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                               Assault

    Jeffrey is a 60 year old who had knee surgery 1 day ago. Ashley the night nurse informs Jalpa the day nurse that Jeffrey received one dose of morphine 2 hours ago and has been sleeping since then with no pain. Jalpa assesses Jeffrey and finds he has no vital signs, a Code Blue is called and Jeffrey is declared deceased. On chart review Ashley did not assess Jeffrey at any time after giving morphine, hospital policy dictated vital signs should be assessed every 15 mins for one hour after giving morphine. Ashley's failure to properly monitor Jeffrey is an example of what:

                                 Intentional Tort

                                 Negligence

                                 Incapacity

     

    2.

    Jeffrey is a 60 year old who had knee surgery 1 day ago. Ashley the night nurse informs Jalpa the day nurse that Jeffrey received one dose of morphine 2 hours ago and has been sleeping since then with no pain. Jalpa assesses Jeffrey and finds he has no vital signs, a Code Blue is called and Jeffrey is declared deceased. On chart review Ashley did not assess Jeffrey at any time after giving morphine, hospital policy dictated vital signs should be assessed every 15 mins for one hour after giving morphine. Ashley's failure to properly monitor Jeffrey is an example of what:

                                 Assault

                                 Intentional Tort

                                 Negligence

                                 Incapacity

     

    3.

    Documentation is used to communicate to all members of the health care team and to monitor client status and progress. All of the following are examples how nurses demonstrate this standard except?

                                 Ensuring timely, complete and accurate record of care provided

                                 Documenting both objective and subjective data accurately

                                 Using abbreviations appropriately

                                 Ensuring documentation is made in a temporary format or record

     

    4. 

    Riley, a 12-year-old boy with leukemia, has been undergoing treatment for the last two years. When asked about his disease, Riley is able to articulate the details of his illness and treatment. For the last six months, Riley's condition has deteriorated, and he has been admitted to the hospital several times. Riley has expressed desire to discontinue his treatment and says "I know if I don't have my treatment, I won't live anymore". According to the Health Care Consent Act:

                                 Riley is a minor and cannot consent to withdrawing treatment

                                 Riley is only 12-years-old and is not capable of making an informed and voluntary decision

                                 Riley appreciates his illness and its consequences and is considered capable of making the decision to withdraw treatment.

                                 Riley can withdraw treatment if his parents agree with the decision

     

    5.

    Monique an RPN has worked in a labour and delivery unit for 20 years. When resolving ethical situations, Monique does not think she needs to consult with her colleagues because they do not have as much experience as she does. Monique insists and is adamant on demonstrating bathing of an infant to the baby's father, because she feels it is beneficial for fathers to be actively involved. This has been raised as an ethical issue on the unit by newer staff. What should the team do in this situation?

                                 Regardless of experience or expertise, consulting about ethical situations helps support decision-making

                                 Monique's experience is enough, and she is able to resolve ethical conflicts independently

                                 Monique is correct. Parents often experience anxiety over a new baby

                                 Monique should be removed from being a client's primary nurse whenever their values do not match

     

    6.

    A Nurse witnesses a nursing colleague hitting a client. The nurse intervenes and stops the abuse. The nurse identified that she was tired and frustrated, and that it will never happen again. She asked the witness not to tell the manager. What is the witness's responsibility in this situation?

                                 You are responsible for supporting your colleague who is suffering from nurse fatigue. You are responsible for protecting the client and must report the incident to the manager

                                 You are responsible for helping your colleague manage challenging patients who cause all nurses to be frustrated

                                 You can be silent because this is the first incident and the nurse said she will deal with her fatigue

                                 You are responsible for supporting your client only

     

    7. 

     

    The nurse is aware that an ethics committee in a health care facility serves to:

                                 Interview all persons involved in an ethical dilemma

                                 Illustrate circumstances that demonstrate malpractice

                                 Serve as a resource for specific situations as they occur

                                 Examine previous similar cases for comparison of outcome decisions

    8.

    Your client who has dementia refuses his 0800 medications. His daughter is his substitute decision-maker. What should the nurse do?

