PROFESSIONAL ADJUSTMENT AND NURSING CARE

MANAGEMENT PRACTICE EXAM ANSWER KEY WITH

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

__Right to select health care team members

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

RATIONALE: An inpatient client usually receives a copy of the Bill of Rights for
psychiatric patients, where they would find options 2, 3, 5, and 6 in writing. However, a client in
an inpatient setting can't select health team members. A client may apply for disability as a result
of a chronic, incapacitating illness; however, disability isn't a patient right, and members of a
psychiatric institution don't decide who should receive it.

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

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

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

RATIONALE: A person who is admitted to a psychiatric hospital on a voluntary basis

may sign out of the hospital unless the health care team determines that the person is harmful to
himself or others. The health care team evaluates the client's condition before discharge. If there
is reason to believe that the client is harmful to himself or others, a hearing can be held to
determine if the admission status should be changed from voluntary to involuntary. Option 3 is
incorrect because it denies the client's rights; option 5 is incorrect because the client doesn't
need a lawyer to leave the hospital; and option 6 is incorrect because a hearing isn't mandated
before discharge. A hearing is held only if the client remains unsafe and requires further
treatment.

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

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

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

RATIONALE: Options 1, 3, and 6 are examples of the nurse-client working phase of

an interaction. In the working phase, the client explores, evaluates, and determines solutions to
identified problems. Options 2, 4 and 5 address what happens during the introductory phase of
the nurse-client interaction.

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

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

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

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

RATIONALE: In emergencies, including danger to life or possibility of permanent

injury, consent may be implied, according to the law. In some books, sabi, ung attending
physician sa ER na ung mag-aako ang consent. Obviouslly, wala dun ang family physician kc
emergency nga. Parents have full responsibility for the minor child and are required to give
informed consent whenever possible. Verbal consent may be obtained.

5. You're admitting a 15-month-old boy who has bilateral otitis media and
bacterial meningitis. Which room arrangements would be best for this client?

A. In isolation off a side hallway

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

RATIONALE: With meningitis, the child should be isolated for the first day but be
close to where he can be observed frequently. In isolation off a side hallway is too far away for
frequent observation. Putting the client in a room with another child who has meningitis or with
two toddlers who have croup present an infectious hazard to the other children.

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

delegating work to team members in order to conserve time?

A. Assign unfinished work to other team members.

B. Explain to each team member what needs to be done.
C. Relinquish responsibility for the outcome of the work.
D. Assign each team member the responsibility to obtain dietary trays.

RATIONALE: When all team members know what needs to be done, they can work
together on the most efficient plan for accomplishing necessary tasks. Delegation can be flexible,
ranging from telling a staff member exactly what needs to be done and how to do it to allowing
team members some freedom to decide how best to carry out the tasks. Assigning unfinished
work to other team members and assigning each team member the responsibility to obtain
dietary trays don't allow for input from team members. It's the team leader's job to maintain
responsibility for the outcome of a task.

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

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

A. the client is mentally ill.

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

RATIONALE: The law doesn't require informed consent in an emergency situation

when the client is unable to give consent and no next of kin is present (NCLEX concept ito, sa
Philippines, ang attending doctor sa ER na ang magcoconsent. A mentally competent client may
refuse or revoke consent at any time. Even though a client who is declared mentally incompetent
can't give informed consent, mental illness doesn't by itself indicate that the client is incompetent
to give informed consent. Although the nurse may act as a client advocate, the nurse can never
give substituted consent. CBQ ito.

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

A. a quality improvement issue.

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

RATIONALE: The nurse should treat this episode as a risk-management incident; her
immediate responsibility is to fill out an incident report and notify the risk manager. Quality
improvement and ethics aren't the nurse's initial concerns. The facility may choose to look at
these types of problems and make changes to deliver a higher standard of care institutionally.
Informed consent isn't a relevant issue in this incident

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

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

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

RATIONALE: When a nurse feels incapable of performing an assignment safely, the

appropriate action is to speak to the manager or nurse in charge. Bawal magmarunong lalo na sa
patient care. The nurse should also document the concerns in writing and ask that the
assignment be changed. In the event that the manager chooses to leave the assignment as
given, the nurse should accept the assignment. The nurse should never abandon the assigned
clients by leaving the workplace or asking another nurse to care for them. The nurse may,
however, refuse to perform a task outside the scope of practice.

