GENERAL INSTRUCTIONS:

1. This test booklet contains 100 test questions

2. Read INTRUCTIONS TO EXAMINEES printed on your answer sheet
3. Shade only one (1) box for each question on your answer sheets. Two or more boxes shaded will
invalidate your answer.
4. AVOID ERASURES.

INSTRUCTIONS:
1. Write the subject title “PROFESSIONAL ADJUSTMENT NURSING” on the box provided.

1. Rosalinda, an ambulatory care nurse is discussing pre-operative procedures with a Japanese

American client who is scheduled for surgery the following week. During the discussion, the client
continually smiles and nods the head. Nurse Rosalinda interprets this nonverbal behavior as:
A. Reflecting a cultural value
B. The client is agreeable to the required procedures
C. The client understands the preoperative procedures
D. An acceptance of the treatment

2. Nurse Malou is preparing a plan of care for a client who is a Jehovah’s Witness. The client has been
told that surgery is necessary. The nurse considers the plan of care and documents that:
A. Medication administration is not allowed
B. Surgery is prohibited in this religious group
C. Administration of blood products is forbidden
D. Religious sacraments are important

3. Nurse Jovan hears a client calling out for help, hurries down the hallway to the client’s room, and
finds the client lying on the floor. Nurse Jovan performs a thorough assessment, assists the client
back to bed, notifies the physician of the incident, and completes an incident report. Which of the
following should Nurse Jovan document on the incident report? A. The client fell out of bed.
B. The client climbed over the side rails.
C. The client was found lying on the floor.
D. The client became restless and tried to get out of bed.

4. A client is brought to the emergency department by emergency medical services (EMS) after being
hit by a car. The name of the client is unknown, and the client has sustained a severe head injury
and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding
informed consent for the surgical procedure, which of the following is the best action? A. Obtain a
court order for the surgical procedure.
B. Ask the EMS team to sign the informed consent.
C. Transport the victim to the operating room for surgery.
D. Call the police to identify the client and locate the family.

5. A nurse has just assisted a client back to bed after a fall. The nurse and physician have assessed
the client and have determined that the client is not injured. After completing the incident report,
the nurse implements which action next? A. Reassess the client.
B. Conduct a staff meeting to describe the fall.
C. Document in the nurse’s notes that an incident report was completed.

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 D. Contact the nursing supervisor to update information regarding the fall.

6. Nurse Joaquin arrives at work and is told to report (float) to the intensive care unit (ICU) for the
day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse
has never worked in the ICU. The nurse should take which action first? A. Call the hospital lawyer.
B. Refuse to float to the ICU.
C. Call the nursing supervisor.
D. Report to the ICU and identify tasks that can be performed safely.

7. Nurse Manny who works on the night shift enters the medication room and finds a co-worker with
a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to
a syringe containing a clear liquid, into the antecubital area. The appropriate initial action by Nurse
Manny is which of the following? A. Call security.
B. Call the police.
C. Call the nursing supervisor.
D. Lock the co-worker in the medication room until help is obtained.

8. A hospitalized client tells Nurse Yummi that a living will is being prepared and that the lawyer will
be bringing the will to the hospital today for witness signatures. The client asks Nurse Yummi for
assistance in obtaining a witness to the will. The appropriate response to the client is which of the
following?
A. “I will sign as a witness to your signature.”
B. “You will need to find a witness on your own.”
C. “Whoever is available at the time will sign as a witness for you.”
D. “I will call the nursing supervisor to seek assistance regarding your request.”

9. Nurse Tanya has made an error in a narrative documentation of an assessment finding on a client
and obtains the client’s record to correct the error. Nurse Tanya corrects the error by:
A. Documenting a late entry into the client’s record
B. Trying to erase the error for space to write in the correct data C. Using whiteout to delete the
error to write in the correct data.
D. Drawing one line through the error, initialing and dating the line, and then documenting the
correct information

10. Nurse Jenny employed in a hospital is waiting to receive a report from the laboratory via a fax
machine. The fax machine activates and the nurse expects the report, but instead receives a
sexually oriented photograph. The appropriate initial nursing action is to: A. Call the police.
B. Cut up the photograph and throw it away.
C. Call the nursing supervisor and report the incident.
D. Call the laboratory and ask for the individual’s name who sent the photograph.