                                 Crush the medications, put them in apple sauce and then feed it to him

                                 Contact his daughter to discuss the change in behavior

                                 Get someone to help you open his mouth and make sure he swallows the medications

                                 Contact his daughter and insist she come to the home and make sure her father takes his medications

     

    9.

    Alyssa is a client on a mental health unit. On admission, she is a voluntary client and is competent to make treatment decisions. She is diagnosed with an eating disorder. At meal times, she is anxious and only eats fruit with ice cream. Her nurses want to give her a prn (take as needed) medication to reduce her anxiety in order that she will eat more food. Alyssa is undernourished and has lost weight. Identify the correct statement about Alyssa's situation

                                 A voluntary patient lacks capacity to make treatment decisions

                                 A patient with incapacity is not able to understand the information relevant to making a decision about the proposed treatment

                                 A patient with capacity is able to understand the information relevant to making a decision about the proposed treatment

                                 A person capable of making treatment decisions never needs to be an involuntary patient

     

    10.

    Joanne is a RPN on a surgical unit. She has noticed that when she works with RPN Kerri that the narcotic count is not accurate and Kerri often has slurred speech and an unsteady gait. Joanne suspects that Kerri is abusing substances. According to the CNA Fact Sheet on problematic substance abuse by nurses, the most important reason that Joanne needs to address her colleague's behaviour is:

                                 To ensure there are no potential negative effects on patient care

                                 To ensure Kerri receives appropriate counselling

                                 To report the behaviour to the nurse manager and the police

                                 To report the behaviour to the CNO

     

    11.

    Barbara an RPN has been found guilty of a criminal offense. She physically assaulted Rafael an RPN in the hospital parking lot. She was sentenced to prison for six months. In accordance with the regulation under the provincial nursing act what must she do?

                                 She can work as a nurse while she is in prison, and then reapply for her job once she gets out

                                 Provide the College of Nurses with details and findings of the court case. They will determine a back to work plan when she is released

                                 She does not need to report any information to the College of Nurses as this did not involve a patient or her role as a nurse

                                 Recommend that her lawyer began an appeal so that it does not affect her license

     

    12.

    Sandra is an RPN in a busy downtown emergency department which has been chronically short staffed. Sandra has been asked to stay past her shift for another 8 hours because of 2 last minute sick calls. She is feeling very tired as this is her 4th shift in a row and her second overtime shift this week. Despite feeling pressure to take the shift, Sandra refuses the extra hours, explaining to her manager that she is too tired and is aware that fatigue can have a very negative impact on patient care. She also advocates that the manager start to implement some work life strategies in the ED to help make the ED a safe work environment for staff. This is an example of which of the following:

                                 Macro level of influence

                                 Micro level of influence

                                 Meso level of influence

                                 Patient abandonment

    13.

    Mr. Patel is a 40 year old male who requires a below the knee amputation of the left leg as a result of severe ulcers and gangrene. He refuses to have the operation. After the physician explains to him the purpose for the surgery, the risks, benefits and outcomes of the surgery and answers questions that he has, Mr. Patel continues to refuse to have surgery. His family says he is irrational and incompetent and his wishes must be overruled. They want him to have the surgery. If the health care team tells Mr. Patel that he must agree to the surgery or else they will have him labeled as incompetent, their action is an example of:

                                 Coercion of Mr. Patel

                                 Following hospital protocol

                                 Looking out for his own best interests

                                 Making sure Mr. Patel knows the consequences of his decision

     

    14.

    What is nursing fatigue primarily caused by?

                                 Environmental factors

                                 Nurses' inability to sleep during the day

                                 Nursing shortage

                                 Heavy workloads

                                 All of the above

     

    15.

    According to the CNO, a nurse is guilty of patient abuse especially neglect when s/he:

                                 Tells a teenage patient to "grow up"

                                 Does not answer a call bell because the patient rings frequently

                                 Forgets to give patient medications at the correct time

                                 Does not chart on a patient after a busy shift

     

    16. 

