effective way of intervention when compared to the process of stopping the feed for a short period?
Does controlling the amount of sublingual sugar help completely conscious children suffering from hypoglycemia?
Is the lithotomy position an ideal position for giving birth to women in labor?
Does group therapy help patients with schizophrenia to help their conversational skills?
What are the probable after-effects, in the form of bruises and other injuries, of heparin injection therapy for COPD patients?
Would standardized discharge medication education improve home medication adherence in adults age 65 and older compared to-standardized discharge medication education?
In patients with psychiatric disorders is medication non-compliance a greater risk compared with adults experiencing chronic illness?
Is the use of beta-blockers for lowering blood pressure for adult men over the age of 70 years effective?
Nasal swab or nasal aspirate? Which one is more effective for children suffering from seasonal flu?
What are the effects of adding beta-blockers for lowering blood pressure for adult men over the age of 70 years?
Does the process of stopping lipids for 4 hours an effective measure of obtaining the desired TG level for patients who are about to receive TPN?
Is medical intervention a proper way of dealing with childhood obesity among school-going children?
Can nurse-led presentations of mental health associated with bullying help in combating such tendencies in public schools?
What are the impacts of managing Prevacid before a pH probe study for pediatric patients with GERD?
What are the measurable effects of extending ICU stays and antibiotic consumption amongst children with sepsis?
Does the use of infrared skin thermometers justified when compared to the tympanic thermometers for a pediatric population?
What are the roles of a pre-surgery cardiac nurse in order to prevent depression among patients awaiting cardiac operation?
Does the increase in the habit of smoking marijuana among Dutch students increase the chances of depression?
What is the direct connection between VAP and NGT?
Is psychological intervention for people suffering from dementia a more effective measure than giving them a placebo?
Are alarm sensors effective in preventing accidents in hospitals for patients over the age of 65 years?
Is the sudden change of temperature harmful for patients who are neurologically devastated?
Is it necessary to test blood glucose levels, 4 times a day, for a patient suffering from Type 1 diabetes?
Is the use of MDI derive better results, when compared to regular nebulizers, for pediatric patients suffering from asthma?
What are the effects of IVF bolus in controlling the amount of Magnesium Sulfate for patients who are suffering from asthma?
Is the process of stopping lipids for 4 hours an effective measure of obtaining the desired TG level for patients who are about to receive TPN?
What are the standards of vital signs for a pediatric population?
Is daily blood pressure monitoring help in addressing the triggers of hypertension among males over 65 years?
Does receiving phone tweets lower blood sugar levels for people suffering from Type 1 diabetes?
Are males over the age of 30 years who have smoked for more than 1 year exposed to a greater risk of esophageal cancer when compared to the same age group of men who have no history of smoking?
Does the increase in the use of mosquito nets in Uganda help in the reduction of malaria among the infants?
Does the increase in the intake of oral contraceptives increase the chances of breast cancer among 20-30 years old women in the UK?
In postpartum women with postnatal depression (P), does group therapy (I) compared to individual therapy (C) improve maternal-infant bonding (O) after eight weeks (T)?
In patients with chronic pain (P), does mindfulness-based cognitive therapy (I) compared to pharmacotherapy (C) improve quality of life (O) after 12 weeks (T)?
In patients with type 2 diabetes (P), does continuous glucose monitoring (I) compared to self-monitoring of blood glucose (C) improve glycemic control (O) over a period of three months (T)?
In patients with chronic kidney disease (P), does a vegetarian diet (I) compared to a regular diet (C) slow the decline in renal function (O) after one year (T)?
In pediatric patients with acute otitis media (P), does delayed antibiotic prescribing (I) compared to immediate antibiotic prescribing (C) reduce antibiotic use (O) within one week (T)?
In older adults with dementia (P), does pet therapy (I) compared to no pet therapy (C) decrease agitation (O) after three months (T)?
In patients with chronic heart failure (P), does telemonitoring of vital signs (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
In patients with anxiety disorders (P), does exposure therapy (I) compared to cognitive therapy (C) reduce anxiety symptoms (O) after 12 weeks (T)?
In postpartum women with breastfeeding difficulties (P), does lactation consultation (I) compared to standard care (C) increase breastfeeding rates (O) after four weeks (T)?
In patients with chronic obstructive pulmonary disease (P), does long-acting bronchodilator therapy (I) compared to short-acting bronchodilator therapy (C) improve lung function (O) after three months (T)?
In patients with major depressive disorder (P), does bright light therapy (I) compared to placebo (C) reduce depressive symptoms (O) after six weeks (T)?
In patients with diabetes (P), does telemedicine-based diabetes management (I) compared to standard care (C) improve glycemic control (O) over a period of six months (T)?
In patients with chronic kidney disease (P), does a low-phosphorus diet (I) compared to a regular diet (C) decrease serum phosphate levels (O) after one year (T)?
In pediatric patients with acute gastroenteritis (P), does probiotic supplementation (I) compared to placebo (C) reduce the duration of diarrhea (O) within 48 hours (T)?
In patients with chronic pain (P), does acupuncture (I) compared to sham acupuncture (C) reduce pain intensity (O) after eight weeks (T)?
In older adults at risk of falls (P), does a home modification program (I) compared to no intervention (C) reduce the incidence of falls (O) over a period of six months (T)?
In patients with schizophrenia (P), does cognitive remediation therapy (I) compared to standard therapy (C) improve cognitive function (O) after one year (T)?
In patients with chronic kidney disease (P), does angiotensin-converting enzyme inhibitors (I) compared to angiotensin receptor blockers (C) slow the progression of renal disease (O) over a period of two years (T)?
In postoperative patients (P), does chlorhexidine bathing (I) compared to regular bathing (C) reduce the risk of surgical site infections (O) within 30 days (T)?
In patients with type 2 diabetes (P), does a low-carbohydrate, high-fat diet (I) compared to a low-fat diet (C) improve glycemic control (O) over a period of six months (T)?
In patients with chronic obstructive pulmonary disease (P), does pulmonary rehabilitation combined with telemonitoring (I) compared to standard pulmonary rehabilitation (C) improve exercise capacity (O) after three months (T)?
In patients with heart failure (P), does a nurse-led heart failure clinic (I) compared to usual care (C) improve self-care behaviors (O) after six months (T)?
In postpartum women with postnatal depression (P), does telephone-based counseling (I) compared to face-to-face counseling (C) reduce depressive symptoms (O) after eight weeks (T)?
In patients with chronic migraine (P), does prophylactic treatment with topiramate (I) compared to amitriptyline (C) reduce the frequency of migraines (O) after three months (T)?
In pediatric patients with acute otitis media (P), does watchful waiting (I) compared to immediate antibiotic treatment (C) reduce the duration of symptoms (O) within seven days (T)?
In older adults with dementia (P), does reminiscence therapy (I) compared to usual care (C) improve cognitive function (O) after three months (T)?
In patients with chronic heart failure (P), does telemonitoring combined with a medication reminder system (I) compared to telemonitoring alone (C) reduce hospital readmissions (O) within six months (T)?
In patients with asthma (P), does self-management education (I) compared to standard care (C) reduce asthma exacerbations (O) over a period of one year (T)?
In postoperative patients (P), does the use of wound dressings with antimicrobial properties (I) compared to standard dressings (C) reduce the incidence of surgical site infections (O) within 30 days (T)?
In patients with chronic kidney disease (P), does mindfulness-based stress reduction (I) compared to usual care (C) improve psychological well-being (O) over a period of three months (T)?
In adult patients with chronic pain (P), does biofeedback therapy (I) compared to relaxation techniques (C) reduce pain intensity (O) after eight weeks (T)?
In patients with type 2 diabetes (P), does a low-glycemic index diet (I) compared to a high-glycemic-index diet (C) improve glycemic control (O) over a period of six months (T)?
In patients with chronic obstructive pulmonary disease (P), does regular physical activity (I) compared to no physical activity (C) improve health-related quality of life (O) after three months (T)?
In patients with major depressive disorder (P), does mindfulness-based cognitive therapy (I) compared to antidepressant medication (C) reduce depressive symptoms (O) after eight weeks (T)?
In postpartum women (P), does perineal warm compresses (I) compared to standard perineal care (C) reduce perineal pain (O) after vaginal delivery (T)?
In patients with chronic kidney disease (P), does a low-protein, low-phosphorus diet (I) compared to a low-protein diet alone (C) slow the progression of renal disease(O) after two years (T)?
In pediatric patients with attention-deficit/hyperactivity disorder (P), does mindfulness-based interventions (I) compared to medication alone (C) improve attention and behavior (O) after six months (T)?
In patients with chronic pain (P), does cognitive-behavioral therapy (I) compared to physical therapy (C) reduce pain interference (O) after 12 weeks (T)?
In elderly patients with osteoarthritis (P), does aquatic exercise (I) compared to land-based exercise (C) improve joint flexibility and reduce pain (O) after eight weeks (T)?
In patients with multiple sclerosis (P), does high-intensity interval training (I) compared to moderate-intensity continuous training (C) improve physical function (O) after three months (T)?
In postoperative patients (P), does preoperative carbohydrate loading (I) compared to fasting (C) reduce postoperative insulin resistance (O) within 24 hours (T)?
In patients with chronic obstructive pulmonary disease (P), does home-based tele-rehabilitation (I) compared to center-based rehabilitation (C) improve exercise capacity (O) after six months (T)?
In patients with rheumatoid arthritis (P), does tai chi (I) compared to pharmacological treatment (C) reduce joint pain and improve physical function (O) after six months (T)?
In postpartum women with postpartum hemorrhage (P), does early administration of tranexamic acid (I) compared to standard administration (C) reduce blood loss (O) within two hours (T)?
In patients with hypertension (P), does mindfulness meditation (I) compared to relaxation techniques (C) reduce blood pressure (O) after eight weeks (T)?
In elderly patients with hip fractures (P), does multidisciplinary geriatric care (I) compared to standard care (C) improve functional outcomes (O) after three months (T)?
In patients with chronic kidney disease (P), does aerobic exercise (I) compared to resistance exercise (C) improve renal function (O) after six months (T)?
In patients with major depressive disorder (P), does add-on treatment with omega-3 fatty acids (I) compared to placebo (C) reduce depressive symptoms (O) after 12 weeks (T)?
In postoperative patients (P), does preoperative education using multimedia materials (I) compared to standard education (C) improve patient satisfaction (O) after surgery (T)?
In patients with type 2 diabetes (P), does a plant-based diet (I) compared to a standard diet (C) improve glycemic control (O) after three months (T)?
In patients with chronic obstructive pulmonary disease (P), does high-flow oxygen therapy (I) compared to standard oxygen therapy (C) improve exercise tolerance (O) after three months (T)?
In patients with heart failure (P), does nurse-led telephone follow-up (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
In postpartum women with postnatal depression (P), does online cognitive-behavioral therapy (I) compared to face-to-face therapy (C) reduce depressive symptoms (O) after eight weeks (T)?
In patients with chronic migraine (P), does mindfulness-based stress reduction (I) compared to medication alone (C) reduce the frequency and severity of migraines (O) after three months (T)?
In older adults with delirium (P), does structured music intervention (I) compared to standard care (C) reduce the duration of delirium episodes (O) during hospitalization (T)?
In patients with chronic low back pain (P), does yoga (I) compared to physical therapy (C) reduce pain intensity (O) after six weeks (T)?
In pediatric patients with acute otitis media (P), does watchful waiting with pain management (I) compared to immediate antibiotic treatment (C) reduce the need for antibiotics (O) within one week (T)?
In patients with schizophrenia (P), does family psychoeducation (I) compared to standard treatment (C) improve medication adherence (O) over a period of six months (T)?
In patients with chronic kidney disease (P), does a low-phosphorus diet (I) compared to a regular diet (C) slow the progression of renal disease (O) after one year (T)?
In postoperative patients (P), does wound irrigation with saline solution (I) compared to povidone-iodine solution (C) reduce the incidence of surgical site infections (O) within 30 days (T)?
In patients with type 1 diabetes (P), does continuous subcutaneous insulin infusion (I) compared to multiple daily injections (C) improve glycemic control (O) over a period of six months (T)?
In postoperative patients (P), does the use of prophylactic antibiotics (I) compared to no antibiotics (C) reduce the incidence of surgical site infections (O) within 30 days (T)?
In patients with chronic obstructive pulmonary disease (P), does smoking cessation counseling (I) compared to no counseling (C) decrease the frequency of exacerbations (O) over a period of six months (T)?
In patients with diabetes (P), does a multidisciplinary team approach (I) compared to standard care (C) improve self-management behaviors (O) over a period of one year (T)?
In pregnant women with gestational hypertension (P), does bed rest (I) compared to regular activity (C) reduce the risk of developing preeclampsia (O) before delivery (T)?
In patients with chronic kidney disease (P), does angiotensin-converting enzyme inhibitors (I) compared to placebo (C) slow the progression of renal disease (O) over a period of two years (T)?
In older adults with hip fractures (P), does early surgical intervention (I) compared to delayed surgery (C) improve functional outcomes (O) after six months (T)?
In patients with major depressive disorder (P), does exercise (I) compared to antidepressant medication (C) reduce depressive symptoms (O) after eight weeks (T)?
In children with autism spectrum disorder (P), does applied behavior analysis (I) compared to standard therapy (C) improve social communication skills (O) over a period of one year (T)?
In postoperative patients (P), does the use of incentive spirometry (I) compared to no spirometry (C) decrease the incidence of postoperative pulmonary complications (O) within seven days (T)?
In patients with hypertension (P), does a combination of diet modification and exercise (I) compared to medication alone (C) lower blood pressure (O) after six months (T)?
In patients with chronic obstructive pulmonary disease (P), does home oxygen therapy (I) compared to no oxygen therapy (C) improve exercise capacity (O) after threemonths (T)?
In patients with heart failure (P), does a multidisciplinary heart failure management program (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
In postpartum women with postnatal depression (P), does mindfulness meditation (I) compared to relaxation techniques (C) reduce depressive symptoms (O) after eight weeks (T)?
In patients with chronic kidney disease (P), does a low-sodium diet (I) compared to a regular diet (C) lower blood pressure (O) after six months (T)?
In pediatric patients with attention-deficit/hyperactivity disorder (P), does neurofeedback training (I) compared to medication (C) improve attention and behavior (O) after six months (T)?
In patients with chronic pain (P), does transcranial direct current stimulation (I) compared to sham stimulation (C) reduce pain intensity (O) after eight weeks (T)?
In older adults with osteoporosis (P), does a structured exercise program (I) compared to no exercise (C) improve bone mineral density (O) after six months (T)?
In patients with type 2 diabetes (P), does a low-carbohydrate, high-protein diet (I) compared to a standard diet (C) improve glycemic control (O) over a period of six months (T)?
In patients with chronic obstructive pulmonary disease (P), does mindfulness-based stress reduction (I) compared to usual care (C) improve dyspnea symptoms (O) after three months (T)?
In postpartum women with postnatal depression (P), does online peer support (I) compared to individual therapy (C) reduce depressive symptoms (O) after eight weeks (T)?
In patients with chronic kidney disease (P), does resistance training (I) compared to aerobic training (C) improve muscle strength (O) after six months (T)?
In pediatric patients with asthma (P), does a written asthma action plan (I) compared to verbal instructions (C) reduce emergency department visits (O) within six months (T)?
In patients with chronic pain (P), does yoga (I) compared to pharmacological treatment (C) reduce pain interference (O) after eight weeks (T)?
In older adults at risk of falls (P), does a multifactorial falls prevention program (I) compared to no intervention (C) reduce the rate of falls (O) over a period of six months (T)?
In patients with schizophrenia (P), does cognitive-behavioral therapy (I) compared to medication alone (C) reduce positive symptom severity (O) after six months (T)?
In postpartum women with breastfeeding difficulties (P), does breast massage (I) compared to no massage (C) improve milk flow (O) after four weeks (T)?
In patients with chronic obstructive pulmonary disease (P), does long-term oxygen therapy (I) compared to short-term oxygen therapy (C) improve survival rates (O) after one year (T)?
In patients with major depressive disorder (P), does repetitive transcranial magnetic stimulation (I) compared to sham treatment (C) reduce depressive symptoms (O) after six weeks (T)?
In patients with diabetes (P), does a digital health app (I) compared to standard care (C) improve medication adherence (O) over a period of six months (T)?
In patients with chronic kidney disease (P), does a low-potassium diet (I) compared to a regular diet (C) lower serum potassium levels (O) after one year (T)?
In pediatric patients with acute gastroenteritis (P), does oral rehydration solution (I) compared to intravenous fluid therapy (C) reduce hospital admissions (O) within 48 hours (T)?
In patients with chronic pain (P), does hypnotherapy (I) compared to no hypnotherapy (C) reduce pain intensity (O) after eight weeks (T)?
In older adults at risk of falls (P), does a tai chi program (I) compared to no exercise program (C) improve balance and stability (O) after six months (T)?
In patients with chronic heart failure (P), does a home-based self-care intervention (I) compared to standard care (C) reduce hospital readmissions (O) within six months (T)?
In patients with anxiety disorders (P), does acceptance and commitment therapy (I) compared to cognitive-behavioral therapy (C) reduce anxiety symptoms (O) after 12 weeks (T)?
In postpartum women with breastfeeding difficulties (P), does the use of nipple shields (I) compared to no nipple shields (C) improve breastfeeding success (O) after four weeks (T)?
In patients with chronic obstructive pulmonary disease (P), does a comprehensive self-management program (I) compared to usual care (C) improve health-related quality of life (O) after three months (T)?
In patients with major depressive disorder (P), does internet-based cognitive-behavioral therapy (I) compared to face-to-face therapy (C) reduce depressive symptoms (O) after eight weeks (T)?
Does the increase in the habit of smoking marijuana among Dutch students increase the likelihood of depression?
Does the use of pain relief medication during surgery provide more effective pain reduction compared to the same medication given post-surgery?
Does the increase in the intake of oral contraceptives increase the risk of breast cancer among women aged 20-30 in the UK?
Does the habit of washing hands among healthcare workers decrease the rate of infections in hospitals?
Does the use of modern syringes help in reducing needle injuries among healthcare workers in America?
Does encouraging male work colleagues to talk about sexual harassment decrease the rate of depression in the workplace?
Does bullying in boarding schools in Scotland increase the likelihood of domestic violence within a 20-year timeframe?
Does breastfeeding among toddlers in urban United States decrease their chances of obesity as pre-schoolers?
Does the increase in the intake of antidepressants among urban women aged 30 years and older affect their maternal health?
Does forming work groups to discuss domestic violence among the rural population of the United States reduce stress and depression among women?
Does the increased use of mosquito nets in Uganda help in reducing malaria cases among infants?
Can colon cancer be more effectively detected when colonoscopy is supported by an occult blood test compared to colonoscopy alone?
Does regular usage of low-dose aspirin effectively reduce the risk of heart attacks and stroke for women above the age of 80 years?
Is yoga an effective medical therapy for reducing lymphedema in patients recovering from neck cancer?
Does daily blood pressure monitoring help in addressing the triggers of hypertension among males over 65 years?
Does a regular 30-minute exercise regimen effectively reduce the risk of heart disease in adults over 65 years?
Does prolonged exposure to chemotherapy increase the risk of cardiovascular diseases among teenagers suffering from cancer?
Does breastfeeding among toddlers in the urban United States decrease their chances of obesity as pre-schoolers?
Are first-time mothers giving birth to premature babies more prone to postpartum depression compared to second or third-time mothers in the same condition?
For women under the age of 50 years, is a yearly mammogram more effective in preventing breast cancer compared to a mammogram done every 3 years?
After being diagnosed with blood sugar levels, is a four-times-a-day blood glucose monitoring process more effective in controlling the onset of Type 1 diabetes?

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Home / NCLEX-RN Practice Test Questions

NCLEX-RN Practice Test Questions

You've learned about the NCLEX-RN exam, studied the sections, and are ready to put your knowledge to the test. Take our practice NCLEX exam below to get ready for the real deal.

Jump to Section

Click on the section names below to jump to a particular section of the RegisteredNursing.org NCLEX-RN Practice Exam.

The Safe and Effective Care Environment: The Management of Care
The Safe and Effective Care Environment: Safety and Infection Control
Health Promotion and Maintenance
Psychosocial Integrity
Physiological Integrity: Basic Care and Comfort
Physiological Integrity: Pharmacological and Parenteral Therapies
Physiological Integrity: Reduction of Risk Potential
Physiological Integrity: Physiological Adaptation

The NCLEX-RN Test Plan is organized into four major Client Needs categories. Two of the four categories are divided into subcategories as shown below:

Management of Care – 17% to 23%
Safety and Infection Control – 9% to 15%
Health Promotion and Maintenance – 6% to 12%
Psychosocial Integrity – 6% to 12%
Basic Care and Comfort – 6% to 12%
Pharmacological and Parenteral Therapies – 12% to 18%
Reduction of Risk Potential – 9% to 15%
Physiological Adaptation – 11% to 17%

For more practice test questions from professional sources try these .

The Safe & Effective Care Environment: The Management of Care Practice Questions

You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions.

You should be aware of the fact that the wife of the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need.
You should be aware of the fact that the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need.
You should reinforce the wife’s belief that legally married spouses automatically serve for the other spouse’s durable power of attorney for health care decisions and that others than the spouse cannot be legally appointed while people are married

Correct Response: A

Both the client and the client’s spouse have knowledge deficits relating to advance directives. Legally married spouses do not automatically serve for the other spouse’s durable power of attorney for health care decisions; others than the spouse can be legally appointed while people are married.

Privacy and to have their medical information confidential unless the client formally approves the sharing of this information with others such as family members.
Make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so.
Be fully informed about all treatments in term of their benefits, risks and alternatives to them so the client can make a knowledgeable and informed decision about whether or not to agree to having it
Make decisions about who their health care provider is without any coercion or undue influence of others including healthcare providers.

Correct Response: B,D

The Patient Self Determination Act, which was passed by the US Congress in 1990, gives Americans the right to make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. These decisions can also include rejections for future care and treatment and these decisions are reflect in advance directives. This Act also supports the rights of the client to be free of any coercion or any undue influence of others including healthcare providers.

The Health Insurance Portability and Accountability Act (HIPAA) supports and upholds the clients’ rights to confidentially and the privacy of their medical related information regardless of its form. It covers hard copy and electronic medical records unless the client has formally approved the sharing of this information with others such as family members.

The elements of informed consent which includes information about possible treatments and procedures in terms of their benefits, risks and alternatives to them so the client can make a knowledgeable and informed decision about whether or not to agree to having it may be part of these advanced directives, but the law that protects these advance directives is the Patient Self Determination Act.

Call the doctor and advise them that the client’s physical status has significantly changed and that they have just had a cardiopulmonary arrest.
Begin cardiopulmonary resuscitation other emergency life saving measures.
Notify the family of the client’s condition and ask them what they should be done for the client.
Insure that the client is without any distressing signs and symptoms at the end of life.

Correct Response: B

You must immediately begin cardiopulmonary resuscitation and all life saving measures as requested.by the client in their advance directive despite the nurse’s own beliefs and professional opinions. Nurses must uphold the client’s right to accept, choose and reject any and all of treatments, as stated in the client’s advance directive.

You would not call the doctor first; your priority is the sustaining of the client’s life; you would also not immediately notify the family for the same reason and, when you do communicate with the family at a later time, you would not ask them what should or should not be done for the client when they wishes are already contained in the client’s advance directive.

Finally, you would also insure that the client is without pain and all other distressing signs and symptoms at the end of life, but the priority and the first thing that you would do is immediately begin cardiopulmonary resuscitation and all life saving measures as requested by the client in their advance directive, according to the ABCs and Maslow’s Hierarchy of Needs.

Case manager
Collaborator
Coordinator of care

Correct Response: D

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

Client advocate
Entrepreneur

A nurse who organizes and establishes a political action committee (PAC) in their local community to address issues relating to the accessibility and affordability of healthcare resources in the community is serving as the client advocate. As you should know, the definition of “client” includes not only individual clients, and families as a unit, but also populations such as the members of the local community.

Although the nurse, as the organizer of this political action committee (PAC), will have to collaborate with members of the community to promote the accessibility and affordability of healthcare resources in the community, this is a secondary role rather than the primary role.

Additionally, although the nurse is serving in a political advocacy effort, the nurse is not necessarily a politician and there is no evidence that this nurse is an entrepreneur.

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

The Five Rights of Delegation include the right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback.

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

The American Nurses Association’s Scopes of Practice
The American Nurses Association’s Standards of Care
State statutes
Federal law

Correct Response: C

The registered nurse, prior to the delegation of tasks to other members of the nursing care team, evaluates the ability of staff members to perform assigned tasks for the position as based on state statutes that differentiate among the different types of nurses and unlicensed assistive personnel that are legally able to perform different tasks.

Although the American Nurses Association’s Standards of Care guide nursing practice, these standards are professional rather than legal standards and the American Nurses Association does not have American Nurses Association’s Scopes of Practice, only the states’ laws or statutes do.

Lastly, scopes of practice are within the legal domain of the states and not the federal government.

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

The best way to objectively evaluate the effectiveness of an individual staff member’s time management skills in a longitudinal manner is to collect outcome data over time, and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty. Another way to perform this longitudinal evaluation is to look at the staff member’s use of over time, like the last six months, when the unit was adequately staffed.

Observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities is a way to evaluate the short term abilities for establishing priorities and not assignment completion and observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks is a way to evaluate the short term abilities for completing established priorities and not a complete assignment which also includes tasks that are not of the highest priority.