11. A nursing instructor delivers a lecture to nursing students regarding the issue of client’s rights and
asks a nursing student to identify a situation that represents an example of invasion of client
privacy. Which of the following, if identified by the student, indicates an understanding of a
violation of this client right?
A. Performing a procedure without consent
B. Threatening to give a client a medication
C. Telling the client that he or she cannot leave the hospital
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 D. Observing care provided to the client without the client’s permission

12. Nursing staff members are sitting in the lounge taking their morning break. A nursing assistant tells
the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS)
and proceeds to tell the nursing staff that the secretary probably contracted the disease from her
husband, who is supposedly a drug addict. Which legal tort has the nursing assistant violated?
A. Libel B. Slander C. Assault D. Negligence

13. Maria Rosario, an 87-year-old woman is brought to the emergency department for treatment of a
fractured arm. On physical assessment, the nurse notes old and new ecchymotic areas on the
client’s chest and legs and asks the client how the bruises were sustained. The client, although
reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on
time when he arrives home from work. Which of the following is the appropriate nursing response?
A. “Oh, really. I will discuss this situation with your son.”
B. “This is a legal issue, and I must tell you that I will need to report it.”
C. “Let’s talk about the ways you can manage your time to prevent this from happening.”
D. “Do you have any friends that can help you out until you resolve these important issues with
your son?”

14. Nurse Benj calls the physician regarding a new medication prescription because the dosage
prescribed is higher than the recommended dosage. The nurse is unable to locate the physician,
and the medication is due to be administered. Which action should Nurse Benj implement? A.
Contact the nursing supervisor.
B. Administer the dose prescribed.
C. Hold the medication until the physician can be contacted.
D. Administer the recommended dose until the physician can be located.

15. A nurse-manager notices that a staff nurse isn’t providing tracheostomy care to a client according
to policy. The nurse’s method isn’t harmful to the client. How should the nurse-manager proceed?
A. Pull the nurse aside in a private area and tell her that she should review the procedure for
tracheostomy care.
B. Do nothing because the nurse’s method wasn’t harmful to the client.
C. Stop the nurse immediately and tell her she isn’t following the facility procedure for
tracheostomy care.
D. Wait until the nurse is at the nurses’ station with her peers and tell her she should review the
procedure because she wasn’t performing tracheostomy care correctly.

16. A client’s blood pressure is lower than the specified limits, so Nurse Weena withhold his blood
pressure medication. The nurse documents the omission on the medication administration record.
Where should she document the reason for withholding the medication if there’s no space in the
medication administration record?
A. Client care Kardex C. Care plan
B. Progress notes D. Blank sheet of paper

17. A client is admitted to your client-care area with a diagnosis of dehydration and pneumonia. After
the client is settled in bed, the nurse begins asking questions about his health history. Which action
should the nurse avoid when conducting the health history interview?
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 A. Using general leads to questions C. Restating information
B. Asking open-ended questions D. Asking persistent questions

18. For a hospitalized client, a physician orders meperidine, 75 mg I.M., every 3 hours as needed for
pain. However, the client refuses to take injections. Which nursing action is most appropriate?
A. Administering the injection as prescribed
B. Calling the physician to request an oral pain medication
C. Withholding the injection until the client understands its importance
D. Explaining that no other medication can be given until the client receives the injection

19. A nurse is conducting a physical assessment on an obese 17-year-old client who has asked for
information regarding gastric bypass surgery. Select the statement that best explains informed
consent as it applies to this client.
A. The nurse is allowed to provide the client with all information requested regarding the
procedure.
B. The nurse should inform the client that he can sign a consent form for the surgical procedure
if a parent
C. The nurse should inform the client that in most states, only the parents can give consent for
a minor’s medical care.
D. The nurse is allowed to provide the client’s legal guardian with all information regarding the
procedure.

20. A 42-year-old client admitted with an acute myocardial infarction asks to see his chart. What should
the nurse do first?
A. Allow the client to view his chart.
B. Contact the nurse-manager and physician for approval.
C. Ask the client if he has concerns about his care.
D. Tell the client that he isn’t permitted to view his chart.

21. A client is to undergo a thoracotomy in the morning. The physician asks the nurse to witness the
client’s signing of the consent form. What should the nurse do?
A. Make sure the physician thoroughly describes the procedure.
B. Provide emotional support for the client.
C. Make sure the physician explains the risks of undergoing the procedure.
D. Make sure the client is competent, awake, and alert before he signs the consent form.

22. A 92-year-old client fell as he attempted to get out of bed on his own. Which information should
the nurse include in her documentation of the incident?
A. Describe what she saw and heard and the actions she took when she reached the client.
B. Mention that an incident report was completed.
C. Describe what she thinks occurred.
D. Describe what she was doing when the event occurred.

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23. A client asks to be discharged from the health care facility against medical advice. What should the
nurse do?
A. Prevent the client from leaving.
B. Notify the physician.
C. Have the client sign an against medical advice form.
D. Call a security guard to help detain the client.