    Obtaining informed surgical consent is the responsibility of:

                                 The physician

                                 The nurse manager

                                 The nurse (RN or RPN)

                                 The unit secretary

     

    17.

    Identify the correct statement regarding restraint use in mental health facilities.

                                 The least restraint policy does not apply

                                 Restraints are proven to reduce difficult behaviours

                                 Restraints do not need a doctor's order; only if using medications

                                 Most injuries to staff occur when clients are in some type of restraint

     

    18.

    A client that you have been caring for the last three weeks has just been declared incompetent to manage person finances. It is now time to administer her 0800hr medications. What should the nurse do?

                                 Withhold treatment until consent can be obtained from a Substitute Decision Maker

                                 Withhold medical information from the client so that she does not get confused

                                 No longer consider the client's willingness to accept medication as consent

                                 Proceed as usual with prescribed care

     

    19.

    Erica is 16 years old and presents to the community clinic in her home town to request guidance regarding emergency contraception. Later that day RPN Jane receives a phone call from Erica's grandmother inquiring about the reason for Erica's visit as she bumped into her while waiting to see the dietician. Erica's grandmother expresses she is worried about her, further that she did not know she was ill. Nurse Jane responds appropriately by saying:

                                 I cannot really say Ms. Brown, but it may be a good idea to have a talk with Erica about the birds and the bees.

                                 I understand you may be concerned. Have you spoken with Erica about your worries? It would be best that you engage Erica directly regarding your inquiry

                                 I understand you may be concerned about Erica's well being, perhaps you could speak with the doctor on duty, and he may be able to shed more light regarding your inquiry

                                 I could book an appointment for both you can Erica to come next week and we can discuss her visit then

     

    20.

     

    Lakeview hospital is laying off 50 staff. What negative impact may this change have on the healthcare organization as well as contribute to possible violence in the workplace?

                                 Increased workload, reduced safety, increased services in the community

                                 Stress, increased efficiency and frustration

                                 Conflict between staff, increased workload and reduced safety

                                 Increased workload, reduced patient services and decreased wait times

     

    21.

    Mr. Cardinal is found outside a downtown hospital when there is an extreme cold weather warning. He has hypothermia and is at risk of dying. He is taken to the emergency room immediately. The emergency room staff says they must amputate his foot to save his life. He cannot give consent. Which comment is correct?

                                 Because he has a history of mental illness, consent is not needed

                                 Because he is at risk of losing a limb and his life, consent is not needed

                                 No need to offer treatment because he created this problem: he prefers traditional health practices

                                 He has been in and out of the hospital. We cannot spend more resources on these cases

     

    22.

    Which statement is correct?

                                 Adverse events must always be reported regardless of who is responsible

                                 If you report an adverse event to your supervisor, it is mandatory that you report it to the College of Nurses of Ontario

                                 Adverse events always cause serious injury to the client

                                 Adverse events are never preventable

     

    23.

     

    Mr. Patel is a 40 year old male who requires a below the knee amputation of the left leg as a result of severe ulcers and gangrene. He refuses to have the operation. After the physician explains to him the purpose for the surgery, the risks, benefits and outcomes of the surgery and answers questions that he has, Mr. Patel continues to refuse to have surgery. His family says he is irrational and incompetent and his wishes must be overruled. They want him to have the surgery. Capacity when giving an informed consent is demonstrated when:

                                 The client is given relevant information

                                 The client freely makes the decision

                                 The client gives a written or verbal statement of consent

                                 The client understands and appreciates his/her condition, options and outcomes of the decision made

     

    24.

    According to the RNAO Healthy Work Environment Framework increasing the number of nurses - including front line, maintaining new graduate guarantees and meeting 70% full time employee target are all examples at which level:

                                 Macro

                                 Meso

                                 Micro

                                 Novice

     

    25.

    Alice arrives in the ER with her husband. He is unconscious and needs emergency surgery and a blood transfusion to save his life. Alice gives the nurses a card signed by her husband which is dated and witnessed by a lawyer. The card says he is a Jehovah's Witness and he never wants a blood transfusion. It is the duty of the nurse and emergency room staff to:

                                 Tell Alice the card is not enough proof of his wishes

                                 Respect the advance directive about refusal of a blood transfusion

                                 Explain to her that she should consent to a blood transfusion because it is in her husband's best interest and he could survive

                                 Determine if Alice is competent and not pressured by others

     

    26.

