Fundamentals of Nursing NCLEX Practice Questions Quiz #8 | 80 Questions

Questions related to Nursing Jurisprudence: Legal and Ethical Considerations

FNDNRS-08-001

The best explanation of what Title VI of the Civil Rights Act mandates is the freedom to:

A. Pick any physician and insurance company despite one’s income.
B. Receive free medical benefits as needed within the county of residence.
C. Have equal access to all health care regardless of race and religion.
D. Have basic care with a sliding scale payment plan from all healthcare facilities.

Correct Answer: C. Have equal access to all health care regardless of race and religion.

Title VI of the Civil Rights Act of 1964 states that “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”

Option A: The Affordable Care Act puts consumers back in charge of their health care. Under the law, a new “Patient’s Bill of Rights” gives the American people the stability and flexibility they need to make informed choices about their health. Through this bill, the client may choose the primary care physician he wants from his plan’s network.
Option B: Since the Patient’s Bill of Rights was enacted, the Affordable Care Act has provided additional rights and protections. The health care law covers preventive care at no cost. Clients may be eligible for recommended preventive health services without a copayment.
Option D: Under the Patient’s Bill of Rights, a client’s premium dollars are ensured to be spent on primary healthcare, not on administrative costs. Also, the bill removes insurance company barriers to emergency services that are outside of their health plan’s network.

FNDNRS-08-002

Which statement would best explain the role of the nurse when planning care for a culturally diverse population? The nurse will plan care to:

A. Include care that is culturally congruent with the staff from predetermined criteria.
B. Focus only on the needs of the client, ignoring the nurse’s beliefs and practices.
C. Blend the values of the nurse that are for the good of the client and minimize the client’s individual values and beliefs during care.
D. Provide care while aware of one’s own bias, focusing on the client’s individual needs rather than the staff’s practices.

Correct Answer: D. Provide care while aware of one’s own bias, focusing on the client’s individual needs rather than the staff’s practices.

Without understanding one’s own beliefs and values, a bias or preconceived belief by the nurse could create an unexpected conflict or an area of neglect in the plan of care for a client (who might be expecting something totally different from the care). During assessment values, beliefs, practices should be identified by the nurse and used as a guide to identify the choices by the nurse to meet specific needs/outcomes of that client. Therefore identification of values, beliefs, and practices allows for planning meaningful and beneficial care specific for this client.

Option A: As nurses strive to learn more about becoming culturally sensitive nurses, they should also let others know what they are doing and why. Encourage co-workers to provide more culturally competent care. Approach sharing awareness with openness and positivity, rather than from a critical point of view.
Option B: Cultural competency in the health care sector supports positive patient outcomes and improves medical research accuracy. Cultural competence is learning about how cultural differences may impact healthcare decisions and being able to modify care to align with that patient’s culture.
Option C: Active listening in the healthcare community is imperative, especially when individuals of different racial or cultural backgrounds are involved. It’s important that patients feel heard and validated, particularly when they are in a vulnerable position.

FNDNRS-08-003

Which factor is least significant during assessment when gathering information about cultural practices?

A. Language, timing
B. Touch, eye contact
C. Biocultural needs
D. Pain perception, management expectations

Correct Answer: C. Biocultural needs

Cultural practices do not influence biocultural needs because they are inborn risks that are related to a biological need and not a learned cultural belief or practice. Culturally competent healthcare professionals learn about different groups and the values that drive them. They develop nonjudgmental acceptance of cultural and noncultural differences in patients and coworkers, using diversity as a strength that empowers them to achieve mutually acceptable healthcare goals.

Option A: When a patient doesn’t speak English and there is no interpreter, spend more time visiting to allay patients’ anxiety. Learn key phrases from the family and use flashcards to enhance communication. When all else fails, sign language does work. Remember that making the effort shows the patient that you care. You are using the language of the heart and building trust.
Option B: Both the clinician and the interpreter must pay particular attention to nonverbal feedback during communication with the patient to ensure understanding of the patient’s concerns and desires. During the exchange, the clinician and the interpreter must be able to convey caring and support to gain patients’ confidence and trust, particularly when they are revealing sensitive information.
Option D: Culture influences patients’ perceptions of illness, pain, and healing. These perceptions may conflict with clinicians’ views based on the medical model. Keep an open mind and listen actively to what patients say about their illness.

FNDNRS-08-004

Transcultural nursing implies:

A. Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate.
B. Working in another culture to practice nursing within their limitations.
C. Combining all cultural beliefs into a practice that is a non-threatening approach to minimize cultural barriers for all clients’ equality of care.
D. Ignoring all cultural differences to provide the best-generalized care to all clients.

Correct Answer: A. Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate.

Transcultural care means that by understanding and learning about specific cultural practices the nurse can integrate these practices into the plan of care for a specific individual client who has the same beliefs or practices to meet the client’s needs in a holistic manner of care.

Option B: Nurses should explore new ways of providing cultural care in multicultural societies, understand how culture affects health-illness definitions, and build a bridge for the gap between the caring process and the individuals in different cultures.
Option C: The individuals’ beliefs about health, attitudes, and behaviors, past experiences, treatment practices, in short, their culture, play a vital role in improving health, preventing and treating diseases. Health workers must collect cultural data to understand the attitudes of coping with illness, health promotion, and protection.
Option D: Nurses should offer acceptable and affordable care for the individuals under the conditions of the day. Knowing what cultural practices are done in the target communities and identifying the cultural barriers to offering quality health care positively affects the caring process.

FNDNRS-08-005

What should the nurse do when planning nursing care for a client with a different cultural background? The nurse should:

A. Allow the family to provide care during the hospital stay so no rituals or customs are broken.
B. Identify how these cultural variables affect the health problem.
C. Speak slowly and show pictures to make sure the client always understands
D. Explain how the client must adapt to hospital routines to be effectively cared for while in the hospital.

Correct Answer: B. Identify how these cultural variables affect the health problem.

Without assessment and identification of the cultural needs, the nurse cannot begin to understand how these might influence the health problem or health care management. Culture is influential at many levels in health, ranging from the formation of new diagnostic groups to the diagnosis of disease to the determination of what is called a disease or no symptoms and disease cues

Option A: The transcultural approach should be considered in a wide range of subjects, starting from asking if there are any religious practices to be followed or done by the patient during the hospitalization, and writing the signs in the hospital in two different languages.
Option C: Health culture is concerned with every individual’s or the society’s patterns of living, celebrating, being happy in life, suffering, and dying. It is not enough for the individual to acquire only health-related information, but basic skills such as comprehending health-related values, developing a healthy lifestyle, and self-evaluation must be developed.
Option D: The environment is an integral part of the culture. Individuals as physical, ecological, sociopolitical, and cultural beings are continuously interacting with each other. Nurses may have to intervene in the patient and family relationship because of frequent bureaucratic arrangements and procedures.

FNDNRS-08-006

Which activity would not be expected by the nurse to meet the cultural needs of the client?

A. Promote and support attitudes, behaviors, knowledge, and skills to respectfully meet the client’s cultural needs despite the nurse’s own beliefs and practices.
B. Ensure that the interpreter understands not only the language of the client but feelings and attitudes behind cultural practices to make sure an ethical balance can be achieved.
C. Develop structure and process for meeting cultural needs on a regular basis and means to avoid overlooking these needs with clients.
D. Expect the family to keep an interpreter present at all times to assist in meeting the communication needs all day and night while hospitalized.

Correct Answer: D. Expect the family to keep an interpreter present at all times to assist in meeting the communication needs all day and night while hospitalized.

It is not the family’s responsibility to assist in the communication process. Many families will leave someone to help at times, but it is the hospital’s legal obligation to find an interpreter for continued understanding by the client to make sure the client is fully informed and comprehends in his or her primary language.

Option A: When caring for a patient from a culture different from the nurse’s own, she needs to be aware of and respect his cultural preferences and beliefs; otherwise, he may consider the nurse insensitive and indifferent, possibly even incompetent. But beware of assuming that all members of any one culture act and behave in the same way; in other words, don’t stereotype people.
Option B: Establishing an environment where cultural differences are respected begins with effective communication. This occurs not just from speaking the same language, but also through body language and other cues, such as voice, tone, and loudness. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires facilities to have interpreters available, so every facility should make a list available.
Option C: Thinking about one’s beliefs and recognizing one’s own cultural bias and world view will help understand differences and resolve cultural and ethical conflicts one may face. But while caring for this patient, promote open dialogue and work with him, his family, and health care providers to reach a culturally appropriate solution. For example, a patient who refuses a routine blood transfusion might accept an autologous one.

