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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.

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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.

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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

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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.

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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.

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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

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