24. A nursing assistant is assigned to provide morning care to a client. How should the nurse document
care given by the assistant?
A. “Morning care provided by B.C., nursing assistant”
B. “Morning care given”
C. There’s no need to document morning care.
D. “Morning care given by Melanie Enriquez, NA”

25. A nurse administers the wrong I.V. fluid to a client. The hospital’s risk manager should receive
which information to document the incident?
A. Oral report from the nurse
B. Copy of the client care Kardex
C. Order change written by the physician
D. Incident report

26. When developing a care plan for a client with a do-not-resuscitate order, the nurse should not
include which intervention on the care plan?
A. Withdrawing foods and fluids from a competent client under his direction if specified through
his living will
B. Administering pain medications as needed and within the prescribed dosage ranges
C. Ensuring access to individuals who can provide spiritual care when requested by a client
D. Administering lethal doses of medications when requested by a competent terminally ill client

27. A mother brings her 3-year-old child to the emergency department (ED). The mother states that
she found blood in her daughter’s underwear. The physical examination reveals sexual assault with
vaginal penetration. The mother doesn’t want the police notified because of the potential publicity.
What action should the nurse take?
A. No action is necessary because the mother is the child’s legal guardian.
B. Report the findings to the police and have a social worker talk with the mother.
C. Encourage the mother to reconsider her decision.
D. Ask the ED physician to talk to the mother.

28. Which action can be interpreted as a breach in client confidentiality?

A. A nurse provides the consulting physician with an update of the client’s hospital course.
B. An intensive care nurse updates the floor nurse about a client transferred to the intensive
care unit 2 days ago.

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 C. A physician notifies the client’s family about the client’s diagnosis of epilepsy against the
client’s wishes.
D. A physician notifies the client’s sister because the client has threatened to kill his sister.

29. Which would Nurse Lydia not list as a purpose of the nursing code of ethics when discussing it with
a group of new employees?
A. Reminding nurses of the special responsibility they assume when caring for the sick
B. Guiding the profession in self-regulation
C. Providing solutions for specific ethical situations
D. Outlining the major ethical considerations of the nursing profession

30. When trying to make a responsible ethical decision, what should Nurse Ronald understand as the
basis for ethical reasoning?
A. Ethical principles and codes C. The nurse's emotional feelings
B. The nurse's experience D. The policies and practices of the institution

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31. Nurse Leslie is working in the Emergency Department. She is asked to care for an openly gay
client with AIDS. She tells her supervisor that caring for the client is against her religious beliefs,
and asks if she must take the assignment. Does Nurse Leslie have a moral obligation to care for
the client?
A. No, because the client's behavior caused him to contract AIDS
B. Yes, unless the risk exceeds the responsibility
C. No, the nurse does not have to violate religious beliefs.
D. Yes, but the nurse should hide her negative feelings

32. A fully alert and competent 89-year-old client is in end-stage liver disease. The client says, "I'm
ready to die," and refuses to take food or fluids. The family urges the client to allow Nurse Gigi to
insert a feeding tube. What is nurse Gigi’s moral responsibility? A. The nurse should obtain an
order for a feeding tube.
B. The nurse should encourage the client to reconsider the decision.
C. The nurse should honor the client's decision.
D. The nurse must consider that the hospital can be sued if she honors the client's request.

33. Which act would the nurse consider passive euthanasia?

A. Removing a "no code" client from a ventilator
B. Refusing to assist a client wishing to commit suicide
C. Administering a lethal dose of medication to a client with terminal cancer D. Providing pills
to a client wishing to commit suicide

34. A client with cancer has decided against further treatment. Which nursing action would be most
helpful?
A. Making sure the client has accurate information and understands the consequences of the
decision
B. Informing the client's wife, and encouraging her to talk to the client and intervene, if
necessary
C. Accepting the decision and making no comments to the client
D. Talking to the client and trying to persuade the client to think about reversing the decision

35. Patient ABC asks you not to tell his wife that he has cancer. He does not want to burden her with
this information. What would be the most appropriate response by Nurse Nita?
A. "I'm sorry, the doctor already told her."
B. "Why are you afraid to tell her?"
C. "What benefits do you see from doing this?"
D. "Don't you think she has a right to know?"

36. Nurse Po notes that a client has a slight red rash after taking a dose of an antibiotic. What action
by Nurse Po would demonstrate the moral principle of nonmaleficence?
A. Teaching a cardiac client about a strenuous exercise program

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 B. Getting informed consent prior to an invasive procedure
C. Allowing a new postoperative client to ambulate independently to the bathroom D. Noting
the reaction and getting a new medication ordered

37. A mentally competent client with end-stage liver disease continues to consume alcohol after being
informed of the consequences of this action. What action best illustrates the nurse's role as a
client advocate?
A. Asking the spouse to take all the alcohol out of the house
B. Accepting the client's choice and not intervening
C. Reminding the client that the action may be an end-of-life decision
D. Refusing to care for the client because of the client's noncompliance

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38. Which of the following terms are moral principles? Select all that apply.
1. Autonomy 3. Ethics
2. Beneficence 4. Fidelity
A. 1, 2 B. 2, 3 C. 1, 2,3 D. 1,2,4

39. Mr. Elizalde has low postoperative hemoglobin and hematocrit levels. He refuses a potentially
lifesaving blood transfusion. When questioning Mr. Elizalde about the refusal, he states, "I know
about the risks of AIDS and hepatitis and do not want a blood transfusion." The physician enters
the room and begins to coerce Mr. Elizalde to accept the blood transfusion. Nurse Katie’s best
response would be?
A. "Didn't you hear him? He does not want a transfusion!"
B. "The client understands the risks associated with blood transfusions. Perhaps you can speak
with him about his concerns."
C. "I will give the blood to him when he is asleep."
D. "Let's bring his family in to the discussion to change his mind."