FNDNRS-08-007

Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the:

A. American Nurses Association’s (ANA’s) Code of Ethics
B. Nurse Practice Act (NPA) written by state legislation
C. Standards of care from experts in the practice field
D. Good Samaritan laws for civil guidelines

Correct Answer: A. American Nurses Association’s (ANA’s) Code of Ethics

This set of ethical principles provides the professional guidelines established by the ANA to maintain the highest standards for ideal conduct in practice. As a profession, the ANA wanted to establish rules and then incorporate guidelines for accountability and responsibility of each nurse within the practice setting.

Option B: Every state and territory in the US sets laws to govern the practice of nursing. These laws are defined in the Nursing Practice Act (NPA). The NPA is then interpreted into regulations by each state and territorial nursing board with the authority to regulate the practice of nursing care and the power to enforce the laws. Fifty states, the District of Columbia and 4 United States (US) territories, have state boards of nursing (BON) that are responsible for regulating their individual NPA.
Option C: Professional standards describe the competent level of care in each phase of the nursing process. They reflect a desired and achievable level of performance against which a nurse’s actual performance can be compared. The main purpose of professional standards is to direct and maintain a safe and clinically competent nursing practice.
Option D: Good Samaritan laws have their basis on the idea that consensus agreement favors good “public policy” to limit liability for those who voluntarily perform care and rescue in emergency situations. It is well known that medical emergencies outside of the umbrella “medical setting” or “clinical environment” are common.

FNDNRS-08-008

A bioethical issue should be described as:

A. The physician’s making all decisions of client management without getting input from the client.
B. A research project that included treating all the white men and not treating all the black men to compare the outcomes of specific drug therapy.
C. The withholding of food and treatment at the request of the client in a written advance directive given before a client acquired permanent brain damage from an accident.
D. After the client gives permission, the physician’s disclosing all information to the family for their support in the management of the client.

Correct Answer: B. A research project that included treating all the white men and not treating all the black men to compare the outcomes of specific drug therapy.

The ethical issue was the inequality of treatment based strictly upon racial differences. Secondly, the drug was deliberately withheld even after results showed that the drug was working to cure the disease process in white men for many years. So after many years, the black men were still not treated despite the outcome of the research process that showed the drug to be effective in controlling the disease early at the beginning of the research project. Therefore harm was done. Nonmaleficence, veracity, and justice were not followed.

Option A: Patients have a right to make their own decisions about their healthcare, guided by the advice of health professionals. This guidance means making sure one fully understands his medical treatment options so one can weigh up options along with the benefits and risks before making a decision. This is called shared decision-making. It ensures that the patient and the doctor are making treatment and healthcare decisions together.
Option C: Advance care planning can help the people close to the patient and those caring for him know what is important to him about the level of healthcare and quality of life he would want if, for some reason, the patient is unable to participate in the discussions.
Option D: Information about medical conditions and treatments is more available than ever before, thanks largely to health websites on the internet. But despite this easy access to health information, it is hard to know what is relevant and appropriate for each patient. Everyone is different and only health professionals can provide the right health information that relates to an individual medical condition.

FNDNRS-08-009

When the nurse described the client as “that nasty old man in room 201,” the nurse is exhibiting which ethical dilemma?

A. Gender bias and ageism
B. HIPAA violation
C. Beneficence
D. Code of ethics violation

Correct Answer: A. Gender bias and ageism

Stereotyping an “old man” as “nasty” is a gender bias and an ageism issue. The nurse is verbalizing a negative descriptor about the client. Anyone who lives long enough is at risk of experiencing ageism. In Western, industrialized countries, older people are often perceived as unproductive and as using too much of society’s resources (Gullette 2004). As countries’ demographics shift toward larger percentages of older citizens (due to declines in birth rates and increases in longevity), aging is often framed in public policy debates as a social problem, and the hyperbolic language that is frequently used (e.g., “the gray tsunami”) to describe shifting demographics contributes to ageism.

Option B: The Health Insurance Portability and Accountability Act of 1996 is a landmark piece of legislation that was introduced to simplify the administration of healthcare, eliminate wastage, prevent healthcare fraud, and ensure that employees could maintain healthcare coverage when between jobs. A HIPAA violation is a failure to comply with any aspect of HIPAA standards and provisions detailed in 45 CFR Parts 160, 162, and 164.
Option C: Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation. All professionals have the foundational moral imperative of doing right.
Option D: Serious ethical violations are acts that not only disregard codes of medical ethics, but also risk directly harming patients and subjecting the wrongdoer to criminal, tort, or medical board actions.

FNDNRS-08-010

The distribution of nurses to areas of “most need” in the time of a nursing shortage is an example of:

A. Utilitarianism theory
B. Deontological theory
C. Justice
D. Beneficence

Correct Answer: C. Justice

Justice is defined as the fairness of distribution of resources. However, guidelines for a hierarchy of needs have been established, such as with organ transplantation. Nurses are moved to areas of greatest need when shortages occur on the floors. No floor is left without staff, and another floor that had five staff will give up two to go help the floor that had no staff.

Option A: Utilitarianism is a theory of morality, which advocates actions that foster happiness or pleasure and opposes actions that cause unhappiness or harm. When directed toward making social, economic, or political decisions, a utilitarian philosophy would aim for the betterment of society as a whole.
Option B: In contemporary moral philosophy, deontology is one of those kinds of normative theories regarding which choices are morally required, forbidden, or permitted. In other words, deontology falls within the domain of moral theories that guide and assess our choices of what we ought to do (deontic theories), in contrast to those that guide and assess what kind of person we are and should be (aretaic [virtue] theories).
Option D: Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation. All professionals have the foundational moral imperative of doing right.

FNDNRS-08-011

Nurses are bound by a variety of laws. Which description of a type of law is correct?

A. Statutory law is created by an elected legislature, such as the state legislature that defines the Nurse Practice Act (NPA).
B. Regulatory law includes prevention of harm for the public and punishment for those laws that are broken.
C. Common law protects the rights of the individual within society for fair and equal treatment.
D. Criminal law creates boards that pass rules and regulations to control society.

Correct Answer: A. Statutory law is created by an elected legislature, such as the state legislature that defines the Nurse Practice Act (NPA).

Statutory law is created by the legislature. It creates statutes such as the NPA, which defines the role of the nurse and expectations of the performance of one’s duties and explains what is contraindicated as guidelines for breach of those regulations.

Option B: Federal and state regulations influence everything from the air we breathe to the fine print on credit card agreements. Regulatory law involves creating and/or managing the rules and regulations created by federal and state agencies.
Option C: Common law is a body of unwritten laws based on legal precedents established by the courts. Common law influences the decision-making process in unusual cases where the outcome cannot be determined based on existing statutes or written rules of law.
Option D: Criminal law, as distinguished from civil law, is a system of laws concerned with the punishment of individuals who commit crimes. Thus, wherein a civil case of two individuals dispute their rights, a criminal prosecution involves the government deciding whether to punish an individual for either an act or an omission.

FNDNRS-08-012

Besides the Joint Commission on Accreditation of Healthcare Organizations (JACHO), which governing agency regulates hospitals to allow continued safe services to be provided, funding to be received from the government, and penalties if guidelines are not followed?

A. Board of Nursing Examiners (BNE)
B. Nurse Practice Act (NPA)
C. American Nurses Association (ANA)
D. Americans With Disabilities Act (ADA)

Correct Answer: D. Americans With Disabilities Act (ADA)

If the hospital fails to follow ADA guidelines for meeting special needs, the facility loses funding and status for receiving low-income loans or reimbursement of expenses. ADA protects the civil rights of disabled people. It applies to both the hospital clients and hospital staff. Privacy issues for persons who are positive for human immunodeficiency virus (HIV) have been one issue in relation to getting information when hospital staff has been exposed to unclean sticks. The ADA allows the infected client the right to choose whether or not to disclose that information.