    There are many serious client safety risks associated with restrain use. Which are examples of these risks?

                                 Aspiration, and deep vein thrombosis

                                 Difficulties breathing and jeopardizing trust in the health care providers

                                 Pressure ulcers and deterioration of mental status

                                 None of the above

                                 All of the above

     

    27.

     

    Gabi is the RPN in charge on a unit with 4 PSW's and 20 residents. Up to today, the PSW's used a tick sheet to record the care they gave. Now an electronic documentation program is to replace the paper records. The manager tells Gabi that she needs to chart the care for each resident. According to the CNO:

                                 Nurses are not responsible for documenting on care their client's receive

                                 Nurses should not document on care they do not provide

                                 If it is a direction from management, the nurse can document all care given by the PSW's

                                 Gabi can get the PSW's to co-sign her charting if it involves their clients

     

    28.

     

    Negligence is failure to:

                                 Take the care that a reasonable nurse in similar circumstances would have taken

                                 Take the care that a reasonable nurse in different circumstances would have taken

                                 Take the care that a new graduate in similar circumstances would have taken

                                 Take the care that a nurse with five years' experience in similar circumstances would have taken

     

    29.

    Identify which person or group for whom involuntary hospitalization (being placed on a Form 1) is justified:

                                 Seneca students protesting to advocate for lower student fees that refuse to leave the college cafeteria

                                 Homeless persons because they discourage tourists coming to Toronto

                                 Persons with depression who try to jump in front of the subway

                                 Wealthy parents who decide to leave their fortune to a charity and not their children

     

    30.

     

    Mr. Cardinal is found outside a downtown hospital when there is an extreme cold weather warning. He has hypothermia and is at risk of dying. He is taken to the emergency room immediately. The emergency room staff says they must amputate his foot to save his life. He cannot give consent. Which comment is correct?

                                 Because he has a history of mental illness, consent is not needed

                                 Because he is at risk of losing a limb and his life, consent is not needed

                                 No need to offer treatment because he created this problem: he prefers traditional health practices

                                 He has been in and out of the hospital. We cannot spend more resources on these cases

     

    31.

     

    A client with a mental health disorder is deteriorating badly. His family is very concerned about the client deteriorating mental state and wants him brought to hospital. The client will not go on his own. The family can legally take the following action:

                                 Provide information to their son's psychiatrist who does not require sworn oath and ask the psychiatrist to have the police apprehend the individual.

                                 Provide information to the police to apprehend the individual.

                                 Provide information by sworn oath to a Justice of the Peace and have the police apprehend the individual.

                                 Provide information without need for sworn oath to the brother of the individual and ask him, as a family member, to attempt to apprehend the individual.

     

    32.

    The Canadian Nurses Association (CNA) believes that nurses who are fatigued could be placing both the patient and themselves at risk. It is supported by research that links fatigue to adverse events for patients and health problems for health system providers. All of the following symptoms are associated with workplace fatigue except:

                                 Slow reaction time

                                 Compromised safety

                                 Increased response time

                                 Interference with cognitive ability

     

    33.

     

    The patient has requested that certain information remain confidential. Which of the following is an exception to maintaining client confidentiality?

                                 The nurse must disclose the information to his manager

                                 The nurse must disclose the information if someone is in danger

                                 The nurse must disclose the information at an ethics committee review hearing

                                 The nurse must disclose the information during morning report if it is a pertinent discussion about the patient

     

    34.

    Nurses agree to be advocates for their clients. The practice of advocacy calls for the nurse to:

                                 Seek out a nursing supervisor in situations involving conflict

                                 Work to understand the law as it applies to the client's condition

                                 Assess the client's point of view and prepare to articulate this point of view

                                 Document all clinical changes in the medical record in a timely manner

    35.