40. Samantha, 43 year-old client with end stage ovarian cancer is admitted to the hospital with a
bowel obstruction. Samantha, in a tremendous amount of pain, states, "please give me enough
morphine to kill me." Nurse Francheska’s best response would be?
A. "I can't give you an overdose, but once you are discharged, you can do anything that you
want."
B. "I can see that you are in a lot of pain. Let me rub your back too."
C. "I am trying to understand what you are saying. Describe the pain, where is it? How intense
is the pain? What do you normally do for this type of pain?" D. "All right, I can give you a
little extra medication."

41. A famous actress has had plastic surgery. The media contacts Nurse Rita on the unit and asks for
information about the surgery. Nurse Rita knows?
A. Any information released will bring publicity to the hospital.
B. Nurses are obligated to respect client's privacy and confidentiality.
C. It does not matter what is disclosed, the media will find out any way.
D. According to beneficence, the nurse has an obligation to implement actions that will benefit
clients.
42. Nurse Haydee did not follow hospital procedure and hung a unit of blood on the wrong client. The
client had an anaphylactic reaction and the team is called in for emergency treatment. During the
resuscitation, Nurse Haydee does not reveal that the wrong blood was given. Which moral
principles were violated? Select all that apply.
1. Veracity 3. Beneficence
2. Fidelity 4. Autonomy
A. 2,4 B.1,4 C. 3,4 D. 1,3
43. Which term is defined as answerable to oneself and others for one's own actions?
A. Responsibility B. Nonmaleficence C. Justice D. Accountability

44. When a client arrives in the preoperative suite, Nurse Mark asks the client if he has any allergies.
The client responds that he doesn’t feel safe because no one seems to be communicating that
information about him to each other. Nurse Mark’s best response is?
A. “I just have to check to make sure.”
B. “I don’t trust them either, which is why I asked you.”
C. “You need to get used to it. Everyone is trained to ask that question to every client.”
D. “With every phase of treatment, we ask that question for verification and for your safety.”

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45. Nurse Carla is preparing to administer a preoperative sedative medication. Which of the following
interventions should be completed prior to administration?
A. Have a family member in attendance at the bedside
B. Instruct the client to empty his bladder
C. Establish intravenous (IV) access
D. Perform the preoperative shave

46. Romeo, a 14-year-old male requires emergency surgery, but family lives more than an hour away
from the hospital. The client is accompanied by a 21-year-old cousin, and a 16-year-old brother.
The best course of action is to?
A. Obtain verbal consent from parents over the telephone with another nurse as witness
B. Have the 21-year-old cousin sign the consent form
C. Proceed with the emergency surgery without consent
D. Obtain verbal consent via telephone from the mother of the client, and have the brother
cosign

47. In which situation would the nurse understand that implied consent is given? A. The nurse
prepares to insert a nasogastric tube into a client.
B. The client will have anesthesia by a nurse anesthetist for a surgical procedure.
C. A client is nearing delivery, attended by a nurse midwife.
D. An emergency room Emergency Department client with a laceration requiring sutures

48. A nurse has been in the peer assistance program voluntarily after being charged with drug abuse
on the nursing unit. Which statement is true about this nurse's ability to practice? A. The nurse
may work in a critical care area if closely supervised.
B. There are no restrictions on work if the nurse agrees to random drug screening.
 C. The nurse may only work day shift, with no overtime.
D. The nurse may no longer practice nursing under state law.

49. Which situation is an example of an unintentional tort?

A. Forcibly restraining a client for a procedure
B. Telling another nurse that the client is gay
C. Administering a medication that causes client harm
D. Documenting in the chart that the client is incompetent

50. The client responds when Nurse Chito calls the client by name. After giving the client a
medication, Nurse Chito realizes that it is the wrong client. The physician is notified, and Nurse
Chito documents no adverse reactions to the medication. What should Nurse Chito understand
about the possibility of being sued for malpractice?
A. There is no validity to a lawsuit for malpractice, because the client did not sustain harm or
injury from the action.
B. If the nurse notifies the physician, the nurse is no longer liable for the action.
C. The nurse can be sued, because the action was below the standard of practice.
D. There would be no lawsuit, because the client identified himself by answering when the
nurse called his name.