Option A: Boards of nursing are state governmental agencies that protect the public’s health by overseeing and ensuring safe nursing practice. They establish standards for safe nursing care and issue licenses to practice nursing, monitor licensees’ compliance to state laws, and take action against the licenses of nurses who have exhibited unsafe nursing practice. Most boards also review and approve or accredit nursing education programs to ensure that graduates are prepared for safe, effective practice.
Option B: Every state and territory in the US sets laws to govern the practice of nursing. These laws are defined in the Nursing Practice Act (NPA). The NPA is then interpreted into regulations by each state and territorial nursing board with the authority to regulate the practice of nursing care and the power to enforce the laws. Fifty states, District of Columbia and 4 United States (US) territories, have state boards of nursing (BON) that are responsible for regulating their individual NPA.
Option C: The American Nurses Association (ANA) is the premier organization representing the interests of the nation’s 4 million registered nurses. ANA is at the forefront of improving the quality of health care for all. Founded in 1896, and with members in all 50 states and U.S. territories, ANA is the strongest voice for the profession.

FNDNRS-08-013

When a client is confused, left alone with the side rails down, and the bed in a high position, the client falls and breaks a hip. What law has been broken?

A. Assault
B. Battery
C. Negligence
D. Civil tort

Correct Answer: C. Negligence

Knowing what to do to prevent injury is a part of the standards of care for nurses to follow. Safety guidelines dictate raising the side rails, staying with the client, lowering the bed, and observing the client until the environment is safe. As a nurse, these activities are known as basic safety measures that prevent injuries, and to not perform them is not acting in a safe manner. Negligence is conduct that falls below the standard of care that protects others against unreasonable risk of harm.

Option A: Assault is the intentional act of making someone fear that the nurse will cause them harm. One does not have to actually harm them to commit assault. Threatening them verbally or pretending to hit them are both examples of assault.
Option B: Battery is the intentional act of causing physical harm to someone. Unlike assault, one doesn’t have to warn the victim or make him fearful before they hurt them for it to count as a battery. If a nursing home attendant surprises the patient and pushes the patient from behind, that would qualify as a battery.
Option D: Torts are civil laws that address the legal rights of patients and the responsibilities of the nurse in the nurse-patient relationship. Some torts specific to nursing and nursing practice include things like malpractice, negligence, and violations relating to patient confidentiality.

FNDNRS-08-014

When signing a form as a witness, your signature shows that the client:

A. Is fully informed and is aware of all consequences.
B. Was awake and fully alert and not medicated with narcotics.
C. Was free to sign without pressure.
D. Has signed that form and the witness saw it being done.

Correct Answer: D. Has signed that form and the witness saw it being done

Your signature as a witness only states that the person signing the form was the person who was listed in the procedure. A witness’s signature can be useful for evidentiary purposes. If a party to the agreement later says they did not sign, the person who witnessed the party signing can be called to confirm it. The witness can confirm that the specific person signed and that was the sign they made.

Option A: In a legal contract, a witness is someone who watches the document is signed by the person they are being a witness for and who verifies its authenticity by singing their own name on the document as well.
Option B: Having a witness helps to reinforce the validity and authenticity of a document by adding another layer of security should the contract ever be questioned in court.
Option C: Though witnesses aren’t always a requirement for executing a legal document, they can help solidify and authenticate a contract by providing proof that the signatures are legitimate and consensual.

FNDNRS-08-015

Which criterion is needed for someone to give consent to a procedure?

A. An appointed guardianship
B. Unemancipated minor
C. Minimum of 21 years or older
D. An advocate for a child

Correct Answer: A. An appointed guardianship

A guardian has been appointed by a court and has full legal rights to choose management of care. A situation may arise in which a patient cannot make decisions independently but has not designated a decision-maker. In this instance, the hierarchy of decision-makers, which is determined by each state’s laws, must be sought to determine the next legal surrogate decision-maker. If this is unsuccessful, a legal guardian may need to be appointed by the court.

Option B: An exception to this rule is a legally emancipated child who may provide informed consent for himself. Some, but not all, examples of an emancipated minor include minors who are (1) under 18 and married, (2) serving in the military, (3) able to prove financial independence or (4) mothers of children (married or not).
Option C: Children (typically under 17) cannot provide informed consent. As such, parents must permit treatments or interventions. In this case, it is not termed “informed consent” but “informed permission.” Legislation regarding minors and informed consent is state-based as well. It is important to understand the state laws.
Option D: An advocate for the child is not legally appointed by court. Several exceptions to the requirement for informed consent include (1) the patient is incapacitated, (2) life-threatening emergencies with inadequate time to obtain consent, and (3) voluntary waived consent. If the patient’s ability to make decisions is questioned or unclear, an evaluation by a psychiatrist to determine competency may be requested.

FNDNRS-08-016

Which of the following statements is correct?

A. “Consent for medical treatment can be given by a minor with a sexually transmitted disease (STD)”.
B. “A second-trimester abortion can be given without state involvement.”
C. “Student nurses cannot be sued for malpractice while in a nursing clinical class.”
D. “Nurses who get sick and leave during a shift are not abandoning clients if they call their supervisor and leave a message about their emergency illness.”

Correct Answer: A. “Consent for medical treatment can be given by a minor with a sexually transmitted disease (STD).”

Anyone, at any age, can be treated without parental permission for an STD infection. The client is “advised” to contact sexual partners but is not “required” to give names. Permission from parents is not needed, based upon current privacy laws. According to the CDC, as of 2020, all jurisdictions have laws that explicitly allow a minor of a particular age (as defined by each state) to give informed consent to receive STD diagnosis and treatment services. In some jurisdictions, a minor might be legally allowed to give informed consent to receive specific STD or HIV services, including PrEP, even if the law is silent on those disease-related services.

Option B: Abortion is legal throughout the United States and its territories, although restrictions and accessibility vary from state to state. Abortion is a controversial and divisive issue in the society, culture and politics of the U.S., and various anti-abortion laws have been in force in each state since at least 1900.
Option C: One very important point is that student nurses are personally responsible for their own negligent acts. Student nurses are responsible for providing care to their patients, and students are held to the same standards as a licensed professional nurse when performing the duties of a nurse (Pozgar, 2016).
Option D: North Dakota Board of Nursing defines “abandonment” as accepting the client assignment and disengaging the nurse and client relationship without giving notice to a qualified person. Behavior that demonstrates professional misconduct includes abandoning a client who is in need of or receiving nursing care and may be grounds for disciplinary action.

FNDNRS-08-017

Most litigation in the hospital comes from the:

A. Nurse abandoning the clients when going to lunch.
B. Nurse following an order that is incomplete or incorrect.
C. Nurse documenting blame on the physician when a mistake is made.
D. Supervisor watching a new employee check his or her skills level.

Correct Answer: B. Nurse following an order that is incomplete or incorrect

The nurse is responsible for clarifying all orders that are illegible, unreasonable, unsafe, or incorrect. The failure of the nurse to question the physician about an order creates an area of liability on the nurse’s part because this is perceived as a medical action and not the role of the nurse to write orders. Some RNs do have prescriptive privileges based upon advanced degrees and certification. Therefore the nurse who cannot correct the order must document that the physician was called and clarification or a new order was given to correct the unclear or illegible one that was currently on the chart. Contact of the staff’s chain of command should also be specifically stated for the proof of the responsibilities being followed according to hospital policy.

Option A: North Dakota Board of Nursing defines “abandonment” as accepting the client assignment and disengaging the nurse and client relationship without giving notice to a qualified person. Behavior that demonstrates professional misconduct includes abandoning a client who is in need of or receiving nursing care and may be grounds for disciplinary action.
Option C: Phone calls, follow-up, and lack of follow-up by the physician should also be documented if there is a problem with getting the information in a timely manner. The nurse must show the sequence of events of a situation in a clear manner if there is any conflict or question about any orders or procedures that were not appropriate. Assessments and documentation of the client’s status should also be included if there is a potential risk for harm present.
Option D: The competence of new RN graduates, both at the point of joining the workforce on graduation and as they gain experience, is an important dimension of quality and safety. Thus each nursing school and prospective employer has a vested interest in ensuring that the initial skills and competency of the new graduate and the conditions for the transition and the ongoing development of the new graduate RN are optimized.