    Maureen left the hospital in a hurry due to a family emergency. She later remembered that she did not document on some of her patients nor give report. She:

                                 Is guilty of professional misconduct

                                 Needs to self-report this to the College of Nurses

                                 Is incompetent and should not be working at this time of crisis

                                 Needs to call the unit, give a verbal report then return to make late entries in the charts

     

    36.

    Healthcare Informed consent is a signed document that is required for all hazardous procedures. Which of the following are required elements of informed consent:

                                 The person must be over the age of 16 and understand the information provided?

                                 The client cannot change his mind once consent has been given

                                 There must always be parental consent when it comes to children, regardless of their age

                                 The person must understand the risks and benefits of the procedure and treatment,the risks of not undergoing the procedure or treatment, and any available alternative

     

    37.

    RPN Hillary works on a surgical unit. There is an influenza epidemic on the unit. Hilary is a single parent and has two school aged children. Her children want her to call in sick because they are afraid of getting the flu from her. If Hillary follows the CNO Practice Standard Refusing Assignments and Discontinuing Nursing Services, what should she do?

                                 She has a duty to work but can discuss her concerns with her manager

                                 Call her employer and say she is sick

                                 Discuss her concerns with her manager and ask another colleague to work her shifts

                                 Ask her manager to explain to her family that she must work

     

    38.

    Alex is brought to the emergency department by his family after intentionally trying to kill himself, he states that he does NOT want to be at the hospital and he wishes he was dead. He is assessed by the doctors who determine that Alex needs a psychiatric admission for safety, which admission and form would the Doctor need to order?

                                 Voluntary: Form 1

                                 Involuntary: Form 2

                                 Voluntary: Form 2

                                 Involuntary: Form 1

     

    39.

    According to the CNO Practice Guideline, Refusing Assignments and Discontinuing Nursing Services, employers are responsible for:

                                 Establishing a safe working environment

                                 Protecting the rights of the recipients of care

                                 Providing risk situations for patients in isolation

                                 Informing clients of unknown outcomes of care

     

    40.

    Regarding restrictions on delegating, consider this statement: RNs and RPNs cannot delegate the controlled act of dispensing a drug.

                                 Correct

                                 False

                                 Using the three-factor framework, RN may be able to delegate to RPN

                                 Depends on the workload of the RN and RPN

     

    41.

    According to RNAO's Healthy Work Environment Framework, recommendations for addressing issues at the Meso level includes all of the following EXCEPT:

                                 Promoting choice of shift

                                 Enforcing breaks

                                 Occupational health and safety policies

                                 Role clarity

     

    42.

    What scheduling strategies can reduce nurse fatigue?

                                 Working no more than six 12-hour shifts in a seven day period

                                 Limiting the number of hours worked in one day to 12-hours, not including on call hours

                                 Advocate for a shift schedule that apply to circadian rhythm principles

                                 Encouragement not to take breaks so they can leave early

     

    43

    The CNO's Jurisprudence examination assesses all of the following for its applicants except:

                                 Knowledge and understanding of the laws

                                 Practice standards and guidelines that govern the nursing profession in Ontario

                                 Disciplinary actions and protocols

                                 Knowledge and understanding of regulations and by-laws

     

    44.

    Nurses themselves can reduce fatigue by:

                                 Working part time at 2 different jobs

                                 Refusing overtime hours

                                 Advocating for clients with fewer care needs

                                 Scheduling 5 shifts in a row so that they can have several days off

     

    45.

    Greg is a novice RPN who recently started practicing on a busy medical unit. Greg's co-worker, Sang-ki, asks him to obtain signed consent for a blood transfusion from her client. Greg informs Sang-ki that he has no experience with blood transfusions and does not know much about them. Sang-ki tells Greg that he does not need to explain the procedure to the client; he only needs to witness the signature. Which is the correct response?

                                 Greg may witness the signature; he only needs to ensure that it is the correct patient signing the document

                                 He is unable to inform the client of the risks and benefits of the procedure, hence should not witness consent

                                 Only a physician or nurse practitioner can explain and obtain consent for treatments, hence should not witness consent

                                 Greg should witness the consent, but ensure that he documents his discomfort

     

    46.