51. When giving a report to the oncoming shift, which action by Nurse Ida could be considered an
invasion of the client's privacy?
A. Asking the client if a nursing student can participate in their care
B. Allowing a photographer to take a sleeping client's photograph
C. Telling the oncoming nurse that the client has active herpes
D. Telling a visitor the client's room number
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52. Nurse Diane is interviewing for a position at a major hospital. Which information regarding liability
insurance should the nurse keep in mind when asking questions about hospital versus private
liability insurance?
A. Private liability insurance is not recommended, because the hospital has an umbrella policy
covering all nurses.
B. Hospitals must carry complete liability insurance for all nurses employed.
C. Private liability insurance covers the nurse in all situations, inside and outside the hospital.
D. Nurses can be countersued by the hospital if they are found negligent and the hospital has
to pay.

53. A majority of disciplinary actions by the state boards of nursing pertain to:
A. Malpractice claims C. Negligence
B. Impaired nurses D. Practicing without a license

54. Judith, the day shift nurse receives report of a critically ill client who has pneumonia and is on a
ventilator. The departing nurse shares the vital signs with Nurse Judith and reports that the
temperature and blood pressure are within normal limits. When Nurse Judith performs an
assessment, the client's temperature is 104.8° F. After checking the previous shift's vital signs,
Nurse Judith notes that the last time the temperature was taken was at midnight. It was now 8
am and the patient begins to seize. Nurse Judith knows:
A. Causation occurred
B. There was no foreseeability
C. Duty had not occurred since the client's first night shift nurse went home with the flu.
D. The night shift nurse should be fired for negligence.

55. Patient R is being involuntarily committed to the psychiatric unit after threatening to kill his spouse
and children. The involuntary commitment is an example of what bioethical principle?
A. Veracity B. Beneficence C. Fidelity D. Autonomy

56. Patient C expressed concern regarding the confidentiality of her medical information. Nurse
Joanne assures the client that the nurse maintains client confidentiality by?
A. Limiting discussion about clients to the group room and hallways.
B. Explaining the exact limits of confidentiality in the exchanges between the client and the
nurse.
C. Summarizing the information the client provides during assessments and documenting this
summary in the chart.
D. Sharing the information with all members of the health care team.

57. Nurse Carol restrains a client in a locked room for 3 hours until the client acknowledges who
started a fight in the group room last evening. Nurse Carol’s behavior constitutes?
A. False imprisonment. C. Contract of care.
B. Duty of care. D. Standard of care practice.

58. Nurse Pat is helping in bathing an elderly resident in a nursing home due to short staffing. A
nursing assistant has run the bathwater for an elderly resident. Nurse Pat comes in to relieve the
nursing assistant and lowers the resident in the tub chair into the bathwater. The elderly resident
 is badly burned because the nursing assistant ran only hot water in the tub. No one checked the
water temperature before lowering the tub chair into the water. What are both nurses guilty of?
A. Invasion of privacy C. Negligence
B. Defamation D. Assault/battery

59. Nurse Janice is just about to come on duty. The nurse that she is relieving has already procured
the medications for the particular client that she was taking care of. In order to ensure that the
patient is receiving the proper medication, what should Nurse Janice, who is taking over the care
of the client, do?
A. The nurse should assume the nurse she is relieving has procured the correct medication and
should not recheck anything.
B. The nurse should not check to see if the medication is the correct medication as long as she
is sure that the client is not mistakenly identified.
C. The nurse should check the medication administration record against the armband of the
client.
D. The nurse should only check to see if the medication is the correct medication.

60. Nurse Pamela happens to be driving by the scene of an accident, and she notices that the
Emergency Medical Service has not yet arrived. She stops her car and attempts to render medical
aid. She sees that the client is unconscious but she does not really remember how to do CPR.
Should she administer care anyway?
A. No, she should not administer aid because she does not know how to do CPR.
B. She should administer aid regardless of her training since she cannot be held liable.
C. No, she should not administer aid, mainly because she has not received the permission of
the client.
D. She should administer aid anyway even though she is not trained in CPR.

61. Lola Ellen has been receiving nourishment through feeding tubes for the past 20 years. She has
decided to ask Nurse Joyce to discontinue feeding so she can die. Lola Ellen has no relatives or
guardian. What should Nurse Joyce do in this case?
A. The nurse should consult an attorney before she aids the client in doing anything.
B. The nurse is permitted legally to honor her client's refusal of food and fluids and therefore
be her client's advocate in this.
C. The nurse should try to convince the client to continue living and not offer the client the
option of ending her life through discontinuation of food.
D. The nurse should refuse to aid the client in this endeavor and inform the supervising doctor
to administer antidepressants to the client.

62. When the children of an aged grandmother suffering from metastatic cancer request the doctor
not to tell their mother her diagnosis and instead to proceed with the chemotherapy is an example
of what universal principles of biomedical ethics?