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

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

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

RATIONALE: The nurse has spoken to her colleague under the appropriate
circumstances and the behavior hasn't changed. Therefore, the appropriate action is to bring the
problem to the manager's attention. It's unproductive to talk with other staff members about the
situation because they don't have the authority to bring the colleague's practice into compliance.
The nurse should never point out to a client that another staff member's practice isn't meeting
standards.

11. An adult client is diagnosed with acquired immunodeficiency

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

A. Fraud
B. Defamation of character
C. Assault and battery
D. Breach of confidentiality

RATIONALE: A nurse shouldn't disclose confidential information about a client to a

third party who has no legal right to know; doing so is a breach of confidentiality. Defamation of
character is injuring someone's reputation through false and malicious statements. Assault and
battery occurs when the nurse forces a client to submit to treatment against the client's will. A
nurse commits fraud when she misleads a client to conceal a mistake she made during
treatment. CBQ ito.

12. A nurse accidentally administers 40 mg of propranolol (Inderal) to a

client instead of 10 mg. Although the client exhibits no adverse reactions to the
larger dose, the nurse should:

A. call the facility's attorney.

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

RATIONALE: The nurse should file an incident report. Incident reports highlight areas
of potential liability. It's then the risk manager's responsibility to notify the facility's attorney if
the incident is believed to be serious. The risk manager, in consultation with the physician and
facility administrator, will decide who should inform the family of the error. The quality assurance
coordinator may choose to use such incidents when trying to improve the quality of care received
by clients in a particular facility. Taking no action isn't an acceptable option. CBQ ito.

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

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

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

RATIONALE: The nurse should refer this client to a sex counselor or other
professional. Making appropriate referrals is a valid part of planning the client's care. The nurse
doesn't normally provide sex counseling.
 14. The nurse is assigned to care for eight clients. Two nonprofessionals
are assigned to work with the nurse. Which statement is valid in this situation?

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

RATIONALE: Assistive personnel may not be assigned to care for clients without the
supervision of a professional nurse. The nurse doesn’t delegate responsibility, keep in mind
respondeat superior. It's essential that assistive personnel understand that they're responsible for
their own actions. Assistive personnel must be adequately trained to perform all tasks they're
assigned to perform.

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

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

RATIONALE: Each state has a nurse practice act that defines the scope of nursing
practice within the state. Consent to treatment refers to informed consent for a treatment or
procedure. The client's bill of rights defines the rights of clients. Licensure requirements are
constructed by the state board of nursing to set standards for receiving a nursing license. CBQ
ito.

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

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

A. detain him until he signs the paperwork.

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

RATIONALE: The nurse is obligated to let him leave. Detaining him in any form is a
violation of the patient's bill of rights.

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

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

A. properly educated this client about safety measures.

B. restrained the client.
C. documented that she left the client.
D. arranged for continual care of the client.

RATIONALE: By leaving the client, the nurse is at fault for abandonment. The better
course of action is to turn on the call bell or elicit help on the way to the client's room. Never
ever leave a client na at risk for injury alone! Educating the client about safety measures doesn't
alleviate the nurse from responsibility for ensuring the client's safety. The nurse can't restrain the
client without a physician's order and restraints won't ensure the client's safety. Documenting
that she left the client doesn't excuse the nurse from her responsibility for ensuring the client's
safety.

18. When prioritizing a client's care plan based on Maslow's hierarchy of

needs, the nurse's first priority would be:

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

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

RATIONALE: In Maslow's hierarchy of needs, pain relief is on the first layer. Activity
is on the second layer. Safety is on the third layer. Love and belonging are on the fourth layer.

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

should begin preparing the client for termination of the relationship:

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

RATIONALE: When initiating a therapeutic relationship with a client, preparation for

termination of the relationship should begin during the first meeting. For example, the nurse
should introduce herself to the client and tell him exactly when she'll be involved in his care. This
sets the boundaries of the relationship. In the middle and at discharge of care, the relationship
may be too involved to end abruptly without warning. The client's ability to function
independently isn't the deciding factor in preparing the client for the termination of the
therapeutic relationship. CBQ ito.

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

environment must:

A. expect all staff to accept change.

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

RATIONALE: The clinical nurse-manager is responsible for making things happen, not
just letting things happen. She must be more than a role model who goes along with change ,
she must also encourage change and support staff during change. Documentation of the nurses'
reactions to change can be threatening and serves no purpose in helping change to occur.