Lastly, asking the staff member how they feel like they have been able to employ their time management skills for the last six months is the use of subjective rather than objective evaluation.

An unlicensed staff member who has been “certified” by the employing agency to monitor telemetry: Monitoring cardiac telemetry
An unlicensed assistive staff member like a nursing assistant who has been “certified” by the employing agency to insert a urinary catheter: Inserting a urinary catheter
A licensed practical nurse: The circulating nurse in the perioperative area
A licensed practical nurse: The first assistant in the perioperative area

An unlicensed staff member who has been “certified” by the employing agency to monitor telemetry can monitor cardiac telemetry; they cannot, however, interpret these cardiac rhythms and initiate interventions when interventions are indicated. Only the nurse can perform these roles.

Unlicensed assistive staff member like a nursing assistant cannot under any circumstances be certified” by the employing agency to insert a urinary catheter or insert a urinary catheter because this is a sterile procedure and, legally, no sterile procedures can be done by an unlicensed assistive staff member like a nursing assistant.

Lastly, the role of the circulating nurse is within the exclusive scope of practice for the registered nurse and the role of the first assistant is assumed only by a registered nurse with the advanced training and education necessary to perform competently in this capacity. Neither of these roles can be delegated to a licensed practical nurse or an unlicensed assistive staff member like a nursing assistant or a surgical technician.

Only the VA health care services because he is not 65 years of age
Medicare because he has been deemed permanently disabled for 2 years
Medicaid because he is permanently disabled and not able to work
Choices B and C

This client is legally eligible for Medicare because he has been deemed permanently disabled for more than 2 years in addition to the VA health care services. People over the age of 65 and those who are permanently disabled for at least two years, according to the Social Security Administration, are eligible for Medicare.

Based on the information in this scenario, the client is not eligible for Medicaid because has a “substantial” VA disability check on a monthly basis and is not indigent and with a low income.

The case manager’s role in terms of organization wide performance improvement activities
The case manager’s role in terms complete, timely and accurate documentation
The case manager’s role in terms of the clients’ being at the appropriate level of care
The case manager’s role in terms of contesting denied reimbursements

Registered nurse case managers have a primary case management responsibility associated with reimbursement because they are responsible for insuring that the client is being cared for at the appropriate level of care along the continuum of care that is consistent with medical necessity and the client’s current needs. A failure to insure the appropriate level of care jeopardizes reimbursement. For example, care in an acute care facility will not be reimbursed when the client’s current needs can be met in a subacute or long term care setting.

Nurse case managers do not have organization wide performance improvement activities, the supervision of complete, timely and accurate documentation or challenging denied reimbursements in their role. These roles and responsibilities are typically assumed by quality assurance/performance improvement, supervisory staff and medical billers, respectively.

The ProACT Model: Registered nurses perform the role of the primary nurse in addition to the related coding and billing functions
The Collaborative Practice Model: The registered nurse performs the role of the primary nurse in addition to the role of the clinical case manager with administrative, supervisory and fiscal responsibilities
The Case Manager Model: The management and coordination of care for clients throughout a facility who share the same DRG or medical diagnosis
The Triad Model of Case Management: The joint collaboration of the social worker, the nursing case manager, and the utilization review team

The Triad Model of case management entails the joint collaboration of the social worker, the nursing case manager, and the utilization review team.

The Professionally Advanced Care Team, referred to as the ProACT Model, which was developed at the Robert Wood Johnson University Hospital, entails registered nurses serving in the role of both the primary nurse the clinical case manager with no billing and coding responsibilities; these highly specialized and technical billing and coding responsibilities are done by the business office, medical billers and medical coders.

The Case Manager Model entails the registered nurses’ role in terms of case management for a particular nursing care unit for a group of clients with the same medical diagnosis or DRG. In contrast to this Case Manager Model of Beth Israel Hospital, the Collaborative Practice Model of case management entails the role of some registered nurses in a particular healthcare facility to manage, coordinate, guide and direct the complex care of a population of clients throughout the entire healthcare facility who share a particular diagnosis or Diagnostic Related Group.

The Case Manager Model
The ProACT Model
The Collaborative Practice Model
The Triad Model of Case Management

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

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

An opt out consent
An implicit consent
An explicit consent
No consent at all is given

The type of legal consent that is indirectly given by the client by the very nature of their voluntary acute care hospitalization is an implicit consent indirectly given by the client by the very nature of their voluntary acute care hospitalization is an implicit consent.

An explicit consent, on the other hand, is the direct and formal consent of the client; and an opt out consent is given when a patient does NOT refuse a treatment; this lack of objections by the patient indicates that the person has consented to the treatment or procedure with an opt out consent.

Take the photographs because these photographs are part of the holiday tradition at this facility
Take the photographs because all of the residents are properly attired and in a dignified condition
Refuse to take the photographs unless you have the consent of all to do so
Refuse to take the photographs because this is not part of the nurse’s role

You should refuse to take the photographs unless you have the consent of all to do so because to do otherwise is a violation of the residents’ rights to privacy and confidentiality as provided in the Health Insurance Portability and Accountability Act (HIPAA). This, rather than the false belief that this is not part of the nurse’s role, is the reason that you would not automatically take these photographs.

Regardless of whether or not these photographs are part of the holiday tradition at this facility and whether or not the residents are properly attired and in a dignified condition, no photographs can be legally taken without the residents’ permission and consent.

The Patient Self Determination Act: The client’s right to choose the level of care
The Patient Self Determination Act: The clients’ right to healthcare insurance coverage for mental health disorders
The Mental Health Parity Act: The privacy and security of technological psychiatric information
The Health Insurance Portability and Accountability Act (HIPAA): The privacy and security of technological medical information

The Health Insurance Portability and Accountability Act (HIPAA) protects the client’s legal rights to the privacy, security and confidentiality of all medical information including data and information that is technologically stored and secured.

The Patient Self Determination Act uphold the client’s right to choose and reject care and not the level of care that is driven and decided upon as based on medical necessity and health insurance reimbursement; this Act also does not give client’s the right to any health insurance including healthcare insurance coverage for mental health disorders.

Lastly, the Mental Health Parity and Addiction Equality Act, passed in 2008, mandates insurance coverage for mental health and psychiatric health services in a manner similar to medical and surgical insurance coverage; it does not protect the privacy and security of technological psychiatric information, HIPAA does.

The physical therapist
The occupational therapist
The podiatrist
The nurse practitioner

The member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait is a physical therapist. Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient’s functional abilities in terms of their gait, strength, mobility, balance, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens.

Occupational therapists assess, plan, implement and evaluate interventions including those that facilitate the patient’s ability to achieve their highest possible level of independence in terms of their activities of daily living such as bathing, grooming, eating and dressing.

Podiatrists care for disorders and diseases of the foot; and nurse practitioners, depending on their area of specialty, may also collaborate with nurses when a client is affected with a disorder in terms of gait, strength, mobility, balance, coordination, and joint range of motion, however the member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait is a physical therapist.

The dietician

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

Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient’s functional abilities in terms of their gait, strength, mobility, balance, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens.

Dieticians assess, plan, implement and evaluate interventions including those relating to dietary needs of those patients who need regular or therapeutic diets. They also provide dietary education and work with other members of the healthcare need when a client has dietary needs secondary to physical disorders such as dysphagia; and podiatrists care for disorders and diseases of the foot.

To fulfill the nurse’s role in terms of collaboration
To plan and provide for optimal client outcomes
To solve complex multidisciplinary patient care problems
To provide educational experiences for experienced nurses

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

A Pedorthist
A pediatric nurse practitioner
A trauma certified clinical nurse specialist
A prosthetist

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

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

Conceptualization conflicts
Avoidance - Avoidance conflicts
Approach - Approach conflicts
Resolvable conflicts
Unresolvable conflicts
Double Approach - Avoidance conflicts
Approach-Avoidance conflicts

Correct Response: B, C, F, G

According to Lewin, the types of conflict are Avoidance-Avoidance conflicts, Approach- Approach conflicts, Double Approach - Avoidance conflicts and Approach-Avoidance conflicts.

Frustration: The phase of conflict that is characterized with personal agendas and obstruction
Conceptualization: The phase of conflict that occurs when contending parties have developed a clear and objective understanding of the nature of the conflict and factors that have led to it
Taking action: The phase of conflict that is characterized with individual responses to and feelings about the conflict
Resolution: The type of conflict that can be resolved
Avoidance-Avoidance: A stage of conflict that occurs when there are NO alternatives that are acceptable to the contending parties
Approach- Approach Conflicts: The type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict.
Approach-Avoidance Conflicts: The type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory nor completely dissatisfactory.

Correct Response: C, F, G

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

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

Competition
Accommodating Others

Conflicts can be effectively resolved using a number of different strategies and techniques such as compromise, negotiation, and mediation.

Avoidance of the conflict, withdrawing in addition to other passivity, competition, and accommodating others are not effective and healthy conflict resolution techniques.

Conceptualization
Frustration
Taking action

Correct Response: B, A, D, C

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

The Patient Self Determination Act
The Mental Health Parity Act
The Health Insurance Portability and Accountability Act
The Americans with Disabilities Act of 1990

The federal law is most closely associated with the highly restrictive “need to know” is the Health Insurance Portability and Accountability Act. This law restricts access to medical information to only those persons who have the need to know this information in order to provide direct and/or indirect care to the client.

The Mental Health Parity Act passed in 2008, mandates insurance coverage for mental health and psychiatric health services in a manner similar to medical and surgical insurance coverage.

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

The facility’s Performance Improvement Director who is not a healthcare person and who has no direct contact with clients
A nursing student who is caring for a client under the supervision of the nursing instructor
The facility’s Safety Officer who is not a healthcare person and who has no direct contact with clients
A department supervisor with no direct or indirect care duties

A department supervisor with no direct or indirect care duties does not have the “right to know” medical information; all of the others have the “right to know” medical information because they provide direct or indirect care to clients.

For example, both the facility’s Performance Improvement Director who is not a healthcare person and who has no direct contact with clients and the facility’s Safety Officer who is not a healthcare person and who has no direct contact with clients provide indirect care to clients. For example, they collect and analyze client data in order to fulfill their role and responsibilities in terms of process improvements and the prevention of incidents and accidents, respectively.

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

“A computer in the hallway was left unattended and a client’s medical record was visible to me.”
“I just saw a nursing student looking at the medical record for a client that they are NOT caring for during this clinical experience.”
“As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians’ progress notes.”
“I refused the nursing supervisor’s request to share my electronic password for the new nurse on the unit.”

A staff members comment, “As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians’ progress notes” “indicates the need for the Nurse Manager to provide an educational activity relating to confidentiality and information security because dieticians often have the “need to know” about laboratory data so that they can, for example, assess the client’s nutritional status in terms of their creatinine levels.

The report that the nursing student was “looking at the medical record for a client that they are NOT caring for during this clinical experience” indicates that the reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; the report that a “computer in the hallway was left unattended and a client’s medical record was visible to me” indicates that the reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; and lastly, “I refused the nursing supervisor’s request to share my electronic password for the new nurse on the unit” also indicates that the staff member is knowledgeable about privacy and confidentiality.

Case management
Continuity of care
Medical necessity
Critical pathway

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

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

The Four P's

The standardized “hand off” change of shift reporting system that you may want to consider for implementation on your nursing care unit is ISBAR. Other standardized change of shift “hand off” reports, as recommended by the Joint Commission on the Accreditation of Healthcare Organization, include:

SBAR, not IBAR
The Five Ps not the Four Ps and

Lastly, MAUUAR is a method of priority setting and not a standardized “hand off” change of shift reporting system.

SBAR: Symptoms, background, assessment and recommendations
ISBAR: Interventions, symptoms, background, assessment and recommendations
The Five Ps: The patient, plan, purpose, problems and precautions
BATON: Background, assessment, timing, ownership and next plans

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

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

SBAR stands for:

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

ISBAR stands for:

I: Introduction: The introduction of the nurse, the nurse’s role in care and the area or department that you are from
R: Recommendations: All unresolved issues including things like pending diagnostic testing results and what has to be done over the next few hours

BATON stands for:

B: Background: Past and current medical history, including medications
A: Actions: What actions were taken and/or those actions that are currently required
T: Timing: Priorities and level of urgency
O: Ownership: Who is responsible for what? and
N: Next: The future plan of care

IPASS stands for:

I ntroduction: The introduction of the nurse, the nurse’s role in care and the area or department that you are from
P: Patient: The patient’s name, age, gender, location and other demographic data
A: Assessment: The current assessment of the situation and the patient’s status
S: Situation: The patient’s diagnosis, complaint, plan of care and the patient's prioritized needs and
S: Safety concerns: Physical, mental and social risks and concerns
Atrial fibrillation
First degree heart block
Shortness of breath upon exertion
An obstructed airway
Fluid needs
Respect and esteem by others
3,4,2,1,5,6
3,4,5,1,2,6
2,3,5,1,4,6
3,2,4,1,5,6

Correct Response:

Client needs are prioritized in a number of different ways including Maslow’s Hierarchy of Human Needs and the ABCs. In terms of priorities from # 1 to # 6 the conditions above are prioritized as follows:

The ABCs identifies the airway, breathing and cardiovascular status of the patient as the highest of all priorities in that sequential order; and Maslow’s Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others and the self-actualization needs in that order of priority.

Understanding level

One of the 2 nd priority needs according to the MAAUAR method of priority setting is risks.

The ABCs / MAAUAR method of priority setting places the ABCs, again, as the highest and greatest priorities which are then followed with the 2 nd and 3 rd priority level needs of the MAAUAR method of priority setting.

The 2 nd priority needs according to the MAAUAR method of priority setting after the ABCs include M-A-A-U-A-R which stands for:

M ental status changes and alterations
A cute pain
A cute urinary elimination concerns
U naddressed and untreated problems that require immediate priority attention
A bnormal laboratory and other diagnostic data that are outside of normal limits and
R isks including those relating to a healthcare problem like safety, skin breakdown, infection and other medical conditions

The 3 rd level priorities include all concerns and problems that are NOT covered under the 2 nd level priority needs and the ABCs. For example, increased levels of self care abilities and skills and enhanced knowledge of a medical condition are considered 2 nd level priority needs.

Time management skills
Communication skills
Collaboration skills
Supervision skills

Time management skills are most closely related to successfully meeting the established priority needs of a group of clients.

In addition to prioritizing and reprioritizing, the nurse should also have a plan of action to effectively manage their time; they should avoid unnecessary interruptions, time wasters and helping others when this helping others could potentially jeopardize their own priorities of care.

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

Client rights

Morals are most closely aligned with ethics. Ethics is a set of beliefs and principles that guide us in terms of the right and wrong thing to do which is the most similar to ethics.

Laws and statutes defined what things are legal and what things are illegal. Lastly, client rights can serve as a factor to consider when ethical decisions are made; but they are not most closely aligned with ethics, but only, one consideration of many that can be used in ethical decision making.

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

The two major classifications of ethical principles and ethical thought are utilitarianism and deontology. Deontology is the ethical school of thought that requires that both the means and the end goal must be moral and ethical; and the utilitarian school of ethical thought states that the end goal justifies the means even when the means are not moral.

Justice: Equally dividing time and other resources among a group of clients
Beneficence: Doing no harm during the course of nursing care
Veracity: Fully answering the client’s questions without any withholding of information
Fidelity: Upholding the American Nurses Association’s Code of Ethics

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

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

Planning a way to evaluate the effectiveness of the class by seeing a decrease in the amount of referrals to the facility’s Ethics Committee
Establishing educational objectives for the class that reflect the methods and methodology that you will use to present the class content
The need to exclude case studies from the class because this would violate client privacy and confidentiality
Some of the most commonly occurring bioethical concerns including genetic engineering into the course content

You would consider including some of the most commonly occurring bioethical concerns including genetic engineering into the course content.

You would also plan how you could evaluate the effectiveness of the class by seeing an increase, not a decrease in the amount of referrals to the facility’s Ethics Committee, because one of the elements of this class should address ethical dilemmas and the role of the Ethics Committee in terms of resolving these.

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

Serve as the witness to the client’s signature on an informed consent.
Get and witness the client’s signature on an informed consent.
Get and witness the durable power of attorney for health care decisions’ signature on an informed consent.
None of the above

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

Other roles and responsibilities of the registered nurse in terms of informed consent include identifying the appropriate person to provide informed consent for client, such as the client, parent or legal guardian, to provide written materials in client’s spoken language, when possible, to know and apply the components of informed consent, and to also verify that the client comprehends and consents to care and procedures.

The registered nurse does not get the client’s or durable power of attorney for health care decisions’ signature on an informed consent, this is the role and responsibility of the physician or another licensed independent practitioner.

Self determination
Nonmalficence

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

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

The purpose of the proposed treatment or procedure
The expected outcomes of the proposed treatment or procedure
Who will perform the treatment or procedure
When the procedure or treatment will be done

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

Other essential elements include:

The benefits of the proposed treatment or procedure
The possible risks associated with the proposed treatment or procedure
The alternatives to the particular treatment or procedure
The benefits and risks associated with alternatives to the proposed treatment or procedure
The client’s right to refuse a proposed treatment or procedure
The Security Rule
The American Nurses Association’s Code of Ethics
The American Hospital’s Patients’ Bill of Rights
The Autonomy Rule

Prohibitions against sharing passwords are legally based on the Security Rule of HIPAA mandates administrative, physical, and technical safeguards to insure the confidentiality, integrity, and availability of electronic protected health information. This rule relates to electronic information security as well as other forms of information.

The American Nurses Association’s Code of Ethics and the American Hospital’s Patients’ Bill of Rights both address client confidentiality and their rights to privacy, however, these statements are not legal, but instead ethical and regulatory statements; and lastly, there is no autonomy law or rule.

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

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

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

Assault: Touching a person without their consent
Battery: Threatening to touch a person without their consent
Slander: False oral defamatory statements.
Slander: False written defamatory statements.

Slander is false oral defamatory statements; and libel is written defamation of character using false statements.

Assault, an intentional tort, is threatening to touch a person without their consent; and battery, another intentional tort, is touching a person without their consent.

Ensured the client’s safety which is a high patient care priority
Violated Respondeat Superior
Violated the client’s right to dignity
Committed a crime

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

Respondeat Superior is the legal doctrine or principle that states that employers are legally responsible for the acts and behaviors of its employees. Respondeat Superior does not, however, relieve the nurse of legal responsibility and accountability for their actions. They remain liable.

There is no evidence in this question that you have violated the client’s right to dignity.

Respondeat Superior does not mean that a nurse cannot be held liable.
Respondeat Superior does not mean that a nurse cannot be held libel.
Respondeat Superior is an ethical principle.
Respondeat Superior is a law.

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

Respondeat Superior is the legal doctrine or principle and not a law or ethical principle.

Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct rather than indirect harm to the client.
Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client.
Causation, correlation, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client.
Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and a medical license.

The six essential components of malpractice include causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and, lastly, this breach of duty led to direct and/or indirect harm to the client.

A medical license is not necessary; nurses and other healthcare professionals can be found guilty of malpractice. Lastly, correlation is the relationship of simultaneously changing variables. For example, a ppositive correlation exists when the two variables both increase or decrease; and a negative occurs when one variable increases and the other decreases.

Sound structures like policies and procedures
Processes and how they are being done
Optimal client outcomes
Optimal staff performance

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

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

An adverse event
A root cause
A healthcare acquired event
A sentinel event

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

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

Discover a process flaw
Determine who erred
Discover environmental hazards
Determine basic client needs

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

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

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

Historical data and performance improvement activities focus on current data.
Current data and performance improvement activities focus on historical data.
Decreasing financial liability and performance improvement activities focus on process improvements.
Decreasing falls and performance improvement activities focus on process improvements.

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

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

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

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

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

The Safe & Effective Care Environment: Safety & Infection Control Practice Questions

The sensitizing dose of penicillin can lead to anaphylaxis.
The second dose of penicillin can lead to distributive shock.
You should be aware of the fact that about 10% of the population has an allergy to both penicillin and latex.
You should be aware of the fact that about 20% of the population has an allergy to both penicillin and latex.

The second dose of penicillin can lead to anaphylactic shock which is a form of distributive shock.

The first exposure to penicillin, referred to as the “sensitizing dose”, sensitizes and prepares the body to respond to a second exposure or dose. It is then the second exposure or dose that leads to anaphylaxis, or anaphylactic shock.

It is estimated that approximately 10% of people have had a reaction to penicillin. Some of these reactions are an allergic response and others are simply a troublesome side effect. There is no scientific data that indicates that 10% or 20% of the population has an allergy to both penicillin and latex.

A 77 year old female client in a client room that has low glare floors.
An 87 year old female client in a client room that has low glare floors.
A 27 year old sedated male client.
A 37 year old male client with impaired renal perfusion.

The 27 year old sedated male client is at greatest risk for falls.

Some of the risk factors associated with falls are sedating medications, high glare, not low glare, floors and other environmental factors such as clutter and scatter rugs, not low glare floors, a history of prior falls, a fear of falling, incontinence, confusion, sensory deficits, a decreased level of consciousness, impaired reaction time, advancing age, poor muscular strength, balance, coordination, gait and range of motion and some physical disorders, particularly those that affect the musculoskeletal or neurological systems; falls are not associated with poor and impaired renal perfusion.

The nurse should advise clients in a smoke filled room to open the windows.
The first thing that the nurse should do when using a fire extinguisher to put out a small fire is to aim the fire extinguisher at the base of the fire.
Rapidly lift and move a client away from the source of the fire when their slippers are on fire.
The home health care nurse should advise the client that the best fire extinguisher to have in the home is an ABC fire extinguisher.

The home health care nurse should advise the client that the best fire extinguisher to have in the home is an ABC fire extinguisher because this one fire extinguisher is a combination of a type A fire extinguisher, a type B and a type C, which put out all types of fires including common household solids like wood, household oils like kitchen grease and electrical fires.

The nurse should advise the client GET LOW AND GO if a room fills with smoke. They should not take any time to open window.

The first thing to do when using a fire extinguisher is to pull the pin and then aim it at the base of the fire. Later, you would squeeze the trigger and sweep the spray over and over again over the base of the fire. The acronym PASS is used to remember these sequential steps.

When a person has clothing that has caught on fire, the person should STOP, DROP AND ROLL. Tell the person, to STOP, DROP, and to not run, and as you also cover the person with a blanket to smother the fire.

A tornado that has touched down on the healthcare facility
A severe cyclone that has destroyed nearby homes
A massive train accident that brings victims to your facility
An act of bioterrorism in a nearby factory

A tornado that has touched down on the healthcare facility is an example of an internal disaster because this tornado has directly affected the healthcare facility. Tornados, cyclones, hurricanes and other severe weather emergencies can be both an internal disaster when they affect the healthcare facility and also an external disaster when they impact on the lives of those living in the community. Hurricane Katrina is a good example of a weather emergency that affected not only healthcare facilities but also members of the community.

Use a slide board.
Use a mechanical lift.
Use a gait belt.
Notify the client's doctor that the client cannot be safely transferred by you.

The best and safest way to transfer this paralyzed client when you suspect that you will need the help of another for the client’s first transfer out of bed is to use a mechanical lift. It is not necessary or appropriate to notify the doctor.

Mechanical lifts are used mostly for patients who are obese and cannot be safely moved or transferred by two people, and also for patients who are, for one reason or another, not able to provide any help or assistance with their lifts and transfers, such as a person who is paralyzed.

A gait or transfer belt and slide boards are assistive devices that can be used to assist with transfers and lifting however, they are not appropriate for this client as based on your assessment.

Advise the nurse that the legs must be close together for stability during lifting and transfers.
Advise the nurse that the legs should be one in front of the other and not spread apart during a transfer.
Validate the nurse’s competency in terms of the application of body mechanics principles during a transfer.
Validate the nurse’s competency in terms of the application of ergonomics principles during a transfer.

You should validate the nurse’s competency in terms of the application of body mechanics principles during a transfer because the nurse had spread her legs apart during the transfer to provide a wide base of support, which is a basic principle of body mechanics and not ergonomics.

Simply defined ergonomics addresses correct bodily alignment such as the lumbar curve accommodation in an ergonomically designed chair; and body mechanics is the safe use of the body using the correct posture, bodily alignment, balance and bodily movements to safely bend, carry, lift and move objects and people.

The client has refrigerated foods labelled with an expiration date.
You assess that the home is free of scatter rugs that many use to protect the feet against hard floors.
The client uses the FIFO method for insuring food safety.
The client assures you that the smoke alarm batteries are replaced annually to insure that they work.

When the client assures the nurse that they replace their smoke alarm batteries annually to insure that they work, the assessing nurse should immediately know that the client is in need of education relating to the fact that smoke alarm batteries should be changed at least twice a year.

The client has demonstrated that they are knowledgeable about food safety and environmental safety because they have expiration dates on refrigerated foods, they use the FIFO method for food safety and they do not use scatter rugs which can lead to falls.

The FIFO rule is F irst I n is F irst O ut. In other words, the first foods in the pantry or refrigerator are the first foods that should be consumed or discarded.

It is clear?
It is damaging to the lungs.
It is damaging to the spleen and the liver.
It leads to the over production of hemoglobin.

Carbon monoxide is particularly dangerous because it is clear, invisible and odorless. Carbon monoxide poisoning can occur when a person is exposed to an excessive amount of this odorless and colorless gas; it severely impairs the body to absorb life sustaining oxygen which is the result of this deadly gas and not damage to the lungs. This oxygen absorption deficit can lead to serious tissue damage and death. For these reasons, home carbon monoxide alarms are recommended.

These dangers are associated with deoxygenation and not splenic or hepatic damage or the over production of hemoglobin.

