Clinical Decision-Making and Patient Safety in Nursing Practice

1. A nurse is caring for a client who is recovering from a stroke. The provider recommends an extracranial-intracranial bypass, but the client tells the nurse that he will not have the surgery. Which of the following actions should the nurse take? a. Inform the client of the consequences of decreased cerebral circulation. b. Initiate a mental health consultation to determine why the client refuses the surgery. c. Discuss the client’s concerns about having the surgery. d. Provide the client with information on additional treatment options. 2. A nurse on a quality improvement team is implementing a plan to decrease the rate of pressure injuries in a long-term care facility. Which of the following actions should the team take to evaluate the effectiveness of the plan? a. Compare data from clients’ records regarding skin integrity with established criteria. b. Measure staff attendance at an educational program on managing pressure injuries. c. Interview clients regarding their satisfaction with their care. d. Monitor use of supplies used to prevent pressure injuries. 3. A nurse asks a newly hired assistive personnel (AP) to remove a client’s indwelling urinary catheter. Which of the following actions should the nurse take to ensure the AP is qualified to perform this task? a. Show the AP how to remove an indwelling urinary catheter. b. Review the AP’s skill competency checklist. c. Ask the AP if they know how to remove an indwelling urinary catheter. d. Pair the newly hired AP with an experienced AP. 4. A nurse is caring for four clients. Which of the following assessment finding is the priority? a. A client who has facial drooping following a stroke 8 hours ago b. A client who has a femur fracture and reports feeling short of breath c. A client who had an appendectomy 12 hr. ago and reports pain as on a scale of 0 to 10 d. A client who had an open cholecystectomy 4 days ago and has serosanguineous drainage on the wound dressing 5. A home health nurse is planning her daily visits and receives laboratory results for four adult clients. The nurse should first visit the client who has which of the following laboratory values? a. Digoxin 1.0 ng/mL b. WBC 6,000/mm3 c. Platelets 100,000/mm3 i. A client who has a platelet count of 100,000/mm3 is unstable because this value is below the expected reference range of 150,000 to 400,000/mm3, which places the client at risk for bleeding; therefore, the nurse should visit this client first. d. Serum potassium 4.0 mEq/L i. A client who has a serum potassium level of 4.0 mEq/L is stable because this value is within the expected reference range of 3.5 to 5.0 mEq/L; therefore, the nurse should visit another client first. 6. A nurse is assigning care for four clients. Which of the following tasks should the nurse plan to delegate to an assistive personnel (AP)? a. Instruct a client how to take their blood pressure b. Administer subcutaneous medications to a client c. Determine a client’s intake and output d. Provide a status update to a client’s family member 7. A client who has back pain presents to an emergency department and is provided a prescription for oxycodone. A staff nurse tells the charge nurse that they think the client is seeking drugs and is not actually in distress. Which of the following responses should the charge nurse make? a. "It sounds like nonpharmacological interventions would be best for this client." b. "Let's withhold the oxycodone until we can consult with the provider." c. "Contact mental health services to arrange for a consultation." d. "Clients are the experts on their own pain." 8. A nurse is observing a newly licensed nurse perform a sterile dressing change on a client who has a central venous catheter. Which of the following actions should the newly licensed nurse take? a. Open the top flap of the sterile package towards the body. b. Maintain a 1.25 cm (0.5 in) border around the edges of the sterile field. c. Pick up the first sterile glove by grasping the folded cuff edge. d. Remove soiled dressings using sterile gloves. 9. A nurse is conducting an orientation class for new clients and their families at a longterm care facility. Which of the following client rights should the nurse address at the orientation? (Select all that apply.) a. The right to be treated with respect and dignity b. The right to full access of the facility c. The right to refuse their medications d. The right to leave regardless of provider recommendations e. The right to be fully informed of their health conditions 10. A nurse manager is auditing client charts and identifies an increase in ventilatorassociated pneumonia (VAP). Which of the following actions should the nurse manager take? a. Report the findings to the hospital ethics committee. b. Alert central supply. c. Fill out an incident report. d. Notify the quality improvement team. 11. A nurse manager finds that there has been an increase in urinary tract infections on the unit. To address this problem, which of the following actions should the nurse manager take first. a. Conduct an in-service that reviews proper catheter insertion and maintenance. b. Perform a chart review to gather data about the clients who developed infections. c. Observe each staff nurse perform a urinary catheter insertion. d. Require completion of a self-paced instruction program. 12. A charge nurse is observing a newly licensed nurse’s use of time-management skills. Which of the following actions by the newly licensed nurse indicated effective use of this skill? a. Documents client tasks at the end of the shift b. Gathers supplies as needed while completing an activity c. Groups tasks that are in the same location d. Skips breaks throughout the day to complete work on time 13. Which of the following instructions provided by the nurse reflects effective communication regarding delegation of a task to an assistive personnel (AP)? a. "Take vital signs every 2 hours for the client who had a cholecystectomy in room 6122." b. "Check the urinary output at 1100 for John Doe and report it to me immediately." c. "Report to me if the chest tube drainage is excessive for Jane Doe in room 2438." d. "Please notify me of any clients whose vital signs or blood glucose levels are significant." 14. A charge nurse is planning client care assignments for a unit. Which of the following tasks should the nurse assign to a licensed practical nurse (LPN)? a. Determine the swallowing ability of a client who has had a stroke. b. Provide an enteral feeding to a client who has Crohn's disease. c. Develop a teaching plan for a client who has a new diagnosis of type 2 diabetes mellitus. d. Weigh a client who is 3 days postoperative following coronary artery bypass grafting. 15. A nurse is planning discharge care for a client who had a stroke and now has leftsided weakness. Which of the following interventions should the nurse include in the plan of care? a. Request crutches from a medical equipment provider. b. Advise the client to install grab bars in the bathroom at home. c. Encourage the client to allow a home care aide to perform ADLs for them. d. Contact hospice to provide follow-up care for the client. 