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 A. Beneficence C. Justice
B. Nonmaleficence D. Benevolent deception

63. Vicky, a newly registered nurse knows that a professional nurse must possess specific
qualifications and abilities. Choose among the following statements the personal qualities and
professional proficiencies a professional nurse must have. Select all that apply.
1. A warm personality and concern for people.
2. Initiative to improve self and service.
3. Skill in decision-making, communicating and relating with others and being research oriented
4. Competence in performing work through the use of nursing process.
5. Active participation in issues confronting nurses and nursing.
A. 2, 3, 4, 5 C. 1, 3, 5
B. 1, 2, 3, 4, 5 D. 1, 3, 4, 5

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64. A nurse-manager appropriately behaves as an autocrat in which situation?
A. planning vacation time for the staff
B. directing staff activities if a client has a cardiac arrest
C. evaluate a new medication administration process
D. identifying the strengths and weaknesses of a client education video

65. Delegation is a process of transferring work to subordinates. A nurse-manager can appropriately

delegate which task?
A. scheduling staff assignments for the next month
B. terminating a nursing assistant for insubordination
C. deciding on salary increases for licensed practical nurses after they complete orientation D.
telling a staff to initiate disciplinary action against one of her peers

66. The critical care unit is having problems with staff members clocking in late and clocking out early
from the shift. Which statement by the charge nurse indicates he has a democratic leadership
style?
A. “You cannot clock out 1 minute before your shift is complete.”
B. “As long as your work is done you can clock out any time you want.”
C. “We are going to have a meeting to discuss the clocking in procedure.” D. “The clinical
manager will take care of anyone who clocks out early.”

67. Zander arrives in the emergency room and is assessed by the nurse. He is staggering, confused,
and verbally abusive, complains of a headache from drinking alcohol, and is asking for medication.
The nurse explains to him that the physician will need to perform an assessment before the
administration of medication. When Zander becomes verbally abusive, the nurse obtains leather
restraints and threatens to place him in the restraints. With which of the following can the Zander
legally charge the nurse as a result of the nursing action?
A. Assault C. Negligence
B. Battery D. Invasion of privacy
68. Which client should the charge nurse of a long-term care facility see first after receiving shift
report?
A. The client who is unhappy about being placed in a long-term care facility.
B. The client who wants to have the HCP to order a nightly glass of wine.
C. The client who is upset because the call light was not answered for 30 minutes.
D. The client whose son is being discharged from the hospital after heart surgery.

69. Susan, a nursing graduate is employed as a staff nurse in a local hospital. During orientation, the
new graduate asks the nurse educator about the need to obtain professional liability insurance.
The appropriate response by the nurse educator is:
A. “It is very expensive and not necessary.”
B. “The hospital's liability insurance will cover your actions.”
C. “The majority of suits are filed against physicians and the hospital.”
D. “Nurses are encouraged to have their own professional liability insurance.”

70. The newly admitted client in a long-term care facility stays in the room and refuses to participate
in client activities. Which statement is a priority for the nurse to discuss with the client?
A. “You have to get out of this room or you will never make friends here at the home.”
B. “It is not so bad living here; you are lucky that we care about what happens to you.”
C. “You seem sad; would you like to talk about how you are feeling about being here?”
D. “The activities director can arrange for someone to come and visit you in your room.”

71. The nurse in the critical care unit of a medical center answers the phone and the person says,
“There is a bomb in the hospital kitchen.” Which action should the nurse take? A. Notify the
kitchen that there is a bomb.
B. Call the operator to trace the phone call.
C. Notify the hospital security department.
D. Call the local police department.

72. Nurse Jey gives an inaccurate dose of a medication to a client. Following assessment of the client,
the nurse completes an incident report. The nurse notifies the nursing supervisor of the
medication error and calls the physician to report the occurrence. The nurse who administered the
inaccurate medication dose understands that: A. The error will result in suspension.
B. The incident will be reported to the board of nursing.
C. The incident will be documented in the personnel file.
D. An incident report needs to be completed and is a method of promoting quality care and risk
management.

73. The 65-year-old client is being discharged from the hospital following major abdominal surgery
and is unable to drive. Which referral should the nurse make to ensure continuity of care? A. A
church that can provide transportation.

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 B. A home health agency.
C. An outpatient clinic.
D. The healthcare provider’s office.

74. Ferdinand, A hospitalized client tells the nurse that a living will is being prepared and that the
lawyer will be bringing the will to the hospital today for witness signatures. The client asks the
nurse for assistance in obtaining a witness to the will. The appropriate response to the client is
which of the following?
A. “I will sign as a witness to your signature.”
B. “You will need to find a witness on your own.”
C. “Whoever is available at the time will sign as a witness for you.”
D. “I will call the nursing supervisor to seek assistance regarding your request.”

75. The resident in a long-term care facility tells the nurse, “I think my family just put me here to die
because they think I am too much trouble.” Which statement is the nurse’s best response?
A. “Can you tell me more about how you feel since your family placed you here?”
B. “Your family did what they felt was best for your safety.”
C. “Why would you think that about your family? They care for you.” D. “Tell me, how much
trouble were you when you were at home?”