Sentinel event.
System variance.
Adverse effect.
Provider variance.

The lack of necessary supplies and equipment to adequately and safely care for patients is an example of a system variance.

A variance is defined as a deviation that leads to a quality defect or problem. Variances can be classified as a practitioner variance, a system/institutional variance, a patient variance, a random variance and a specific variance.

A sentinel event is defined as is an event or occurrence, incident or accident that has led to or may possibly lead to client harm. Adverse effects are serious and unanticipated responses to interventions and treatments, including things like medications.

Notify the doctor.
Render care.
Assess the cleint.
Notify the nurse manager.

The first thing that you should do immediately after a client accident is to assess the client and the second thing you should do is render care after this assessment and not before it.

Lastly, notifications to the doctor and the nurse manager are only done after the client is assessed and emergency care, if any, is rendered.

Counsel the staff about their need to stop wasting the resources of this department.
Check the equipment yourself to determine the accuracy of this equipment department.
Ignore it because everyone can make an innocent mistake.
Plan an educational activity about determining what equipment to send for repairs.

You should plan an educational activity about determining what equipment should and should not be sent for repairs. This data suggests that the staff members need education and training about the proper functioning of equipment used on the nursing care unit.

Counseling the staff about their need to stop wasting the resources of this department is placing blame and this blame may prevent future valid returns of equipment.

You should not check the equipment yourself to determine the accuracy of this equipment department because they are the experts, not you, with these matters.

You should also not ignore it because everyone can make an innocent mistake. The issue has to be addressed and corrected.

Education and training on all pieces of equipment
Pilot testing new equipment
Reading all the manufacturer’s instructions
Researching the equipment before recommending its purchase

Education and training on all pieces of equipment is an essential component for insuring that medical equipment is being used safely and properly by those who you supervise. Other essential components include validated and documented competency to use any and all pieces of equipment by a person qualified to do so, preventive maintenance and the prompt removal of all unsafe equipment from service.

Pilot testing new equipment, researching the equipment before recommending its purchase, and reading the entire manufacturer’s instructions are things done prior to the purchase of the equipment and these things do not impact on the safety of the piece of medical equipment.

A possible vulnerability of the facility’s information technology to hacking
The assisted suicide of a client in your facility by the spouse of the client
Vulnerability to computer hacking
Potential information theft

The assisted suicide of a client in your facility by the spouse of the client is a security concern that is also a sentinel event that must be reported.

A possible vulnerability of the facility’s information technology to hacking, vulnerability to computer hacking and potential information theft is security concerns but they are not sentinel events that must be reported.

Training all nurses to serve as a part of a security response team
Training all clerical staff to be a part of a security response team
The restriction of visitors in a special care area
Bar coded client identification bands to insure proper identification

The restriction of visitors in a special care area is an effective security plan that you may want to consider for implementation within your facility.

Some of the other security measures that you may want to consider include security alert systems to alert staff to a security breach such as security breach of the newborn nursery, the use of visitor identification badges or stickers that identify people who are authorized to be in a facility, closed circuit monitoring and alarm systems in high risk areas such as the emergency care area, automatically locking security doors, and electronic wristbands for the newborn and the mother to prevent infant abductions.

Special assignments and training for a group of people so that this specially trained group can act when a security breach occurs is also a good idea but it is not necessary to train all nurses or clerical staff; it is sufficient to train a limited group of people, provided an ample number of these team members are assigned and available on all tours of duty around the clock, including on holidays.

Sterile items ONLY are placed on the sterile field.
The nurse must keep the sterile field below waist level.
Coughing or sneezing over the sterile field contaminates the sterile field.
The nurse must maintain a 1/2 inch border around the sterile field that is not sterile.
Moisture and wetness contaminate the sterile field.
Sterile masks are used by staff and the client when a sterile field is being set up and/or maintained

Correct Response: A, C, E

Sterile items ONLY are placed on the sterile field; coughing or sneezing over the sterile field contaminates the sterile field; and all moisture and wetness contaminate the sterile field.

Some of the other principles that are applied to setting up and maintaining a sterile field include keeping the sterile field above the waist level and preventing coughing or sneezing by professional staff and the client during the set up and during the maintenance of the sterile field. If there is a danger that anyone may cough or sneeze over the field, the professional staff and/or the client should don a mask to prevent contamination. Lastly, a one inch border, not a ½ border that is not sterile is maintained around the perimeter of the sterile field.

A physical restraint: A physical restraint is a manufactured device that is used, when necessary, to prevent falls.
A physical restraint: A physical restraint is any mechanical device, material, or equipment attached to or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body.
A chemical restraint: A chemical restraint is a drug used for sedation to prevent falls.
A chemical restraint: A chemical restraint is a drug used for discipline or convenience and not required to treat medical symptoms.

A chemical restraint: A chemical restraint is a drug used for discipline or convenience and not required to treat medical symptoms, according to the Centers for Medicare and Medicaid Services.

The most complete and accurate definition of a physical restraint is any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s body and is NOT a safety devices that is routinely used for certain procedures, according to the Centers for Medicare and Medicaid Services.

Informed consent for the restraint
The reason for the restraint
The type of restraint to be used
Client behaviors that necessitated the restraints

The minimal components of orders for restraint include the reason for and rationale for the use of the restraint, the type of restraint to be used, how long the restraint can be used, the client behaviors that necessitated the use of the restraints, and any special instructions beyond and above those required by the facility’s policies and procedures.

Informed consent is not necessary for the initiation or the use of restraints

The vascular phase
The prodromal phase
The incubation phase
The initial injury
The exudate phase
The convalescence phase

The stages of the inflammatory process in correct sequential order are:

The initial tissue injury which can result from an infection or a traumatic cause
The vascular response. The release of histamine, prostaglandins and kinins. These substances lead to vasodilation which increases the necessary blood supply to the injured tissue and the area surrounding
The exudate response. The release of leukocytes, including macrophages and neutrophils, to the injured area to combat the infection.

The signs of infection such as the incubation, prodromal and convalescence stages, in the correct sequential order are:

The incubation period
The illness stage
The convalescence stage

Health Promotion & Maintenance Practice Questions

The infant had doubled their birth weight at twelve months.
The infant had tripled their birth weight at twelve months.
The mother reports that the infant is drinking 60 mLs per kilogram of its body weight.
The infant had grown ¼ inch since last month.

The normal assessment data for the infant at 12 months of age is that the infant has doubled their birth weight at 12 months of age.

The mother’s reports that the infant is drinking 60 mLs per kilogram of its body weight and the fact that the infant had grown ¼ inch since last month are not normal assessment data. Infants are fed breast milk or formula every two to four hours with a total daily intake of 80 to 100 mLs per kilogram of body weight.

As the neonate grows, they gain five to seven ounces during the first six months and then they double their birth weight during the first year; the head circumference increases a half inch each month for six months and then two tenths of an inch until the infant is one year of age. Similarly, the height or length of the newborn increases an inch a month for the first 6 months and then 1/2 inch a month until the infant is 1 year of age.

The Programmed Longevity Theory
The Immunological Theory of Aging
The Endocrine Theory
The Rate of Living Theory

The theory of aging that supports your belief that strict infection control prevention measures are necessary is the Immunological Theory of Aging. The Immunological Theory of Aging states that aging leads to the decline of the person’s defensive immune system and the decreased ability of the antibodies to protect us against infection.

The Programmed Longevity Theory of aging states that genetic instability and changes occur such as some genes turning on and off lead to the aging process; the Endocrine Theory of aging states that aging results from hormonal changes and the biological clock’s ticking; and Rate of Living Theory states that one’s longevity is the result of one’s rate of oxygen basal metabolism.

Other theories of aging are:

Wear and Tear Theory: This theory describes aging as a function of the simple wearing out of the tissues and cells as one ages.
Cross Linking Theory: This theory of aging explains that aging results for cell damage and disease from cross linked proteins in the body.
Free Radicals Theory: This theory is based on the belief that free radicals in the body lead to cellular damage and the eventual cessation of organ functioning.
Somatic DNA Damage Theory: Somatic DNA Damage theory is based on the belief that aging and death eventually occur because DNA damage, as continuously occurs in the human cells, continues to the point where they can no longer be repaired and replaced and, as a result, they accumulate in the body.
Increased creatinine clearance.
Impaired immune system.
Decreased hepatic metabolism.
Increased bodily fat.

The elderly population is at risk for more side effects, adverse drug reactions, and toxicity and over dosages of medications because the elderly have a decrease in terms of their hepatic metabolism secondary to the hepatic functioning changes of the elderly secondary to a decreased hepatic blood flow and functioning.

The elderly have decreased rather than increased creatinine clearance; the immune system is also decreased in terms of its functioning, however, this change impacts on the elderly’s ability to resist infection rather than impacting a medication’s side effects, adverse drug reactions, toxicity and over dosages; and, lastly, a decrease in terms of bodily fat, rather than an increase in terms of bodily fat impacts on medications. The distribution of drugs is impaired by decreases in the amount of body water, body fat and serum albumin; drug absorption is decreased with the aged patient’s increases in gastric acid pH and decreases in the surface area of the small intestine which absorbs medications and food nutrients.

The expected date of delivery is calculated using Nagle’s rule which is:

The first day of last menstrual period – 3 months + 7 days = the estimated date of delivery

For example, when the first day of the last menstrual period is 10/20/2016 you would:

Subtract three months from 10/20/2016 and then you get 7/20/2016 and then
Add seven days to 7/20/2016 and then get 7/27/2016, after which you would
Add one year to 7/27/2016 to get the estimated date of delivery for7/27 of the following year which is 7/27/2017.
You should explain that fetal lie is where the fetus’ presenting part is within the birth canal during labor, among other information about the other assessments.
You should explain that fetal presentation is the relationship of the fetus’s spine to the mother’s spine, among other information about the other assessments.
You should explain that fetal attitude is the relationship of the fetus’ presenting part to the anterior, posterior, right or left side of the mother’s pelvis, among other information about the other assessments.
You should explain that fetal station is the level of the fetus’ presenting part in relationship to the mother’s ischial spines, among other information about the other assessments.

You should explain that fetal station is the level of the fetus’ presenting part in relationship to the mother’s ischial spines. Fetal station is measured in terms of the number of centimeters above or below the mother’s ischial spines. Fetal station is -1 to -5 when the fetus is from 1 to 5 centimeters above the ischial spines and it is from +1 to +5 when the fetus is from 1 to 5 centimeters below the level of the maternal ischial spines.

Fetal lie is defined as the relationship of the fetus’s spine to the mother’s spine. Fetal lie can a longitudinal, transverse or oblique life. Longitudinal lie, the most common and normal lie, occurs when the fetus’ spine is aligned with the mother’s spine in an up and down manner; a transverse lie occurs when the fetus’ spine is at a right ninety degree angle with the maternal spine; and, lastly, an oblique lie occurs when the fetus’ spine is diagonal to the mother’s spine.

Fetal presentation is defined by where the fetus’ presenting part is within the birth canal during labor. The possible fetal presentations are the cephalic presentation, the cephalic vertex presentation, the cephalic sinciput presentation, the cephalic face presentation, the cephalic brow presentation, the breech presentation, the complete breech presentation, the frank breech presentation, the shoulder breech presentation, and the footling presentation.

Fetal attitude is the positioning of the fetus’s body parts in relationship to each other. The normal attitude is general flexion in the “fetal position”. All attitudes, other than the normal attitude, can lead to a more intense and prolonged labor.

Fetal position is the relationship of the fetus’ presenting part to the anterior, posterior, right or left side of the mother’s pelvis.

You should apply the principles of initiative when caring for preschool children.
You should apply the principles of sensorimotor thought when caring for preschool children.
You should apply the principles of intimacy when caring for the adolescent.
You should apply the principles of concrete operations when caring for the adolescent.

You should apply the principles of initiative when caring for preschool children. The developmental task for preschool children is initiative, according to Eric Erickson.

The other developmental tasks, according to Eric Erickson are:

Infant: Trust
Toddler: Autonomy
School Age Child: Industry
Adolescent: Identity formation
Young Adult: Intimacy
Middle Aged Adult: Generativity
Older Adults: Ego integrity

In the correct sequential order, Jean Piaget’s levels of cognitive development include:

Sensorimotor thought: Infancy to About 2 Years of Age
Preoperational and symbolic functioning: From 2 to 7 Years of Age
Concrete operations: 7 to 11 Years of Age
Formal operations: 12 Years of Age
Childhood immunizations
Separation anxiety

The expected life transition should you apply into your practice for these pediatric clients as you are caring for pediatric clients of all ages is puberty.

Throughout the life span, there are several significant expected life transitions that require the person to cope and adjust. Some of these expected life transitions include puberty, maternal and paternal attachments and bonding to the neonate, pregnancy, care of the newborn, parenting, and retirement.

Although young children will experience separation anxiety and they will also be maintained on an immunization schedule, these are not expected life changes.

The Biophysical Dimension
The Psychological and Emotional Dimension
The Spiritual Dimension
The Health Systems Dimension

The Dimensions Model of Health includes six dimensions that impact on the client, including the community. The Spiritual Dimension is not one of these six dimensions.

These dimensions are the:

Biophysical Dimension
Psychological and Emotional Dimension
Health Systems Dimension
Behavioral Dimension
Socio-Cultural Dimension
Physical Environment Dimension
Mediterranean ethnicity for cystic fibrosis.
African American ethnicity for Tay Sachs disease.
British Isles ethnicity for psychiatric mental health disorders.
Saudi Arabian ethnicity for sickle cell anemia.

You would identify a client who is of Saudi Arabian ethnicity for sickle cell anemia. Other ethnicities at greatest risk for sickle cell anemia include those who are African, Latin Americans, Southern Europeans and some clients from some Mediterranean nations.

Other disorders and diseases and the ethnicities associated with them are listed below

Thalassemia: Clients with a Mediterranean ethnicity
Tay Sachs Disease: Ashkenazi Jewish people
Cystic Fibrosis: Clients with a European ethnicity
Psychiatric Mental Health Disorders: African Americans and Native Americans
Hypertension: African Americans, Pacific Islanders , Native Americans, Alaskan natives, Hispanic and Caribbean clients
Diabetes: African Americans, Caribbeans, Native Americans and clients from India, Pakistan and Bangladesh
Cancer: Caucasians and clients from Scotland and Ireland
The need for a targeted assessment is based on the application of the nurse’s knowledge of pathophysiology and the presenting symptoms.
The need for a targeted assessment is based on the application of the nurse’s knowledge of developmental needs and developmental delays.
Targeted assessment is done on an annual basis for existing clients rather than a complete assessment that is done for new clients.
Targeted assessments consist of a brief medical history and a complete assessment consists of a complete health history and a complete physical assessment.

The need for a targeted assessment is based on the application of the nurse’s knowledge of pathophysiology and the presenting symptoms. Targeted assessments and screenings are done in addition to routine and recommended screenings when a particular disorder has a genetic pathophysiological component for risk and when a client is presenting with a particular sign or symptom.

For example, a targeted assessments relating to nutritional status may be indicated when an infant or young child is listless and not gaining weight according the established criteria; an adolescent may be target screened for visual acuity when a high school teacher reports that the teen does not seem to be able to read things on the blackboard; and a toddler may be target screened when the parent reports that the child is not responding to their name.

Genetic predisposition
Lifestyle choices
High risk behaviors
An external locus of control

Life style choices are the risk factors that are most likely able to be corrected. Poor life style choices place a person at risk and they are often considered also risky behaviors.

As discussed before, some risks are preventable and correctable and others are not. For example, genetics, age and gender are NOT modifiable risks, but the risks associated with life style choices are modifiable, correctable and able to be eliminated when the person changes their behavior in reference to these risky behaviors.

Some risky life style choices include:

Excessive sun exposure
The lack of regular exercise
A poor diet
Cigarette smoking and the use of other tobacco products
Alcohol use
Illicit drug use
Unprotected sex
Avocational and hobby choices such as rock climbing
Inadequate sleep and rest

Genetic predisposition is an innate and not correctable risk factor and an external locus of control can lead to poor life style choices, however, this is not the most likely correctable risk factor.

A transdermal contraceptive patch
A diaphragm
A vaginal contraceptive ring

You would not recommend any of the above methods of contraception for this family.

You would not recommend the use of a transdermal contraceptive patch or a vaginal contraceptive ring for the couple because both of these contraceptive methods are contraindicated when the woman has a history of deep vein thrombosis and cigarette smoking; and you would also not recommend a diaphragm because the compliance of this couple cannot trusted because the couple has a history of the lack of adherence to medical regimens.

Information about the lack of scientific evidence regarding the effectiveness of all herbs.
Data to support the fact that magnets can be effective in terms of fibromyalgia pain, and as such, may be a good choice for this client.
Research that suggests that prayer is an effective alternative method to relieve pain and stress that can be helpful to this client.
Information that contraindicates the use of biofeedback because this alternative, complementary health practice can interfere with the client’s pacemaker functioning.

Scientific data now indicates that prayer is effective for the relief of stress, anxiety and pain, and as such, may be helpful to this client.

Some herbs, minerals and supplements are scientifically deemed as safe and effective and others are not scientifically effective and they can also lead to harm; at the current time, the National Institutes of Health (NIH) states that magnets are not scientifically effective and they are also not considered safe for clients with a pacemaker or insulin pump because these internally implanted devices can be adversely affected by the magnetic force of the magnet; and, lastly, biofeedback does not interfere with the client’s pacemaker functioning.

A social worker
A physical therapist
An occupational therapist
A speech therapist

The healthcare professional would you most likely refer this family to in order to address this deficit in terms of their instrumental activities of daily living (ADLs) is a social worker.

The activities of daily living are differentiated in terms of the basic activities of daily living and the instrumental activities of daily living. Examples of basic activities of daily living include things like bathing, mobility, ambulation, toileting, personal care and hygiene, grooming, dressing, and eating. Deficits in terms of the basic activities of daily living are best addressed by a physical and/or occupational therapist.

The instrumental activities of daily living are more advanced than the basic activities of daily living. The instrumental activities of daily living include things like grocery shopping, housework, meal preparation, the communication with others using something like a telephone, and having transportation. Deficits in terms of the instrumental activities of daily living are best addressed by a social worker. For example, the social worker may assist the client in terms of their transportation and they can also teach the client about how to grocery shop, for example.

Olfactory Cranial Nerve: The sensory nerve that transmits the sense of smell to the olfactory foramina of the nose
Optic Cranial Nerve: This sensory nerve transmits the sense of vision from the retina to the brain.
Oculomotor Cranial Nerve: This motor and sensory nerve controls eye movements and visual acuity.
Trochlear Cranial Nerve: This motor nerve innervates eye ball movement and the superior oblique muscle of the eyes.
Abducens Cranial Nerve: This motor nerve innervates and controls the abduction of the eye using the lateral rectus muscle.
Facial Cranial Nerve: This motor nerve controls facial movements, some salivary glands and gustatory sensations from the anterior part of the tongue.
Glossopharyngeal Cranial Nerve: This sensory nerve This nerve gives us the sense of taste from the posterior tongue, and it also innervates the parotid glands

Correct Response: A,B,D,E

The olfactory cranial nerve is a sensory nerve that transmits the sense of smell to the olfactory foramina of the nose; the optic cranial nerve is also a sensory nerve and it transmits the sense of vision from the retina to the brain.

The trochlear cranial nerve is a motor nerve that innervates eye ball movement and the superior oblique muscle of the eyes; and the abducens cranial nerve is a motor nerve that innervates and controls the abduction of the eye using the lateral rectus muscle.

The oculomotor cranial nerve is a motor nerve controls eye movements, the sphincter of the pupils and the ciliary body muscles; it has no sensory function. The facial cranial nerve is a motor and sensory nerve which controls facial movements, some salivary glands and gustatory sensations from the anterior part of the tongue. And, lastly, the glossopharyngeal cranial nerve is both a motor and sensory nerve that gives us the sense of taste from the posterior tongue, and it also innervates the parotid glands.

The Taylor test
The Rinne test
The Babinski test
The APGAR test

The sense of hearing is assessed using the Rinne test and the Weber test and a tuning fork.

A Taylor hammer, not a Taylor test, is used to check reflexes like the biceps and triceps reflexes; the Babinski sign occurs when the foot goes into dorsiflexion and the great toe curls up; this sign is an abnormal response to this stimulation and it can indicate the presence of deep vein thrombosis. And lastly, the APGAR test is used to assess the neonate immediately after birth in terms of the infant’s appearance, grimace and reflexes, appearance in terms of skin color, and respiratory rate and effort.

Light palpation
Deep palpation

Deep palpation is cautiously done after light palpation when necessary because the client’s responses to deep palpation may include their tightening of the abdominal muscles, for example, which will make the light palpation less effective for this assessment, particularly if an area of pain or tenderness has been palpated.

Inspection is typically the first step and percussion of the abdomen should be done prior to any palpation, particularly deep palpation.

The five types of sounds that are elicited during percussion are flatness, resonance, hyperresonance, tympany and dullness. Dullness is heard when percussion is done over a solid organ like the liver and spleen.

Flatness is normally assessed over muscles and bones; resonance is a hollow sound that is heard, for example, over the air filled lungs; and hyperresonance, which is a booming sound that is heard over abnormal lung tissue, as occurs among clients with chronic obstructive pulmonary disease (COPD); and, lastly, tympany is heard over the stomach with air as a drum like sound.

A complete medical history, a general survey and a complete physical assessment.
A complete medical history, a general survey and a focused physical assessment.
A client interview, a significant other interview, a general survey and a complete physical assessment.
A client interview, a significant other interview, a general survey and a focused physical assessment.

A comprehensive health assessment includes a complete medical history, a general survey and a complete physical assessment.

Although a complete medical history is done using a client interview and a significant other interview for much data, it is the health history and not the interview that is part of the comprehensive health assessment. A focused assessment is done as based on some pathology, sign or symptom and it is not considered a part of a comprehensive health assessment.

Tympany: A hollow sound
Dullness: A thud like sound
Dullness: A hollow sound
Resonance: A booming sound

Dullness is a thud like sound and not a hollow sound. Tympany is a drum like sound; and resonance is a hollow sound.

Psychosocial Integrity Practice Questions

A couple which consists of a husband and wife both of whom are affected with Alzheimer’s disease
A poverty stricken couple without any healthcare resources in the community
A pregnant woman and a husband who was physically abused as a young child
A wealthy couple with feelings that they are immune from punishment and above the law

A pregnant woman and a husband who was physically abused as a young child is the couple is at most risk for domestic violence because pregnancy and a personal prior history of abuse are two commonly occurring risk factors among abused woman and male abusers, respectively.

Current research indicates that abuse and neglect affect all people of all ages and of all socioeconomic classes including the wealthy as well as the poverty stricken.

Other patient populations at risk of abuse and neglect include female gender, infants, children, the cognitively impaired, the developmentally challenged, the elderly and those with physical or mental disabilities; some of the other traits and characteristics associated with abusers include substance related use and abuse, a psychiatric mental health disorder, poor parenting skills, poor anger management skills, poor self-esteem, poor coping skills, poor impulse control, immaturity, and the presence of a current crisis.

Restrain the client
Place the client in seclusion
Get an order for a sedating medication
Establish trust with the client.

The first thing that you should do to prevent violence towards others is to establish trust with the client. The first step in the nurse-client relationship is to establish trust in this therapeutic relationship. Without trust future collaboration, interventions and client outcomes cannot be accomplished to facilitate appropriate and safe behaviors.

Restraints and seclusion are not indicated until others are in imminent danger because of this client’s current violent behaviors and not a history of it. Lastly, sedating medications to prevent violence are also not the first things that are done.

Psychological dependence secondary to amphetamine use
Substance abuse secondary to amphetamine use
Addiction secondary to amphetamine use
Physical dependence secondary to amphetamine use

The appropriate nursing diagnosis for this client is “Psychological dependence secondary to amphetamine use”. Psychological dependence is defined as the person’s need to continue the use of the substance to avoid any unpleasant feelings and experiences that can occur when the substance is not taken. Amphetamines and hallucinogenic drugs like LSD are often associated with psychological dependence.

Substance abuse, simply defined, is one’s overindulgence of an addictive substance which can be alcohol, prescription drugs and/or illicit, illegal drugs. Substance abuse does not include prescribed medications, such as narcotic pain medications, that are being used for medical reasons; however, these same medications when used after there is no longer a medical need to use them is considered substance abuse.

Addiction is defined as the unending and constant need for the person to have the chosen substance even when the use of the substance causes the client to have serious physical, psychological, social and/or economic consequences and harm including a loss of control over the substance abuse and use. Contrary to popular opinion, addiction can occur with and without physical dependence.

Physical dependence occurs when the cessation of a drug causes adverse physical effects; these ill effects are typically greater and more intense when the cessation of the drug is rapid and abrupt. Some of the drugs that are most often associated with physical dependence include cocaine, opioid drugs, alcohol and benzodiazepines. As previously stated, physical dependence does not necessarily indicate addiction; addiction can be present with or without any physical dependency.

Orem’s Self Care Model
Nagi's Model
A cognitive model of disability
A biomedical model of disability

Nagi’s Model of disability model describes disabilities and its limitations are the result of a discrepancy between the client’s abilities and the limitations of the physical and social environment within which the client lives.

Although clients with disabilities should be assessed and have interventions related to their self care abilities, Dorothea Orem’s Self Care Model is not a model of disability. This model describes self care needs and abilities as wholly compensatory, partly compensatory and supportive educative.

Cognitive models of disability focus on the importance of affected client’s ability to remain as independent as possible and ways that the empowered client can exercise their own self-determination, confidence, self efficacy, and control.