     

    According to the Health Care Consent Act, which of the following individuals would be considered incapable of making his/her own health care decision?

                                 A 74 year old with an acute hearing impairment who is taking a number of medications

                                 A 45 year old smelling of alcohol that is responding accurately to questions, and wants to talk to someone about rehab

                                 An agitated 25 year old female who keeps changing her mind about treatment and possible outcomes

                                 A 14 year old who expresses an understanding of the treatment and consequences

     

    47.

    Amanda an RPN provides nursing care to Mr. Banks in his home. Mr. Banks is a competent 54 year old paraplegic. Amanda knows that her professional services can be stopped if:

                                 Mr. Bank's family requests a discontinuation of services

                                 Mr. Banks states he does not want to burden the nurse over the weekend

                                 Another nurse takes over the care of Mr. Banks

                                 Mr. Bank's visit would force her to work overtime

     

    48.

    According to the Occupational Health and Safety Act (1990) and the CNA, nurses rights must be considered in the context of nurses' professional obligations to their clients. This means that nurses only have the right to refuse care when:

                                 The client is the nurse's neighbour

                                 When their scheduled shifts occur during a severe weather warning

                                 The assigned patient is combative, agitated and uncooperative

                                 They are asked to care for a client who has had an illegal transplant

     

    49.

    A substitute decision maker is required when:

                                 A client is deemed "capacity to give consent"

                                 A client is struggling to decide whether they should consent to a treatment

                                 A client is unable to make their own health care decisions

                                 A client is a minor

     

    50

    The nurse demonstrates the standard of security by doing all of the following except:

                                 Maintaining confidentiality of the client's health record

                                 Accessing only the health records for clients which the nurse is providing care

                                 Using correction tape to correct documentation errors to ensure accurate medical records

                                 Logging off the computer so that others cannot gain access through his password

     

    51

    One day Bob is asked by the hospital administrator to work on the post-partum floor. Bob has never worked in this area. What is Bob's best response to the hospital administrator?

                                 "I refuse to float to the post-partum floor"

                                 "Sure, no problem"

                                 "I will float but I am only comfortable to do the skills that I am competent to perform"

                                 "I do not like floating

     

    52

    A number of nurses noted that a client consistently refused to take his medications and that all strategies tried by the nurses failed. Instead of addressing the issue the nurses collaboratively decided to throw out his doses and record that it was administered. Under the CNO document of "Professional Misconduct" what category does this scenario fall under?

                                 Incompetency

                                 Misrepresentation

                                 Inadequate record keeping

                                 Failure to meet legal obligations

     

    53.

    In the Practice Guideline; Refusing Assignments and Discontinuing Nursing Services, the CNO gives a process for decision-making about discontinuing or refusing an assignment. The process includes four components. The first step is:

                                 Completing research about best practices

                                 Call your nurse educator for help

                                 Identify the issues, conflicts and your values

                                 Follow instructions and then complain

     

    54.

    Mr. Patel is a 40 year old male who requires a below the knee amputation of the left leg as a result of severe ulcers and gangrene. He refuses to have the operation. After the physician explains to him the purpose for the surgery, the risks, benefits and outcomes of the surgery and answers questions that he has, Mr. Patel continues to refuse to have surgery. His family says he is irrational and incompetent and his wishes must be overruled. They want him to have the surgery. Capacity when giving an informed consent is demonstrated when:

                                 The client is given relevant information

                                 The client freely makes the decision

                                 The client gives a written or verbal statement of consent

                                 The client understands and appreciates his/her condition, options and outcomes of the decision made

     

    55.

    As stated by the CNO: Conduct that demonstrates lack of integrity; dishonesty; abuse of power, access and authority; or disregard for the welfare and safety of members of the public can be applied to all except:

                                 Accepting sick pay from one facility while working at another

                                 Falsifying research data

                                 Sleeping while on duty

                                 Arriving late to work due to a snow storm

     

    56.