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

related to health care belongs to the:

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

RATIONALE: The client is primarily responsible for health care decisions in

community-based nursing. The nurse assists with monitoring of health treatment and teaching
and intervenes only as needed after assessing the client's ability to follow a regimen. The health
care team collaborates on decisions related to treatment. The physician dictates medical orders
related to treatment and medication.
 22. A client became seriously ill after a nurse gave him the wrong
medication. After his recovery, he files a lawsuit. Who is most likely to be held liable?

A. No one because it was an accident

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

RATIONALE: Nurses are always responsible for their actions. The hospital is liable for
negligent conduct of its employees within the scope of employment. Consequently, both the
nurse and the hospital are liable. Although the mistake wasn't intentional, standard procedure
wasn't followed. CBQ ito.

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

A. change his own dressing.

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

RATIONALE: Walking from his room to the end of the hall and back before discharge
is a specific, measurable, attainable, timed goal. It's also a client-oriented outcome goal. Having
the client change his own dressing is incomplete and not as significant. Just walking in the hall
isn't measurable. The need for a special diet isn't evident in this case.

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

A. Tell him that it's a legal question beyond the scope of nursing practice.
B. Give him a copy of the client's bill of rights.
C. Provide information on active euthanasia.
D. Discuss documenting his wishes in an advance directive.

RATIONALE: Advance directives give a competent client control over his situation
and a legal forum in which to express his wishes about his care. Discussion of advance directives
isn't outside the scope of nursing practice. The client's bill of rights involves multiple client rights
and doesn't provide detailed information about advance directives. Active euthanasia is illegal.
CBQ ito.

25. While admitting a client with pneumonia, the nurse notes multiple
bruises in various stages of healing. The client has Alzheimer's disease and a history
of multiple fractures. Legally, the most important action for the nurse to take is to:

A. document findings thoroughly.

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

RATIONALE: This client may be experiencing elder abuse based on her history and
symptoms. Authorities to be notified may include local social service or law enforcement
agencies. The nurse should also document findings and include illustrations to support the
assessment. The client with Alzheimer's disease may not be able to accurately inform the nurse
about what happened. Reporting findings to the physician may not be sufficient for fulfilling the
nurse's legal responsibility.

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

A. The client's family

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

RATIONALE: Support groups consist of clients with the same diagnoses who share
experiences of the disease with each other. Sharing experiences helps the client understand
disease-related problems and gives him a forum in which he can vent his feelings, which are
usually similar to those of the group. The client's family and clergy, although supportive, can't
share similar disease experiences. Hospice care is usually implemented late in the disease, at the
end of life.

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

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

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

RATIONALE: The most appropriate nursing intervention is to discuss organ donation

with the family. The decision to withdraw life isn't within a nurse's scope of practice. Because the
client is brain-dead, he doesn't need sedation. Although talking to the staff is a viable strategy for
staff decompression, it isn't the first action to take. Ito ay controversial na tanong! Madaming
nag-away na lecturers because of this.

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

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

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

RATIONALE: An enterostomal nurse therapist is a registered nurse who has received

advanced education in an accredited program to care for clients with stomas. The enterostomal
nurse therapist can assist with selection of an appropriate stoma site, teach about stoma care,
and provide emotional support. Social workers provide counseling and emotional support, but
they can't provide preoperative and postoperative teaching. A registered dietitian can review any
dietary changes and help the client with meal planning. The occupational therapist can assist a
client with regaining independence with activities of daily living.

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

respiratory distress and is admitted to a medical unit from a skilled nursing facility.
His advance directive states that he doesn't want to be placed on a ventilator or
receive cardiopulmonary resuscitation. Based on the client's advance directive, which
intervention should the nursing care plan include?
 A. Check on the client once per shift.
B. Provide mouth and skin care only if the family requests it.
C. Turn the client only if he's uncomfortable.
D. Provide emotional support and pain relief.

RATIONALE: When advance directives state that a client doesn't want life-prolonging
interventions, nursing care focuses on providing emotional and spiritual support and comfort
measures. The client still needs to be checked regularly. The client and family shouldn't feel as if
they've been abandoned. Providing mouth and skin care makes the client more comfortable.
Turning the client provides comfort and prevents potentially painful complications such as
pressure ulcers.