76. The admitting nurse is subpoenaed to give testimony in a case in which the client fell from the bed
and fractured the left hip. The nurse initiated fall precautions on admission but was not on duty
when the client fell. Which issue should the nurse be prepared to testify about the incident? A.
What preceded the client’s fall from the bed.
B. The extent of injuries the client sustained.
C. The client’s mental status before the incident.
D. The facility’s policy covering falls prevention.

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77. Lilly is a charge nurse in an extended care facility notes an elderly male resident holding hands
with an elderly female resident. Which intervention should the charge nurse implement? A. Do
nothing, because this is a natural human need.
B. Notify the family of the residents about the situation.
C. Separate the residents for all activities.
D. Call a care plan meeting with other staff members.

78. Agata, a community health nurse is triaging victims at the scene of a building collapse. Which
intervention should the nurse implement first?
A. Discuss the disaster situation with the media.
B. Write the client’s name clearly in the disaster log.
C. Place disaster tags securely on the victims.
D. Identify an area for family members to wait.
79. A charge nurse has been orienting a graduate nurse to the unit. She tells the nurse-manager that
she feels the graduate nurse isn’t progressing through orientation. Which action by the
nursemanager is most appropriate?
A. Meet with the graduate nurse and formulate a plan to help improve the graduate nurse’s
performance.
B. Speak with the employee relations director about terminating the graduate nurse.
C. Tell the graduate nurse that if her performance doesn’t improve by the deadline she’ll be
terminated.
D. Encourage the graduate nurse to transfer to a less stressful unit.

80. A primary nurse is performing an admission assessment on a client admitted with pneumonia.
When should the nurse begin discharge planning for this client?
A. When the client’s condition is stabilized
B. The day before discharge
C. At the time of admission
D. After the physician writes the discharge order

81. The hospice care nurse is conducting a spiritual care assessment. Which statement is the scientific
rationale for this intervention?
A. The client will ask all of his or her spiritual questions and get answers.
B. The nurse is able to explain to the client how death will affect the spirit.
C. Spirituality provides a sense of meaning and purpose for many clients.
D. The nurse is the expert when assisting the client with spiritual matters.

82. Nurse Lois should include which of the following in the plan of care for a client who is confused,
combative, bedridden, and has a vest restraint?
A. Securely tie the straps of the vest restraint to the side rails of the bed
B. Crisscross the vest in the front and tie the vest with a quick-release knot
C. Remove the client’s gown before applying the vest to ensure a snug fit
D. Provide hygienic care around the vest, taking care not to untie or remove the vest

83. The nurse is caring for an older adult client who is very combative and is constantly hitting the
staff at a long-term care facility. The decision was made that extremity restraints are temporarily
necessary. Which of the following is most appropriate to include in this client’s plan of care?
A. Place the client in a lateral position
B. Insert one finger between the restraint and the client’s extremity
C. Secure the restraint to the nonmovable part of the bed
D. Remove the restraint after four hours to assess the skin

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84. The nurse appropriately applies a mummy restraint to which of the following clients?
A. A n older adult client who is confused
B. A screaming child prior to an eye irrigation
C. A n adolescent who is having a drug reaction
D. A n older adult client who is combative and scratching the staff

85. Verga, a registered nurse is preparing to delegate nursing tasks. Which of the following should the
nurse delegate to unlicensed assistive personnel?
A. Perform a neurovascular assessment on an older adult client who has a jacket restraint
B. Assess the skin integrity of an older adult client with a belt restraint
C. Perform range-of-motion exercises on an older adult client with an extremity restraint
D. D. Assess the oxygenation status of an older adult client with a vest restraint

86. Jaire, a registered nurse is preparing the client assignments for the day in a long-term care
facility. Which of the following client assignments would be appropriate for the registered nurse to
delegate to unlicensed personnel?
A. Application of a prescribed restraint
B. Administration of medications through a nasogastric tube
C. Assessment of a postoperative stoma
D. Irrigation of a Foley catheter

87. Fausto tells the nurse, “Every time I come in the hospital you hand me one of these advance
directives (AD). Why should I fill one of these out?” Which statement by the nurse is most
appropriate?
A. “You must fill out this form because Medicare laws require it.”
B. “An AD lets you participate in decisions about your health care.”
C. “This paper will ensure no one can override your decisions.”
D. “It is part of the hospital admission packet and I have to give it to you.”

88. Nurse Greg is presenting an in-service discussing do not resuscitate (DNR) orders and advance
directives. Which statement should the nurse discuss with the class? A. Advance directives must
be notarized by a notary public.
B. The client must use an attorney to complete the advanced directive.
C. Once the DNR is written, it can be used for every hospital admission.
D. The health-care provider must write the DNR order in the client’s chart.