FNDNRS-08-018

The nurse places an aquathermia pad on a client with a muscle sprain. The nurse informs the client the pad should be removed in 30 minutes. Why will the nurse return in 30 minutes to remove the pad?

A. Reflex vasoconstriction occurs.
B. Reflex vasodilation occurs.
C. Systemic response occurs.
D. Local response occurs.

Correct Answer: A. Reflex vasoconstriction occurs.

If heat is applied for 1 hour or more, blood flow is reduced by reflex vasoconstriction. Vasoconstriction is the opposite of the desired effect of heat application. An aquathermia (Aqua-K) pad, which produces dry heat, is used to treat muscle sprains and mild inflammations and for pain relief. Temperature-controlled, distilled water flows through the waterproof pad.

Option B: Aquathermia pad is used as a heating pad for various parts of the body. This heating pad is used on the upper side of the body because it cannot be placed on the underside of the body part. There is a specific time period, beyond which blood vessels will start shrinking leading to increased blood pressure.
Option C: Hot aquathermia pad is applied for 20 to 40 minutes and then it should be removed to avoid vasoconstriction. The human body cannot tolerate this heating aquathermia pad for more than 40 minutes, if it exceeds 40 minutes, the patient will start feeling a burning sensation and the blood vessels will constrict leading to further complications.
Option D: Increased temperature of aquathermia pad may burn the skin and the blood vessels may constrict. Due to vasoconstriction, blood pressure may rise. So there is a specific temperature that should be maintained. The ideal temperature set for adults is 45°C. A thin cloth or pillowcase should be placed between a hot aquathermia pad and skin, as it prevents direct heat action on the skin. 20 to 40 minutes is the ideal time for the application of these pads and they should not be placed for more than 40 minutes.

FNDNRS-08-019

A client has recently been told he has terminal cancer. As the nurse enters the room, he yells, “My eggs are cold, and I’m tired of having my sleep interrupted by noisy nurses!” The nurse may interpret the client’s behavior as:

A. An expression of the anger stage of dying.
B. An expression of disenfranchised grief.
C. The result of a maturational loss.
D. The result of previous losses.

Correct Answer: A. An expression of the anger stage of dying.

In the anger stage of Kubler-Ross’s stages of dying, the individual resists the loss and may strike out at everyone and everything, in this case, the nurse. Anger, as Kubler-Ross pointed out, is commonly experienced and expressed by patients as they concede the reality of a terminal illness. It may be directed, as with blame of medical providers for inadequately preventing the illness, of family members for contributing to risks of not being sufficiently supportive, or of spiritual providers or higher powers for the diagnosis’ injustice.

Option B: Grief can be caused by situations, relationships, or even substance abuse. Children may grieve a divorce, a wife may grieve the death of her husband, a teenager might grieve the ending of a relationship, or one might have received terminal medical news and are grieving pending death.
Option C: Maturational loss happens as a person develops and goes through the cycle of life, where developmental changes can create a loss specific to every stage of life. It’s a form of anticipatory loss — a type of loss that people anticipate happening at every stage.
Option D: Losses will occur in everyone’s life at different stages and under different circumstances. The pain of loss is universally acknowledged by all people. It’s the loss itself that can be categorized in a couple of different ways. Throughout lifetimes, people can be expected to experience two types of losses, called maturational losses and situational losses.

FNDNRS-08-020

When helping a person through grief work, the nurse knows:

A. Coping mechanisms that were effective in the past are often disregarded in response to the pain of a loss.
B. A person’s perception of a loss has little to do with the grieving process.
C. The sequencing of stages of grief may occur in order, they may be skipped, or they may recur.
D. Most clients want to be left alone.

Correct Answer: C. The sequencing of stages of grief may occur in order, they may be skipped, or they may recur.

Grief is manifested in a variety of ways that are unique to an individual and based on personal experiences, cultural expectations, and spiritual beliefs. The sequencing of stages or behaviors of grief may occur in order, they may be skipped, or they may recur. The amount of time to resolve grief also varies among individuals.

Option A: Coping mechanisms are the strategies people often use in the face of stress and/or trauma to help manage painful or difficult emotions. Coping mechanisms can help people adjust to stressful events while helping them maintain their emotional well-being.
Option B: When a person loses someone close to them, it is natural to grieve. This process takes time and involves many different emotions and behaviors. People with cancer and their families may also grieve other cancer-related losses. These may include the loss of a breast, the loss of fertility, or the loss of independence.
Option D: There is no specific time period suggested for any of these stages. Someone may experience the stages fairly quickly, such as in a matter of weeks, where another person may take months or even years to move through to a place of acceptance.

FNDNRS-08-021

A client is hospitalized in the end stage of terminal cancer. His family members are sitting at his bedside. What can the nurse do to best aid the family at this time?

A. Limit the time visitors may stay so they do not become overwhelmed by the situation.
B. Avoid telling family members about the client’s actual condition so they will not lose hope.
C. Discourage spiritual practices because this will have little connection to the client at this time.
D. Find simple and appropriate care activities for the family to perform.

Correct Answer: D. Find simple and appropriate care activities for the family to perform.

It is helpful for the nurse to find simple care activities for the family to perform, such as feeding the client, washing the client’s face, combing hair, and filling out the client’s menu. This helps the family demonstrate their caring for the client and enables the client to feel their closeness and concern. a. Older adults often become particularly lonely at night and may feel more secure if a family member stays at the bedside during the night.

Option A: The nurse should allow visitors to remain with dying clients at any time if the client wants them. It is up to the family to determine if they are feeling overwhelmed, not the nurse. Provide family-focused interventions that assist parents in connecting or reconnecting with their existing families, friends, and networks of support as a means of re-establishing coherence and meaning as they go forward.
Option B: Truthful and open communication between the healthcare provider and patient is essential for trust in the relationship and for respect for autonomy. Withholding pertinent medical information from patients in the belief that disclosure is medically contraindicated creates a conflict between the healthcare provider’s obligations to promote patient welfare and to respect patient autonomy.
Option C: It is important to keep in mind that there are numerous individual, familial, and cultural differences that make responding appropriately to another person’s grief anything but a formula. The United States, as most Western countries, has a variety of cultural, religious, and ethnic variations that mediate and modulate the experience of grief and mourning.

FNDNRS-08-022

When caring for a terminally ill client, it is important for the nurse to maintain the client’s dignity. This can be facilitated by:

A. Spending time to let clients share their life experiences.
B. Decreasing emphasis on attending to the client’s appearance because it only increases their fatigue.
C. Making decisions for clients so they do not have to make them.
D. Placing the client in a private room to provide privacy at all times.

Correct Answer: A. Spending time to let clients share their life experiences.

Spending time to let clients share their life experiences enables the nurse to know clients better. Knowing clients then facilitates the choice of therapies that promote client decision-making and autonomy, thus promoting a client’s self-esteem and dignity. Regarding emotional needs, a review found that important actions for healthcare professionals providing end-of-life care include communicating, listening, conveying empathy, and involving patients in decision-making. Furthermore, good communication between the patient and their partner about their feelings should be promoted.

Option B: Regarding physical needs, when trying to enhance and preserve dignity, a systematic review found that symptom control and being placed in the correct environment are important in delivering dignified end-of-life care 5. Good management of physical symptoms such as pain, dyspnoea, constipation, nausea, and respiratory secretions may allow for opportunities to work through unfinished emotional, psychological, and spiritual issues, and promote a sense of closure towards the end of life.
Option C: Dignity can be upheld by measures such as symptom control 5; promoting independence, privacy, social support, and a positive tone of care; listening, giving appropriate information, having a caring bedside manner; and showing respect, empathy and companionship. Spiritual care has been shown to be facilitated by having sufficient time, employing effective communication, and reflecting on one’s personal experiences.
Option D: Other measures found to promote dignity include enabling the management of finances, facilitating activities such as reading or watching television, allowing the patient to spend time with their family, providing choices regarding the place of death, remembering the dignity of the family after the death of the individual, and offering emotional support.

FNDNRS-08-023

What are the stages of dying according to Elizabeth Kubler-Ross?