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

A. interprets clinical data.

B. collects clinical data.
C. is trained in the nursing process.
D. can function independently.

RATIONALE: Unlicensed personnel make observations, collect clinical data, and

report findings to the nurse. The registered nurse has learned critical thinking skills and is able to
interpret the clinical findings. Unlicensed assistants are trained to perform skills, they don't learn
the nursing process. Unlicensed assistants don't function independently, they're assigned tasks by
a registered nurse who retains overall responsibility for the client. Other nursing responsibilities
when delegating tasks to unlicensed assistants include knowing the institutions policies regarding
delegation, knowing the assistant's training, knowing the client's needs, receiving frequent
updates from the assistant, asking specific questions, and making frequent rounds of clients.

31. A nurse on a medical-surgical floor is making assignments for an 8-

hour shift. Which of the following considerations has the highest priority?

A. Complexity of care required

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

RATIONALE: The nurse is legally responsible for assigning personnel according to

skill level. All of the other factors are important but don't take priority.

32. The nurse is caring for a homeless client with active tuberculosis. The
client is almost ready for discharge; however, the nurse is concerned about the
client's ability to follow the medical regimen. Which intervention will best ensure that
the client complies with treatment?

A. Referring the client to a social worker for discharge planning

B. Providing individualized client education
C. Having the client attend a formal education session
D. Attempting to contact a member of the client's family to provide assistance

RATIONALE: Referring the client to a health care professional with knowledge of

community resources is the best intervention to ensure compliance in a homeless client.
Educating the client about his condition may help, but basic needs for shelter, food, and clothing
must be met first. Providing formal education and attempting to contact family members are
inappropriate when seeking to help a homeless client.
 33. The nurse is following a critical pathway to help a client who
underwent hip replacement surgery meet specific objectives. What's a critical
pathway?

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

RATIONALE: Critical pathways are management tools developed for particular types
of cases or conditions. They set forth expectations for interventions, outcomes, and client
progression. Elements of the nursing care plan are commonly folded into the critical pathway.
The descriptions of standardized and multidisciplinary plans of care don't adequately describe the
critical pathway. Because the critical pathway is standardized and multidisciplinary, the nurse
may need to develop a separate care plan to document nursing diagnoses for an individual client.

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

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

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

RATIONALE: Before a disaster occurs, the nurse should know how the hospital's
disaster plan works and what she'll be required to do in a disaster. During a disaster, the charge
nurse will assign staff to areas where the needs are; therefore, a nurse may find herself
performing tasks outside of her usual practice. This practice is permitted if the nurse has the
knowledge, skill, and comfort level to perform assigned tasks. However, the nurse should never
perform activities outside of the nurse's scope of practice as outlined in the state's nurse practice
act.

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

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

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

RATIONALE: Autocratic leaders obtain power with a group by maintaining control

over the group. Democratic leaders share power by allowing consensus decision making and
distribution of power. Participative leadership is another term for democratic leadership. Laissez-
faire leaders maintain no control over the group; decision making is unstructured and commonly
performed by an unofficial leader of the group. CBQ ito, make sure that you know this by heart,
kinda of leadership and for what situations xa applicable.

36. The registered nurse of a hospital unit is acting as charge nurse. The
charge nurse's responsibility is to delegate client care appropriately to the licensed
practical nurse (LPN) and the nurse's aide. Delegation of activities should be
primarily based on which factors?

A. Whether the LPN or nurse's aide provided care for the client before
B. The staff member whose turn it is to perform certain, less pleasant tasks
C. The job description and experience level of the LPN and the aide
D. The staff member who volunteers to perform the various tasks

RATIONALE: The primary considerations related to appropriate and effective care

delegation are the job descriptions of the assistive staff members and their levels of expertise.
Both factors must be considered together, neither in isolation. The other options identify factors
that may help determine client care assignments, but only after considering job description and
experience levels.

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

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

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

RATIONALE: Storming refers to the stage when resistance to group influence occurs
and the objectives of the group aren't yet clearly established. Forming is the first stage, when the
members of the group first meet. During the norming stage, which occurs after storming,
consensus begins to evolve, cohesion and norms develop, and conflict and resistance are
resolved. Performing is the stage when the group focuses on the task at hand and constructive
group efforts improve task performance.