89. In which client situation would the advance directive be consulted and used in decision making?
A. The client diagnosed with Guillain-Barre who is on a ventilator.
B. The client with a C6 spinal cord injury in the rehabilitation unit.
C. The client in end-stage renal disease who is in a comatose state.
D. The client diagnosed with cancer who has Down syndrome.

90. Nurse Lanie is moving to another state which is part of the multistate licensure compact. Which
information regarding ADs should the nurse be aware of when practicing nursing in other states?
A. The laws regarding ADs are the same in all the states.
B. Advance directives can be transferred from state to state.
C. A significant other can sign a loved one’s advance directive.

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 D. Advance directives are state regulated, not federally regulated.

91. Which client would be most likely to complete an advance directive? A. A 55-year-old Caucasian
person who is a bank president.
B. A 34-year-old Asian licensed practical nurse.
C. A 22-year-old Hispanic lawn care worker.
D. A 65-year-old African American retired cook.

92. Monmon, a client with an advance directive tells the nurse, “I have changed my mind about my
advance directive. I really want everything possible done if I am near death since I have a
grandchild.” Which action should the nurse implement?
A. Notify the health information systems department to talk to the client.
B. Remove the AD from the client’s chart and shred the document.
C. Inform the client he or she has the right to revoke the AD at any time.
D. Explain this document cannot be changed once it is signed.

93. Reanne has just signed an advance directive (AD)at the bedside. Which intervention should the
nurse implement first?
A. Notify the client’s health-care provider about the AD.
B. Instruct the client to discuss the AD with significant others.
C. Place a copy of the advance directive in the client’s chart.
D. Give the original advance directive to the client.

94. Horhe, a health-care proveider has notified the family of a client in a persistent vegetative state
on a ventilator of the need to “pull the plug.” The client does not have an advance directive or a
durable power of attorney for health care, and the family does not want their loved one removed
from the ventilator. Which action should the nurse implement? A. Refer the case to the hospital
ethics committee.
B. Tell the family they must do what the health-care provider orders.
C. Follow the HCP’s order and “pull the plug.”
D. Determine why the client did not complete an advance directive (AD).

95. Ricky asks the nurse, “When will the durable power of attorney for health care take effect?” On
which scientific rationale would the nurse base the response?
A. It goes into effect when the client needs someone to make financial decisions.
B. It will be effective when the client is under general anesthesia during surgery.
C. The client must say it is all right for it to become effective and enforced.
D. It becomes valid only when the clients cannot make their own decisions.

96. Romeo, a male client requested a do not resuscitate (DNR) per advance directive (AD), and the
health-care provider wrote the order. The client’s death is imminent and the client’s wife tells the
nurse, “Help him please. Do something. I am not ready to let him go.” Which action should the
nurse take?
A. Ask the wife if she would like to revoke her husband’s AD.

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 B. Leave the wife at the bedside and notify the hospital chaplain.
C. Sit with the wife at the bedside and encourage her to say good-bye.
D. Request the client to tell the wife he is ready to die, and don’t do anything.

97. Which situation would cause the nurse to question the validity of an advance directive (AD) when
caring for the elderly client?
A. The client’s child insists the client make his or her own decisions.
B. The nurse observes the wife making the husband sign the advance directive.
C. A nurse encouraged the client to think about end-of-life decisions.
D. A friend witnesses the client’s signature on the AD form.
98. Sarah, a spouse of a client dying from lung cancer states, “I don’t understand this death rattle.
She has not had anything to drink in days. Where is the fluid coming from?” Which is the hospice
care nurse’s best response?
A. “The body produces about two (2) teaspoons of fluid every minute on its own.”
B. “Are you sure someone is not putting ice chips in her mouth?”
C. “There is no reason for this, but it does happen from time to time.”
D. “I can administer a patch to her skin to dry up the secretions if you wish.”

99. Linlin is discussing placing the client diagnosed with chronic obstructive pulmonary disease
(COPD) in hospice care. Which prognosis must be determined to place the client in hospice care?
A. The client is doing well but could benefit from the added care by hospice.
B. The client has a life expectancy of six (6) months or less.
C. The client will live for about one (1) to two (2) more years.
D. The client has about eight (8) weeks to live and needs pain control.

100. Luna, a client diagnosed with end-stage congestive heart failure and type 2 diabetes is
receiving hospice care. Which action by the nurse demonstrates an understanding of the client’s
condition? A. The nurse monitors the blood glucose four (4) times a day.
B. The nurse keeps the client on a strict fluid restriction.
C. The nurse limits the visitors the client can receive.
D. The nurse brings the client a small piece of cake.

This is the end of the PROFESSIONAL ADJUSTMENT EXAM.

REVIEW YOUR ANSWERS BEFORE SUBMITTING YOUR ANSWER

SHEET TOGETHER WITH THIS TEST BOOKLET.

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