A. Numbing; yearning and searching; disorganization and despair; and reorganization.
B. Accepting the reality of loss, working through the pain of grief, adjusting to the environment without the deceased, and emotionally relocating the deceased and moving on with life.
C. Anticipatory grief, perceived loss, actual loss, and renewal.
D. Denial, anger, bargaining, depression, and acceptance.

Correct Answer: D. Denial, anger, bargaining, depression, and acceptance.

The most commonly taught system for understanding the process of dying was introduced by Dr. Elizabeth Kubler-Ross in her 1969 book, On Death and Dying. The book explored the experience of dying through interviews with terminally ill patients and described Five Stages of Dying: Denial, Anger, Bargaining, Depression, and Acceptance (DABDA). The model, which was the result of a qualitative and experiential study, was purposely personal and subjective and should not be interpreted as natural law. Rather, the stages provide a heuristic for patterns of thought and behavior, common in the setting of terminal illness, which may otherwise seem atypical.

Option A: Bowlby and Parkes proposed a reformulated theory of grief based in the 1980s. Their work is based on Kubler-Ross’ model. Their model has 4 stages and emphasizes that the grieving process is not linear.
Option B: Woden’s model of grief does not rely on stages but instead states that 4 tasks must be completed by the patient to complete bereavement. These tasks do not occur in any specific order. The grieving person may work on a task intermittently until it is complete. This model is more applicable to the grief of a survivor but may also be applied to a patient-facing death.
Option C: Anticipatory grief is the name given to the tumultuous set of feelings and reactions that occur when someone is expecting the death of a loved one. These emotions can be just as intense as the grief felt after a death. The most important thing to remember is that anticipatory grief is a normal process, even if it’s not discussed as often as regular grief.

FNDNRS-08-024

Bereavement may be defined as:

A. The emotional response to loss.
B. The outward, social expression of loss.
C. Postponing the awareness of the reality of the loss.
D. The inner feeling and outward reactions of the survivor.

Correct Answer: D. The inner feeling and outward reactions of the survivor.

Bereavement is the state of loss when someone close to an individual has died. The death of a loved one is one of the greatest sorrows that can occur in one’s life. People’s responses to grief will vary depending upon the circumstances of the death, but grief is a normal, healthy response to loss. Feelings of bereavement can also accompany other losses, such as the decline of one’s health or the health of a close other, or the end of an important relationship.

Option A: Grief is the psychological, physical, and emotional experience and reaction to loss. People may experience grief in various ways, but several theories, such as Kübler-Ross’ stages of loss theory, attempt to explain and understand the way people deal with grief.
Option B: Physical expressions of grief may include poor sleep, aches and pains, weakness and fatigue, loss of appetite, more crying, and other stress-related symptoms. Emotional expressions of grief may include feels of sadness, numbness, anger, fear, irritability, guilt, regret, and loneliness.
Option C: Talk about death. This will help the surviving individuals understand what happened and remember the deceased in a positive way. When coping with death, it can be easy to get wrapped up in denial, which can lead to isolation and a lack of a solid support system.

FNDNRS-08-025

A client who had a “Do Not Resuscitate” order passed away. After verifying there is no pulse or respirations, the nurse should next:

A. Have family members say goodbye to the deceased.
B. Call the transplant team to retrieve vital organs.
C. Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately.
D. Call the funeral director to come and get the body.

Correct Answer: C. Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately.

The body of the deceased should be prepared before the family comes into view and says their goodbyes. This includes removing all equipment, tubes, supplies, and dirty linens according to protocol, bathing the client, applying clean sheets, and removing trash from the room. In a home care, the nurse would ask the family if it was alright to remove any tubes or catheters from the patient, and if they would like to assist in bathing/preparing the patient for transport to the funeral home. The nurse would assist the family in removing any jewelry or other items from the patient. Be sure to maintain the highest dignity and respect for the deceased patient during this post-mortem care.

Option A: When the death is imminent, the family must be informed that death is near. As mentioned before, sometimes this is shocking to the family, despite knowing that their loved one is dying. This has to be communicated to the family in a sensitive and calm manner. Each nurse will have their own way to exchange this information, but it is very important that the family be told that death can occur at any time so that they can prepare. There may be a family in the area or out of town that would like to come and see the patient and who is waiting until the patient gets closer to death.
Option B: Correct information given to a family clearly, sensitively, and in a professional manner can accommodate relatives’ understanding of why their loved one is in a critical condition, which can help them accept death and therefore consider the option of organ donation. Nurses must acquire through regular training specific skills and knowledge in order to practice efficiently and adhere to the needs of a dying patient’s family.
Option D: Following the death of a patient, the nurse should offer their condolences to the family and extend assistance with contacting any other family members or individuals the family requests. Depending on the location of the death, the nurse would contact the medical examiner to notify them of the death, as well as the physician and other clinicians who were involved with the patient. The nurse can also contact the funeral home for the family as requested.

FNDNRS-08-026

A client’s family member says to the nurse, “The doctor said he will provide palliative care. What does that mean?” The nurse’s best response is:

A. “Palliative care is given to those who have less than 6 months to live.”
B. “Palliative care aims to relieve or reduce the symptoms of a disease.”
C. “The goal of palliative care is to affect a cure of a serious illness or disease.”
D. “Palliative care means the client and family take a more passive role and the doctor focuses on the physiological needs of the client. The location of death will most likely occur in the hospital setting.”

Correct Answer: B. “Palliative care aims to relieve or reduce the symptoms of a disease.”

The goal of palliative care is the prevention, relief, reduction, or soothing of symptoms of disease or disorders without effecting a cure. Palliative care improves the quality of life of patients and that of their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social, or spiritual. The quality of life of caregivers improves as well.

Option A: Palliative care is required for a wide range of diseases. The majority of adults in need of palliative care have chronic diseases such as cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%), and diabetes (4.6%). Many other conditions may require palliative care, including kidney failure, chronic liver disease, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological disease, dementia, congenital anomalies, and drug-resistant tuberculosis.
Option C: Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illnesses. It prevents and relieves suffering through the early identification, correct assessment, and treatment of pain and other problems, whether physical, psychosocial, or spiritual.
Option D: Addressing suffering involves taking care of issues beyond physical symptoms. Palliative care uses a team approach to support patients and their caregivers. This includes addressing practical needs and providing bereavement counseling. It offers a support system to help patients live as actively as possible until death.

FNDNRS-08-027

Which of the following is not included in evaluating the degree of heritage consistency in a client?

A. Gender
B. Culture
C. Ethnicity
D. Religion

Correct Answer: A. Gender

The term heritage consistency is used to describe how much or how little a person’s lifestyle reflects his or her traditional culture. If one is very “consistent” with their heritage, then one maintains more of the core values, beliefs, attitudes, and behaviors of one’s cultural heritage.

Option B: Acculturation is necessary to survival so it is involuntary. The degree to which one becomes acculturated and the speed of the process is affected by an individual’s circumstances and choices. Children, who can easily avail themselves of socialization via public schools, tend to acculturate quickly in the U.S. They have an easier time learning a new language.
Option C: Many European Americans today – Irish Americans, Italian Americans, French Americans, etc. – are disconnected from their cultural heritage. Exploring the assimilation experience of one’s forebears can be very eye-opening. America’s history is truly a history of immigration, acculturation, and assimilation (with notable exceptions/variations).
Option D: Along with the socio-economic factors of poverty, literacy, and health literacy, culturally responsive care takes into account the heritage consistency of individual patients within the context of family dynamics. In an effort to avoid applying cultural generalizations too rigidly, providers explore the indicators of cultural consistency with their patients from different cultural backgrounds to understand how closely each individual adheres to the traditional culture in which they were raised.

FNDNRS-08-028

When providing care to clients with varied cultural backgrounds, it is imperative for the nurse to recognize that:

A. Cultural considerations must be put aside if basic needs are in jeopardy.
B. Generalizations about the behavior of a particular group may be inaccurate.
C. Current health standards should determine the acceptability of cultural practices.
D. Similar reactions to stress will occur when individuals have the same cultural background.

Correct Answer: B. Generalizations about the behavior of a particular group may be inaccurate.

Nurses can pay close attention to their own biases and how they react to people whose backgrounds and cultural experiences differ from their own. For example, a person who becomes conscious that they think of immigrants as illegal aliens achieves cultural awareness of that particular bias.

