Safe and Effective Care Environment NCLEX Review Questions

1.    The Client Self-Determination Act of 1990 requires all hospitals to inform clients of advance directives. What should nurse Byron tell the client about such advance directives as living wills and health care power of attorney?
a.    They guide the client’s treatment in certain health care situations
b.    They can’t provide do-not-resuscitate (DNR) orders for clients with terminal illnesses
c.    They allow physicians to make decisions about treatment
d.    They permit physicians to give verbal DNR orders

2.    Nurse Calvin receives a medication order over the telephone. How should the nurse handle this situation?
a.    Tell the physician that the nurse practice act prohibits taking medication orders over the telephone
b.    Verify the order by repeating it over the phone
c.    Request that a second physician repeat the order to the nurse over the telephone
d.    Insist that the physician sign the medication order within 1 hour

3.    A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a transplant recipient?
a.    Blood relationship
b.    Sex and size
c.    Compatible blood and tissue types
d.    Need

4.    Emergency restraints or seclusion may be implemented without a physician’s order under which of the following conditions?
a.    When a written order will be obtained from the primary physician within 8 hours
b.    Never
c.    If a voluntary client wants to leave against medical advice
d.    When a minor child is out of control

5.    The basis for building a strong therapeutic nurse-client relationship begins with the nurse’s:
a.    sincere desire to help others
b.    acceptance of others
c.    self-awareness and understanding
d.    sound knowledge of psychiatric nursing

6.    Nurse Carl 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.

7.    A man found wandering in a local park is unable to state who or where he is or where he lives. He is brought to the emergency department, where his identification is eventually discovered. The client’s wife states that he was diagnosed with Alzheimer’s disease 3 years ago and has had increasing memory loss. She tells the nurse she is worried about how she’ll continue to care for him. Which response by the nurse would be most helpful?
a.    Because of the nature of your husband’s disease, you should start looking into nursing homes for him
b.    What aspect of caring for your husband is causing you the greatest concern?
c.    You may benefit from a support group called Mates of Alzheimer’s Disease Clients
d.    Do you have any children or friends who could give you a break from his care every now and then?

8.    Nurse Carrol works on a general medical-surgical unit where nurses work on 12-client pods. Each pod is staffed by two registered nurses. When one of the nurses leaves the unit for any reason, the remaining nurse cares for all 12 clients. If she needs help, she can call the agency’s in-house resource nurse. One evening when a coworker nurse left the unit, the remaining nurse, who was making rounds on the departed nurse’s clients, found medications left at bedsides and a client with a blood-draw tourniquet remaining on his arm. In addressing the problems, the nurse should:
a.    inform the nurse-supervisor right away
b.    correct the problems and submit a written report
c.    speak to the coworker when she returns to the unit
d.    ask for a meeting with the coworker and a manager

9.    Nurse Carter at a substance abuse center answers the phone. A probation officer asks if a client is in treatment. The nurse responds, “No, the client you’re looking for isn’t here.” Which of the following statements best describes the nurse’s response?
a.    Correct because she didn’t give out information about the client
b.    A violation of confidentiality because she informed the officer that the client wasn’t there
c.    A breech of the principle of veracity because the nurse is misleading the officer
d.    Illegal because she’s withholding information from law enforcement agents

10.    Nurse Carey 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 facility

11.    A client is being discharged after undergoing abdominal surgery and colostomy formation to treat colon cancer. Which nursing action is most likely to promote continuity of care?
a.    Notifying the American Cancer Society of the client’s diagnosis
b.    Requesting Meals On Wheels to provide adequate nutritional intake
c.    Referring the client to a home health nurse for follow-up visits to provide colostomy care
d.    Asking an occupational therapist to evaluate the client at home

12.    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

13.    A client requests his medication at 9 p.m. instead of 10 p.m. so that he can go to sleep earlier. Which type of nursing intervention is required?
a.    Intradependent
b.    Interdependent
c.    Dependent
d.    Independent

14.    A family member visiting on an acute care psychiatric unit approaches the nurse’s station and reports that an elderly client is walking in the hall without her clothing. Nurse Casper doesn’t assist the client and suggests that the family member inform the nurse assigned to that client. Which of the following terms describes the nurse’s action?
a.    Negligent
b.    Sensitive
c.    Compassionate
d.    Organized

15.    The client’s rights to information, informed consent, and treatment refusal are addressed in the:
a.    standards of nursing practice
b.    client’s bill of rights
c.    nurse practice act
d.    code for nurses

16.    An agitated client demands to see her chart so she can read what has been written about her. Which of the following statements is nurse Cedric best response to the client?
a.    I’m sorry the chart is the property of the facility. We don’t permit clients to read them
b.    You have the right to see your chart. Please discuss this with your primary care provider
c.    You may see your chart after you’re discharged
d.    Please discuss this matter with your attorney

17.    Nurse Chadwick 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.    Nursing assistant

18.    When prioritizing a client’s plan of care based on Maslow’s hierarchy of needs, nurse Charles 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

19.    Nurse Chester manages a unit that has four full-time vacant positions, and nurses volunteer to work extra shifts to cover the staffing shortages. One of the staff nurses hasn’t volunteered and states, “Forty hours a week of nursing is all I can manage to do. I won’t volunteer for overtime.” The nurse-manager says to an attending physician on the unit, “I’ll adjust her schedule to make her wish she’d volunteered.” The physician to whom she commented should:
a.    choose to ignore the comment because it isn’t the physician’s domain
b.    report the nurse-manager to the labor relations board
c.    ensure that the nurse-manager receives counseling about her comment
d.    tell the staff nurse what the manager said about her

20.    A client with mitral valve prolapse is advised to have elective mitral valve replacement. Because the client is a Jehovah’s Witness, she declares in her advance directive that no blood products are to be administered. As a result, the consulting cardiac surgeon refuses to care for the client. It would be most appropriate for nurse Christian who’s caring for the client to:
a.    realize the surgeon has the right to refuse to care for the client
b.    advise the surgeon to arrange for an alternate cardiac surgeon
c.    tell the client that she can donate her own blood for the procedure
d.    inform the client that her decision could shorten her life

21.    A newly hired charge nurse assesses the staff nurses as competent individually but ineffective and nonproductive as a team. In addressing her concern, the charge nurse should understand that the usual reason for such a situation is:
a.    unhappiness about the change in leadership
b.    unexpressed feelings and emotions among the staff
c.    fatigue from overwork and understaffing
d.    failure to incorporate staff in decision making

22.    Which of the following options serves as a framework for nursing education and clinical practice?
a.    Scientific breakthroughs
b.    Technological advances
c.    Theoretical models
d.    Medical practices

23.    Nurse Chrisopher is caring for an infant with congenital clubfoot. After the final cast has been removed, which member of the health care team will most likely help the infant with leg and ankle exercises and provide his parents with a home exercise regimen?
a.    Occupational therapist
b.    Physical therapist
c.    Recreational therapist
d.    Speech therapist

24.    Which statement reflects appropriate documentation in the medical record of a hospitalized client?
a.    Small pressure ulcer noted on left leg
b.    Client seems to be mad at the physician
c.    Client had a good day
d.    Client’s skin is moist and cool

25.    Critical pathways of care refer to:
a.    a plan of care that provides outcome-based guidelines with a designated length of stay
b.    a plan of care designed for physicians to prescribe medications
c.    a design of treatment that includes approved therapies
d.    a technique in therapy to care for the client holistically


Answers and Rationale

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