CliffsTestPrep NCLEX PN eBook
SUBJECT AREA REVIEW CHAPTERS
PART I Coordinated Care
This chapter contains questions and answers from the following topic areas:
■ Advance Directives
■ Client Care Assignments
■ Client Rights
■ Concepts of Management and Supervision
■ Consultation with Members of the Health Care
■ Continuity of Care
■ Establishing Priorities
■ Ethical Practice
■ Informed Consent
■ Legal Responsibilities
■ Performance Improvement (Quality Assurance)
■ Referral Process
■ Resource Management
1. A 97-year-old man has severe coronary artery disease. His daughter informs you that he has a living will and a durable power of attorney for health care (DPAHC). These documents allow the daughter to:
1. sell her father’s house for funds to be used in his care.
2. make all decisions if her father becomes incompetent.
3. make health care decisions based on her father’s designated wishes if he is not competent or able to speak
4. have no say in her father’s care because the documents do not convey legal authority.
(3) A DPAHC designates legal authority for health care decision-making to a specific individual. Decision-making is to be guided by the living will. Choices 1 and 2 are incorrect because the client has only designated authority for health care decision-making, not financial or other decision-making. Choice 4 is incorrect because legal authority is delegated by a DPAHC.
2. While helping Mrs. Smith with her mouth care the evening before she is scheduled for exploratory abdominal surgery, she asks, “What do you think I should do if it’s cancer?” The response, “Let’s hope not. It’s such a bad disease. Almost everyone I’ve taken care of with cancer dies in a short time,” is an expression of:
1. personal opinion.
2. professional values.
3. ethical values.
4. moral values.
(1) The response conveys a personal opinion based on experience. Choice 2 is incorrect. Professional values are shaped
by education and professional standards of practice, which are not conveyed in the response. Choice 3 is incorrect; ethical
values are based on beliefs regarding right and wrong. Choice 4 is incorrect; moral values are based on sociocultural
3. It is appropriate to share personal values with a client:
1. if you believe the client can benefit from your advice.
2. when you need to make a choice for the client.
3. when the client asks for your opinion and you state it as such.
4. to settle a difference of opinion.
(3) It is appropriate to share personal values with a client if he or she seeks your input and understands that it is your
personal opinion only. However, nurses should always be judicious when sharing personal values with clients. Choices
1, 2, and 4 are incorrect.
Part I: Subject Area Review Chapters
4. If a client is deemed incompetent, it means that:
1. he or she can’t afford to pay his or her hospital bill.
2. he or she won’t follow medical direction.
3. a court proceeding has declared him or her unable to make his or her own decisions.
4. as a nurse, you have assessed that he or she is not making good choices or decisions.
(3) Only a court can determine competency status based on medical and psychological evaluations. Choices 1, 2, and 4 are incorrect. Choice 1 speaks to financial status only, which is not an issue of competence. Choice 2 describes non adherence, not incompetence. Choice 4 falsely implies that a nurse can judge competence based on his or her own perceptions of the quality of the client’s decision-making.
5. A DNRCC code status means:
1. the client should not have his or her symptoms actively treated.
2. the client’s care is of lower priority than another client who has a full code status.
3. therapies and treatments for the client have been limited to those that promote comfort.
4. it’s no longer necessary to take the client’s vital signs.
(3) Clients with a DNRCC code status should have quality symptom management to ensure comfort without efforts to sustain or prolong life. Choices 1, 2, and 4 are incorrect. All clients should have equal access to care regardless of code status. The nurse is responsible for continuous client assessment and for ensuring that comfort goals are met.
6. An 85-year-old male client is unconscious and unable to speak for himself. His daughter produces his advanced directive stating that she is responsible for making health care decisions on his behalf. This type of advance directive is:
1. a living will.
2. a durable power of attorney for health care (DPAHC).
3. a durable power of attorney for finance (DPAF).
4. a guardianship.
(2) Choices 1, 3, and 4 are incorrect. A living will is a written expression of personal wishes regarding the end of life.
A DPAF gives authority for financial decision-making only. A guardianship is court appointed.
7. Quality of life is:
1. an individual’s perception of his or her well being.
2. determined by a legally responsible person.
3. based on financial resources.
4. consistent by legal definition in all health care settings.
(1) Quality of life is based on an individual’s personal biopsychosocial and spiritual beliefs. Choices 2, 3, and 4 are
8. In dealing with illness, a nurse should pursue values clarification with a client when:
1. the client and nurse have different opinions.
2. the nurse is unsure of the client’s values.
3. the client has embraced nontraditional values.
4. the client verbalizes personal conflict.
(4) Choices 1, 2, and 3 are incorrect. Differing opinions do not necessarily mean a lack of clarity of values. Unless the
client has a value conflict, it is not appropriate for the nurse to address values because the client has the right to privacy
9. Advance directives are:
1. a source of information about a client’s values and wishes to be used when he or she is unable to express them.
2. an irrevocable listing of personal wishes.
3. transferable from state to state.
4. legal only if they have been recorded in court proceedings.
(1) Choice 2 is incorrect because advance directives are not irrevocable. Choice 3 is incorrect because the format differs from state to state. Choice 4 is incorrect because advance directives are legally binding if executed according to state guidelines and do not require court action.
10. The term DNR refers to:
1. CPR only.
2. a decision regarding care in an acute care hospital.
3. the use of artificial nutrition and hydration.
4. the use of medications and treatments to achieve a client’s comfort goals.
(4) Choice 1 is incorrect because, although CPR is a component of DNR, depending on a state’s definitions and protocols,
DNR can include other aspects of care. Choice 2 is incorrect because DNR status applies across the entire care continuum. Choice 3 is incorrect because the use of artificial nutrition and hydration is only part of the DNR discussion.
11. A living will addresses a client’s wishes regarding:
1. fluid and hydration treatment.
2. place of burial.
3. financial disbursements upon death.
4. dispersement of personal property.
(1) Choices 2, 3, and 4 are incorrect. Financial and personal property are not addressed in a living will.
12. Nursing advocacy is:
1. making decisions for clients.
2. encouraging clients to follow all orders from the doctor.
3. encouraging and supporting client decisions concerning rights and health care choices.
4. completion of all forms for clients.
(3) Nursing advocacy includes encouraging and supporting client decisions concerning rights and health care choices. It is built on the ethical principle of autonomy, which is a client’s right.
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