Option A: Often, individual beliefs and values do not correspond to their behavior and actions. Nurses can work to acknowledge that this disconnect exists and view knowledge as an important element of developing cultural competence. Research has shown that people who score low on prejudice tests may still use labels such as “illegal alien.”
Option C: Nurses put their awareness, attitude, and knowledge into practice by repeating culturally competent behaviors until they become integrated into their daily interactions. These behaviors include effective and respectful communication and body language. Among various cultures, nonverbal communication methods, such as gestures, can mean very different things.
Option D: Once nurses tap into awareness, they can actively analyze their increased awareness and internal belief systems. Using the above example, the person can examine their background, beliefs, and values to understand their cultural bias regarding immigrants.

FNDNRS-08-029

To respect a client’s personal space and territoriality, the nurse:

A. Avoids the use of touch.
B. Explains nursing care and procedures.
C. Keeps the curtains pulled around the client’s bed.
D. Stands 8 feet away from the bed, if possible.

Correct Answer: B. Explains nursing care and procedures

The respect of territory and personal space represents an ethical and respectful approach to patients, which can permit them to maintain their dignity even under vulnerable conditions, favoring their recovery, as most studies have highlighted. The patients reported that requesting permission to manipulate their body, to examine them, or to perform other care/procedures shows consideration and attention on the part of the professional, which makes the patient feel valued and in control of the situation. This approach may minimize the effects of the invasion and the feeling of being seen as an object.

Option A: The greater perception of territorial invasion is probably due to the fact that patients are somehow prepared for personal invasion in the hospital as they are aware that the approximation by unknown people to perform procedures and to touch their body is part of the treatment. However, territorial invasion is less tolerated since the instinctive drive is stronger, directing the control to personal possessions.
Option C: Touching the patient’s possessions without permission, changing the bedside table to a position that cannot be reached, and raising or lowering the window blinds without consulting the patient are attitudes of the nursing staff that cause much discomfort. Healthcare providers need to be more attentive to the patient’s space and respect the territoriality established by them, often with their personal objects and possessions.
Option D: In the hospital setting, most procedures and interventions are performed at this distance, the intimate zone, often without due affectivity and permission. Within this context of the cultural and personal use of space, healthcare providers need to know and respect the limits of the physical distance that should be maintained in different situations of interaction with the patient so that both feel comfortable.

FNDNRS-08-030

To be effective in meeting various ethnic needs, the nurse should:

A. Treat all clients alike.
B. Be aware of the client’s cultural differences.
C. Act as if he or she is comfortable with the client’s behavior.
D. Avoid asking questions about the client’s cultural background.

Correct Answer: B. Be aware of the client’s cultural differences.

Option A: Once nurses tap into awareness, they can actively analyze their increased awareness and internal belief systems. Using the above example, the person can examine their background, beliefs, and values to understand their cultural bias regarding immigrants.
Option C: Often, individual beliefs and values do not correspond to their behavior and actions. Nurses can work to acknowledge that this disconnect exists and view knowledge as an important element of developing cultural competence. Research has shown that people who score low on prejudice tests may still use labels such as “illegal alien.”
Option D: Nurses put their awareness, attitude, and knowledge into practice by repeating culturally competent behaviors until they become integrated into their daily interactions. These behaviors include effective and respectful communication and body language. Among various cultures, nonverbal communication methods, such as gestures, can mean very different things.

FNDNRS-08-031

The most important factor in providing nursing care to clients in a specific ethnic group is:

A. Communication
B. Time orientation
C. Biological variation
D. Environmental control

Correct Answer: A. Communication

The ability to communicate effectively with patients and families is paramount for good patient care. This practice point reviews the importance of communicating effectively in cross-cultural encounters. The LEARN (Listen, Explain, Acknowledge, Recommend, Negotiate) model is a framework for cross-cultural communication that helps build mutual understanding and enhance patient care.

Option B: One way of looking at cultural attitudes to time is in terms of time orientation, a cultural or national preference toward past, present, or future thinking. The time orientation of a culture affects how it values time, and the extent to which it believes it can control time.
Option C: Biological variations in transcultural nursing relate to the genetic difference between cultures that may or may not predispose certain groups to specific diseases. This dimension may also include variations of “pain tolerance and deficiencies and predilections in nutrition” (Albougami, Pounds, & Alotaibi, 2016).
Option D: Environmental control refers to how the patient “perceives society and its internal and external factors, such as beliefs and understandings regarding how illness occurs, how it should be treated, and how health is uplifted and maintained” (Albougami, Pounds, & Alotaibi, 2016).

FNDNRS-08-032

A health care issue often becomes an ethical dilemma because:

A. A client’s legal rights coexist with a health professional’s obligation.
B. Decisions must be made quickly, often under stressful conditions.
C. Decisions must be made based on value systems.
D. The choices involved do not appear to be clearly right or wrong.

Correct Answer: D. The choices involved do not appear to be clearly right or wrong.

Advances in medicine, increasing economic stress, a rise of patient self-determination, and differing values between healthcare workers and patients are among the many factors contributing to the frequency and complexity of ethical issues in healthcare.

Option A: Nurses are required to administer prescribed medicine, but patients, at the same time, can refuse them. Patient autonomy can go against medical directives, despite clearly defined needs. Patients have a right to refuse all medical care. ANA highlights that it is important for nurses and nurse managers to understand patient backgrounds and individual circumstances to inform the patient of the medical necessity.
Option B: Nurses can also benefit by surrounding themselves with well-seasoned nurses as well as experienced nurse managers. They can rely on the guidance of nurse managers when it comes to situations they may not know how to address. Nurse managers can cultivate educational environments, in which they regularly discuss ethical issues with the nurses in their units. By having open dialogues about ethical issues, nurses can learn from the mistakes others have made and learn how to approach ethical issues and challenges.
Option C: Healthcare, which is science-based and results-driven, can impede religious or personal beliefs. Some religions restrict medical interventions and lifesaving techniques. Nurses focus on providing medical care to reduce suffering and to allow patients to concentrate on self-care. For patients or their families with strong religious or spiritual convictions, the focus may be on adhering to a strict set of guidelines.

FNDNRS-08-033

A document that lists the medical treatment a person chooses to refuse if unable to make decisions is the:

A. Durable power of attorney
B. Informed consent
C. Living will
D. Advance directives

Correct Answer: D. Advance directives

An advance directive is a legal document that explains how the patient wants medical decisions about him to be made if he cannot make the decisions himself. An advance directive lets the health care team and loved ones know what kind of health care the patient wants, or who he wants to make decisions for him when he can’t. An advance directive can help the patient think ahead of time about what kind of care he wants. It may help guide loved ones and the health care team in making clear decisions about health care when the patient can’t do it himself.

Option A: A power of attorney (POA) authorizes someone else to handle certain matters, such as finances or health care, on the patient’s behalf. If a power of attorney is durable, it remains in effect if the patient becomes incapacitated, such as due to illness or an accident.
Option B: Informed consent is the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention. The patient must be competent to make a voluntary decision about whether to undergo the procedure or intervention.
Option C: A living will, also called a directive to physicians or advance directive, is a document that lets people state their wishes for end-of-life medical care, in case they become unable to communicate their decisions. It has no power after death.

FNDNRS-08-034

Which statement about an institutional ethics committee is correct?

A. The ethics committee is an additional resource for clients and healthcare professionals.
B. The ethics committee relieves health care professionals from dealing with ethical issues.
C. The ethics committee would be the first option in addressing an ethical dilemma.
D. The ethics committee replaces decision making by the client and health care providers.

Correct Answer: A. The ethics committee is an additional resource for clients and healthcare professionals.

In hospitals throughout the United States, institutional ethics committees (IECs) have become a standard vehicle for the education of health professionals about biomedical ethics, for the drafting and review of hospital policy, and for clinical ethics case consultation.