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

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

RATIONALE: The nurse has a moral and professional responsibility to advocate for
clients who experience decreased independence, loss of freedom of action, and interference with
their ability to make autonomous choices. Coordinating a meeting between the physician and
family members may allow the client an opportunity to express his wishes and promote
awareness of his feelings, as well as influence future care decisions. All other options are
inappropriate. Haler!! Lalo na ung option D.
 39. The nurse works in a managed-care environment. The nurse is
expected to be oriented to which of the following criteria?

A. Performing tasks in the shortest time possible

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

RATIONALE: Managed care principles mandate the most efficient use of limited
resources; therefore, quality of care and cost-containment are the main issues. Nurses must look
for the most cost-effective method of achieving a desired outcome without compromising quality.
Problem solving and time management are skills used to implement the care plan, but aren't
unique to the managed care environment. Performing tasks quickly doesn't always achieve
quality care. Adhering to client preferences isn't a guiding principle.

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

A. Take measures to prevent the client from leaving.

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

RATIONALE: If a client requests discharge AMA, the nurse should notify the
physician immediately. If the physician can't convince the client to stay, the physician will ask the
client to sign an AMA form. This form releases the hospital from legal responsibility. If the
physician isn't available, the nurse should obtain the client's signature on the AMA form. A client
who refuses to sign the form shouldn't be detained; forced detention violates the client's rights.
After the client leaves, the nurse should document the incident thoroughly and notify the
physician that the client has left. CBQ ito.

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

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

RATIONALE: When a nurse is unsure about a procedure or piece of equipment, she

should tell the nursing supervisor that she isn't comfortable and ask for assistance with the task.
Bawal na bawal magmarunong and maglider-lideran lalo na sa Area wherein everything you do
has direct impact on the client. A nurse must always be prudent, therefore, pick options wherein
safety is also addressed. If appropriate training or assistance isn't available, the nurse should ask
for a different assignment. The procedure shouldn't be omitted for the shift because this could
lead to serious complications for the client. The nurse should never perform a procedure that she
doesn't feel prepared to perform.

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

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

RATIONALE: A nurse who suspects another nurse of impaired practice has a duty to
report the colleague to the nursing supervisor, not the police. A nurse who fails to report an
impaired nurse may face disciplinary action. The nurse shouldn't cover for an impaired nurse or
give her one more chance. These actions place clients at risk, place the nurse at risk for
disciplinary action, and prevent the impaired nurse from receiving help. Remember, pantay lang
kau ng level ng co staff nurse mo, you don’t have the authority na maglider-lideran amd
pagsabihan xa.

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

A. record the nurse's interpretation of data.

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

RATIONALE: All entries in the medical record should include the time and date they
were written. The nurse should document observations and measurements, but avoid giving an
interpretation of the data, kc the nurse’s interpretation is considered subjective and dapat,
objective data lang dinodocument. Correcting fluid is never used to correct an error, hahaha! Kc
uso ngaun micropore (jowk). When a mistake in documentation is made, the nurse should draw
a single line through the entry, write the word error next to it, and sign her name; otherwise, it
may appear as if a nurse is trying to alter or hide information. Never leave blank spaces in the
medical record. The nurse should draw a line through any blank spaces and sign her name at the
end to prevent others from adding information to the entry.

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

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

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

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

RATIONALE: Biographical data provided in the client's Kardex or care plan shouldn't
be repeated in a change-of-shift report. The shift report should include essential information,
such as the client's name, sex, age, changes in the client's condition, treatments, and the client's
response to treatment. Other significant information, such as scheduled tests and preparations,
may be included.

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

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

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

RATIONALE: Providing information to an adult client's family without the client's

knowledge or permission is an invasion of the client's privacy. Walang lugar sa ospital ang
intrimitida and atribidang nurse. The other options, properly covering a client before moving
him through hospital corridors, shielding a client during personal care, refusing to discuss client
information with people who don't have a need to know , all demonstrate appropriate respect for
the client's privacy.

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

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

RATIONALE: A genetic counselor can educate the couple about an inherited disorder,
screening tests that can be done, and treatments and can provide emotional support. Clergy are
available to provide spiritual support. A social worker can provide emotional support and help
with referrals for financial problems. A nurse midwife cares for women during pregnancy and
birth.