Lastly, biomedical models address pathology, impairments and the manifestations of impairments that can be cured or lead to death.

The characteristics of the stages or phases of crisis, in the correct sequential order, are:

Level 1 Crisis Signs and Symptoms: Patients experiencing a level one crisis typically experience anxiety and they also typically begin to use one or more psychological ego defense mechanisms.
Level 2 Crisis Signs and Symptoms: Patients experiencing a level two crisis most likely exhibit some loss of their ability to function. They may also try to experiment with alternative methods of coping in order to deal with the crisis that is not being effectively coped with using one’s currently used coping mechanisms.
Level 3 Crisis Signs and Symptoms: Patients experiencing a level three crisis show the signs and symptoms of the General Adaptation Syndrome which is characterized with fight, flight and panic as discussed above under the section entitled “Coping Mechanisms: Introduction”.
Level 4 Crisis Signs and Symptoms: Clients experiencing a level four crisis exhibit severe signs and symptoms such as being totally detached and removed from others, feeling overwhelmed, becoming disoriented, and even with thoughts of violence toward self and others.
Displacement
Sublimation
Dissociation
Reaction formation

Dissociation is the psychological ego defense mechanism occurs when the client detaches and dissociates with person or time to avoid the stress until they are ready to cope with it.

Displacement transforms the target of one’s anger and hostility from one person to another person or object. Displacement allows the person to ventilate and act out on their anger in a less harmful and a more socially acceptable manner.

A client uses the ego defense mechanism of sublimation when they transform and replace unacceptable urges and feelings into a socially acceptable urge or feeling.

A client is using reaction formation when the client acts and behaves in a manner that is completely the polar opposite of their true feelings.

Jean Watson's
Martha Rogers'
Nagi's theory
Madeleine Leininger’s theory

The theoretical framework that you would recommend that this committee should consider when addressing mutiethnicity and the culturally diverse nature of this facility for this philosophy is Madeleine Leininger’s theory.

Madeleine Leininger’s theory of Transcultural Nursing and her book “Culture Care Diversity and Universality: A Theory of Nursing” “searches for comprehensive and holistic care data relying on social structure, worldview, and multiple factors in a culture in order to get a holistic knowledge base about care” (Leininger, 2006, p. 219)

Jean Watson’s Jean Watson developed the Human Caring Theory which states that caring is the essence of nursing. Watson's theory has the four major concepts of health, nursing, society/environment and human being. Caring consists of the following 10 nursing interventions that demonstrate genuine caring.

Martha Rogers’ theory is the Science of Unitary Human Beings which is based on general systems theory without any focus on multiethnicity and cultural diversity; and lastly, Nagi’s Model of disability model describes disabilities and its limitations are the result of a discrepancy between the client’s abilities and the limitations of the physical and social environment within which the client lives.

The client will accept impending death
Guilt related to past transgressions
Spiritual distress related to guilt
Pain related to end of life symptoms

“The client will accept impending death” is the client goal would be the most likely appropriate and expected for the vast majority of these clients. In fact, one of the primary goals of hospice and palliative care is to facilitate the client’s and family member’s acceptance.

Other goals are the freedom for guilt, spiritual distress and pain at the end of life; therefore, these diagnoses are not expected.

The client will be free of constipation
The client will remain free of pain and distress
The administration of an antiemetic to prevent vomiting and further dehydration
The administration of an enema to correct the constipation

Based on this client’s signs and symptoms and the fact that the client is expected to die in a day or two, the appropriate client outcome for this client is that the client will remain free of pain and distress.

“The client will be free of constipation” requires interventions such as an enema which are not indicated when death is imminent unless, of course, the client is adversely affected with pain and discomfort as the result of it which is not the case with this client. Additionally, the administration of an antiemetic to prevent vomiting is not indicated because there is no evidence in this question that the client is actually vomiting.

“You should try to come to a few sessions at least because they may be very informative to you”.
“You are probably correct. This really is not your problem”.
“Despite the fact that it is your grandson’s drug addiction, situations such as this affect all members of the family including grandparents who live in the home.”
"You should attend because the doctor has ordered family therapy for you as extended family members”.

You should respond to the grandparents’ statement with “Despite the fact that it is your grandson’s drug addiction, situations such as this affect all members of the family including grandparents who live in the home”.

After this statement, you should also educate the grandparents about the fact that group and family therapy is often indicated when the family unit is affected with stressors and dysfunction because family members may not fully understand the need for the entire family unit to participate when only one member of the family is adversely affected with a stressor and poor coping and that all family members are affected when only one member of the family unit is adversely affected.

You would NOT state “You should try to come to a few sessions at least because they may be very informative to you” because these sessions are therapeutic and not educational; you would not state “You are probably correct. This really is not your problem” because this statement is not true; and you should also not state “You should attend because the doctor has ordered family therapy for you as extended family members” because this is not the real reason why attending these sessions is needed.

Engel's theory
Kubler Ross' theory
Lewin's theory
Warden's theory

The theory of grief and loss would you most likely integrate into your practice as you perform this role is Warden’s Four Tasks of Mourning. This theory has four tasks that people go through after the loss of a loved one. These tasks are accepting the loss, coping with the loss, altering, modifying and changing the environment to cope with and accommodate for the absence of the lost person, and, finally, resuming one’s life while still having a healthy connection with the loved one.

Engel’s Stages of Grieving include stages both prior to and after a loss and these stages are:

Shock and disbelief
Developing awareness
Restitution
Resolving the loss
Idealization

Kubler Ross’s Stages of Grieving occur prior to the death and these stages include:

Lastly, Lewin developed theories of change, leadership and conflict and NOT a theory related to grief after the loss of a loved one.

The concern related to the client’s cultural reluctance to report psychological symptoms because of some possible culturally based stigma associated with psychiatric mental health disorders
Concerns revolving around the lack of financial and health insurance resources to pay for psychological care
Concerns related to the compliance with psychological treatment regimens because of the client’s lack of social support systems
The concern related to the culturally based client apathy about nursing care and nursing assessments

The concern related to the client’s cultural reluctance to report psychological symptoms because of some possible culturally based stigma associated with psychiatric mental health disorders which is a barrier to assessment because the client fears being stigmatized and rejected when divulging psychological data including anxiety and other symptoms.

The lack of financial and health insurance resources to pay for psychological care, the lack of social support systems, and the client’s apathy are barriers to psychological care but these factors are not a barrier to a psychological assessment and these factors are not cultural, but instead social and psychological.

Cognitive psychotherapy
Behavioral psychotherapy
Cognitive behavioral psychotherapy
Psychoanalysis

Behavioral psychotherapy is particularly useful among clients who are adversely affected with phobias, substance related disorders, and other addictive disorders. Some of the techniques that are used with behavioral therapy include operant conditioning as put forth by Skinner, aversion therapy, desensitization therapy, modeling and complementary and alternative stress management techniques.

Cognitive psychotherapy is most often used to treat clients, including groups of clients, with depression, eating disorders, anxiety, and anxiety disorders to facilitate the altering of the clients’ attitudes and perspectives relating to stressors.

Cognitive behavioral psychotherapy, which is a combination of cognitive psychotherapy and behavioral psychotherapy and also referred to as dialectical behavioral therapy is most often used for clients affected with a personality disorder and those at risk for injury and harm to self and/or others.

Psychoanalysis, in contrast to cognitive behavioral therapy and other individual and group therapies, dives into the client’s subconscious and it often focuses on the past as well as the client’s current issues. This therapy is not conducted by registered nurses but, instead, by experienced psychotherapists.

The client religion that is the most pertinent to the role of the admissions coordinator of hospital who assigns the rooms and beds of clients who will be admitted is the Islam religion which requires that the followers face Mecca for daily prayer, therefore, Islam clients should be placed in a room that faces the holy city of Mecca.

Although most religions impact on the care of the client, only Islam is pertinent to the admissions coordinator. Other religions practices and their impact on health care are shown below:

Christians: End of life rituals like the Sacrament of the Sick, baptisms for newborns, fasting, and the Eucharist.
Judaism: Religious based circumcisions, a kosher diet which separates dairy foods from meat based foods, and death rituals called a Shiva.
Hinduism: Many followers are vegetarian; personal hygiene is paramount and they also have death rituals without the prolongation of life.
Mormonism: Baptism for the newborn, last rites at the time of death, communion, and burials of the dead. Additionally, the Mormon religion prohibits alcohol, tobacco, and caffeine.
Jehovah’s Witnesses: Prohibitions against blood transfusions, foods containing blood, homosexuality, sex before marriage, abortion, suicide, gambling, alcoholic beverages, tobacco and illicit drugs.
Psychotic symptoms related to sensory overload
Psychotic symptoms related to a previously undiagnosed psychosis
Visual disturbances related to dementia
Visual disturbances related to delirium

“Visual disturbances related to delirium” is the most appropriate nursing diagnosis for this client, as based on their signs, symptoms, past history and current medical status.

Delirium is characterized with a sudden and abrupt onset of episodic and intermittent periods of time vacillating between periods of impaired cognition and periods of mental clarity. Visual hallucinations are a sign of delirium and delirium can result from a number of different causes including dehydration and anticholinergic medications.

The signs and symptoms of sensory overload do not include visual hallucinations and a sudden and abrupt onset of episodic and intermittent periods of time vacillating between periods of impaired cognition and periods of mental clarity. Instead, the signs and symptoms of sensory overload include anxiety, restlessness, sleep deprivation, fatigue, poor problem solving and decision making skills, poor performance, and muscular tension.

There is no evidence in this question that the client has psychotic symptoms related to a previously undiagnosed psychosis; all the evidence substantiates the suspicion that the client is affected with delirium.

Lastly, dementia has a gradual and progressive onset rather than an abrupt and sudden onset.

Collect baseline blood pressure readings prior to the beginning of this educational series and then collect and compare blood pressure data during the series and after the series is completed.
Collect baseline blood pressure readings prior to the beginning of this educational series and then collect and compare blood pressure data after the series is completed.
Ask the clients how often they use the stress management techniques that they have learned during this educational series.
Use a questionnaire at the end of the series that asks the participants how they liked the class and what they learned during this educational series.

The best way to evaluate the effectiveness of this educational series is to collect baseline blood pressure readings prior to the beginning of this educational series and then collect and compare blood pressure data during the series and after the series is completed. This technique entails evaluating the outcomes of the education in terms of changes in the client and it also includes formative evaluation during the series and summative evaluation at the end of the series.

Collecting baseline blood pressure readings prior to the beginning of this educational series and then collecting and comparing blood pressure data after the series is completed gives us only summative evaluation; it does not provide you with formative evaluation.

Because the primary goal of this series is to lower the blood pressures of clients through the use of stress management techniques, asking the clients how often they use the stress management techniques that they have learned during this educational series and using a questionnaire at the end of the series that asks the participants how they liked the class and what they learned during this educational series does not reflect data and information about the effectiveness of the classes in terms of reducing the blood pressures of hypertensive clients.

Tai Chi is a type of a mind body exercise that deeply focuses on breathing, movement and meditation. Yoga is similar to tai chi in that yoga also employs a combination of breathing, movement and meditation.

Reiki is done for the client when the therapist places their hands on or near the person’s body to promote the client’s energy field and its own natural healing processes. Feng shui is an eastern method of decorating using colors, items and the placement of objects in the environment to promote a harmonious relationship of man and its environment; and lastly Jiu Jitsu is a martial art.

You should advise the couple to move closer to their children so that they can care for their father.
You should teach the wife about this progressive disease and the need to promote as much independence as possible.
You should teach the wife about this progressive disease and the need to do all that she can for the husband to avoid his depression and frustration.
You should advise the couple to decrease their social activities in order to preserve the husband’s dignity and self-esteem.

You should teach the wife about this progressive disease and the need to promote as much independence as possible. Client’s with Alzheimer’s disease and other disabilities, including physical disabilities, should be coached and encouraged to be as independent as possible.

Moving closer to the children may not be appropriate advice particularly if the children are unable or unwilling to care for their father. Lastly, you should advise the couple to continue their social activities and to only avoid those situations where the necessary compassion and understanding about the client and his condition are absent.

According to the Global Deterioration Scale, clients in the first stage of Alzheimer’s disease tend to cover up their failing abilities
According to the Reisberg Scale, clients in the first stage of Alzheimer’s disease tend to cover up their failing abilities
According to the Global Deterioration Scale, clients in the third stage of Alzheimer’s disease tend to cover up their failing abilities
According to the Reisberg Scale, clients in the fourth stage of Alzheimer’s disease tend to cover up their failing abilities

According to the Global Deterioration Scale, also referred to as the Reisberg Scale, clients in the third stage of Alzheimer’s disease tend to cover up their failing abilities.

The Global Deterioration Scale stages Alzheimer’s according to seven stages. These stages include

Stage 1: Cognitive abilities are intact.
Stage 2: Minimal and hardly noticeable forgetfulness occurs.
Stage 3: Mild changes in terms of cognition occur. The client may have difficulty in terms of their memory, which at times the client may “cover up” to avoid the detection by others. The signs and symptoms of this stage are similar to those of the Early Stage of Alzheimer’s disease, as discussed immediately above.
Stage 4: This stage is characterized with increasing confusion about recent events and conversations, mild problems with math and some rather routinized sequential tasks such as cooking. The client may withdraw from others and debate the fact that they are having some cognitive issues.
Stage 5: Early Dementia occurs. Short and long term memory losses, a lack of orientation to place and time, poor judgment, and some of the client’s self care in terms of the activities of daily living become progressively more problematic. The client may need the assistance and supervision of others to promote the client’s highest possible level of independence in the performance of their basic activities of daily living.
Stage 6: This stage is referred to a Middle Dementia and moderately severe Alzheimer’s disease. There is almost complete short term and long term memory loss, communication is highly limited and it may only consist of nonverbal behavioral responses, and the client needs complete care to manage their activities of daily living. Sundowner’s syndrome is present and hallucinations as well as agitation may occur.
Stage 7: This stage is referred to as Late or Severe Dementia and Failure to Thrive. The client is in need of complete care; and immobilization, in addition to the hazards of immobility, may affect the client and the family members at this stage.
Probing for more information from the client
Sublimation to determine hidden messages
Providing privacy so the client is comfortable
Silence to allow contemplation and thought
A safe environment of care that is conducive to the prevention of medical errors.
A client care area that provides personal privacy and the confidentiality of medical information.
A European method of design and color to promote health and wellness.
The provision of a therapeutic environment of consistency to promote health.

A therapeutic milieu eliminates as many stressors from the environment as possible. The goal of this environment is to facilitate the client’s coping and recovery without the need to cope with these extraneous and avoidable stressors. Some of the elements of a therapeutic milieu environment include consistency, client rules, limitations and boundaries, and client expectations, including contracts, relating to appropriate behavior.

Physiological Integrity: Basic Care & Comfort Practice Questions

Psychomotor domain: The client will slightly bend their elbows when holding the hand grips.
Psychomotor domain: The client will rest their weight on the padded areas on the top of the crutches.
Cognitive domain: The client will slightly bend their elbows when holding the hand grips.
Cognitive domain: The nurse will tell the client how often the tips on the crutches must be replaced.

The client goal that is paired with its learning domain that should be included in the patient teaching plan for this client and the parents is “The client will slightly bend their elbows when holding the hand grips” which is part of the psychomotor domain and not the cognitive domain. Lastly, the “nurse will” is an intervention and not a client goal or expected outcome which should be learner, not nurse, oriented.

An aphasia aid
A button hook
Honey thickened liquids
A word board

The basic activity of daily living assistive device can be useful for the client who is affected with poor fine motor coordination is a button hook that would be used for the dressing activity of daily living.

An aphasia aid and a word board are assistive devices to facilitate communication when the client is affected with a communication deficit such as aphasia; and, lastly honey thickened liquids are indicated for clients with a swallowing disorder and they are not indicated for clients with poor fine motor coordination.

Place the client in a wheelchair to protect their safety in the clinic.
Remove the cane from the client to protect their safety.
Teach the client about the proper length of a cane.
Have the client use a wheelchair rather than the cane.

You should teach the client about the proper length of a cane. The proper length of the cane should be the length that only permits the client’s elbow to be slightly flexed. Some canes like a wooden cane are not adjustable to the client’s height and others can be adjusted to meet the height needs of the client.

You would not place the client in a wheelchair or ask the client to use a wheelchair and you would also not take the cane, which is their personal property, away from them. You would use this observation as a learning need assessment and, as such, you should teach the client about the proper length of a cane and help them to adjust the height of the cane if the client’s cane is a height adjustable one.

A cleansing enema
A retention enema
A return-flow enema

The most likely intervention for this client, after getting a doctor’s order, is a return flow enema. Return-flow enemas, similar to a carminative enema, are used to relieve flatus and stimulate peristalsis which is frequently a problem after a client has received anesthesia.

Cleansing enemas are used to relieve constipation; and a retention enema is used to administer a medication, to soften stool and to lubricate the rectum so that it is easier and more comfortable for the client to defecate.

Finally, the data in this question does not indicate that the client is constipated and in need of a laxative.

Both can lead to infection.
Both are invasive procedures.
Both are considered sentinel.
Both are the last resort.

The commonality that is shared in terms of both restraints and urinary catheters is that both are the last, not the first, treatment of choice. Both indwelling urinary catheters and restraints pose risks and complication; therefore, both of these interventions must be prevented with the use of preventive measures.

Indwelling urinary catheters are invasive but restraints are not invasive; indwelling urinary catheters can lead to infection but restraints do not. Lastly, neither are sentinel. A sentinel event is an event or occurrence, incident or accident that has led to or may have possibly led to client harm. Even near misses, that have the potential for harm, are considered sentinel events because they have the potential to cause harm in the future.

Any solid skin barrier
A hydrocolloid solid skin barrier
Hollister’s Flextend
A skin sealant

You would recommend a skin sealant, including products like Bard’s Protective Barrier and Convatec’s Allkare, which are a fast drying polymer transparent film that can be applied relatively simply with a wipe or a spray. These products are easy to use and less expensive than solid skin barriers, including Hollister’s Flextend and others containing hydrocolloids.

A prolapsed stoma
A vitamin B12 deficiency
Nocturnal enuresis
GI stone formation

Some of the complications associated with a colostomy include a prolapsed stoma, infection, dehiscence, an ischemic ileostomy, a peristomal hernia, stoma stenosis, stomal retraction, necrosis, mucocutaneous separation, stomal trauma, peristomal skin damage as the result of leakage and parastomal hernias.

A vitamin B12 deficiency, nocturnal enuresis and urinary stone formations are complications associated with urinary diversion and not fecal ostomy diversions.

Bone demineralization: Turning and positioning every 2 hours
Urinary stasis: The client will consume 1,000 mL of oral fluids per day
Muscle atrophy: The client will perform range of motion exercises at least 3 times a day
Hypercalcemia: Maintaining fluid intake of 1,000 mL per day

“The client will perform range of motion exercises at least 3 times a day” is an appropriate expected outcome of care that the nurse provides to prevent this complication.

Urinary stasis and hypercalcemia, both hazards of immobility, can be prevented when the client will consume 2,000 mL of oral fluids per day. Lastly, calcium loss from the bones can be prevented by weight bearing activity, and not turning and positioning in bed.

1 on the scale of 1 to 3
2 on the scale of 1 to 5
3 on the scale of 0 to 5
4 on the scale of 0 to 5

You would document this client’s muscular strength as a 3 on a scale of 0 to 5.

Muscular strength is classified on a scale of zero to five, as below.

Zero: No muscular contraction
One: No muscular movement, only a quiver is noted
Two: Muscular movement but only when assisted with gravity
Three: Muscular movement against gravity but not against resistance
Four: Muscular movement against resistance
Five: Full muscular movement and strength

You would document the size of this wound as 24 cm. After the wound is assessed and measured, the wound dimension is calculated by multiplying the length by the width by the depth of the wound. For example when the length of the sound is 3 cm deep, 2 cm long and 4 cm wide, it is calculated with 3 x 2 x 4 = 24 cm.

Secondary intention healing
Tertiary intention healing
Primary prevention healing
Secondary prevention healing

Secondary intention healing is the most likely type of wound healing for this client because of the risks associated with the deep infection associated with the ruptured appendix and the peritonitis.

Secondary intention healing, also referred to as healing by second intention, is done for contaminated wounds in order to prevent infections, to prevent the formation of abscesses and to promote healing from the bottom up to the outer surface of the skin so that any potential infection is not closed in at the bottom of the wound. These open wounds are irrigated with a sterile solution and then packed to keep them open and, over time, they will heal on their own. The resulting scar is more obvious than those scars that result from primary intention healing.

Primary intention healing is facilitated with wounds without infection. The wound edges are approximated and closed with a closure technique such as suturing, Steri Strips, and surgical glues.

Tertiary intention healing, also referred to as healing by tertiary intention, is a combination of secondary and primary healing. Tertiary intention healing begins with several days of open wound irrigations and packing, which is secondary healing, followed by the closure of the wound edges with approximation and suturing which is primary healing. Some traumatic wounds are healed with tertiary intention.

Primary, secondary and tertiary prevention strategies are prevention, interventions and restorative or rehabilitation care and not methods of wound healing.

A barrier film
An alginate dressing
Surgical laser debridement
Autolytic debridement

The treatment of pressure ulcers is complex and it often includes a combination of treatments and therapies. The RYB Color Code of Wounds is sometimes used by nurses to guide the treatment options. RYB stands for the colors of red, yellow and black. The rules of treatment for these three colors are:

Red: Covering with a dressing such as a hydrocolloid film, turning and positioning the client and avoiding pressure, friction and shearing
Yellow: Using an alginate dressing
Black: Debridement, including surgical laser debridement, mechanical debridement, autolytic debridement, enzymatic debridement and sharp instrument debridement, of the area to remove the black necrotic eschar.
Moritz Schiff’s theory of pain
The Intensive Theory of Pain
Melzack and Wall’s theory of pain
The Specificity Theory of Pain

Melzack and Wall’s Gate Control Theory of pain supports the belief that some of the factors that open this “gate” to pain are low endorphins and anxiety and that some of the factors that close this “gate” to pain are decreased anxiety and fear. The substantia gelatinosa is the “gate” that facilitates or blocks the transmission of pain.

The Specificity Theory of Moritz Schiff described pain as a sensation that was different from all the other senses in that pain had its own specific nervous system pathways from the spinal cord that traveled to the brain; the Intensive Theory of pain is based on the belief that pain is an emotional state, rather than a sensory phenomenon; the Peripheral Pattern Theory of pain of Sinclair and Weddell describes pain as the result of an intense stimulus applied to the skin; and the Neuromatrix Theory of Pain supports the fact that pain is a dynamic and multidimensional process with physical, behavioral, perceptual, psychological and social responses and one that can only be described by the person who is experiencing it.

Pain level, the quality of the pain, the region or area of the pain, the severity of the pain, and the pain triggers
Precipitating factors, the quality of the pain, relief factors, the severity of the pain, and the pain triggers
Pain level, the quantitative numerical pain score, the region or area of the pain, the severity of the pain, and the pain triggers
Precipitating factors, the quality of the pain, the region or area of the pain, the severity of the pain, and the pain triggers

Precipitating factors, the quality of the pain, the region or area of the pain, the severity of the pain, and the pain triggers are the PQRSTs of the PQRST method of pain assessment.

The severity of the pain, which can include a quantitative, numerical pain score from 1 to 10, for example, is the S of the PQRST method of pain assessment.

Assessment data, biochemical data, clinical data and dietary data
Ancestral cultural data, biochemical data, clinical data and dietary data
Anthropometric data, biological data, chemical data and dietary data
Anthropometric data, biochemical data, clinical data and dietary data

Anthropometric data, biochemical data, clinical data and dietary data are the A, B, C and Ds of a complete and comprehensive nutritional assessment.

The elements of these A, B, C and Ds of nutritional assessment include:

A: Anthropometric Data: This data includes variables such as height, weight, body mass index and arm measurements such as the mid arm circumference and the triceps skin fold.
B: Biochemical Data: Laboratory testing data like serum albumin, hemoglobin, urinary creatinine, and serum transferrin.
C: Clinical Data: The client’s skin condition, level of activity and status of the client’s mucous membranes.
D: Dietary Data: This data includes the client’s subjective reports of their food and fluid intake over the last 24 hours and the types of foods that are typically eating.
Constipation: The provision of a high fiber diet
Urinary pH changes: Encouraging ample oral fluid intake
Aspiration: Maintaining the client in at least a 30 degree angle
Aspiration: Maintaining the client in at least a 90 degree angle

Aspiration can be prevented by maintaining the client in at least a 30 degree angle; a 90 degree angle is not only not necessary, this angle places a client at greater risk for the development of a pressure ulcer.

Diarrhea, rather than constipation is a complication of tube feedings; and urinary pH changes are not a commonly occurring complication of tube feedings.

Some of the other complications and preventive measures are:

Diarrhea: Maintaining a slow rate of infusion whenever possible, changing the ordered rate and formula when necessary
Abdominal pain: Maintaining a slow rate of infusion whenever possible
Dehydration: Monitor the client for any signs and symptoms of dehydration, measure intake and output and notify the doctor of any abnormalities
Nausea and Vomiting: Slowing the rate down, changing the formula and antiemetic medications to stop the vomiting and to prevent any aspiration
Tube Dislodgment: Secure and monitor the tube
Locus of control
Bodily surface area
Diaphoresis

There are a wide variety of different factors that influence and impact on our clients’ hygiene habits and routines. For example, cultural practices and beliefs, ethnical factors, religious practices and beliefs, the client’s level of growth and development.