Option B: Institutional ethics committees (IECs) initially was proposed to review decisions to limit or withdraw life-sustaining treatment for neurologically devastated or dying adult patients and were viewed as a reasonable approach to the complex issues raised by decisions not to treat seriously ill or disabled newborns.
Option C: An IEC that is engaged in providing ethics consultations should have a policy and procedure statement that includes the following: who can request a consultation, how the IEC is contacted, who responds to the request, how the consultation is conducted, who is to be included in the consultation, proper notification of affected persons, protection of patient confidentiality, how the consultation is documented, whether in some circumstances an ethics consultation is required, and the advisory nature of the consultant’s recommendations.
Option D: IECs help resolve conflicts about treatment decisions through case consultation, provide a forum for discussion of policies relating to institutional ethics, and educate their health care communities about ethical concepts.

FNDNRS-08-035

The nurse is working with parents of a seriously ill newborn. Surgery has been proposed for the infant, but the chances of success are unclear. In helping the parents resolve this ethical conflict, the nurse knows that the first step is:

A. Exploring reasonable courses of action.
B. Collecting all available information about the situation.
C. Clarifying values related to the cause of the dilemma.
D. Identifying people who can solve the difficulty.

Correct Answer: B. Collecting all available information about the situation.

Autonomy allows healthcare teams to respect and support a patient’s decision to accept or refuse life-sustaining treatments. As patient advocates, it’s our duty to ensure that our patients receive all of the necessary information, such as potential risks, benefits, and complications, to make well-informed decisions. The healthcare team can then formulate care in compliance with the patient’s wishes.

Option A: Nurses use nonmaleficence by selecting interventions that will cause the least amount of harm to achieve a beneficial outcome. For example, if a patient verbalizes homicidal ideations with a plan, we may be torn between wanting to ensure patient privacy and our duty to escalate the patient’s care to safeguard the public. The principle of nonmaleficence points us to place the safety of the patient and community first in all care delivery.
Option C: Family members should refrain from making decisions for the patient or inflicting undue pressure to alter his or her decisions unless the patient is incapacitated or found to be legally incompetent. Many factors may influence a patient’s acceptance or refusal of medical treatment, such as culture, age, general health, social support system, and previous exposure to individuals who received a similar treatment modality with negative clinical outcomes.
Option D: Paternalism provides the power for healthcare professionals to make decisions to reveal or conceal a diagnosis, potential treatment modalities, or expected prognosis. An example of paternalism is when we admit an adolescent with multiple complete cervical spine fractures whose family is stating that the teen needs to participate in a state basketball championship in 3 months. The benefit of sharing the anticipated prognosis of quadriplegia at this time is far outweighed by the potential emotional trauma it may cause the family.

FNDNRS-08-036

Miss Mary, an 88-year old woman, believes that life should not be prolonged when hope is gone. She has decided that she does not want extraordinary measures taken when her life is at its end. Because she feels this way, she has talked with her daughter about her desires, completing a living will and left directions with her physician. This is an example of:

A. Affirming a value
B. Choosing a value
C. Prizing a value
D. Reflecting a value

Correct Answer: C. Prizing a value.

The alternative goal of value awareness is enabling patients to achieve their desired balance between rational and nonrational decision-making, allowing them to be as rational as they can and want to be. That means doing everything possible to make the critical issues clear, thereby expanding the envelope of potentially rational decision-making.

Option A: Nurses engaged with mortality through a process of recognition and through the affirmation of their values. The affirmed values are aligned with the palliative care approach and within the ethics of finitude lens in that their enactment is partly premised on the recognition of patients’ accumulated losses related to human facticities (social, temporal, mortal).
Option B: Advance directives treat patients (and their surrogates) as rational actors, who will choose the option with the highest expected utility if provided needed information. The rational actor model assumes well-formulated decisions, with each option (e.g., treatment) represented as a vector of expected outcomes (e.g., pain, anxiety, life expectancy) that a decision-maker can weigh by relative importance.
Option D: Reflection brings learning to life. Reflective practice helps learners find relevancy and meaning in a lesson and make connections between educational experiences and real-life situations. It increases insight and creates pathways to future learning. Reflection is called by many different names in the education field including processing, reviewing, and debriefing.

FNDNRS-08-037

The scope of nursing practice is legally defined by:

A. State nurses practice acts
B. Professional nursing organizations
C. Hospital policy and procedure manuals
D. Physicians in the employing institutions

Correct Answer: A. State nurses practice acts

Every state and territory in the US sets laws to govern the practice of nursing. These laws are defined in the Nursing Practice Act (NPA). The NPA is then interpreted into regulations by each state and territorial nursing board with the authority to regulate the practice of nursing care and the power to enforce the laws. Fifty states, District of Columbia and 4 United States (US) territories, have state boards of nursing (BON) that are responsible for regulating their individual NPA.

Option B: Professional organizations and associations in nursing are critical for generating the energy, flow of ideas, and proactive work needed to maintain a healthy profession that advocates for the needs of its clients and nurses, and the trust of society.
Option C: From patient discharge procedures to maintaining the hygiene of the staff workers, policies and procedures are comprehensive guidelines to ensure the organization is complying with the rules and regulations. The maintenance of policies also ensures reduced risk of accidents, improves efficiency, and helps maintain a sound working environment for patients, staff, and visitors.
Option D: Collaboration, between physicians and nurses, means cooperation in work, sharing responsibilities for solving problems, and making decisions to formulate and carry out plans for patient care. Although the provision of healthcare is becoming more complex, collaboration among healthcare workers can be a path to improve the quality of healthcare services especially in hospitals in which the environment is characterized by ongoing interaction among professionals.

FNDNRS-08-038

A student nurse who is employed as a nursing assistant may perform any functions that:

A. Have been learned about in school.
B. Are expected of a nurse at that level.
C. Are identified in the position’s job description.
D. Require technical rather than professional skill.

Correct Answer: C. Are identified in the position’s job description.

A student nurse works to maintain, promote and restore the health of patients while following the procedures of the hospital where she is gaining practical experience. A student nurse must follow the instructions of her clinical instructor. Working at a health care facility offers a chance for a student nurse to practice what she has learned in school. It is a challenging experience that involves several duties.

Option A: Student nurses should research the basics of their patients’ needs. Clinical instructors expect student nurses to read and understand the diagnoses of their designated patients. Student nurses must understand the medical conditions of their patients as well as any medications they might require. In addition, student nurses need to be versed in modern technologies, which are important for patient care.
Option B: As part of their clinical rotations, student nurses should administer medications after researching the effects of the medications on patients. They should carry out this function only with the approval of the physician or clinical instructor. Administering medications involves preparing them in the appropriate doses, administering them at the specified times and using the right procedures. Student nurses must also ensure that they are administering medications to the right patients by asking them their names. Additionally, student nurses should check patient IDs to confirm their identities.
Option D: Student nurses also provide nursing care for their patients by assisting them to bathe and eat. Bathing patients may be laborious, especially when they are bedridden. The student nurse has to cover the patient with blankets or sheets to keep him warm. In addition, she should keep the bed dry by placing a towel under the patient. Part of the nursing care demands that student nurses should change bedding after bathing their patients. Gaining a patient’s consent to care for him is vital because he may be uncomfortable with a student nurse.

FNDNRS-08-039

A confused client who fell out of bed because side rails were not used is an example of which type of liability?

A. Felony
B. Assault
C. Battery
D. Negligence

Correct Answer: D. Negligence

Negligence is defined as doing something or failing to do something that a prudent, careful, and reasonable nurse would do or not do in the same situation. It is the failure to meet accepted standards of nursing competence and nursing scope of practice.

Option A: Some examples of felonies include murder, rape, burglary, kidnapping and arson. People who have been convicted of a felony are called felons. Repeat felons are punished extra harshly because sentencing laws take into consideration their criminal history. A more serious crime than a misdemeanor with punishment greater than that for misdemeanors; can be grounds for license denial, revocation, suspension, or probation of a healthcare provider. It is punishable by imprisonment or death, depending on state law and the type of crime.
Option B: Assault is the intentional act of making someone fear that you will cause them harm. You do not have to actually harm them to commit assault. Threatening them verbally or pretending to hit them are both examples of assault that can occur in a nursing home.
Option C: Battery comprises a direct and intentional [or reckless] act of the defendant which causes some physical contact with the person of the plaintiff without the plaintiff’s consent.