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

A. Member of the clergy

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

RATIONALE: A parent or legal guardian may give permission for organ donation. A
member of the clergy can't give permission for organ donation; however, a family member may
seek the clergy's guidance in making this decision. The physician may only ask the family to
consider organ donation. The Uniform Anatomical Gift Act provides clients and family members
with the right to choose organ donation, but doesn't allow for designation of a surrogate to make
decisions related to organ donation.

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

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

RATIONALE: Celiac disease is believed to be a dominantly inherited, inborn error of

metabolism. A genetic counselor could explain about inherited disorders, how they're inherited
and, when appropriate, provide screening tests. A registered dietitian could provide in-depth
education about a gluten-free diet and help the family adapt the diet to their special needs. A
social worker could provide the family with emotional support and help with referrals for financial
problems. A nurse midwife cares for women during pregnancy and childbirth.

49. The nurse is caring for a school-age child with cerebral palsy. The child
has difficulty eating using regular utensils and requires a lot of assistance. Which of
the following referrals is most appropriate?

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

RATIONALE: An occupational therapist helps physically disabled clients adapt to

physical limitations and is most qualified to help a child with cerebral palsy eat and perform other
activities of daily living. A registered dietitian manages and plans for the nutritional needs of
children with cerebral palsy, but isn't trained in modifying or fitting utensils with assistive devices.
A physical therapist is trained to help a child with cerebral palsy gain function and prevent further
disability but not to assist the child in performing activities of daily living. A nurse's aide can help
a child eat; however, the nurse's aide isn't trained in modifying utensils.

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

A. may not take care of herself.

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

RATIONALE: The client needs to know that resources are available to her, and the
nurse should help her to find those resources. Health care can be costly, but it doesn't
necessarily mean that the client has no interest in caring for herself or her child. Taking up a
second job doesn't necessarily rectify this situation.

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

A. On the day of discharge

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

RATIONALE: Discharge planning should begin when a client is first admitted to the
hospital. Initially, discharge planning requires collecting information about the client's home
environment, support systems, functional abilities, and finances. This information is used to
determine what support services will be needed. Notifying support services on the day of
discharge won't be sufficient to ensure meeting the client's needs in a timely fashion. Waiting
until the day of discharge to begin planning is also likely to cause the client to become
overwhelmed and anxious. Factors such as when the client stops vomiting or expresses readiness
to learn shouldn't influence when the nurse begins discharge planning.

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

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

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

RATIONALE: Because more information needs to be obtained from the child and
family, an immediate appointment is most appropriate. It's unclear what type of abuse the
parents are concerned about. Taking the child to the emergency department would be
appropriate if the child had been sexually abused within the past few hours or if the child needed
immediate treatment for trauma. Calling child protective services is appropriate but isn't the first
action to take; neither is talking to an attorney.

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

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

RATIONALE: When a nurse attempts to influence a family's decision with her own
opinions and values, the situation becomes one of overinvolvement on the nurse's part and a
nontherapeutic relationship. Bawal talaga an glider-lideran and nagmamarunong na nurse. When
a nurse keeps communication channels open, works with family members to decrease their
dependence on health care providers, and instructs family members so they can accomplish tasks
independently, she has developed an appropriate therapeutic relationship.

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

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

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

RATIONALE: The nurse can coordinate care when multiple services are involved,
explaining the function of each service (social services, case management, counseling services,
and so forth). For instance, providing parents with information about financial assistance
programs is the responsibility of social services. Informing the family of the diagnosis and
recently discovered findings is a physician's responsibility, as are referring and consulting with
other specialties. CBQ ito.

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

nurse ratio from 8:1 to 6:1, a nurse should emphasize its effect on:

A. institutional resources.
B. standards of practice.
C. client-care quality.
D. nursing recruitment.

RATIONALE: Client-care quality should always be the first consideration when

proposing a change in care provision. Institutional resources, standards of practice, and nursing
recruitment will all influence the decision but none as much as client-care quality should.

56. The employer of a client on the psychiatric unit calls the nursing
station inquiring about the client's progress. The nurse doesn't know if the client has
given consent to allow the staff to give information out to callers on the phone.
Which of the following would be the nurse's best response?
 A. "I'm not permitted to discuss her progress."
B. "I'll give you the name and telephone number of her physician."
C. "I'll have her call you."
D. "I can't confirm whether your employee is a client here."