Although the locus of control, bodily surface area and diaphoresis in addition to other factors such as economic constraints, the client’s level of energy, the client’s level of cognition, and environmental factors can impact on hygiene, these are not factors that impact on the client’s hygiene and hygiene practices; they do not typically impact on the lifelong developed hygiene and hygiene practices.

The neonate: 10 to 15 hours a day
The toddler: 11 to 14 hours a day
The preschool child: 12 to 15 hours a day
The school age child: Less than 8 hours a day

The age group that is accurately paired with the normal and recommended hours of sleep each day is the toddler should sleep about 11 to 14 hours per day.

The neonate should sleep 14 to 17 hours per day; the preschool child should sleep 10 to 13 hours per day; and the school age child should sleep 9 to 11 hours per day.

Physiological Integrity: Pharmacological & Parenteral Therapies Practice Questions

Stop the intravenous flow
Slow down the intravenous flow
Notify the doctor

Your first priority intervention is to immediately stop the flow of the intravenous antibiotic because it is highly likely that the signs of anaphylaxis have occurred as the result of the client’s adverse effect to this antibiotic.

The next thing that you would do is assess the client to determine their physical status and to provide necessary emergency measures, including CPR, if it is indicated. Later, you would notify the doctor about this adverse reaction.

Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for color changes
Refer to a compatibility chart
Call the doctor and ask if the medication is compatible with the particular intravenous fluid
Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for any precipitates

The best way to determine whether or not a medication is compatible for a particular intravenous fluid is to refer to a compatibility chart.

Although, at times, incompatibility can be evidenced with changes such as those related to color changes and the formation of a cloudy solution or obvious precipitate, at other times incompatibility may not be noticeable. For this reason, nurses must refer to a compatibility or incompatibility chart before they mix medications or medications and solutions.

Lastly, there is no need to call the doctor for compatibilities when you have, and should use, a compatibility chart.

Prevent polypharmacy
Conserve financial resources
Prevent interactions
Prevent allergies

The medication reconciliation process to insure that the nurse is aware of all medications that the client is taking, some of which may have been ordered by a physician other than the client’s primary care doctor and some of which are over the counter or alternative therapies that the client has added. The complete and current list of medications is then reviewed by the nurse and possible interactions are identified and addressed with the client.

Although this medication reconciliation process can also save costs by eliminating unnecessary medications, particularly when the client is taking multiple medications (polypharmacy), this is not a primary purpose. Lastly, medications that the client is allergic to should never be given, therefore, these medications should not appear during the medication reconciliation process; they should never have been given to or taken by the client.

The fact that drugs classified as categories C, D and X are contraindicated for women who are pregnant.
The fact that drugs classified as categories A, B and C are contraindicated for women who are pregnant.
The fact that drugs classified as categories C, D and E are contraindicated for women who are pregnant.
The fact that drugs classified as categories C, D and Z are contraindicated for women who are pregnant.

Drugs classified as categories C, D and X are contraindicated for women who are pregnant because of the risks associated with these categories in terms of the developing fetus when these medications cross the placental barrier.

The nurse must be knowledgeable about the fact that this client has A and B agglutinins and lacks the Rh factor
The nurse must be knowledgeable about the fact that this client has B and O agglutinins and lacks the Rh factor
The nurse must be knowledgeable about the fact that this client has B agglutinins and lacks the Rh factor
The nurse must be knowledgeable about the fact that this client has A agglutinins and lacks the Rh factor

The nurse must be knowledgeable about the fact that this client has A agglutinins and they lack the Rh factor.

Type A blood has B agglutinins; type B blood has A agglutinins, type AB blood has no antibodies, or agglutinins, and type O blood has both A and B agglutinins.

People also have a rhesus, or Rh, factor antigen or the lack of it. Clients with an Rh positive blood, which is the vast majority of people, have Rh positive blood and people without the Rh factor antigen have Rh negative blood.

Hemolysis: Typing and cross matching the blood and checking for ABO compatibility prior to administration
Hemolysis: Insuring that the client does not have a prior history of hemolysis in the past
Febrile reactions: Insuring that the client does not have a prior history of hemolysis in the past
Febrile reactions: Typing and cross matching the blood and checking for ABO compatibility prior to administration

Hemolysis can be prevented by typing and cross matching the blood and checking for ABO compatibility prior to administration. This incompatibility can occur as the result of a laboratory error in terms of typing and cross matching and a practitioner error in terms of checking the blood and matching it to the client’s blood type.

Febrile reactions are the most commonly occurring reaction to blood and blood products administration. Although a febrile reaction can occur with all blood transfusions, it is most frequently associated with packed red blood cells and this reaction is not accompanied with hemolysis nor is it associated with its occurrence.

You must insure that the client has a patent intravenous catheter that is at least 20 gauge.
You will need the help of another nurse prior to the administration of these packed red blood cells.
The unit of packed red blood cells should start no more than 1 hour after it is picked up.
You must remain with and monitor the client for at least 30 minutes after the transfusion begins.

You will need the help of another nurse prior to the administration of these packed red blood cells. Two nurses must check the blood, the doctor’s order, the ABO compatibility and the client’s identity using at least two unique identifiers prior to the administration of this blood.

You must insure that the client has a patent intravenous catheter that is at least 18 gauge and not 20 gauge; you will be using normal saline and a Y infusion set for the administration of the blood because Ringer’s lactate and other intravenous solutions are not compatible with blood; blood should not remain in the client care area for more than 30 minutes so it is important that the nurse is prepared to begin the transfusion shortly after the blood is delivered to the patient care area; and, lastly, the nurse should remain with and monitor the client for at least 15 minutes after the transfusion begins at a slow rate since most serious blood reactions and complications occur shortly after the transfusion begins.

A percutaneous, non tunneled subclavian catheter
A peripheral intravenous catheter that is 20 gauge
A multi lumen implanted tunneled and cuffed central venous catheter
A peripherally inserted central venous catheter

You would most likely anticipate that this client will be given a multi lumen implanted tunneled and cuffed central venous catheter because this multi trauma client is in need of multiple intravenous therapies such as blood, medications and total parenteral nutrition over an extended period of time.

A percutaneous, non tunneled subclavian catheter would not be the device of preference because percutaneous, non tunneled subclavian catheters are used when short term treatments are anticipated; a peripheral intravenous catheter that is at least 18 gauge is necessary for the administration of blood; and a peripherally inserted central venous catheter would also not be the venous access device of choice for this seriously ill client who will require long term treatments and care.

1.5 tablets
1.25 tablets
1.33 tablets

You have to determine how many tablets the patient will take if the doctor has ordered 200 mg a day and the tablets are manufactured as 150 mg per tablet.

The mathematical rule for this type of calculation is:

Have = Desired Quantity X

This problem is calculated as shown below.

200 mg: X tablets = 150 mg: 1 tablet

200 mg = 150 mg

X tablets 1 tab

You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below.

200 x 1 = 150 X

200/150 = 1.33 tabs rounded off to 1 1/3 tabs

You have to determine how many mLs the patient will take if the doctor has ordered 10 mg twice a day and there are 12 mg in each mL.

10 mg: X mL = 12 mg: 1 mL

10 mg = 12 mg X mL 1 mL

10 x 1 = 10 X

10/12 = 0.833 mL rounded off to 0.8 mL

You have to determine how many mLs the patient will take if the doctor has ordered 6,500 units of heparin subcutaneously and there are 4,500 units in one mL.

6,500 units: X mL = 4,500 units: 1 mL

6,500 units = 4,500 units X mL 1 mL

6,500 x 1 = 6,500

6,500/4,500 = 1.44 mL which is rounded off to 1.4 mL

To calculate the number of mg that this pediatric client will receive in each dose, you will have to calculate the client’s weight in kg and then determine the total mg for the day after which you will divide the daily dosage by 2 because the order is for two equally divided doses each day.

The steps for this calculation are shown below:

This is how to determine the client’s weight in terms of kg:

48 pounds: x kg = 2.2 pounds: 1 kg

48 pounds = 2.2 pounds x kg 1 kg

48 x 1 = 48

48/2.2 = 21.81 or 21.81 kg

This is how to determine the client’s total daily dosage when the doctor has ordered has ordered 5 mg/kg/day:

21.81 kg x 5 = 109.05 mg per day

This is how to determine the client’s dose for each of the two divided doses:

109.05/2 = 54.53 mg which is rounded off to 55 mg for each of two divided doses.

The first step of this calculation is to calculate the number of mLs, or cc s, per hour and then determine the number of drops per minute. This calculation is done as follows:

1000 ml = 125 mL per hour 8 hrs

The next step is done using this rule that reflects the fact that there are 60 minutes per hour in order to determine the number of mLs per minute .

1 hour = The ordered mL per hour 125 mLs X min 60 min

1 hour = 125 mL X min 60 min

60 x 1 = 60

88/60 = 2.08 mL per minute

Finally, the number of drops per minute is calculated by using the intravenous infusion set’s drop factor by using this rule.

Volume per minute x Drop factor

2.08 x 20 = 41.6 gtts per minute which is rounded off to 42 gtts per minute

With this type of calculation, the amount of normal saline that will be added to a powder in a vial to reconstitute the medication is important, instead, it is the amount of medication that results after the addition of the normal saline. For example, this reconstituted medication yields it is the yield of 12 mg in an mL that is relevant. It is this that will be used in the calculation.

This calculation is done as shown below:

12 mg = 25 mg 1 mL X mL

25 x 1 = 25

25/12 = 2.08 mL which is 2.1 mL rounded off

When the doctor has ordered 1200 mLs of intravenous fluid every 8 hours, you would calculate the number of mLs per hour, as below.

1200/8 = 150 mLs per hour

From 8 am to 12 noon there are 4 hours so:

150 mLs x 4 = 600 mLs

Because you had 600 mLs at 8 am, you should be prepared to hand another intravenous bag because this 600 mLs should all be infused at 12 noon.

Question the order because Benadryl is an antihistamine and not a sleeping medication.
Refuse to give the Benadryl because this medication is a stimulant.
Question the order because Benadryl is contraindicated when the client has a sleep inducement disorder.
Give the Benadryl because sleep inducement is an accepted off label use of this medication.

You would administer this Benadryl because sleep inducement is an accepted off label use of this medication. When a medication is used for any other than these established and approved uses, this usage is referred to as an “off label use”.

The “right” verification
The “right” to refuse
The “right” documentation
The “right” client education

The “right verification” is not one of the “Ten Rights of Medication Administration”. The verification of the doctor’s order for a medication is to confirm the right paint, medication, dose, route and time or frequency, it, in itself, is not one of the “10 Rights”.

The “Ten Rights of Medication Administration” are the right, or correct:

Time or frequency
Client education
Documentation
Right to refuse
Assessment and
Gluteus maximus muscle.
Vastus lateralis muscle.
Deltoid muscle.
The sternocledomastoid muscle.

The administration of an intramuscular injection to a neonate should be given in the vastus lateralis, rectus femoris and ventrogluteal muscle sites and not the deltoid or the gluteus maximus muscles because these muscles have not yet developed.

The sternocledomastoid muscle is not an intramuscular injection site.

A subcutaneous injection site
The PQRST technique
The Z track technique
The sublingual site

You would expect to use to use the Z track technique to administer ferrous sulfate.

Ferrous sulfate IM is given using the Z Track technique to avoid the leakage and dark staining of the injection site with this medication.

Ferrous sulfate is not administered with a subcutaneous injection or using the sublingual route. Lastly, the PQRST method is used to assess pain and not used as a guideline for medication administration.

1,5,4,2,3,6
4,3,2,6,1,5
4,2,5,3,1,6
1,5,3,6,4,2

The steps for mixing NPH, the long acting insulin, with regular insulin, the short acting insulin in the correct sequential order are:

Prep the top of the longer acting insulin vial with an alcohol swab.
Inject air that is equal to the ordered dosage of the longer acting insulin using the insulin syringe. Do NOT withdraw the longer acting insulin yet.
Prep the top of the shorter acting insulin with an alcohol swab
Inject air that is equal to the ordered dosage of the shorter acting insulin using the same insulin syringe.
Withdraw the ordered dosage of the shorter acting insulin using the same insulin syringe.
And, then lastly, withdraw the ordered dosage of the longer acting insulin using the same insulin syringe.
Allow the nurse to administer the injection.
Ask the nurse to use the vastus lateralis muscle instead.
Ask the nurse to verify the doctor’s order again.
Stop the nurse from administering the injection.

You would stop the nurse from administering the injection when you observe that the nurse has palpated the gluteus maximum muscle to determine the correct site. Intramuscular injection sites are determined by using boney landmarks and not by palpating the muscle.

You would not allow the nurse to administer the injection and you would not ask the nurse to use the vastus lateralis muscle instead because nothing indicates the need to do so. Lastly, you would verify the doctor’s order prior to entering the room and preparing to administer the injection and not during the time that the intramuscular site is being identified.

You have failed to have another nurse witness the 0.8 mLs and the 0.2 mLs of waste.
You have failed to have another nurse witness the 0.8 mLs of waste.
You have failed to have another nurse witness the 0.2 mLs of waste.
You have failed ask another nurse to verify the calculation of the dosage.

You have failed to have another nurse witness the 0.8 mLs and the 0.2 mLs.

All controlled substances are documented on the narcotics record as soon as they are removed, and all controlled substances that are wasted for any reason, either in its entirety or only partially, must be witnessed or documented by the wasting nurse and another nurse. Both nurses document this wasting.

It should not be necessary for you to ask another nurse to verify this calculation; the nurse is accountable and responsible for accurate dosage calculations.

The procedure for this medication reconciliation process is:

2. Compile a list of current medications and other preparations 1. Compile a list of newly prescribed medications 4. Compare the two lists and make note of any discrepancies and inconsistencies 5. Employ critical thinking and professional judgments during the comparisons of the two lists 6. Communicate and document the new list of medications to the appropriate healthcare providers

The client with heart failure who is receiving Ringer’s lactate
The client with cancer who is receiving bendamustine
The client who is receiving potassium supplementation intravenously
The client who is receiving total parenteral nutrition

The client with cancer who is receiving bendamustine is at greatest risk for extravasation. Extravasation occurs when vesicant and other vein irritating drugs infiltrate into the tissue. In severe cases, extravasation can lead to necrosis and the loss of an affected limb. Bendamustine is a vesicant chemotherapy drug.

Extravasation is not associated with the intravenous administration of Ringers lactate or potassium supplementation intravenously because this solution and medication are not vesicants. These intravenous preparations can lead to infiltration but not extravasation. Lastly, the client who is receiving total parenteral nutrition is at risk for other complications such as infection, but not extravasation.

Infection: Lowering the limb to promote circulation
Infiltration: The application of cold to the site
Extravasation: The aspiration of contents including blood from the IV cannula
Hematoma: The administration of dexrazonxane

In addition to other interventions, intravenous fluid contents including blood are aspirated from the IV cannula.

Other interventions include immediate cessation of the infusion, elevating the limb, applying warm compresses initially to rid the area of any remaining drug that is in the tissues which is then followed by cool compresses to reduce any swelling, and the administration of an ordered substance specific medication such as dexrazoxane.

One of the interventions for infection include the elevation, not lowering, of the affected limb; infiltration is treated with the application of warm, not cold, compresses and one of the interventions for hematoma is the application of pressure and heat and not the administration of dexrazonxane.

Assess motor functioning.
Assess sensory functioning.
Evaluate responses to a tactile stimulation.
Evaluate responses to a pain analgesic.

The CRIES scale is used to evaluate the neonate’s response to a pain analgesic; this pain scale is also used to assess pain among neonates.

Observational behavioral pain assessment scales for the pediatric population are used among children less than three years of age. Some of these standardized pediatric pain scales, in addition to the CRIES scale, include the FACES Pain Scale, the Toddler Preschooler Postoperative Pain Scale (TPPPS), the Neonatal Infant Pain Scale (NIPS), the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), the Faces Legs Activity Cry Consolability Pain Scale (FLACC), the Visual Analog Scale (VASobs) the Observation Scale of Behavioral Distress (OSBD), the COMFORT Pain Scale and the Pre-Verbal Early Verbal Pediatric Pain Scale (PEPPS) that is used with toddlers.

Opioid Agonist: Dilaudid: Constipation
Opioid Agonist: Naloxone: Constipation
Opioid Antagonist: Dilaudid: Anaphylaxis
Opioid Antagonist: OxyContin: Anaphylaxis

Dilaudid is an opioid agonist that can cause constipation.

Other opioid agonists are codeine, OxyContin, Darvon, Dilaudid, Demerol and Percocet. The side effects and adverse reactions to this classification of drugs include constipation, sedation, nausea, dizziness, pruritus, and sedation, respiratory depression and arrest, hepatic damage, an anaphylactic reaction, circulatory collapse and cardiac arrest.

Opioid antagonists also referred to as opioid receptor antagonists, such as naloxone and naltrexone, can have side effects such as hepatic damage, joint pain, insomnia, vomiting, anxiety, headaches and nervousness.

Your client may be experiencing a fluid overload.
Your client may be experiencing an embolus.
Your client may be hyperglycemic.
Your client may have an inadvertent pneumothorax.

The client may be experiencing an embolus, which is a complication of total parenteral nutrition. Some of the signs and symptoms of an embolus are chest pain, dyspnea, shortness of breath, coughing, and respiratory distress.

Emboli, secondary to total parenteral nutrition occur when air is permitted to enter this closed system during tubing changes and when a new bottle or bag of hyperalimentation is hung. This complication can be prevented by instructing the client to perform the Valsalva maneuver and the nurse’s rapid changing of tubings and solutions when the closed system is opened to the air.

An inadvertent pneumothorax can occur and become symptomatic during the insertion of the TPN catheter and not four days later.

Other side effects of TPN and their signs and symptoms are listed below.

Infection: The classical signs of infection including a fever, malaise, swelling and redness at the insertion site, diaphoresis, chilling and pain in the area of the TPN catheter insertion site.
Fluid overload: Hypertension, edema, adventitious breath sounds like crackles and rales, shortness of breath, and bulging neck veins.
Hyperglycemia: High blood glucose levels, thirst, excessive urinary output, headache, nausea and fatigue.
Hypoglycemia: Low blood glucose levels, shakiness, clammy and cool skin, blurry vision, diaphoresis and unconsciousness and seizures.
Clients are at high risk for infection when they are getting TPN because they are immunocompromised.
Clients are at high risk for hyperglycemia when they are getting TPN because they are diabetic.
The client should perform the Valsalva maneuver when the nurse changes the TPN tubing.
The client should perform the Valsalva maneuver when the nurse changes the TPN dressing.

The client should perform the Valsalva maneuver when the nurse changes the TPN tubing to prevent an embolus which can occur when the tubing is opened to the air while it is being changed.

A mask, not the Valsalva maneuver, is indicated for TPN dressing changes.

Lastly, clients are at risk for infection secondary to TPN because these solutions are high in dextrose and because TPN is an invasive sterile procedure; and clients are at high risk for hyperglycemia when they are getting TPN because these solutions are high in dextrose and not because the client is already a diabetic client.

Physiological Integrity: Reduction of Risk Potential Practice Questions

Respiratory rate: 32 breaths per minute
Pulse: 110 beats per minute
Blood pressure: 55/82
“The respiratory rate is a little too fast but the other vital signs are normal.”
“The pulse rate is a little too fast but the other vital signs are normal.”
“The blood pressure is a little low but the other vital signs are normal.”
“All of these vital signs are normal for a child that is 2 years of age.”

All of these vital signs are normal for the toddler who is 2 years old. The normal vital signs for the toddler are:

Respiratory rate: From 20 to 40 per minute
Pulse rate: From 90 to 140 beats per minute
Blood pressure: Diastolic from 50 to 80 mm Hg and systolic from 80 to 112 mm Hg
Pulse: 100 beats per minute
Blood pressure: 85/55

The respiratory rate is a little too fast for this 5 year old preschool client. The normal respiratory rate for this client should be from 22 to 30 per minute.

The normal pulse rate and blood pressure for the preschool child are from 80 to 110 beats per minute and a diastolic from 50 to 78 mm Hg and a systolic from 82 to 110 mm Hg.

Pulmonary Artery Systolic Pressure: 22 mm Hg
Pulmonary Artery Wedge Pressure: 22 mm Hg
Pulmonary Artery Diastolic Pressure: 10 mm Hg
Central Venous Pressure: 5 mm Hg

You would report the pulmonary artery wedge pressure of 22 mm Hg because the normal pulmonary artery wedge pressure is from 4 to 12 mm Hg.

The other normal hemodynamic values are:

Pulmonary Artery Systolic Pressure: 15 to 26 mm Hg
Pulmonary Artery Diastolic Pressure: 5 to 15 mm Hg
Central Venous Pressure: 1 to 8 mm Hg
The need to cleanse the perineal area with circular wipes.
The need to cleanse the perineal area from the “dirtiest” to the “cleanest”.
The need to use a new antiseptic wipe for each wipe from the inner to the outer labia.
The need to use a new antiseptic wipe for each wipe from the outer to the inner labia.

You would instruct your female client to use a new antiseptic wipe for each wipe from the inner to the outer labia.

A principle of asepsis is the cleansing of areas from the cleanest to the dirtiest and NOT the reverse; therefore, the inner labia are cleansed before the outer labia. The female perineal area is prepped with straight strokes and wipes; and the male wipes with a circular pattern around the urinary meatus.

Turn the finger down so the blood will drop with gravity.
Wipe off the first drop of blood using sterile gauze.
Prick the side of the finger using the lancet.
Prick the pad of the finger using the lancet.

Pricking the pad of the finger using the lancet is NOT a step in the procedure for obtaining a blood glucose sample for testing. Instead, the side of the finger is pricked with the lancet.

The procedure for checking the client’s blood glucose levels in correct sequential order is as follows:

Verify and confirm that the code strip corresponds to the meter code.
Disinfect the client’s finger with an alcohol swab.
Turn the finger down so the blood will drop with gravity.
Collect the next drop on the test strip.
Hold the gauze on the client’s finger after the specimen has been obtained.
Read the client’s blood glucose level on the monitor.
PaO2: 65 mm Hg
PaCO2: 40 mm Hg
Arterial blood pH: 7.39

You would report the client’s PaO2 of 65 mm Hg because it is not within normal parameters and it is also a significant change for the client. The normal partial pressure of oxygen (PaO2) is from 75 to 100 mm Hg.

The other blood gases, above, are within normal limits, as follows:

Partial pressure of carbon dioxide (PaCO2): 38 - 42 mmHg
Arterial blood pH: 7.38 - 7.42
Oxygen saturation (SaO2): 94 - 100%
Triglycerides: 75 mg/dL
Total cholesterol: 6.5 mmol/L
High-density lipoprotein (HDL): 60 mg/dL
Low-density lipoprotein (LDL): 955 mg/dL

You would report a total cholesterol level of 6.5 mmol/L because this value exceeds the high normal for total cholesterol which is 5.5 mmol/L and the normal range is from 3 to 5.5 mmol/L.

The other lipid levels are normal as follows:

Triglycerides: 50-150 mg/dL
High-density lipoprotein (HDL): 40-80 mg/dL
Low-density lipoprotein (LDL): 85-125 mg/dL
Albumin: 40 g/L
Amylase: 40 U/L
Direct bilirubin: 17 µmol/L
Total bilirubin: 17 µmol/L

You would report a direct bilirubin level of 17 µmol/L because this value exceeds the high normal for direct bilirubin which is 6 µmol/L and the normal range is from 0-6 µmol/L.

The other gastrointestinal related normal laboratory values are as follows:

Albumin: 35-50 g/L
Amylase: 30-125 U/L
Total bilirubin: 2-20 µmol/L
A 76 year old female client who has a history of alcohol abuse.
A 76 year old female client who has a history of radon gas exposure.
A 64 year old male client who has a history of cigarette smoking.
A 64 year old male client who has hypotension.

A 64 year old male client who has hypotension is at greatest risk for impaired vascular perfusion.

Other risk factors associated with impaired vascular and tissue perfusion are:

Hypervolemia
Hypovolemia
Low hemoglobin
An immobilized limb
Decreased cardiac output
Impaired oxygen transportation
Hypoventilation

Alcohol abuse, cigarette smoking and exposures to radon place people at risk for cancer, rather than impaired perfusion.

A 76 year old female client who has a history of diabetes.
A 64 year old male client who has a history of impaired oxygen transport.

The client who is at greatest risk for the development of cancer is the 76 year old female client who has a history of alcohol abuse. Data indicates that alcohol abuse can lead to cancer of the liver and other cancers.

Diabetes, a history of impaired oxygen transport and hypotension are risk factors associated with poor tissue perfusion, and not cancer.

The level of pain among school age children.
The risk for the impairment of skin integrity.
Levels of muscular strength.
Levels of mobility.

The Norton Scale measures the client’s risk for the impairment of skin integrity. The Norton Scale and the Braden Scale are standardized tools to screen clients for their risk of skin breakdown, pressure ulcers and an impairment of skin integrity.

Pain levels among school age children are measured with other standardized pain tools for pediatric clients; and levels of muscular strength and mobility are measured also with other standardized tests and not the Norton Scale.

Impaired tissue perfusion

Impaired tissue perfusion is an intrinsic, or internal, risk factor that places the client at risk for pressure ulcers.

Pressure, shearing and friction are extrinsic, or external, risk factors that places the client at risk for pressure impaired tissue perfusion.

Other intrinsic risk factors associated with skin breakdown include:

Poor nutritional status
A decreased level of consciousness including that which occurs with sedating medications
Fecal and/or urinary incontinence
Impaired circulation
Alterations in terms of the fluid balance
Altered neurological sensory functioning
Changes in terms of skin turgor
Boney prominences
Inflate the cuff if the cuff is deflated.
Deflate the cuff if the cuff is inflated.
Remove the inner cannula of the tube.
Call the doctor about this airway obstruction.

