Chapter 19: Reflecting on Your Transition My Nursing Test Banks

Chapter 19: Reflecting on Your Transition

Test Bank

MULTIPLE CHOICE

1. A toddler is brought to the well-child community clinic by her grandmother. The health history reveals recurrent nausea, vomiting, and diarrhea. Her physical exam reveals a negligible gain in height and weight, lethargy, and a delay in achieving milestones. As a result of the childs delays, multiple disciplines would likely be involved in caring for the child. Which of the following represents the most effective role the nurse would play in caring for the child?

a.

Coordinator

b.

Teacher

c.

Counselor

d.

Advocate

ANS: A

One of nursings major contributions to the health care team is the role of the coordinator. Care can easily become fragmented when patients are seen by numerous specialists, each interested in a different aspect of the patient. A major risk of this situation is that the orders of different specialists may conflict with one another and be counterproductive. Therefore, it is important for the nurse to make rounds with other health care professionals and to read the results of the various consultations. The nurse can help interpret the specialists findings for the patient and family, prepare the family to participate in the patients plan of care, and serve as a liaison among the members of the health care team. Nurses also play the roles of teacher, counselor, and advocate, but this patient requires coordination of care.

DIF: Cognitive Level: Application REF: Page 296

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. A 43-year-old patient is scheduled for a laparoscopic cholecystectomy. A nurse has a plan to teach the preoperative patient how to splint his abdomen with a pillow and cough and deep breathe, so the patient can avoid fluid accumulation in the lungs postoperatively. When the nurse enters the room, it becomes evident that the patient is blind. What critical thinking skill would you recommend a scenario like this requires?

a.

Intellectual curiosity

b.

Flexibility

c.

Reflection

d.

Open-mindedness

ANS: B

Flexibility is the critical thinking skill that the nurse needs to teach the necessary information to the blind patient. In developing critical thinking, a graduate RN is encouraged to seek out situations that require thinking outside of the box to enhance and broaden the graduate RNs nursing knowledge and experience. Intellectual curiosity, reflection, and open-mindedness are also skills of critical thinking but are not applicable to this scenario.

DIF: Cognitive Level: Application REF: Page 297

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

3. It is 0800 and the nurse just received report. Which patient situation demands the nurses immediate attention? The patient:

a.

with a blood glucose of 200.

b.

who needs a 0800 vancomycin level drawn.

c.

receiving a blood transfusion who reports slight itching and chills.

d.

with a serum potassium level of 4.3 mEq/dL who is receiving digoxin.

ANS: C

Slight itching and chills during a blood transfusion may indicate an allergic reaction and require immediate attention. A blood glucose of 200 and the need for a vancomycin level will eventually need attention. A potassium level of 4.3 mEq/dL is within normal range.

DIF: Cognitive Level: Application REF: Page 297

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

4. A patient who had recent abdominal surgery is becoming increasingly agitated and confused. He has pulled out his IV and his nasogastric tube. His skin is pale and clammy, heart rate 120 bpm, BP 130/60. The physician has been called. What nursing action is most important at this time?

a.

Gather needed supplies and assign the aide to remain with the patient.

b.

Stay with the patient and have another nurse obtain needed supplies.

c.

Administer pain medication and then recheck vital signs.

d.

Assign the aide to retake vital signs every 15 minutes.

ANS: B

Staying with the patient while another nurse obtains needed supplies is the best action because the patients condition is deteriorating. Asking the aide to stay with the patient and assigning the aide to take vital signs every 15 minutes are inappropriate delegations. Administering pain medication is an incorrect action because the patient is not complaining of pain.

DIF: Cognitive Level: Application REF: Page 296

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5. Which patient is at greatest risk for injury and requires the nurses immediate attention? The patient who had a(n):

a.

paracentesis 20 minutes ago and is sitting in bed with the arms resting on the overbed tray.

b.

surgical repair of an incarcerated hernia yesterday and now has slight bruising at the incision site.

c.

echocardiogram that showed an ejection fraction of 40% and has a resting heart rate of 110 occasional PVCs.

d.

needle liver biopsy 1 hour ago and is now thrashing about in bed and complaining of severe abdominal pain.

ANS: D

The only scenario that illustrates a major risk for injury is the patient who had a needle liver biopsy 1 hour ago and is now complaining of severe abdominal pain. The patient may be bleeding internally, requiring immediate attention. The other scenarios illustrate normal expectations.

DIF: Cognitive Level: Application REF: Page 297

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

6. What could a nurse say who believed that a nursing student has a duty to understand pertinent clinical information to make sound clinical judgments?

a.

Sometimes work does get in the way of studying.

b.

Nursing school is difficult, and striving for average is understandable.

c.

You should be honest when critically reflecting on your strengths and weaknesses.

d.

Experience after nursing school will provide real nursing knowledge.

ANS: C

Being honest with yourself when reflecting on strengths and weaknesses is paramount in developing a plan that focuses on your problem areas. A problem can be resolved only after you know the reasons behind it. Your strengths will also help in becoming the best nurse you can be. Allowing your studies to be put aside, striving for average, and believing that real nursing knowledge comes only from experience after nursing school will defeat the goal of becoming the best you can be.