RATIONALE: The nurse's release of information to the client's employer without the
client's consent is a breach of confidentiality. The stigma associated with psychiatric illness may
affect the client's employment; therefore, it's better to maintain confidentiality and refrain from
disclosing any information about the client, including whether she's a client in the hospital. As a
patient advocate, we must always protect the privacy of our patient except on situations of
national security, eg. Politician or prominent figure ung tao. Nagrerelease ng medical bulletin pag
ganun but it’s usually the hospital director or the physician who does that and hindi ang nurse.

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

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

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

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

RATIONALE: Following the identification of a learning need, the first step is to assess
the strengths and needs of the community while identifying barriers to learning. Pancinin, kapag
community setting, kapag you really really don’t know the answer, madalas it’s the longest
statement.

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

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

A. Call the hospital lawyer.

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

RATIONALE: When the nurse is placed in this situation, the most appropriate action
is to set priorities and identify potential areas of harm to the client. Reassignment to another
nursing area is an acceptable legal practice used by hospitals to meet their staffing needs. A
nurse can't legally refuse to be reassigned unless there's a specific clause in her union contract.
Safety is always a priority!

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

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

A. Evaluation of client outcomes

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

RATIONALE: PI programs ensure that the best care is delivered to clients. This can
be measured by evaluating client outcomes. Staff performance evaluations focus on staff, not
client outcomes. Improvement in the efficiency of care may be an aspect of quality care but it
isn't the goal. Although PI is one component required for accreditation, the goal is to ensure that
the best care is delivered, not to ensure accreditation.

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

A. Call security to come and intervene.

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

RATIONALE: The first action would be to protect the child by removing him from the
room. Calling security is necessary but only after ensuring the safety of the child. Asking one of
the family members to leave the room or reasoning with them would be ineffective at this point
and may even escalate the situation. Wag makialam sa mga away ng family members ng patient
ok.

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

with a 10-month-old infant with injuries consistent with child abuse. The nursing
supervisor confers with the emergency department physician. To whom must she
report the incident?

A. A social worker
B. The medical director of the emergency department
C. A Children's Protective Services (CPS) representative
D. A public health nurse

RATIONALE: Suspected child abuse must be reported to a CPS representative. Sa

Pilipinas, bantay Bata or DSWD. Reporting a potential abuse doesn't indicate guilt, only suspicion
or risk. The CPS and the judicial system will follow the correct legal process to establish the need
for prosecution and counseling.

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

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

A. Document it on their evaluation.

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

RATIONALE: Identification of causes of medication errors requires in-service

education to inform the staff of strategies to decrease these errors. Errors are frequently the
result of systemic problems that can be identified and rectified through problem-solving
techniques and changes in procedures. Documenting or reporting the situation wouldn't directly
assist the nurses in eliminating errors. Reporting the incidents to the hospital attorney isn't
necessary.

63. When reporting to the surgeon that a chest tube is malfunctioning, the
nurse is ordered to reposition the tube and obtain a chest radiograph. The nurse
should:

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

B. report the surgeon to the Ethics Committee.
C. report the surgeon to the nursing supervisor.
D. follow the order as requested by the surgeon.
 RATIONALE: Initially, the nurse needs to inform the surgeon that the task is outside
the scope of nursing practice. Bawal ang atribida nad nagmamarunong na nurse kea, If the
surgeon still requests the activity, the nurse should refuse to perform the task and should follow
the chain of communication for reporting unsafe practice according to the hospital's policy. The
nurse must not comply with any order that goes beyond the scope of nursing practice.

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

A. the gender of the physician.

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

RATIONALE: The Iranian tradition of male authority is still strong. Accepting a

woman making life-and-death decisions for their son may be very difficult for these parents.
Discussing with the parents other options, such as the idea of turning the case over to a male
Muslim oncologist, would be appropriate. The gender issue is a stronger cultural factor than the
religious difference. There's no basis to relate the parents' behavior to fear of being charged with
abuse or neglect. Attributing the behavior to Middle Eastern aggressiveness reflects a stereotype,
not a culture value.

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

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

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

RATIONALE: Based on the information provided, the client who is on day 1 after a
total laryngectomy would be the priority client for the nurse to evaluate. This client is at risk for
impaired respiratory status and should be monitored closely coz edematous ang neck area nya
and baka magkaron ng airway obstruction. Clients with acute conditions that can affect their
respiratory status are a high priority for nursing care.

End of
PROFESSIONAL ADJUSTMENT AND NURSING CARE
MANAGEMENT PRACTICE EXAM