The first thing that you should do when you insert the suction catheter and you reach a point of resistance is to deflate the cuff when it is inflated and the second thing that you should do is to remove the inner cannula and suction out the mucous plug.

You would not call the doctor because there is an airway obstruction; you should correct this problem with the measures above.

Maintain the client with NPO status for at least 4 hours prior to this procedure.
Teach the client about the fact that they may experience muscle flaccidity.
Teach the client about the fact that they may have a headache after the ECT.
Maintain the client on continuous hemodynamic monitoring after the ECT.

You would teach the client about the fact that they may have a headache after the ECT. Other components of the teaching about the aftermath of the procedure that the client should know about include the fact that the client may have muscle soreness, not muscle flaccidity, confusion, amnesia and hypertension.

The client should be maintained as NPO for at least 6 hours before ECT; and it is not necessary to maintain the client on continuous hemodynamic monitoring after the ECT, however, the client’s vital signs should be monitored.

Strnagulation
Skin breakdown
Skin pallor

The neurological complication can occur when a vest restraint is too tight around the client’s body is numbness and tingling that, unless corrected, can lead to neurological damage.

Strangulation, skin breakdown and skin pallor can also occur when a restraint is too tight, however, these restraint complications are respiratory, integumentary system and circulatory system complications rather than neurological complications.

The appearance of petechiae
Aplastic anemia
The appearance of thrombophlebitis
Elevated platelets

The appearance of petechiae is a sign of thrombocytopenia which is a low platelet count. Other signs and symptoms include purpura, easy bruising, epistaxis, and spontaneous hemorrhage and bleeding.

Thrombocytopenia can occur as the result of several disorders and therapeutic treatments and interventions including aplastic anemia, HIV infection, a genetic disorder, cancer, particularly cancer that affects the bones, some viral pathogens like those that cause mononucleosis, as well as from therapeutic radiation therapy, chemotherapy and some medications such as Depakote.

Pneumothorax

The complication that you should be aware of during the immediate post-operative period of time after a thoracentesis is a pneumothorax.

The signs and symptoms of pneumothorax and hemothorax include dyspnea, chest pain, shortness of breath and pain. The treatment of a pneumothorax includes the correction of the underlying cause whenever possible and the placement of a chest tube to remove the blood and/or air in the pleural space which will re-expand the affected lung and recreate the negative pressure of the pleural space.

Infection would not be evident during the immediate post-operative period; and, aspiration is not a complication of a thoracentesis.

The client’s posterior tibia pulse is Grade B
The client’s posterior tibia pulse is Grade C
The client’s posterior tibia pulse is 1
The client’s posterior tibia pulse is 2

You would document this finding as “The client’s posterior tibia pulse is 1”.

The strength, volume and fullness of the peripheral pulses are categorized and documented as follows:

0: Absent pulses
1: Weak pulse
2: Normal pulse
3: Increased volume
4: A bounding pulse

Grades and grading are not used in reference to pulses.

The Lazarus Cognitive Appraisal Scale
The Hamilton Rating Scale
The McGill Scale
The Rancho Los Amigos Scale

The tool or scale that you would use for a focused neurological assessment of your client is the Rancho Los Amigos Scale.

Levels of consciousness, which is part of a complete focused neurological assessment, can be determined and measured by using the standardized Glasgow Coma Scale for adults and children or the Rancho Los Amigos Scale. The Rancho Los Amigos Scale determines the patient’s level of awareness and functioning which can range from a 1 to an 8 when a 1 is the complete lack of all responsiveness to all stimulation and an 8 is when a patient is fully alert, oriented, appropriate and purposeful.

The McGill Pain Assessment is used to assess pain levels; the Lazarus Cognitive Appraisal Scale is used to assess levels of stress and coping; and the Hamilton Rating Scale is used to measure and assess depression.

A lack of zinc
A lack of vitamin E
High iron levels
High phosphorous levels

A lack of zinc, copper, iron and vitamins C and A are risks associated with impaired and delayed wound healing.

Other risk factors that impede wound healing are:

Advancing age
Nutritional status
Some poor lifestyle choices
Some medications
Some diseases and disorders
“The client is having anesthesia awareness which is not good.”
“This often happens during stage 2 of general anesthesia.”
"The client needs more general anesthesia.”
“The client is having a seizure.”

You should respond to this student nurse by stating, “This often happens during stage 2 of general anesthesia.”

Stage 2 of general anesthesia, often referred to as the Excitement Stage, is characterized with uncontrollable muscular activity, irregular respirations, an irregular cardiac rhythm, and, at times, vomiting. This stage does not indicate the need for more general anesthesia.

Anesthesia awareness, which is a rare complication of general anesthesia, is the lack of amnesia during surgery when the client remembers events during surgery and, at times, they remember the pain.

Lastly, there is no evidence in this question that the client is having a seizure.

Surgical site marking
Medication reconciliation
A neutral zone for sharps

Medication reconciliation prevents medication errors and other complications associated with medications and not a way to reduce surgical risks.

Surgical marking, time outs that are done after surgical site marking is done, and a neutral zone for sharps do reduce surgical risks such as wrong site surgery, wrong patient surgeries and sharps injuries.

Physiological Integrity: Physiological Adaptation Practice Questions

Exclude pregnant visitors from the client’s room.
Place the client in a negative pressure room.
Have all visitors wear protective masks and boots.
All of the above

You would exclude all pregnant visitors from the client’s room in order to protect the pregnant woman’s developing fetus. Brachytherapy is internally placed radioactive material to treat clients who are affected with tumor and cancer of the prostate, lungs, esophagus, cervix, endometrium, rectum, breast, head and neck.

Special radiation precautions are initiated when a client is receiving brachytherapy in order to protect visitors and health care staff from the harmful effects of the radiation. Some of the other special internal radiation precautions include:

The minimization of the duration of time that health care providers are in the client’s room to deliver care and services to the client
The placement of the client receiving internal radiation in a private room. A negative pressure room is not indicated for this client.
The prohibition of the client’s activities outside of their room
The initiation of complete bed rest for the client until the treatment is discontinued
The provision of education to the family members and other visitors that includes information about their need to limit the time of their visits to at least less than 1 hour, to stay at least 6 feet away from the client
The need for health care staff to minimize the amount of time spent in the room, to decline to enter the room if they are pregnant, to retain all supplies and equipment including things like bed linens in the client’s room until they are deemed safe for disposal by a person who is competent to make this decision, and how and when to report concerns about the client’s treatment such as when implanted seeds inadvertently leave the client’s body.
Oral dryness

Fibrosis is an adverse effect to therapeutic radiation therapy.

Radiation fibrosis can affect bones, nerves, ligaments, muscles, blood vessels, tendons, and the heart in addition to the lungs. Fibrosis occurs as the result of abnormal fibrin and protein accumulation within normal irradiated tissue.

Alopecia, and oral dryness which is also referred to as xerostomia, are side effects and complications to radiation, but not adverse effects.

Other side effects, complications and adverse effects associated with therapeutic radiation therapy are:

Skin damage
Damage to the mucosa
Dental caries and oral infections
Nausea and vomiting
Bone marrow suppression and immunosuppression
Radiation pneumonia
Placing the client in the Trendelenburg position
Monitoring the color of the stools
Using a Hoyer lift for patient transfers
Monitoring the arterial blood gases

You would monitor the color of the stools for the client who is receiving phototherapy. Phototherapy is used to treat psoriasis, but it is most commonly employed for the treatment of neonatal hyperbilirubinemia and jaundice which can occur among both full term and pre term infants.

You would also monitor and document the client’s:

Skin for changes in color that may indicate an increase or decrease in the amount of bilirubin in the client’s blood
Laboratory bilirubin levels to determine whether or not the client’s bilirubin levels are decreasing as the result of the phototherapy
Volume, color and characteristics of the stool because phototherapy can lead to frequent, loose stools as well as a color change to green colored stools
Hypokalemia: Hypermagnesemia
Hyponatremia: Dehydration
Hyperkalemia: Ketoacidosis
Hypercalcemia: Hypoparathyroidism

Ketoacidosis is a risk factor for hyperkalemia.

The risk factors for the other electrolyte disorders above are listed below.

Hypokalemia: Diarrhea, vomiting, and diaphoresis as well as some medications like diuretics and laxatives, and with other disorders and diseases such as ketoacidosis. Hypermagnesemia is not a risk factor for hypokalemia.
Hyponatremia: Thyroid gland disorders, cirrhosis, renal failure, heart failure, pneumonia, diabetes insipidus, Addison’s disease, hypothyroidism, primary polydipsia, severe diarrhea or vomiting cancer, and cerebral disorders. Dehydration is a risk factor associated with hypernatremia, not hyponatremia.
Hypercalcemia: Hyperparathyroidism, not hyperparathyroidism, some medications such as thiazide diuretics and lithium, some forms of cancer such as breast cancer and cancer of the lungs, with multiple myeloma, Paget’s disease, non weight bearing activity and elevated levels of calcitriol as occurs with sarcoidosis and tuberculosis.
Hypernatremia: Hepatic failure
Hypocalcemia: Vitamin A deficiency
Hypermagnesemia: Cushing’s disease
Hypomagnesemia: Crohn’s disease

Crohn’s disease is a risk factor for hypomagnesemia.

Other electrolyte disorder risk factors include:

Hypernatremia: Dehydration, renal failure, hyperglycemia and Cushing’s disease
Hypocalcemia: Vitamin D deficiency, Crohn’s disease, sepsis and pancreatitis
Hypermagnesemia: Addison’s disease, renal failure, diabetic ketoacidosis and dehydration
Phosphate: From 0.81 to 1.45 mmol/L.
Chloride: From 60 to 110 mEq/L.
Calcium: From 6.5 - 10.6 mg/dL.
Potassium: From 3.7 to 7.2 mEq/L.

The normal level of phosphate is from 0.81 to 1.45 mmol/L.

The other normal levels for these electrolytes are:

Chloride: From 97 to107 mEq/L.
Calcium: From 8.5 - 10.6 mg/dL.
Potassium: From 3.7 to 5.2 mEq/L.

Idioventricular Rhythm
Bundle Branch Block
Sinus bradycardia
Atrial Flutter

Sinus bradycardia is a sinus rhythm that is like the normal sinus rhythm with the exception of the number of beats per minute. Sinus bradycardia has a cardiac rate less than 60 beats per minute, the atrial and the ventricular rhythms are regular, the P wave occurs prior to each and every QRS complex, the P waves are uniform in shape, the length of the PR interval is form 0.12 to 0.20 seconds, the QRS complexes are uniform and the length of these QRS complexes are from 0.06 to 0.12 seconds.

Atrial flutter
Supraventricular Tachycardia
Premature Atrial Contractions

Atrial flutter, which is a relatively frequently occurring tachyarrhymia; this cardiac rhythm is characterized with an rapid atrial rate of 250 to 400 beats per minute, a variable ventricular rate, a regular atrial rhythm, a possibly irregular ventricular rhythm, the P waves are not normal, the flutter wave has a saw tooth look (f waves), the PR interval is not measurable, QRS complexes are uniform and the length of these QRS complexes are from 0.06 to 0.12 seconds.

Torsades de Pointes
Accelerated Idioventricular Arrhythmia
First Degree Atrioventricular Heart Block
Supraventricular tachycardia

Supraventricular tachycardia, simply defined is all tachyarrhythmias with a heart rate of more than 150 beats per minute.

The atrial and ventricular cardiac rates are from 150 to 250 beats per minute, the cardiac rhythm is regular, the p wave may not be visible because it is behind the QRS complex, the PR interval is not discernable, the QRS complexes look alike, and the length of the QRS complexes ranges from 0.06 to 0.12 seconds.

Third Degree Heart Block
Second-Degree Atrioventricular Block, Type II
Ventricular fibrillation

The two types of ventricular fibrillation that can be seen on an ECG strip are fine ventricular fibrillation and coarse ventricular fibrillation; ventricular fibrillation occurs when there are multiple electrical impulses from several ventricular site. This results in erratic and uncoordinated ventricular and/or atrial contractions.

You would instill 250 mLs of irrigating solution after each suctioning of the nasogastric tube. The typical amount of irrigating solution is from 20 mLs to 300 mLs.

The compression of the renal medulla.
Syncope and dizziness of unknown origin.
Pressure on the vena cava which is a major vein in the body.
Pressure on the vena cava which is the largest artery in the body.

You should explain that superior vena cava syndrome is pressure on the vena cava which is a major vein, not an artery, in the body that carries blood from the systemic circulation to the right atrium of the heart. This pressure on the superior vena cava prevents the normal return of the body’s circulating blood to the heart.

The signs and symptoms of superior vena cava syndrome include tachypnea, dyspnea, venous stasis, a loss of consciousness, edema, seizures, respiratory and/or cardiac arrest and not syncope of unknown origin. This is a life threatening medical emergency.

Hypovolemic shock
Septic shock
A dissected thoracic aortic aneurysm

You would most likely suspect that this client is affected with a dissected thoracic aneurysm. Thoracic aorta rupture and dissections can present with symptoms that can include shortness of breath, dysphagia, dyspnea, coughing, and pain in the chest, arms, jaw, neck, and/or back.

The signs and symptoms of hypovolemic shock vary according to the stage of the shock; some of the signs and symptoms include hypotension, tachycardia, a lack of tissue perfusion, hyperventilation, decreased cardiac output, decreased urinary output, oliguria, anuria, metabolic acidosis, increased blood viscosity, and multisystem failure.

The signs and symptoms of septic shock include the classical signs of infection in addition to hypotension, confusion, metabolic acidosis, respiratory alkalosis, abnormal breath sounds like crackles and rales, a widened pulse pressure, and decreased cardiac output.

Part of the intestine slides into another part of the intestine.
The appendix ruptures.
An ileostomy stoma retracts below the abdominal surface.
Lungs are infiltrated.

Intussusception occurs when a part of the intestine slides into another part of the intestine. This medical emergency can lead to poor perfusion to the intestine.

The signs and symptoms of intussusception include knee to chest posturing, abdominal pain, bloody stool, fever, constipation, vomiting and diarrhea.

A ruptured appendix occurs when an infected appendix ruptures; a stoma retraction occurs when an ileostomy stoma retracts below the abdominal surface; and pneumonia occurs when the lungs become infiltrated.

The administration of a thrombolytic medication
The administration of hyroxyurea
Placing the client in the lithotomy position

You would expect to administer hydroxyurea which prevents the sickling of the client’s red blood cells. You would not administer a thrombolytic medication; however, you would likely administer analgesic medications for the pain associated with the sickle cell crisis.

The lithotomy position is used for procedures involving the pelvis, including gynecological examinations; and the Trendelenburg position is used when the client is in shock and with significant hypotension.

Perform the Valsalva maneuver
Encourage the person to continue coughing
Perform the Heimlich maneuver
Begin CPR and prepare for ACLS measures

You would encourage the person to continue coughing because this person has a partial airway obstruction.

You would perform the Heimlich maneuver when the person has a complete airway obstruction. CPR and ACLS may be necessary later, but not now as based on the fact that the person only has a partial airway obstruction. Lastly, the Valsalva maneuver is done when one exerts pressure against resistance.

Trichomoniasis
Staphylococcus aureus
Neisseria gonorrhoeae

Pelvic inflammatory disease is most often caused by the Neisseria gonorrhoeae and Chlamydia trachomatis pathogens; and it most often occurs as the result of untreated salpingitis, pelvic peritonitis, a tubo ovarian abscess and/or endometritis.

Unlike Neisseria gonorrhoeae, trichomoniasis and infections caused by E. coli and Staphylococcus aureus are not associated with the onset of pelvic inflammatory disease which can lead to infertility, increased risk for ectopic pregnancies, sepsis, septic shock and death when left untreated.

Adaptive immunity
Passive natural immunity
Active natural immunity
Active artificial immunity

The type of immunity occurs when a person has an infectious, communicable disease like the measles is active natural immunity.

Active immunity occurs as the result of our bodily response to the presence of an antigen, with the development of antibodies. Active immunity can be both natural and artificial. Natural active immunity occurs when the body produces antibodies after the client is infected with a pathogen; and artificial active immunity occurs when the body produces antibodies to an immunization vaccine such as those for pneumonia and a wide variety of childhood infectious diseases.

Adaptive immunity is the acquisition of antibodies or activated T cells in the body. Passive immunity occurs when an antibody is introduced into the body by either natural or artificial means. Passive natural immunity occurs when the fetus and neonate receive immunity as a natural process through the placenta; and passive artificial immunity occurs when the client receives an injection of immune globulin.

The incubation stage
The prodromal stage

The prodromal stage, or phase, of the infection process is characterized with general malaise, joint and muscular aches and pains, anorexia, and the presence of a headache. The prodromal stage begins with the onset of symptoms and this stage is characterized with the replication and reproduction of the pathogen.

The incubation stage is asymptomatic; the illness stage is the period of time that begins with continuation of the signs and symptoms and it continues until the symptoms are no longer as serious as they were before; and the convalescence stage is the period of recovery during which time the symptoms completely disappear.

They are not as effective as regular defibrillators.
They are replacing regular defibrillators in acute care settings.
Only BLS certified people in the community should use them.
They can be easily used by people with no healthcare experience.

Automated external defibrillators can be easily used by people with no healthcare experience. Automated external defibrillators are simple to use and there is no need to be able to recognize cardiac arrhythmias or interpret cardiac rhythm strips. Automated external defibrillations are intended to be used by the general public without any healthcare or nursing knowledge of experience; therefore, they are not restricted to only those BLS certified.

Although they are highly effective, they are not replacing the standard defibrillators in the acute care setting.

Episiotomy extension related to a forceps delivery
Respiratory depression related to NSAIDs
Hemothorax related to a latex allergy

Maternal trauma, lacerations, pelvic floor damage, bleeding and an inadvertent extension of the episiotomy to the anus when a forceps delivery of a new born is done.

Respiratory depression can occur as the result of narcotic analgesics such as morphine, and not NSAIDs; pneumothorax and hemothorax can occur as the result of an inadvertent perforation during invasive procedures such as the placement of a total parenteral nutrition catheter and a thoracentesis; and the signs and symptoms of a latex allergy include tachycardia, hypotension, dyspnea, chest pain tremors, and anaphylactic shock, not respiratory depression.

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Nursing Research Questions and Answers

1. Answer: C. Descriptive Research – This type of research describes the current situation in a given period of time.

2. Answer: B. Exploration – Exploratory research is an extension of descriptive research and is more oriented towards the discovery of relationships. Prescription research is intended for both research and practice. Prediction and control may contain a prediction of casualty, and control of the occurrence of casualty. Explanation research is a type of research that sought after predictions that should be tested with research.

3. Answer: D. Debriefing – This is the process wherein the subjects of the research must be able to understand what are they about the undergo. This is the fundamental right of being informed.

4. Answer: B. Anonymity – This is the fundamental right of individuals who participate in research. Being anonymous may place the individual respondent’s information to be free from prejudice. Linking the information from the source or participant is prohibited.

5. Answer: B. “This discussion should only be confined within this group of people. Any information discussed should not be told publicly.” – Confidentiality of information means that any information discussed in a certain period of time should not be made available publicly.

6. Answer: A. This study aims to determine the level of knowledge and practice of prevention of needle prick injuries of Staff Nurses in a certain private hospital. – A general objective involves the broad concept of the study. The other options were examples of specific objectives.

7. Answer: A. This study is for nursing researchers in the future. – This is not a specific objective rather it is a statement of who will be able to benefit from the study.

8. Answer: B. Questionnaire – This is the best data-gathering tool. A structured questionnaire can gather precise information.

9.Answer: A. Limited to the hospital personnel of a private hospital – The study is focused only on nursing personnel. The statement includes hospital personnel which is not specific.

10. Answer: C. There is a significant relationship between the knowledge and sociodemographic profile of staff nurses – This is a positive statement of a hypothesis.

11. Answer: C. Implement planned study – This is similar to the part of nursing process – intervenes. This activity involves consideration of ethical standards.

12. Answer: A. Select a design plan – As the item denotes, there is a clue already – plan.

13. Answer: B. gather, analyze relevant information – Gathering and analyzing the information can lead to selecting the best solution, this is where implementing the planned study comes in when using the Research perspective.

14. Answer: B. Formulate a problem, define variables – A hypothesis is a scientific guess which is similar to making inferences when it comes to the Nursing Process perspective.

15. Answer: B. Plan: Theorize – The planning stage in the nursing process involves determining information needs for the problem

16. Answer: B. Talents – Research skills rather than using the term talent is more appropriate. In research all of the ideas must be stated in a technical form rather than in flowery words.

17. Answer: C. Reveal what is the problem – This is the purpose of introduction of a research paper. The review of related literature would only place the picture properly whether there is a need for further research or not.

18. Answer: B. Give a graphic view of the data – This is the functions of tables and graphs which are important in showing the results of the study in an organized format.

19. Answer: D. A Review on the Performance in Related Learning Experience of student nurses – this is not qualitative research since it uses measurement tools in order to present the data.

20. Answer: B. process of selecting a portion of the population to represent the entire population – It involves many types of sampling as the other definitions would describe stratified random sampling, systematic sampling, purposive sampling.

21. Answer: C. Grapevine – Rumours are not reliable sources of information. The other items would guarantee reliable results.

22. Answer: C. Pre-Test & Post-Test – This is not an appropriate tool in gathering the needed data. Since this type of research is descriptive in nature, the other three options can be utilized.

23. Answer: B . Mode – This is a numerical value in a distribution that occurs frequently.

24. Answer: C. Mean – The point on the scale that is equal to the sum of scores divided by the number of scores.

25. Answer: D . Frequency Distribution – Deviance shows how to disperse a group of samples can from the middle value. Central tendency shows how clustered groups can be in a middle value; mode is an example of central tendency

30 Research Nurse Interview Questions and Answers

Common Research Nurse interview questions, how to answer them, and example answers from a certified career coach.

Embarking on a career as a research nurse is an opportunity to combine your clinical expertise with scientific curiosity and contribute to advancements in healthcare. It’s a rewarding field that requires not only exceptional nursing skills but also the ability to navigate complex research projects and collaborate well with multidisciplinary teams. As you prepare for your interview, it’s important to showcase these essential qualities alongside your passion for making a difference.

In this article, we’ve gathered common research nurse interview questions along with guidance on how to answer them effectively so that you can confidently approach your upcoming meeting and demonstrate your readiness for this vital role.

1. What motivated you to become a research nurse?

Understanding your motivation for becoming a research nurse provides insight into your passion and dedication to the field. This question helps interviewers gauge your enthusiasm for research, your commitment to improving patient care, and your desire to contribute to the medical community. They want to see that you’re driven by more than just a paycheck, and that you have a genuine interest in advancing healthcare through research and evidence-based practice.

Example: “My motivation to become a research nurse stemmed from my passion for both nursing and scientific discovery. As a registered nurse, I found great satisfaction in providing care and support to patients during their most vulnerable moments. However, I also recognized the importance of advancing medical knowledge to improve patient outcomes and overall healthcare.

Becoming a research nurse allowed me to combine these two passions by contributing to clinical trials and studies that have the potential to revolutionize treatments and therapies. This role enables me to not only provide direct patient care but also play an active part in shaping the future of medicine. Knowing that my work can potentially impact countless lives and lead to better treatment options is what truly drives me as a research nurse.”

2. Describe your experience with clinical trials and the role you played in them.

Clinical trials are a critical component of advancements in medical treatments and the role of a research nurse is pivotal in their success. Interviewers want to understand your experience in this area, how you contributed to the clinical trial process, and how you ensured patient safety and ethical standards. By assessing your knowledge and experience in managing clinical trials, they can gauge your ability to contribute to their research team and handle real-world situations.

Example: “During my time as a research nurse, I have been involved in several clinical trials, primarily focusing on oncology treatments. My role in these trials has been multifaceted and included responsibilities such as patient recruitment, informed consent, data collection, and monitoring patients’ progress throughout the study.

I worked closely with the principal investigator to ensure that all trial protocols were followed and that any adverse events or deviations were reported promptly. Additionally, I collaborated with other healthcare professionals, including physicians, pharmacists, and laboratory technicians, to coordinate patient care and maintain accurate records of their treatment plans and outcomes. This experience allowed me to contribute significantly to the success of the clinical trials while ensuring the safety and well-being of our participants.”

3. How do you ensure that study participants fully understand the informed consent process?

Conducting ethical research is of utmost importance, especially when it involves human subjects. The informed consent process is a critical part of research studies, ensuring that participants are fully aware of the risks, benefits, and their rights. By asking this question, interviewers want to assess your ability to effectively communicate complex information and ensure participants’ comprehension, ultimately protecting their safety and autonomy throughout the research process.

Example: “To ensure that study participants fully understand the informed consent process, I prioritize clear communication and take a patient-centered approach. First, I provide them with an easy-to-understand written document outlining the study’s purpose, procedures, potential risks, benefits, and their rights as participants. I then walk them through each section of the document, using layman’s terms to explain complex concepts and medical jargon.

After discussing the document, I encourage participants to ask questions and address any concerns they may have. This open dialogue allows me to gauge their understanding and clarify any misconceptions. Additionally, I make sure to emphasize that participation is voluntary and that they can withdraw from the study at any time without penalty. Ultimately, my goal is to create an environment where participants feel comfortable, well-informed, and empowered to make decisions about their involvement in the research study.”