DIF: Cognitive Level: Synthesis REF: Page 299

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

7. As a graduate nurse, which statement strongly suggests future success in the current nursing practice environment?

a.

I am really good at performing nursing skills.

b.

I always get my work done on time.

c.

When possible I attend all staff meetings.

d.

I am actively involved in decision-making on the unit.

ANS: D

To be a part of the profession of nursing, you must set goals that advance your professional development, building up your knowledge, skill, and critical thinking abilities. Becoming a professional means establishing yourself as capable, competent, and safe. It also means that you act to advance the practice of nursing through your actions and your skills. Being professional is more than just being licensed as an RN. Being good at performing nursing skills, promptly completing work, and attending staff meetings are expectations of a proficient nurse.

DIF: Cognitive Level: Synthesis REF: Pages 299-300

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

8. Which of the following is an example of an anxiety-causing situation below that is potentially caused by a role transition from LPN/LVN to RN?

a.

A shift assignment of four patients

b.

Managing care based on your knowledge and skills

c.

Changing work shifts from days to nights

d.

Delegating tasks to LPNs/LVNs and medical assistants

ANS: B

Change can provoke anxiety, especially at the initiation of a whole new direction in life. Within your nursing program, you have been guided and had a safety net. Now you are going to be making decisions on your own, with patients and a team depending on you. You will be required to manage care based on the soundness of your knowledge and skills. This alone could be a source of anxiety and could give you pause.

DIF: Cognitive Level: Application REF: Page 302

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

9. The patient reports intense pain and rates it 10/10. He is talking and laughing on the telephone but interrupts his conversion to request pain medication. The nurse would make a decision about the administration of medication based on which indicator of pain?

a.

The patients body language and emotional state

b.

The patients level of activity and interaction with others

c.

The patients subjective statements about the pain

d.

The nurses objective data regarding the physical characteristics of the pain

ANS: C

The choice of the patients subjective statements about the pain is correct. With pain, regardless of how the patient behaves, the patients comments and rating of his pain assist the nurse in making the decision to administer pain medication. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patients medical and nursing problems.

DIF: Cognitive Level: Application REF: Page 296

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

10. The nurse asks a hospitalized patient to sign the operative consent. The patient tells the nurse, I do not really understand what is involved in the surgery. The nurse should:

a.

postpone the consent form signing and notify the operating room that the anesthesiologist needs to discuss the surgery with the patient.

b.

explain what the planned surgical procedure entails before having the patient the sign the consent form.

c.

have the patient sign the form and ask the health care provider to visit the patient before surgery to explain the procedure further.

d.

delay the patients signature on the consent form and notify the surgeon that the informed consent process is not complete.

ANS: D

The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate with the surgeon directly about the consent form. It is not within the nurses legal scope of practice to explain the surgical procedure. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patients medical and nursing problems.

DIF: Cognitive Level: Application REF: Page 296

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

11. If a patient refuses a medication or is undergoing a diagnostic test that results in a missed dose of medication, the nurse will document the omission on the medication administration record and:

a.

discontinue the physicians order.

b.

document why the dose was not given.

c.

write an incident report.

d.

double the dose at the next scheduled administration time.

ANS: B

Document what was done. Do not document before performing an intervention. The nurse is not authorized to discontinue any physicians order or to double the dose of medication unless directed by the physician. Missing a medication dose does not warrant an incident report. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patients medical and nursing problems.

DIF: Cognitive Level: Application REF: Page 296

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

12. A patient weighed 200 lb 6 months ago. He now weighs 160 lb. He has not been trying to lose weight. Based on the defining characteristics of nutrition, less than body requirements, the nurses best response would be:

a.

You need to modify your diet so you dont lose more weight.

b.

That is a significant weight loss. How would you account for it?

c.

Congratulations. That is a major achievement.

d.

How tall are you? I am wondering if that is a good weight for your height.

ANS: B

Acknowledging the weight loss and asking how the patient could account for it are respectful and allow the patient to express himself freely without judgment. The other responses are insensitive and/or limiting in patient responses. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patients medical and nursing problems.

DIF: Cognitive Level: Application REF: Page 296

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

13. The nurse enters the room of a sleeping patient to administer the 0200 dose of antibiotic that has been ordered every 6 hours. Which action would most effectively maintain a therapeutic blood level of this medication?

a.

Administer the medication whenever the client awakens.

b.

Omit this dose and chart the reason for doing so.

c.

Awaken the patient and administer the medication.

d.

Let the patient sleep and double the next dose.

ANS: C

Giving the ordered medication on time will maintain the patients therapeutic blood level. Administering the medication or omitting the medication will interfere with this. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patients medical and nursing problems.

DIF: Cognitive Level: Application REF: Page 296

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

14. The nurse is to take a meal tray to a patient the nurse knows nothing about. Before leaving the tray with the patient, which is the most critical safety factor the nurse should determine?

a.

The room is neat and orderly without offending odors.

b.