    In which circumstance would it be appropriate to disclose personal health information without the patient's consent?

                                 If the patient is expressing desire to harm himself or others

                                 If the patient has just turned 18-years-old and her parents are requesting the health information

                                 If law enforcement officials are requesting personal health information

                                 If the nurse who cared for the patient in the Emergency Department is asking how the patient is doing

     

    57.

     

    While Sandeep was walking to work an older lady fell on the side walk. Sandeep was aware that there was ice on the sidewalk but did not do anything to prevent the woman from falling. Sandeep:

                                 Could be found guilty of negligence because he owed a duty to the older woman

                                 Could be found guilty of negligence because his inaction resulted in the woman's injury

                                 Could not be found guilty of negligence because he had no obligation to act in this situation

                                 Could not be found guilty of negligence because he fulfilled his duty

     

    58

    The physician asks the nurse to obtain written consent from the client for electroconvulsive therapy. The client was medicated with Lorazepam (CNS depressant) 30 minutes ago and is currently sleeping. In order to establish an informed consent the nurse knows that:

                                 The client cannot be under the influence of medication that may alter cognition

                                 The client cannot have a diagnosed mental disorder or illness

                                 The client has to have a high school education

                                 The client cannot receive any medication 15 minutes prior to signing the consent form

     

    59.

    Which of the following criteria must be met for an involuntary mental health admission?

                                 The client is homeless

                                 The client is unable to provide for basic needs

                                 The client reports a history of depression

                                 The client requests admission to the hospital

     

    60.

    You overhear your colleague Amanda tell a mental health patient, "you know we have a lot of patients here who are actually sick, we do not have time for people like you to keep coming in here wasting our time." Amanda comes back to the nursing station and says to you, "can you believe all these crazy people keep coming here, don't they know we have real work to do?". How should you respond:

                                 Laugh and tell Amanda, "it must be a full moon"

                                 Speak with Amanda privately and inform her how her comments can negatively impact care

                                 Ignore Amanda for the rest of the shift and hope she will stop speaking that way

                                 Inform Amanda that since the patient is not actually sick you will not need to assess them anymore, and you can focus on other patients instead

     

    61.

    Margot Bentley was a long-time nurse, working mostly with patients with dementia. She wrote a living will to be followed when she could not make her own decisions about treatment. She was determined not to die a slow, lonely, frightful death like so many of her patients. Mrs. Bentley currently has severe dementia and lives in a long term care facility. She is being spoon fed three times daily. In her living will, Ms. Bentley stated:

                                 I want my family to make the final decisions if I am incapable

                                 I want CPR and heroic measures to stay alive

                                 I do not want to be kept alive by heroic measures and artificial means

                                 I want assisted death when I have advanced dementia

     

    62.

    A nurse is deemed incompetent if:

                                 S/he calls in sick many times due to a health condition

                                 S/he has not received a pardon for past criminal offences

                                 Client care shows significant and repeated deficiencies

                                 S/he is late for work every day

     

    63.

    Alyssa is a client on a mental health unit. On admission, she is a voluntary client and is competent to make treatment decisions. She is diagnosed with an eating disorder. At meal times she is anxious and only eats fruit with ice cream. Her nurses want to give her a prn (take as needed) medication to reduce her anxiety in order that she will eat more food. Alyssa is undernourished and has lost weight. Patients with mental illness and their families often feel isolated because:

                                 Mental illness is often associated with a stigma

                                 Their illness makes them want to stay alone

                                 Their behavior is usually very bizarre

                                 Confidentiality prevents them from talking about their illness

     

    64.

     

    A competent client in the nurse's care becomes angry, insists on leaving against medical advice, and refuses to sign the waiver acknowledging that he has been advised that leaving is not recommended at this time. What should the nurse do?

                                 The nurse should allow the client to leave

                                 The nurse should call security to restrain the client

                                 The nurse should let the client go but alert the police

                                 The nurse should refuse to give the client his personal belongings

     

    65.