4. Can you explain the difference between Phase I, II, III, and IV clinical trials?

Understanding the different phases of clinical trials is essential for a research nurse, as each phase has its own unique objectives, protocols, and responsibilities. Demonstrating your knowledge of these phases shows that you are well-prepared for the complexities of the research process and can navigate the various requirements to ensure patient safety, data accuracy, and overall trial success.

Example: “Certainly. Phase I clinical trials are the first stage of testing a new drug or treatment in humans, typically involving a small group of healthy volunteers. The primary goal is to evaluate safety, determine appropriate dosage, and identify any potential side effects.

Phase II trials involve a larger participant group, usually consisting of patients with the specific condition the drug or treatment aims to address. This phase focuses on evaluating the effectiveness of the intervention, while continuing to monitor its safety and further refine the optimal dosage.

Phase III trials are conducted on an even larger scale, often involving hundreds or thousands of participants across multiple sites. These trials aim to confirm the efficacy of the drug or treatment, compare it to existing standard treatments, and gather more information about its safety and side effects. Successful completion of Phase III trials can lead to regulatory approval for public use.

Phase IV trials, also known as post-marketing surveillance studies, occur after a drug or treatment has been approved and released to the market. These trials continue to monitor the long-term safety and effectiveness of the intervention in real-world conditions, detect rare side effects, and assess its impact on different populations and under various circumstances.”

5. How do you handle situations where patients are hesitant or unwilling to participate in a study?

When interviewers ask this question, they’re seeking insights into your interpersonal skills and ability to empathize with patients. It’s critical for research nurses to respect patients’ autonomy, while also being able to educate and alleviate their concerns. Your response should demonstrate your ability to navigate sensitive situations and find ways to help patients feel comfortable and informed about their participation in research studies.

Example: “When encountering patients who are hesitant or unwilling to participate in a study, I believe it’s essential to approach the situation with empathy and understanding. First, I take the time to listen to their concerns and address any misconceptions they may have about the research process. This helps build trust and rapport with the patient.

If the patient still remains hesitant, I provide them with clear and concise information about the study’s purpose, potential benefits, risks, and how their participation could contribute to advancements in medical knowledge. It’s important to ensure that the patient feels well-informed and comfortable asking questions. Ultimately, I respect their decision whether or not to participate, as voluntary consent is a fundamental principle in clinical research.”

6. What strategies do you use to recruit and retain study participants?

Recruitment and retention of study participants are vital to the success of clinical research, as this directly impacts the validity and generalizability of the study results. Interviewers want to know that you, as a research nurse, have effective strategies in place to attract and maintain the engagement of participants, ensuring the study’s smooth progression and timely completion. Demonstrating your understanding of ethical considerations and cultural sensitivity will further emphasize your commitment to the well-being of participants while achieving the research goals.

Example: “Recruiting and retaining study participants is essential for the success of clinical research. To recruit participants, I first ensure that our promotional materials are clear, concise, and highlight the benefits of participating in the study. This includes using targeted advertising on social media platforms and collaborating with local healthcare providers to identify potential candidates.

Once participants are enrolled, retention becomes a priority. Building trust and rapport with them is key, so I make sure to maintain open communication channels and provide regular updates about the study’s progress. Additionally, I emphasize the importance of their contribution to advancing medical knowledge and improving patient care. Providing flexible scheduling options and addressing any concerns or questions promptly also helps keep participants engaged and committed to the study.”

7. Describe your experience working with Institutional Review Boards (IRBs).

Navigating the complex world of research ethics and regulations is a fundamental aspect of being a research nurse. Institutional Review Boards (IRBs) play a critical role in ensuring that research studies protect the rights, safety, and well-being of participants. Your experience working with IRBs demonstrates your understanding of the ethical considerations in research and highlights your ability to collaborate with these oversight bodies to maintain compliance and uphold the highest standards of patient care.

Example: “Throughout my career as a research nurse, I have had multiple opportunities to work with Institutional Review Boards (IRBs) in the context of clinical trials and studies. My experience includes preparing and submitting study protocols, consent forms, and other necessary documents for IRB review and approval. I understand the importance of adhering to ethical guidelines and ensuring that all research activities are conducted in compliance with regulations.

I also maintain open communication with the IRB throughout the course of a study, providing updates on any protocol amendments or adverse events that may occur. This collaboration ensures that patient safety remains a top priority while conducting research. Additionally, I participate in regular training sessions to stay updated on changes in regulatory requirements and best practices related to working with IRBs.”

8. How do you maintain patient confidentiality while conducting research?

Maintaining patient confidentiality is a critical aspect of any healthcare profession, and research nursing is no exception. When interviewers ask this question, they want to assess your understanding of the ethical responsibilities and legal requirements surrounding patient privacy. They also want to gauge your ability to balance the need for accurate research data with protecting the identity and personal information of the patients involved in the study.

Example: “Maintaining patient confidentiality is a top priority in research nursing, as it ensures the protection of patients’ privacy and upholds ethical standards. To achieve this, I adhere to strict protocols when handling sensitive information. Firstly, I anonymize all data collected from patients by assigning unique identification codes or pseudonyms, ensuring that personal identifiers are removed before analysis.

Furthermore, I store all confidential information securely, using password-protected databases and encrypted files. Access to these records is limited only to authorized personnel who have signed confidentiality agreements. When sharing research findings with colleagues or presenting them at conferences, I ensure that any identifiable information is omitted or aggregated to protect individual identities.

This diligent approach to maintaining patient confidentiality not only complies with legal requirements but also fosters trust between patients and researchers, ultimately contributing to the success of clinical studies.”

9. Explain the importance of Good Clinical Practice (GCP) guidelines in research nursing.

Compliance with Good Clinical Practice (GCP) guidelines is essential in research nursing to ensure the safety and well-being of study participants, the quality and integrity of data collected, and adherence to ethical standards. By asking this question, interviewers seek to evaluate your understanding of these guidelines and your commitment to maintaining high-quality research practices in a clinical setting. This knowledge is critical for maintaining the trust of patients, regulatory authorities, and sponsors in the research process.

Example: “Good Clinical Practice (GCP) guidelines are essential in research nursing as they provide a framework for conducting clinical trials ethically and with scientific rigor. Adhering to GCP ensures that the rights, safety, and well-being of trial participants are protected while maintaining the integrity and credibility of the data collected.

Following GCP guidelines also facilitates consistency across different studies, making it easier to compare results and draw meaningful conclusions. This is particularly important when seeking regulatory approval for new treatments or interventions, as adherence to GCP demonstrates that the study has been conducted professionally and responsibly. In summary, GCP plays a vital role in ensuring high-quality research outcomes and safeguarding the interests of all stakeholders involved in clinical trials.”

10. Have you ever encountered an ethical dilemma during a research project? If so, how did you handle it?

A research nurse’s role often involves navigating complex ethical issues that arise during clinical trials and studies. By asking about your experience with ethical dilemmas, interviewers aim to gauge your understanding of research ethics, your ability to identify potential problems, and your problem-solving skills in addressing such challenges. This insight helps them determine if you’re a good fit for their team and if you’re equipped to maintain the highest ethical standards in research activities.

Example: “Yes, I have encountered an ethical dilemma during a research project. We were conducting a clinical trial for a new medication, and one of the participants reported experiencing severe side effects that were not anticipated in the study protocol. The participant was concerned about continuing with the trial but also didn’t want to jeopardize their access to potential treatment.

To handle this situation, I first ensured that the participant’s well-being was our top priority by closely monitoring their condition and reporting the adverse event to the principal investigator. Next, we discussed the issue as a team, including the medical professionals overseeing the trial, to determine the best course of action. It was decided that the participant should be withdrawn from the study for their safety while still receiving appropriate care and support.

Throughout the process, I maintained open communication with the participant, ensuring they understood their options and rights within the study. This experience reinforced the importance of adhering to ethical guidelines and prioritizing patient safety in research projects.”

11. Describe your experience with data collection and management in a research setting.

Research nurses work in environments where data is integral to the success of clinical trials and studies. They need to demonstrate their ability to collect, manage, and maintain accurate data to ensure the integrity of the research. Interviewers ask this question to assess your experience and skills in handling data, as well as your understanding of its importance in a research setting. This will help them determine if you are a good fit for the role and can contribute to the success of their research projects.

Example: “During my time as a research nurse, I have been involved in several clinical trials where data collection and management were essential components. In one particular study, we were investigating the efficacy of a new medication for diabetes patients. My role included collecting patient information, such as medical history, vital signs, and laboratory results, as well as monitoring their progress throughout the trial.

To ensure accurate and consistent data collection, I followed strict protocols and used standardized forms to record all relevant information. Additionally, I utilized electronic data capture systems to input and manage the collected data securely. This allowed for easy access by the research team while maintaining patient confidentiality. Regular communication with the principal investigator and other team members was also critical to address any discrepancies or issues that arose during the data collection process. Ultimately, my attention to detail and adherence to established procedures contributed to the successful completion of the study and provided valuable insights into the potential benefits of the new medication.”

12. How do you stay current on new developments and best practices in research nursing?

Keeping up with the latest developments and best practices in research nursing is essential for success in the field. Interviewers want to ensure that you are dedicated to staying informed about new techniques, technologies, and research findings, so you can provide the highest level of care to patients and contribute effectively to research projects. This also demonstrates your commitment to continuous professional growth and improvement.

Example: “Staying current on new developments and best practices in research nursing is essential for providing the highest quality care to patients and ensuring that research studies are conducted effectively. To achieve this, I actively engage in continuous professional development through various channels.

One of my primary methods is attending conferences and workshops related to research nursing and clinical trials. These events provide valuable opportunities to learn from experts, network with peers, and gain insights into emerging trends and innovations. Additionally, I subscribe to several reputable journals and newsletters within the field, such as the Journal of Clinical Nursing Research and the American Journal of Nursing, which help me stay informed about recent findings and advancements.

Furthermore, I am an active member of professional organizations like the Association of Clinical Research Professionals (ACRP) and the International Association of Clinical Research Nurses (IACRN). These memberships grant access to educational resources, webinars, and online forums where I can discuss challenges and share experiences with fellow research nurses. This multifaceted approach ensures that I remain up-to-date and well-equipped to contribute effectively to research projects and patient care.”

13. What is your approach to educating patients about their participation in a clinical trial?

Educating patients about clinical trials is a critical aspect of a research nurse’s role. The interviewer wants to know if you can effectively communicate complex information to patients in a way that’s easy to understand, while ensuring they feel comfortable and informed. Your approach to patient education should demonstrate empathy, clarity, and a commitment to ethical research practices.

Example: “When educating patients about their participation in a clinical trial, my primary focus is on ensuring they have a clear understanding of the study’s purpose, potential benefits, and risks. I begin by explaining the objectives of the research and how it relates to their specific condition. This helps establish the context and relevance of the trial for the patient.

I then provide them with detailed information about the study protocol, including the treatment or intervention being tested, the duration of the trial, and any required follow-up visits. It’s essential to present this information in layman’s terms so that patients can easily comprehend the process. Additionally, I emphasize the voluntary nature of their participation and their right to withdraw at any time without affecting their standard care.

Throughout the education process, I encourage patients to ask questions and voice any concerns they may have. Addressing these queries promptly and thoroughly helps build trust and ensures that patients feel comfortable and well-informed before consenting to participate in the clinical trial.”

14. Can you discuss any challenges you have faced when implementing a research protocol?

Research nurses play a critical role in ensuring that research protocols are implemented effectively and ethically. Interviewers ask this question to gauge your ability to identify potential challenges, troubleshoot issues, and find creative solutions. They want to see that you can maintain the integrity of the study while adapting to unforeseen circumstances and ensuring the safety of the participants.

Example: “One challenge I faced while implementing a research protocol was related to patient recruitment. The study required participants with specific criteria, and it was difficult to find enough eligible patients within the given timeframe. To address this issue, I collaborated closely with the principal investigator and other team members to develop an effective recruitment strategy.

We expanded our search by reaching out to local clinics and healthcare providers who might have patients meeting the eligibility criteria. We also utilized social media platforms and online forums to raise awareness about the study. This proactive approach helped us overcome the recruitment challenge and ensured that we had a sufficient number of participants for the study, ultimately contributing to its success.”

15. Describe your experience collaborating with interdisciplinary teams in a research setting.

Collaboration is key when it comes to research, especially in a healthcare setting. Research nurses often work alongside physicians, scientists, and other healthcare professionals to develop and implement clinical trials, assess patient care, and analyze data. Your ability to communicate effectively and work cohesively with a diverse group of professionals is vital to the success of the research project. Interviewers want to ensure that you have the experience and skills necessary to contribute positively to their team.

Example: “During my time as a research nurse, I have had the opportunity to work with interdisciplinary teams on various clinical trials. This has involved collaborating closely with physicians, pharmacists, laboratory technicians, and data analysts, among others. Each team member brings their unique expertise to the table, which is essential for the success of the research project.

One specific example was when we were conducting a study on a new medication for diabetes management. My role included patient recruitment, obtaining informed consent, administering the medication, monitoring patients’ progress, and collecting data. Throughout this process, I worked closely with the principal investigator to ensure that the study protocol was followed accurately. Additionally, I collaborated with the pharmacists to manage drug dispensation and storage, while also liaising with lab technicians to coordinate sample collection and analysis. This teamwork allowed us to efficiently conduct the trial, analyze the results, and ultimately contribute valuable insights to the field of diabetes treatment.”

16. How do you manage your time effectively when juggling multiple research projects?

Balancing multiple research projects is a common challenge for research nurses, and this question aims to uncover your time management and organizational skills. Employers want to know that you can handle the workload, prioritize tasks, and keep each project on track without sacrificing the quality of your work or patient care. Demonstrating your ability to manage competing priorities is key to proving your value as a research nurse.

Example: “Effective time management is essential when handling multiple research projects, and I have developed a system that helps me stay organized and on track. First, I prioritize tasks based on their deadlines and importance to each project’s progress. This allows me to allocate my time efficiently and ensure that critical milestones are met.

To keep everything organized, I use a combination of digital tools and traditional methods like calendars, spreadsheets, and checklists. These tools help me visualize my workload, set reminders for important dates, and monitor the progress of each project. Additionally, I maintain open communication with my team members and supervisors, providing regular updates on project status and promptly addressing any issues or concerns that may arise. This collaborative approach ensures that everyone stays informed and aligned with our shared goals.”

17. What steps do you take to ensure patient safety during a clinical trial?

Patient safety is paramount in any medical setting, but it takes on a heightened importance in clinical trials where new treatments and procedures are being tested. Interviewers ask this question to gauge your commitment to ethical research practices, your understanding of study protocols, and your ability to identify and mitigate potential risks—all key components of a successful and responsible research nurse.

Example: “Patient safety is paramount during clinical trials, and as a research nurse, I take several steps to ensure their well-being. First, I thoroughly review the study protocol and inclusion/exclusion criteria to confirm that each participant meets the requirements and fully understands the potential risks and benefits of participating in the trial.

During the trial, I closely monitor patients for any adverse events or side effects, maintaining open communication with them and encouraging them to report any concerns. This allows me to promptly identify and address any issues that may arise. Additionally, I collaborate with the principal investigator and other healthcare professionals involved in the study to discuss patient progress and share relevant information, ensuring a comprehensive approach to patient care.

Furthermore, I meticulously document all observations, interventions, and outcomes throughout the trial, which not only helps maintain accurate records but also contributes to the overall quality and integrity of the study. Ultimately, my goal is to provide the highest level of care while safeguarding the well-being of each patient participating in the clinical trial.”

18. How do you handle adverse events or unexpected outcomes during a study?

Addressing adverse events or unexpected outcomes is a critical aspect of a research nurse’s role. Interviewers ask this question to assess your ability to remain composed, adhere to protocols, and ensure patient safety in the face of unforeseen challenges. Additionally, they want to gauge your problem-solving skills and ability to communicate effectively with the research team and patients when complications arise.

Example: “When handling adverse events or unexpected outcomes during a study, my first priority is to ensure the safety and well-being of the participants. I closely monitor their condition and provide appropriate care as needed, while documenting all relevant information about the event in detail.

Once the participant’s safety is secured, I promptly report the adverse event to the principal investigator and other relevant team members. We then review the situation together, assess potential causes, and determine if any changes need to be made to the study protocol or informed consent documents. If required, we also communicate with the institutional review board (IRB) and regulatory authorities to keep them informed and seek guidance on further actions.

Throughout this process, maintaining clear communication with all stakeholders, including the participants, is essential. This ensures that everyone involved understands the implications of the event and any necessary adjustments to the study. Ultimately, by following established protocols and working collaboratively with the research team, I strive to minimize risks and maintain the integrity of the study while prioritizing participant safety.”

19. Describe your experience with administering investigational medications or treatments.

The interviewer wants to gauge your understanding and experience in handling investigational medications or treatments, which are vital aspects of a research nurse’s role. Your ability to safely administer these treatments and maintain accurate documentation is essential to contribute to the success of clinical trials and the development of new therapies. This question helps to determine if you possess the necessary skills and knowledge to manage the complexities of clinical research.

Example: “During my time as a research nurse, I have had the opportunity to administer investigational medications and treatments in various clinical trials. One notable experience was working on a phase II trial for a new cancer immunotherapy drug. My responsibilities included preparing and administering the investigational medication according to the study protocol, closely monitoring patients for any adverse reactions, and documenting their responses.

To ensure patient safety and maintain the integrity of the trial, I strictly adhered to the study guidelines and Good Clinical Practice (GCP) principles. This involved obtaining informed consent from participants, verifying eligibility criteria, and maintaining accurate records of medication administration and patient outcomes. Through this experience, I gained valuable insights into the complexities of clinical research and honed my skills in managing investigational treatments while prioritizing patient care.”

20. How do you communicate study results to patients and their families?

Effectively conveying research findings to patients and their families is a critical skill for research nurses. Interviewers ask this question to assess your ability to translate complex medical information into clear, digestible language. They want to ensure you have the empathy, patience, and communication skills necessary to help patients and families understand the outcomes and potential implications of the study results.

Example: “When communicating study results to patients and their families, my primary focus is on ensuring that the information is presented in a clear, concise, and empathetic manner. I begin by scheduling a dedicated meeting with the patient and their family members, providing ample time for discussion and questions.

During the meeting, I use layman’s terms to explain the study findings, avoiding medical jargon that may be confusing or overwhelming. I present the key outcomes and discuss how they relate to the patient’s specific condition. Additionally, I emphasize the importance of these results in contributing to the overall understanding of the disease and potential treatment options.

Throughout the conversation, I remain sensitive to the emotional state of the patient and their family, offering support and reassurance as needed. I also encourage them to ask any questions they might have and provide resources for further information if desired. Ultimately, my goal is to ensure that the patient and their family feel informed and empowered regarding the study results and their implications.”

21. What role does cultural competence play in research nursing?

Cultural competence is critical in research nursing because it helps ensure that study participants from diverse backgrounds feel respected, understood, and valued. Research nurses who are culturally competent can better establish trust and rapport with participants, leading to improved communication and more accurate data collection. Additionally, understanding and addressing cultural differences can reduce disparities in healthcare and contribute to more inclusive and effective research outcomes.

Example: “Cultural competence plays a significant role in research nursing, as it ensures that we provide equitable care and effectively communicate with diverse patient populations. Understanding cultural differences helps us build trust with patients, which is essential for obtaining informed consent and ensuring their active participation in clinical trials.

Moreover, being culturally competent allows us to identify potential barriers to participation and develop strategies to overcome them. This can lead to more inclusive research studies, resulting in findings that are generalizable across different populations. Ultimately, incorporating cultural competence into our practice contributes to the advancement of healthcare by promoting diversity and inclusivity in clinical research.”

22. Have you ever had to terminate a patient’s participation in a study? If so, how did you handle it?

Terminating a patient’s participation in a study can be a sensitive and emotional event. Interviewers ask this question to gauge your ability to make tough decisions while prioritizing the safety and well-being of the patients. They want to know that you can navigate these situations with empathy, professionalism, and adherence to ethical guidelines, and still maintain the integrity of the study.

Example: “Yes, I have had to terminate a patient’s participation in a study due to non-compliance with the protocol. It was a difficult decision because we understand that patients may face various challenges during their participation. However, ensuring the integrity of the study and maintaining patient safety are our top priorities.

When faced with this situation, I first discussed the issue with the principal investigator and other team members to ensure that all perspectives were considered before making the final decision. Once it was determined that termination was necessary, I scheduled a meeting with the patient to discuss the reasons for their removal from the study. During the conversation, I maintained a professional and empathetic tone, explaining the importance of adhering to the study protocol and how their non-compliance could impact both their safety and the overall results of the research.

After addressing any questions or concerns they had, I provided them with information on alternative treatment options and resources available outside the study. Although it was a challenging experience, I believe that handling the situation with transparency, empathy, and professionalism helped maintain a positive relationship with the patient while upholding the integrity of the study.”

23. Describe your experience with electronic health records and other research-related software.

Understanding your aptitude with electronic health records (EHR) and research-related software demonstrates your ability to effectively manage patient information, maintain data accuracy, and contribute to the research process. Research nurses must be proficient in utilizing these systems to ensure seamless communication, data organization, and adherence to research protocols, all of which are essential for the success of clinical trials and studies.

Example: “Throughout my nursing career, I have gained extensive experience working with electronic health records (EHR) systems such as Epic and Cerner. These systems have been invaluable in streamlining patient care, allowing me to efficiently access and update patient information, track medications, and monitor vital signs. My familiarity with EHRs has enabled me to maintain accurate documentation and ensure seamless communication among healthcare professionals.

Regarding research-related software, I have worked with REDCap for data collection and management in clinical trials. This platform allowed me to securely input, store, and analyze participant data while maintaining compliance with regulatory requirements. Additionally, I have used statistical analysis tools like SPSS and SAS to interpret study results and draw meaningful conclusions. My proficiency in these software programs has significantly contributed to the success of the research projects I’ve been involved in and enhanced my ability to provide evidence-based care to patients.”

24. How do you address language barriers when working with diverse patient populations?

Addressing language barriers is essential in the healthcare field, as effective communication with patients is vital for ensuring proper care and understanding of medical treatments. When working with diverse patient populations, interviewers want to know your strategies for overcoming these barriers, ensuring that all patients receive the highest quality of care, and that you can foster a trusting and supportive relationship with them.

Example: “Addressing language barriers is essential to ensure effective communication and provide quality care for diverse patient populations. In my experience, I first try to identify the preferred language of the patient using visual aids or simple questions. If a language barrier exists, I utilize available resources such as professional medical interpreters or translation services, either in-person or via phone or video call. This ensures accurate information exchange between the patient and healthcare team while maintaining confidentiality.

Moreover, I make use of translated educational materials and consent forms whenever possible to facilitate understanding. It’s also important to be mindful of non-verbal cues and cultural differences when interacting with patients from diverse backgrounds. Being patient, empathetic, and respectful helps build trust and rapport, ultimately enhancing the overall patient experience and the success of research projects.”

25. What strategies do you use to maintain a strong rapport with study participants?

Establishing and maintaining a strong rapport with study participants is essential in the role of a research nurse. Interviewers want to know if you possess the necessary interpersonal skills and empathy to engage with participants, encourage their consistent involvement, and ensure their comfort throughout the study. Your approach to building relationships with participants can directly impact the quality of data collected and the overall success of the research project.

Example: “Building and maintaining a strong rapport with study participants is essential for successful research outcomes. One strategy I use is effective communication, which involves actively listening to their concerns and providing clear explanations about the study procedures and expectations. This helps establish trust and ensures that participants feel comfortable asking questions or sharing any issues they may encounter during the study.

Another strategy is being empathetic and respectful of each participant’s unique situation. I make an effort to understand their individual needs and preferences, and accommodate them whenever possible within the study protocol. This personalized approach not only fosters a positive relationship but also encourages adherence to the study requirements and improves overall participant satisfaction.”

26. Can you discuss any innovative approaches you have used in your research nursing practice?

In the ever-evolving field of medicine and research, it’s important to stay on top of new techniques and approaches to improve patient care and outcomes. By asking this question, interviewers want to gauge your creativity, adaptability, and willingness to explore new methods in your nursing practice. They are looking for candidates who think critically, embrace change, and are committed to continuous learning and improvement.

Example: “Certainly, in a recent clinical trial I was involved in, we were studying the effects of a new medication on patients with chronic pain. One challenge we faced was ensuring consistent and accurate reporting of pain levels from participants. To address this issue, I proposed implementing an innovative approach using a mobile app for real-time pain tracking.

The app allowed patients to log their pain levels throughout the day, along with any additional notes or observations they wanted to share. This not only provided us with more accurate data but also helped improve patient engagement in the study. The real-time feedback enabled our research team to monitor trends and make timely adjustments to treatment plans when necessary.

This innovative approach proved successful in enhancing the quality of our data collection and ultimately contributed to the overall success of the clinical trial. It demonstrated the importance of embracing technology and creative solutions in research nursing practice to overcome challenges and improve outcomes.”

27. Describe your experience with grant writing or securing funding for research projects.

Securing funding is a critical aspect of research nursing, as it enables the continuation of essential research projects and the advancement of medical knowledge. Interviewers ask this question to assess your ability to navigate the complex process of grant writing, your understanding of funding sources, and your capability to effectively communicate the value and importance of a research project to potential funders.

Example: “During my time as a research nurse, I have been involved in several projects that required grant writing and securing funding. One notable experience was when our team sought funding for a study on the impact of patient education on medication adherence in chronic disease management. My role in this process included conducting literature reviews to gather supporting evidence, collaborating with colleagues to develop a compelling proposal, and identifying potential funding sources.

