Professional Nursing Practice

Every question here, with the answer

1. At 1845, near the end of your shift, you review the record after a treatment and notice the patient's vital signs and symptoms changed during the afternoon. Which entry best reflects the nurse's role described in this section?

   1. Save the details for verbal shift report and keep the written note brief.
   2. Document the patient's symptoms, vital signs, change in condition, and response to treatment.
   3. Write that the patient was “not quite at baseline” without the symptoms or vital signs.
   4. Chart only that treatment was completed, because evaluating response belongs to the provider.

   Answer: Document the patient's symptoms, vital signs, change in condition, and response to treatment.

   Nurses are described as assessing symptoms and vital signs, documenting changes, and evaluating response to treatment. The other entries omit the specific changes, omit response evaluation, or substitute a verbal handoff for the documented change described in the text.

2. At 0215, while reviewing a patient's vital signs and symptoms, you are the first health-care worker to recognize a new medical issue. Before waiting for morning rounds, what action best matches the nurse's professional role?

   1. Leave the concern for the next shift because the nurse remains with the patient during treatment.
   2. Immediately report the issue to the relevant provider.
   3. Ask the patient’s family to decide whether the provider should be notified.
   4. Continue monitoring until the provider asks for an update.

   Answer: Immediately report the issue to the relevant provider.

   The section states that the nurse who recognizes a medical issue must report it immediately to the relevant provider. Monitoring without reporting, leaving it for shift change, or shifting the decision to family delays the responsibility described in the text.

3. You accepted a nursing position in another state and are building an orientation checklist so you do not document or perform activities outside your permitted role. Which sources or actions belong on that checklist? Select all that apply.

   1. Rely on formal membership in a nursing organization as proof that the activity is permitted.
   2. Use only the scope rules from your prior state because nursing scope is uniform nationally.
   3. Identify where to find information on the limitations of practice in the state where you work.
   4. Review rules and regulations from that state's regulatory body, such as the state nursing board.
   5. Review that state's Nurse Practice Act.

   Answer: Identify where to find information on the limitations of practice in the state where you work., Review rules and regulations from that state's regulatory body, such as the state nursing board., Review that state's Nurse Practice Act.

   Scope is state-determined through the Nurse Practice Act and regulatory rules, and the nurse must know the limitations in the state of practice. Prior-state rules and professional organization membership do not establish the licensed scope described here.

4. A unit committee is selecting two documentation review topics that the section explicitly gives as examples of National Patient Safety Goals. Which topics should the committee choose? Select all that apply.

   1. Whether caregiver-to-caregiver communication is effective.
   2. Whether nurses have access to networking and specialty certification opportunities.
   3. Whether patient and family preferences are included in discharge planning.
   4. Whether records support accurate patient identification.
   5. Whether the unit's professional association activities support advocacy.

   Answer: Whether caregiver-to-caregiver communication is effective., Whether records support accurate patient identification.

   The section names patient identification accuracy and caregiver communication effectiveness as NPSG examples. Discharge planning and professional association activities appear elsewhere in the section, but they are not the NPSG examples cited.

5. In the section's Real RN Story, Mr. Marshall does not want heroic measures if his heart stops beating or he stops breathing. Which action by the nurse, Lisa, best shows the patient-centered care role of knowing what matters to the patient and honoring his directives?

   1. Record that the patient is noncompliant with the treatment plan and revisit his wishes after discharge.
   2. Ask the family to decide about resuscitation because they participate in the plan of care.
   3. Assume his wishes are unchanged from a prior admission and leave the record as it is.
   4. Confirm his wishes during each hospitalization and make sure the do-not-resuscitate order is filed in his medical record.

   Answer: Confirm his wishes during each hospitalization and make sure the do-not-resuscitate order is filed in his medical record.

   In the story, Lisa confirms during each hospitalization that Mr. Marshall does not want heroic measures and ensures the do-not-resuscitate order is filed in his medical record. The section lists knowing what is most important to the patient and honoring their directives as part of the nurse's role in patient-centered care. The other options delay, skip the confirmation, or shift the patient's decision to the family.