    Identify the correct statement about Community Treatment Orders (CTOs):

                                 CTOs are suitable for dangerous clients

                                 CTOs do not carry a penalty for non-compliance

                                 CTOs expires after 9 months

                                 CTOs are designed to stop the revolving door syndrome

     

    66.

    A client is brought to the emergency room after a serious accident. He is unconscious and is bleeding profusely. Immediate surgery is required. In regard to informed consent for the surgical procedure and transfusions, which of the following is the best action?

                                 Keep the patient NPO, but do not send to the OR until an informed consent is signed

                                 Transport the client to the operating room immediately without obtaining informed consent

                                 Document the incident in the clients chart

                                 Call the nursing supervisor to initiate a court order for the procedures

     

    67.

    Nurses are required to uphold ethical and legal responsibilities to maintain the confidentiality of their client's personal and health information that is gathered while providing care. The Personal Health Information Protection Act (PHIPA) governs all of the following except:

                                 Financial and payment status

                                 Collection of data

                                 Storing of data

                                 Sharing of client personal health information (within the circle of care)

     

    68.

     

    Who is considered first in line to be a substitute decision maker in a marriage if the client is not capable of making decisions for him/her self?

                                 The client's spouse

                                 The client's adult child

                                 The physician

                                 The client's parent

    69

    Sandeep demonstrates his understanding of creating a trusting relationship when he:

                                 Provides care based on the concept of 'do your best when possible'

                                 Provides safe, competent and knowledgeable care

                                 Provides care according to tort law

                                 Provides uncompassionate care

     

    70

    Margot Bentley was a long-time nurse, working mostly with patients with dementia. She wrote a living will to be followed when she could not make her own decisions about treatment. She was determined not to die a slow, lonely, frightful death like so many of her patients. Mrs. Bentley currently has severe dementia and lives in a long term care facility. She is being spoon fed three times daily. The team arguing that Mrs. Bentley should not be spoon fed made the following point:

                                 This action would respect her living will

                                 Feeding is health care rather than basic care

                                 Refusing to feed Mrs. Bentley would result in beneficence

                                 Mrs. Bentley's husband and daughter are her substitute decision makers and they want a feeding tube inserted

     

    71.

    Burnout is an emotional condition marked by a depletion of mental and physical energy after a prolonged period of stress. Which of the following statements, related to burnout, is the most accurate?

                                 It is caused by a reaction to chronic environmental stressors

                                 The onset is sudden and acute

                                 The symptoms will improve if you leave your job

                                 It results from caring for those who are suffering

     

    72.

    Annie, an elderly woman in a long-term care facility, is confused when approached by two nurses who restrain her in a bath chair and proceed to give her a bath without her consent. What kind of abuse is demonstrated in this scenario?

                                 Neglect

                                 Verbal abuse

                                 Sexual abuse

                                 Physical abuse

     

    73.

    Sandeep is an RPN working on a busy surgical unit. During his medication rounds, Sandeep realizes that he has accidentally administered the wrong medication to his patient. The patient has become severely hypotensive and is being transferred to the ICU. Sandeep knows that this act is considered:

                                 An unintentional tort for which he can be considered negligent

                                 An intentional tort for which he can be considered negligent

                                 An incident of battery for which he can be considered legally liable

                                 An accident for which he cannot be considered legally liable because his actions were not intentional

     

    74.

    Which of the following is not considered a restraint?

                                 A table fixed to a wheelchair

                                 Secured unit

                                 Seclusion in a time-out room

                                 Half bed rail

     

    75.

    The objective of this group is to identify and eliminate potential hazards before anyone is harmed or disabled, and to develop and evaluate policies and procedures that provide guidelines for the institution and direct practice. This group is referred to as:

                                 Risk Management

                                 The Personal Health Information Protection Act (PHIPA)

                                 The Ontario Nurses Association (ONA)

                                 College's Discipline Committee or Fitness to Practice Committee

     

    76.

    To protect himself from negligence cases, what should Sandeep do?

                                 Document according to agency policy only

                                 Familiarize himself with written policies and procedures

                                 Work in a team as much as possible

                                 Follow the client's requests at all times

     

     

     

    Answer & Explanation
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