16. A charge nurse is supervising the care of several clients. Which of the following actions requires intervention by the charge nurse? a. A nurse is photocopying their assigned client's diagnostic test results. b. An assistive personnel (AP) documents a client's vital signs on the client's paperbased graphic record. c. The unit secretary faxes a client's laboratory results to the provider. d. An RN stays with a client who is reading the medical records that were requested. 17. A nurse manager is planning an in-service for a group of nurses about caring for clients following stem cell transplants. Which of the following instructions should the nurse manager include in the teaching? a. Assign two clients who have had a stem cell transplant to the same room. b. Obtain a rectal temperature on clients every 4 hr. c. Wear an N95 respirator mask while caring for these clients. i. Health care personnel should wear an N95 respirator mask while caring for clients who require airborne precautions. These masks protect the nurse from inhaling contaminated droplet nuclei. d. Place clients in positive-pressure airflow rooms. i. The nurse should place a client who requires protective environment precautions following a stem cell transplant in a private, positive-pressure airflow room. The room air is filtered through a HEPA filter and the airflow rate is set at more than 12 air exchanges each hour. 18. A nurse is caring for a client who is 3 days postoperative following open-heart surgery and will be transferred to the medical surgical unit. Which of the following information should the nurse plan to include in the verbal report. a. The client's dressing change schedule b. The client's level of consciousness c. The client's vital signs from the previous shift d. The client's occupation 19. A nurse is caring for a client who has a terminal illness and voices concern about performing self-care after discharge. Which of the following statements should the nurse make? a. "A social worker will address your concerns after discharge." b. "You should plan to go to a skilled nursing facility after discharge." c. "Your case manager will coordinate the resources you will need." d. "You will need hospice care until you feel stronger." 20. A nurse is reviewing safe use of a wheelchair with a group of assistive personnel. Which of the following instructions should the nurse include? a. Raise the footplates of the wheelchair before transferring the client. b. Lock the brake on one wheel of the chair when transferring the client. c. Push the wheelchair into the elevator with the front wheels first. d. Stand behind the wheelchair when moving a client down a ramp. 21. A nurse is providing preoperative teaching for a client who is scheduled for a total knee arthroplasty and speaks a different language than the nurse. Which of the following interprofessional team members should the nurse include in the discussion? a. Interpreter b. Social worker c. Occupational therapist d. Spiritual advisor 22. A nurse from a medical unit is asked to work on an orthopedic unit. The nurse has no orthopedic experience. Which of the following clients should be assigned to the medical nurse? a. A client who is in balanced skeletal traction b. A client who had a total hip arthroplasty 3 days ago c. A client who has a fractured femur with a new cast d. A client who had a right above-the-knee amputation 24 hr ago 23. A nurse is caring for a 19-year-old client who has just been informed that their cancer has metastasized. The client tells the nurse that they do not want to continue chemotherapy. Which of the following responses should the nurse make? a. "I will have the provider discuss treatment options with your parents." b. "I will gather information about palliative care for you." c. "I will contact your spiritual advisor to discuss this decision with you." d. "I will contact your parents about becoming your designees in your durable power of attorney." 24. A client on a general surgical unit tells a nurse that staff members are not answering their call light promptly. The client requests to be transferred to another unit. Which of the following actions should the nurse take first? a. Notify the charge nurse of the client's request for transfer. b. Assure the client that their concern has been shared with the staff. c. Tell the client that future calls will be answered in a timely manner. d. Ask the client to verbalize their expectations. 25. A nurse is caring for a client who is comatose. The client has a living will that declines the use of artificial enteral nutrition as a life-sustaining measure, but the client’s family has requested that the staff begin tube feedings. Which of the following actions should the nurse take? a. Insert the tube and begin feedings per the family's request. b. Ask the provider to discuss the issue with the family. c. Report the dilemma to the facility's dietitian. d. Review the client's request with the family. 26. A charge nurse is observing a newly licensed nurse who is caring for a client who has pulmonary tuberculosis. The charge nurse should expect the newly licensed nurse to take which of the following actions. a. Place the client on droplet precautions. b. Place the client in a room with positive-pressure airflow. c. Wear a surgical mask when taking the client out of the room. i. The client should only leave the room for essential clinical reasons and when this occurs, the nurse should place a surgical mask on the client. d. Wear an N95 respirator mask when in the client's room. i. The nurse should wear an N95 respirator mask when caring for clients who have suspected pulmonary tuberculosis. 27. A nurse is developing a plan of care for a school-age child whose family is homeless. Which of the following findings should the nurse identify as the priority. a. The child has red fissures at the corners of the mouth. b. The child has several small bruises on both legs. c. The child sleeps for about 13 hr each night. d. The child is not regularly attending school. 28. A charge nurse is leading a committee that is revising the policy for client discharge. After developing the initial plan, which of the following actions should the nurse take next? a. Set target dates for completion. b. Identify areas of support. c. Determine goals and objectives. d. Implement recommended strategies. 29. A nurse is caring for a client who is hospitalized and has expressive aphasia. The client’s family reports that the nurse failed to obtain written informed consent before inserting an indwelling urinary catheter. Which of the following responses should the nurse make? a. "Procedures prescribed by the provider do not require consent." b. "This is a procedure that does not require written informed consent." c. "You are right. I will discuss this issue with the charge nurse." d. "Would you mind signing the informed consent form for the procedure at this time?" 30. A nurse is caring for a client who requests pain medication. The nurse fulfills a promise to return with the medication within 15 min. The nurse is demonstrating which of the following ethical principles? a. Beneficence b. Utility c. Justice d. Fidelity