I worked closely with the principal investigator and other team members to ensure that our proposal clearly outlined the project’s objectives, methodology, and expected outcomes. We also emphasized how our research would contribute to improving patient care and align with the priorities of the funding organizations. After submitting our application, we successfully secured funding from a national healthcare foundation, which allowed us to carry out the study and ultimately improve patient outcomes in our target population. This experience has honed my skills in grant writing and collaboration, enabling me to effectively secure resources for future research endeavors.”

28. How do you handle situations where the results of a study may not be favorable for the patient?

In the realm of clinical research, it’s not uncommon for studies to yield results that may be less than ideal for patients. As a research nurse, you’ll be tasked with balancing the pursuit of scientific discovery and the need to provide compassionate care for your patients. Interviewers want to ensure that you’re able to navigate these delicate situations, prioritize patient well-being, and communicate the outcomes in a sensitive, empathetic manner.

Example: “As a research nurse, I understand that not all study results will be favorable for the patients involved. In such situations, my priority is to maintain open and honest communication with the patient while providing emotional support. I would first ensure that I have a thorough understanding of the study results and their implications before discussing them with the patient.

When presenting unfavorable results, I focus on delivering the information in a clear and empathetic manner, allowing the patient to ask questions and express concerns. It’s important to acknowledge their feelings and provide reassurance about the next steps, whether it involves alternative treatment options or additional resources available to them. Ultimately, my goal is to help the patient navigate through this challenging experience by offering guidance and support, while maintaining their trust and confidence in the research process.”

29. What role does evidence-based practice play in your approach to research nursing?

Evidence-based practice is a cornerstone of modern nursing and healthcare, and interviewers ask this question to assess your commitment to using the latest research and evidence to inform your practice. As a research nurse, your role involves generating new evidence and implementing it into clinical practice, and your ability to understand, evaluate, and apply this evidence is essential for successful patient outcomes and the advancement of nursing knowledge.

Example: “Evidence-based practice is the cornerstone of my approach to research nursing. It ensures that I provide the highest quality care and make informed decisions based on current, relevant scientific evidence. This involves staying up-to-date with the latest research findings in my field and integrating them into my daily practice.

When designing or implementing a clinical study, I rely on evidence-based guidelines and best practices to ensure the study’s validity and reliability. This includes selecting appropriate methodologies, adhering to ethical standards, and carefully analyzing data to draw accurate conclusions. Ultimately, incorporating evidence-based practice not only improves patient outcomes but also contributes to the advancement of medical knowledge and the overall healthcare system.”

30. In your opinion, what are the most important qualities for a successful research nurse?

Research nursing is a specialized field that requires a unique skill set. Interviewers want to know if you possess the necessary qualities—such as attention to detail, strong communication skills, adaptability, ability to work in a team, and a genuine passion for research—to excel in the role. Your understanding of these qualities and ability to apply them in your work can demonstrate your commitment to contributing positively to research outcomes and patient care.

Example: “A successful research nurse should possess strong attention to detail and excellent organizational skills. These qualities are essential for accurately collecting, recording, and analyzing data from clinical trials while ensuring that all protocols are followed. This meticulous approach helps maintain the integrity of the study and contributes to reliable results.

Another important quality is effective communication and interpersonal skills. Research nurses interact with various stakeholders, including patients, physicians, and other healthcare professionals. They must be able to clearly explain complex information related to the study, address concerns, and build trust with participants. Additionally, they need to collaborate effectively with their colleagues to ensure a smooth and efficient research process.”

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Nursing Research

Description.

Research is a quest for an answer to a question.
Knowing the answer to a question requires a scientific method and not merely asking from various persons or merely observing several situations that may out-rightly provide haphazard answers to posed questions.
Systematic process of collecting and analyzing information in order to increase our understanding of the phenomenon about which we are concerned or interested.
Is a careful, systematic study and investigation in some fields of knowledge undertaken to discover or establish facts or principles.
The scientific method of doing a research may be briefly stated in these steps:

Step 1. Identify the problem

A research originates from a problem, an unanswered question or an unsolved problem. An inquisitive person sparks the conduct of knowing why things go wrong or unusual that in some ways those may affect human life.

Step 2. Limit the problem

The problem may be very broad. Try to focus, know the scope, established boundaries, set the breadth or make a demarcation line so that you will know what are included and what are excluded. This will ultimately make your study manageable or specific.

Step 3. Formulate Hypothesis

Hypothesis is a brilliant conjecture or a tentative solution to a problem. It is testable statement of a resolution to a verifiable question. Some studies use the term assumption to mean the expected outcome of an investigation or inquiry.

Step 4. Collect Data

Implausible statements shall be supported by factual, unbias, truthful, and convincing evidences gathered through the execution of a carefully devised plan. The preponderance of needed information will make a genuine research.

Step 5. Interpret Data and Make a Conclusion

Extract meanings from tabulated, collated, sifted or organized data. Data will be meaningless if you will not deduce meanings or generalizations from them. Statistical tools may aid you in measuring the significance of one factor to another. The researcher may evaluate, accept, reject, decide or conclude based on the data gathered.

Pure versus Applied Research

Pure or basic research is a study oriented towards the development of a theory. It aims to provide knowledge or understanding.
Applied research is an investigation that enriches a solution to a practical problem. It seeks to improve human condition by providing knowledge that can be used for practicalapplication.

Qualitative versus Quantitative Research

Qualitative Research is undertaken to answer questions about the plethora of phenomena primarily aimed at giving attributes and understanding of nature based on the observer’s view point. It also inquires on context and meaning, embarks on content analysis observation.
Quantitative Research is conducted to find answers to questions about relationships among measurable variables with purpose of explaining, controlling, and predicting phenomena. It is knowing the outcome stated in numerical data.

COMPARATIVE CHARACTERISTICS OF QUANTITATIVE AND QUALITATIVE RESEARCHES

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Thursday, May 2, 2024
Nursing Research

Nursing Research MCQs with Answers 2023

1. The device that is used by researcher to collect data for a study is called? a. Concept b. Sample c. Instrument d. Hypothesis

2. The independent variable refers to one of the following? a. Result b. Cause c. Effect d. Output

3. Gender, age, religion and blood group are measured at? a. Nominal scale of measurement b. Ordinal scale of measurement c. Interval scale of measurement d. Ratio scale of measurement

4. A systematic abstract explanation of some aspects of reality is called a. Concept b. Variable c. Theory d. Conceptual model

5. In qualitative research the people who provide information to a researcher are called a. Study participants and informants b. Study subjects and informants c. Study informants and respondents d. Study subjects and respondents

6. Which of the following sampling techniques is used to get a representative sample ? a. Cluster sampling b. Systematic sampling c. Stratified sampling d. Random sampling

7. If an investigator intends to study the effect of massage on stress and pain, which type of research approach needs to be chosen by the investigator ? a. Basic research b. Qualitative research c. Applied research d. Quantitative research

8. Which one of the following represents a sample group? a. General population b. Control group c. Study group d. Target population

9. The restrictions that a nursing researcher places on the study before gathering the data are called a. Assumptions b. Statistics c. Delimitations d. Limitations

10. The research design in which the investigator studies the life experiences of individuals in their life-world is called a. Ethnography b. Ethology c. Grounded theory d. Phenomenology

11. Deductive reasoning is applied in one of the following: a. Qualitative research b. Quantitative research c. Action research d. Applied research

12. Qualitative research design involves a. Correlative design b. Emergent design c. Experimental design d. Cohort design

13. Facts generally accepted as truth are known as a. Limitations b. Assumptions c. Evaluations d. Statistics

14. Which scale of measurement has an absolute zero? a. Nominal b. Ordinal c. Interval d. Ratio

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Technology as a Tool for Improving Patient Safety

Introduction .

In the past several decades, technological advances have opened new possibilities for improving patient safety. Using technology to digitize healthcare processes has the potential to increase standardization and efficiency of clinical workflows and to reduce errors and cost across all healthcare settings. 1 However, if technological approaches are designed or implemented poorly, the burden on clinicians can increase. For example, overburdened clinicians can experience alert fatigue and fail to respond to notifications. This can lead to more medical errors. As a testament to the significance of this topic in recent years, several government agencies [(e.g. the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare and Medicaid services (CMS)] have developed resources to help healthcare organizations integrate technology, such as the Safety Assurance Factors for EHR Resilience (SAFER) guides developed by the Office of the National Coordinator for Health Information Technology (ONC). 2,3,4 However, there is some evidence that these resources have not been widely used.5 Recently, the Centers for Medicare & Medicaid Services (CMS) started requiring hospitals to use the SAFER guides as part of the FY 2022 Hospital Inpatient Prospective Payment Systems (IPPS), which should raise awareness and uptake of the guides. 6

During 2022, research into technological approaches was a major theme of articles on PSNet. Researchers reviewed all relevant articles on PSNet and consulted with Dr. A Jay Holmgren, PhD, and Dr. Susan McBride, PhD, subject matter experts in health IT and its role in patient safety. Key topics and themes are highlighted below.

Clinical Decision Support

The most prominent focus in the 2022 research on technology, based on the number of articles published on PSNet, was related to clinical decision support (CDS) tools. CDS provides clinicians, patients, and other individuals with relevant data (e.g. patient-specific information), purposefully filtered and delivered through a variety of formats and channels, to improve and enhance care. 7

Computerized Patient Order Entry

One of the main applications of CDS is in computerized patient order entry (CPOE), which is the process used by clinicians to enter and send treatment instructions via a computer application. 8 While the change from paper to electronic order entry itself can reduce errors (e.g., due to unclear handwriting or manual copy errors), research in 2022 showed that there is room for improvement in order entry systems, as well as some promising novel approaches.

Two studies looked at the frequency of and reasons for medication errors in the absence of CDS and CPOE and demonstrated that there was a clear patient safety need. One study found that most medication errors occurred during the ordering or prescribing stage, and both this study and the other study found that the most common medication error was incorrect dose. Ongoing research, such as the AHRQ Medication Safety Measure Development project, aims to develop and validate measure specifications for wrong-patient, wrong-dose, wrong-medication, wrong-route, and wrong-frequency medication orders within EHR systems, in order to better understand and capture health IT safety events.9 Errors of this type could be avoided or at least reduced through the use of effective CPOE and CDS systems. However, even when CPOE and CDS are in place, errors can still occur and even be caused by the systems themselves. One study reviewed duplicate medication orders and found that 20% of duplicate orders resulted from technological issues, including alerts being overridden, alerts not firing, and automation issues (e.g., prefilled fields). A case study last year Illustrated one of the technological issues, in this case a manual keystroke error, that can lead to a safety event. A pharmacist mistakenly set the start date for a medication to the following year rather than the following day , which the CPOE system failed to flag. The authors recommended various alerts and coding changes in the system to prevent this particular error in the future.

There were also studies in 2022 that showed successful outcomes of well-implemented CPOE systems. One in-depth pre-post, mixed-methods study showed that a fully implemented CPOE system significantly reduced specific serious and commonly occurring prescribing and procedural errors. The authors also presented evidence that it was cost-effective and detailed implementation lessons learned drawn from the qualitative data collected for the study. A specific CPOE function that demonstrated statistically significant improvement in 2022 was automatic deprescribing of medication orders and communication of the relevant information to pharmacies. Deprescribing is the planned and supervised process of dose reduction or stopping of a medication that is no longer beneficial or could be causing harm. That study showed an immediate and sustained 78% increase in successful discontinuations after implementation of the software. A second study on the same functionality determined that currently only one third to one half of medications are e-prescribed, and the study proposed that e-prescribing should be expanded to increase the impact of the deprescribing software. It should be noted, however, that the systems were not perfect and that a small percentage of medications were unintentionally cancelled. Finally, an algorithm to detect patients in need of follow-up after test results was developed and implemented in another study . The algorithm showed some process improvements, but outcome measures were not reported.

Usability

Usability of CDS systems was a large focus of research in 2022. Poorly designed systems that do not fit into existing workflows lead to frustrated users and increase the potential for errors. For example, if users are required to enter data in multiple places or prompted to enter data that are not available to them, they could find ways to work around the system or even cease to use it, increasing the potential for patient safety errors. The documentation burden is already very high on U.S. clinicians, 10 so it is important that novel technological approaches do not add to this burden but, if possible, alleviate it by offering a high level of usability and interoperability.

One study used human-factored design in creating a CDS to diagnose pulmonary embolism in the Emergency Department and then surveyed clinician users about their experiences using the tool. Despite respondents giving the tool high usability ratings and reporting that the CDS was valuable, actual use of the tool was low. Based on the feedback from users, the authors proposed some changes to increase uptake, but both users and authors mentioned the challenges that arise when trying to change the existing workflow of clinicians without increasing their burden. Another study gathered qualitative feedback from clinicians on a theoretical CDS system for diagnosing neurological issues in the Emergency Department. In this study too, many clinicians saw the potential value in the CDS tool but had concerns about workflow integration and whether it would impact their ability to make clinical decisions. Finally, one study developed a dashboard to display various risk factors for multiple hospital-acquired infections and gathered feedback from users. The users generally found the dashboard useful and easy to learn, and they also provided valuable feedback on color scales, location, and types of data displayed. All of these studies show that attention to end user needs and preferences is necessary for successful implementation of CDS. However, the recent market consolidation in Electronic Health Record vendors may have an impact on the amount of user feedback gathered and integrated into CDS systems. Larger vendors may have more resources to devote to improving the usability and design of CDS, or their near monopolies in the market may not provide an incentive to innovate further. 11 More research is needed as this trend continues.

Alerts and Alarms

Alerts and alarms are an important part of most CDS systems, as they can prompt clinicians with important and timely information during the treatment process. However, these alerts and alarms must be accurate and useful to elicit an appropriate response. The tradeoff between increased safety due to alerts and clinician alert fatigue is an important balance to strike. 12

Many studies in 2022 looked at clinician responses to medication-related alerts, including override and modification rates. Several of the studies found a high alert override rate but questioned the validity of using override rates alone as a marker of CDS effectiveness and usability. For example, one study looked at drug allergy alerts and found that although 44.8% of alerts were overridden, only 9.3% of those were inappropriately overridden, and very few overrides led to an adverse allergic reaction. A study on “do not give” alerts found that clinicians modified their orders to comply with alert recommendations after 78% of alerts but only cancelled orders after 26% of alerts. A scoping review looked at drug-drug interaction alerts and found similar results, including high override rates and the need for more data on why alerts are overridden. These findings are supported by another study that found that the underlying drug value sets triggering drug-drug interaction alerts are often inconsistent, leading to many inappropriate alerts that are then appropriately overridden by clinicians. These studies suggest that while a certain number of overrides should be expected, the underlying criteria for alert systems should be designed and regularly reviewed with specificity and sensitivity in mind. This will increase the frequency of appropriate alerts that foster indicated clinical action and reduce alert fatigue.

There also seems to be variability in the effectiveness of alert systems across sites. One study looked at an alert to add an item to the problem list if a clinician placed an order for a medication that was not indicated based on the patient’s chart. The study found about 90% accuracy in alerts across two sites but a wide difference in the frequency of appropriate action between the sites (83% and 47%). This suggests that contextual factors at each site, such as culture and organizational processes, may impact success as much as the technology itself.

A different study looked at the psychology of dismissing alerts using log data and found that dismissing alerts becomes habitual and that the habit is self-reinforcing over time. Furthermore, nearly three quarters of alerts were dismissed within 3 seconds. This indicates how challenging it can be to change or disrupt alert habits once they are formed.

Artificial Intelligence and Machine Learning

In recent years, one of the largest areas of burgeoning technology in healthcare has been artificial intelligence (AI) and machine learning. AI and machine learning use algorithms to absorb large amounts of historical and real-time data and then predict outcomes and recommend treatment options as new data are entered by clinicians. Research in 2022 showed that these techniques are starting to be integrated into EHR and CDS systems, but challenges remain. A full discussion of this topic is beyond the scope of this review. Here we limit the discussion to several patient-safety-focused resources posted on PSNet in 2022.

One of the promising aspects of AI is its ability to improve CDS processes and clinician workflow overall. For example, one study last year looked at using machine learning to improve and filter CDS alerts. They found that the software could reduce alert volume by 54% while maintaining high precision. Reducing alert volume has the potential to alleviate alert fatigue and habitual overriding. Another topic explored in a scoping review was the use of AI to reduce adverse drug events. While only a few studies reviewed implementation in a clinical setting (most evaluated algorithm technical performance), several promising uses were found for AI systems that predict risk of an adverse drug event, which would facilitate early detection and mitigate negative effects.

Despite enthusiasm for and promising applications of AI, implementation is slow. One of the challenges facing implementation is the variable quality of the systems. For example, a commonly used sepsis detection model was recently found to have very low sensitivity. 13 Algorithms also drift over time as new data are integrated, and this can affect performance, particularly during and after large disturbances like the COVID-19 pandemic. 14 There is also emerging research about the impact of AI algorithms on racial and ethnic biases in healthcare; at the time of publication of this essay, an AHRQ EPC was conducting a review of evidence on the topic. 15 These examples highlight the fact that AI is not a “set it and forget it” application; it requires monitoring and customization from a dedicated resource to ensure that the algorithms perform well over time. A related challenge is the lack of a strong business case for using high-quality AI. Because of this, many health systems choose to use out-of-the-box AI algorithms, which may be of poor quality overall (or are unsuited to particular settings) and may also be “black box” algorithms (i.e., not customizable by the health system because the vendor will not allow access to the underlying code). 16 The variable quality and the lack of transparency may cause mistrust by clinicians and overall aversion to AI interventions.

In an attempt to address these concerns, one article in 2022 detailed best practices for AI implementation in health systems, focusing on the business case. Best practices include using AI to address a priority problem for the health system rather than treating it as an end itself. Additionally, testing the AI using the health system’s patients and data to demonstrate applicability and accuracy for that setting, confirming that the AI can provide a return on investment, and ensuring that the AI can be implemented easily and efficiently are also important. Another white paper described a human-factors and ergonomics framework for developing AI in order to improve the implementation within healthcare systems, teams, and workflows. The federal government and international organizations have also published AI guidelines, focusing on increasing trustworthiness (National Artificial Intelligence Initiative) 17 and ensuring ethical governance (World Health Organization). 18

Conclusion and Next Steps

As highlighted in this review, the scope and complexity of technology and its application in healthcare can be intimidating for healthcare systems to approach and implement. Researchers last year thus created a framework that health systems can use to assess their digital maturity and guide their plans for further integration.

The field would benefit from more research in several areas in upcoming years. First and foremost, high-quality prospective outcome studies are needed to validate the effectiveness of the new technologies. Second, more work is needed on system usability, how the systems are integrated into workflows, and how they affect the documentation burden placed on clinicians. For CDS specifically, more focus is needed on patient-centered CDS (PC CDS), which supports patient-centered care by helping clinicians and patients make the best decisions given each individual’s circumstances and preferences. 19 AHRQ is already leading efforts in this field with their CDS Innovation Collaborative project. 20 Finally, as it becomes more common to incorporate EHR scribes to ease the documentation burden, research on their impact on patient safety will be needed, especially in relation to new technological approaches. For example, when a scribe encounters a CDS alert, do they alert the clinician in all cases?

In addition to the approaches mentioned in this article, other emerging technologies in early stages of development hold theoretical promise for improving patient safety. One prominent example is “computer vision,” which uses cameras and AI to gather and process data on what physically happens in healthcare settings beyond what is captured in EHR data, 21 including being able to detect immediately that a patient fell in their room. 22

As technology continues to expand and improve, researchers, clinicians, and health systems must be mindful of potential stumbling blocks that could impede progress and threaten patient safety. However, technology presents a wide array of opportunities to make healthcare more integrated, efficient, and safe.

Cohen CC, Powell K, Dick AW, et al. The Association Between Nursing Home Information Technology Maturity and Urinary Tract Infection Among Long-Term Residents . J Appl Gerontol . 2022;41(7):1695-1701. doi: 10.1177/07334648221082024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9232878/
https://www.healthit.gov/topic/safety/safer-guides
https://cds.ahrq.gov/cdsconnect/repository
https://www.cms.gov/about-cms/obrhi
McBride S, Makar E, Ross A, et al. Determining awareness of the SAFER guides among nurse informaticists. J Inform Nurs. 2021;6(4). https://library.ania.org/ania/articles/713/view
Sittig DF, Sengstack P, Singh H. Guidelines for US hospitals and clinicians on assessment of electronic health record safety using SAFER guides. J ama . 2022;327:719-720.
https://library.ahima.org/doc?oid=300027#.Y-6RhXbMKHt
https://www.healthit.gov/faq/what-computerized-provider-order-entry#:~:text=Computerized%20provider%20order%20entry%20(CPOE,paper%2C%20fax%2C%20or%20telephone
https://digital.ahrq.gov/2018-year-review/research-spotlights/leveragin…
Holmgren AJ, Downing NL, Bates DW, et al. Assessment of electronic health record use between US and non-US health systems. JAMA Intern Med. 2021;181:251-259. https://doi.org/10.1001/jamainternmed.2020.7071
Holmgren AJ, Apathy NC. Trends in US hospital electronic health record vendor market concentration, 2012–2021. J Gen Intern Med. 2022. https://link.springer.com/article/10.1007/s11606-022-07917-3#citeas
Co Z, Holmgren AJ, Classen DC, et al. The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support. J Am Med Inform Assoc. 2020;27:1252-1258. https://pubmed.ncbi.nlm.nih.gov/32620948/
Wong A, Otles E, Donnelly JP, et al. External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients. JAMA Intern Med. 2021;181:1065-1070. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2781307
Parikh RB, Zhang Y, Kolla L, et al. Performance drift in a mortality prediction algorithm among patients with cancer during the SARS-CoV-2 pandemic. J Am Med Inform Assoc. 2022;30:348-354. https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocac221/6835770?login=false
https://effectivehealthcare.ahrq.gov/products/racial-disparities-health…
https://www.statnews.com/2022/05/24/market-failure-preventing-efficient-diffusion-health-care-ai-software/
https://www.ai.gov/strategic-pillars/advancing-trustworthy-ai/
Ethics and governance of artificial intelligence for health (WHO guidance). Geneva: World Health Organization; 2021. https://www.who.int/publications/i/item/9789240029200
Dullabh P, Sandberg SF, Heaney-Huls K, et al. Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan. J Am Med Inform Assoc. 2022: 29(7):1233-1243. doi: 10.1093/jamia/ocac059. PMID: 35534996; PMCID: PMC9196686.
https://cds.ahrq.gov/cdsic
Yeung S, Downing NL, Fei-Fei L, et al. Bedside computer vision: moving artificial intelligence from driver assistance to patient safety. N Engl J Med. 2018;387:1271-1273. https://www.nejm.org/doi/10.1056/NEJMp1716891
Espinosa R, Ponce H, Gutiérrez S, et al. A vision-based approach for fall detection using multiple cameras and convolutional neural networks: a case study using the UP-Fall detection dataset. Comput Biol Med. 2019;115:103520. https://doi.org/10.1016/j.compbiomed.2019.103520

This project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The authors are solely responsible for this report’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report. View AHRQ Disclaimers

Perspective

Perspectives on Safety

Annual Perspective

Patient Safety Innovations

Suicide Prevention in an Emergency Department Population: ED-SAFE

WebM&M Cases

The Retrievals. August 9, 2023

Agent of change. August 1, 2018

Amid lack of accountability for bias in maternity care, a California family seeks justice. August 16, 2023

Mirror, Mirror on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens. April 12, 2006

Improving patient safety by shifting power from health professionals to patients. October 25, 2023

Patient Safety Primers

Discharge Planning and Transitions of Care

Medicines-related harm in the elderly post-hospital discharge. March 27, 2019

Emergency department crowding: the canary in the health care system. November 3, 2021

Advancing Patient Safety: Reviews From the Agency for Healthcare Research and Quality's Making Healthcare Safer III Report. September 2, 2020

Exploring Alternatives To Malpractice Litigation. January 15, 2014

Making Healthcare Safer III. March 18, 2020

Special Section: Patient Safety. May 24, 2006

The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise. November 19, 2008

Compendium of Strategies to Prevent HAIs in Acute Care Hospitals 2014. September 1, 2014

Quality, Safety, and Noninterpretive Skills. November 11, 2015

Patient Safety. November 21, 2018

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

Remote response team and customized alert settings help improve management of sepsis.

Using sociotechnical theory to understand medication safety work in primary care and prescribers' use of clinical decision support: a qualitative study. May 24, 2023

Human factors and safety analysis methods used in the design and redesign of electronic medication management systems: a systematic review. May 17, 2023

Journal Article

Reducing hospital harm: establishing a command centre to foster situational awareness.

The potential for leveraging machine learning to filter medication alerts. May 4, 2022

Improving the specificity of drug-drug interaction alerts: can it be done? April 6, 2022

A qualitative study of prescribing errors among multi-professional prescribers within an e-prescribing system. December 23, 2020

The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support. July 29, 2020

Assessment of health information technology-related outpatient diagnostic delays in the US Veterans Affairs health care system: a qualitative study of aggregated root cause analysis data. July 22, 2020

Reducing drug prescription errors and adverse drug events by application of a probabilistic, machine-learning based clinical decision support system in an inpatient setting. August 21, 2019

Improving medication-related clinical decision support. March 7, 2018

The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting. April 6, 2016

The effect of provider characteristics on the responses to medication-related decision support alerts. July 15, 2015

Best practices: an electronic drug alert program to improve safety in an accountable care environment. July 1, 2015

Impact of computerized physician order entry alerts on prescribing in older patients. March 25, 2015

Differences of reasons for alert overrides on contraindicated co-prescriptions by admitting department. December 17, 2014

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