The tray has condiments placed within easy reach.

c.

The patient is seated securely and in a comfortable position.

d.

The patients ability to swallow is intact.

ANS: D

The primary goal for any nurse is delivery of safe patient care. Confirming the patients ability to swallow is critical before leaving a meal tray in reach. Del Bueno remarks that the beginning RN must meet a minimum set of competencies to be safe in the new role. These competencies include the ability to recognize problems from presenting signs and symptoms, awareness of the urgency of a situation and acting appropriately, capacity to design a care plan that safely meets the needs of the patient, and understanding the nature of the care plan in relation to the patients medical and nursing problems.

DIF: Cognitive Level: Application REF: Page 296

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

15. A nurse notices that the respiratory therapist assigned to his unit frequently forgets to raise the bed rails after completing treatments. The nurses best action is to:

a.

ask other nurses whether they have noticed the same problem.

b.

discuss the problem with the therapist.

c.

report the problem to the nurse in charge.

d.

report the problem to the director of respiratory therapy.

ANS: B

Discussing a problem directly with the person involved is a respectful and professional action. Specifically, handling this problem directly and promptly ensures patient safety. Asking others whether they have noticed the same problem does nothing to ensure patient safety. Reporting the problem to the charge nurse or the respiratory therapy director may be necessary if a direct conversation with the respiratory therapist proves futile.

DIF: Cognitive Level: Application REF: Pages 301-302

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

16. A nurse is assigned to care for an elderly, confused patient. The patients son is sitting at the bedside and is watching a loud television program. The nurse needs to complete the respiratory and cardiac assessment and vital signs. What would be the best approach to this situation?

a.

Do not say anything. Just do the best you can with the TV on loud.

b.

Say: That TV is too loud for me to do my work. You have to shut it off.

c.

Say: Ill come back after youve finished watching this TV show. Can you use the call bell to let me know when its over?

d.

Say: I need a quiet environment while I listen to your mothers chest. I will need to turn the TV down until Im finished.

ANS: D

The primary goal for any nurse is delivery of safe patient care. The assessment is the nurses baseline determination of that patients condition and the basis for that shifts plan of care. Working with the family and patient by explaining what the nurse needs can establish a trusting and cooperative rapport. Doing nothing accomplishes nothing. Directing the son to turn off the TV is not a professional response. The nurse manages the care of the patient. Giving the son authority over the nurses duty to care for the patient is inappropriate.

DIF: Cognitive Level: Application REF: Pages 301-302

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

MULTIPLE RESPONSE

1. A graduate RN on the telemetry unit is on the way to the nurses station to chart and suddenly hears from a patients room, Help! Nurse! This is not the nurses assigned patient. Others also hear this cry for help and quickly run in with the crash cart while the graduate RN looks on. In planning care for this patient, the beginning RN must realize the importance of identifying and (select all that apply):

a.

arranging experiences.

b.

correcting weaknesses.

c.

investigating insights.

d.

leveraging strengths.

e.

applying poise.

f.

accepting doubts.

ANS: B, D

In planning care, pointing out and leveraging strengths is as important as identifying and correcting weaknesses. Capitalize on your strengths in your plan of action as tools to be built on. Your strengths will also assist you in your quest to become the best you can be. As a graduate from a mobility program, not needing to concentrate on practicing basic psychomotor skills, you will be more open to the evolving changes in the conditions that define the needs of your patient. Thus your unique set of strengths has enhanced a critical component of your ability to provide safe, effective care. Identifying and arranging experiences, identifying and investigating insights, identifying and applying poise, and identifying and accepting doubts were not discussed.

DIF: Cognitive Level: Application REF: Pages 297-298

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. Which comments by the graduate RN are examples of interventions that will lead to a successful transition into professional nursing? (Select all that apply.)

a.

May I care for patients with COPD? I feel I need more experience with that pulmonary condition.

b.

How should I prioritize my five patients in order of importance?

c.

Thanks for your insights about knowing when to appropriately call the physician.

d.

Now that my new role is as an RN, I would like to be treated as any new graduate RN although Ive worked here as a LVN for 3 years.

e.

Im so nervous every day I come to work, hoping nothing happens to my patients.

ANS: A, C, D

Certain common interventions can be helpful in your role transition. Because learning is better when it has direct application or when it will be used soon after it has taken place, one intervention is to request assignment that complements your area of need. You will learn more about complications of hypertension, for example, if you take a patient with hypertension than if you just read about them. Another way to enhance your knowledge base is to ask your mentor or preceptor questions that help you understand how he or she arrived at a conclusion of decision. It will be important to communicate with your nurse manager or director when your role changes from that of LPN/LVN to RN. Asking assistance in prioritizing the nurses patient assignments is a rudimentary exercise at this point in role transition. Feeling a little nervous at work may give a graduate RN the alertness to anticipate changes in condition, but too much nervousness may be debilitating, giving the impression of a lack of confidence.

DIF: Cognitive Level: Application REF: Page 301

OBJ: Apply the nursing process to transitioning from LPN/LVN to RN.

TOP: Transition and the Nursing Process

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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