FNDNRS-08-040

The nurse puts a restraint jacket on a client without the client’s permission and without the physician’s order. The nurse may be guilty of:

A. Assault
B. Battery
C. Invasion of privacy
D. Neglect

Correct Answer: B. Battery

A battery comprises a direct and intentional [or reckless] act of the defendant which causes some physical contact with the person of the plaintiff without the plaintiff’s consent. Touching a person that does not invite touching or blatantly says to stop is a battery. For example, going by a coworker’s desk and continually pinching, slapping, or punching them, when the force is strong enough to hurt them and your intent is to hurt them, would constitute battery.

Option A: Assault is the intentional act of making someone fear that you will cause them harm. You do not have to actually harm them to commit assault. Threatening them verbally or pretending to hit them are both examples of assault that can occur in a nursing home.
Option C: Invasion of privacy is the unjustifiable intrusion into the personal life of another without consent. However, invasion of privacy is not a tort on its own; rather it generally consists of four distinct causes of action.
Option D: Negligence is defined as doing something or failing to do something that a prudent, careful, and reasonable nurse would do or not do in the same situation. It is the failure to meet accepted standards of nursing competence and nursing scope of practice.

FNDNRS-08-041

In a situation in which there is insufficient staff to implement competent care, a nurse should:

A. Organize a strike.
B. Inform the clients of the situation.
C. Refuse the assignment.
D. Accept the assignment but make a protest in writing to the administration.

Correct Answer: A. Organize a strike

Insufficient staffing ratios are causing tension in the nursing field across the United States, and hospital safety managers should prevent and prepare for picketing or strikes. Staffing is an issue that is becoming increasingly contentious in hospitals and healthcare facilities across the United States. In 2018, nurses in hospitals run HCA, one of the country’s largest healthcare providers, picketed and threatened to strike in five states, according to the New York Times.

Option B: Hospitals have a responsibility to supply patients with uninterrupted healthcare, even should a strike occur. Transparency is key during a nursing strike, so if changes in treatment are inevitable, this must be communicated to patients. Make sure that parents are informed of changes in staffing, whether this is care from nurses or doctors. Patients will appreciate the autonomy to make informed decisions amid staffing disruptions.
Option C: According to the American Nurses Association, Nurses have the “professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm.
Option D: If a nursing union is calling for the health care system to hire more nurses amid staffing shortages, it is a signal to the administration that patient safety might be jeopardized. Walk-outs and strikes are often the last resort for nurses – they don’t want to disrupt patient care or hospital operations as much as hospital administrations don’t. These situations occur when communication does not occur.

FNDNRS-08-042

Which statement about loss is accurate?

A. Loss is only experienced when there is an actual absence of something valued.
B. The more the individual has invested in what is lost, the less the feeling of loss.
C. Loss may be maturational, situational, or both.
D. The degree of stress experienced is unrelated to the type of loss.

Correct Answer: C. Loss may be maturational, situational, or both.

The loss may be actual or perceived and is the absence of something that was valued. An actual loss is recognized and verified by others while others cannot verify a perceived loss. Both are real to the individual who has experienced the loss. Grief is the internal part of the loss; it is the emotional feelings related to the loss.

Option A: The feelings of loss are commonly associated with the death of a loved one, but they can be experienced for a number of reasons. People may experience grief and feelings of loss about a significant change such as the loss of a job, loss of function, loss of a limb, loss of a pet, the feeling of loss of control, and loss of loved ones.
Option B: It is important for the nurse to assist the patient and loved ones in their coping with their grief to include anticipatory grief. Educate them on what is expected to include the stages of grief and what are some normal feelings as well as what are some resources to help adjust to this loss they are experiencing. Evaluate how they are handling this experience and address any fears related to grief and loss.
Option D: Grief may affect individuals differently but can be exhibited through signs and symptoms such as altered immune responses, distress, anger, sleep disturbances, withdrawal, pain, panic, and suffering. It may be evident by one’s lack of understanding of death and its severity and finality of the loss. Encourage loved ones at the bedside to remember to take care of their own health. Remind them or help them have access to food and hydration. Encourage adequate sleep and hygiene.

FNDNRS-08-043

Trying questionable and experimental forms of therapy is a behavior that is characterized by which stage of dying?

A. Anger
B. Depression
C. Bargaining
D. Acceptance

Correct Answer: C. Bargaining

This is the step in the grieving process where one may think “If this __, then this__.” For example: “I will do anything if you take the hurt away” or “I will never sin again if my loved one will be spared.” Bargaining may come in the form of “what if” statements. For example, “What if we found the cancer sooner?” or “What if this accident never happened?” These “what ifs” are a way to negotiate the fact that an individual wants life to go back to how it once was.

Option A: Anger is a necessary stage of the healing process. Before the anger stage, an individual who is experiencing grief may feel like they have been abandoned or may feel no connection to anything. Experiencing anger allows for a connection; it allows for something to hold on to. Anger may be directed at the thing or person that was lost, the doctors, friends, family, God, etc.
Option B: After the thoughts of the past in bargaining, thoughts of the present flood in. They realize that the situation is real. Empty feelings come forward, and one’s grief moves in on a deeper level than before. This type of depression is not a sign of mental illness; although, reaching out for help may be the right step. It is an appropriate response to a great loss.
Option D: Acceptance does not have to mean one is “alright with what has happened.” An individual may never be the same as before after a loss. They may never feel “OK” about the loss. Acceptance, as a stage, is about accepting that this is their new reality, and it is permanent. Life cannot go on as it once did, but through acceptance, life can and will go on.

FNDNRS-08-044

All of the following are crucial needs of the dying client except:

A. Control of pain
B. Preservation of dignity and self-worth
C. Love and belonging
D. Freedom from decision making

Correct Answer: D. Freedom from decision making

Patients should be made aware that they can participate in their end-of-life care in two distinct ways: by actively making decisions at the end of their life and by making decisions about how they believe they would wish to be cared for based on a hypothetical scenario of impairment. The patient should understand that while his or her health care provider may strongly disagree with or object to the patient’s decision to refuse the plan of care, the patient’s decision is constitutionally protected.

Option A: Health care professionals should understand that personal, social, and cultural experiences influence a patient’s definition of pain, health, and illness, and responses to pain vary among individuals and cultural groups.3 A patient’s reaction to pain is influenced by his or her individual perception of it, and the perception of pain reflects his or her attitude toward pain and characteristic way of responding.
Option B: Two key factors which influence the preservation of dignity at the end of life are promoting self-respect and treating the patient with respect; but how are these translated in practice into palliative care? Most end-of-life interventions focus predominantly on symptom control, rather than holistic care. Therefore it may be helpful to consider the physical, emotional and spiritual needs of patients in palliative care settings.
Option C: Regarding emotional needs, a review found that important actions for healthcare professionals providing end-of-life care include communicating, listening, conveying empathy, and involving patients in decision-making 8. Furthermore, good communication between the patient and their partner about their feelings should be promoted.

FNDNRS-08-045

Cultural awareness is an in-depth self-examination of one’s:

A. Background, recognizing biases and prejudices.
B. Social, cultural, and biophysical factors.
C. Engagement in cross-cultural interactions.
D. Motivation and commitment to caring.

Correct Answer: A. Background, recognizing biases and prejudices.

Cultural awareness is an in-depth examination of one’s own background, recognizing biases and prejudices and assumptions about other people. Cultural awareness is sensitivity to the similarities and differences that exist between two different cultures and the use of this sensitivity in effective communication with members of another cultural group.

Option B: Cultural competence is necessary because it helps the nurse offer the best services to every patient, leading to high satisfaction and care on the side of the patient. Without cultural competence, the health sector will suffer a great loss and ultimately limit the services that it can offer.
Option C: A strong background and knowledge of cultural competence prevents professional health caregivers from possessing stereotypes and being myopic in their thoughts. It also helps them offer the best service to all, regardless of their social status or belief.
Option D: Cultural competence prepares nurses to empathize, relate more to patients, and attend more deeply to their needs. Hospital patients can often be agitated or stressed. Having someone on their care team who speaks their language or understands their unique background may help them to relax, leading to greater therapy and overall care.

FNDNRS-08-046

Cultural competence is the process of:

A. Learning about vast cultures.
B. Acquiring specific knowledge, skills, and attitudes.
C. Influencing treatment and care of clients.
D. Motivation and commitment to caring.

Correct Answer: B. Acquiring specific knowledge, skills, and attitudes.

Cultural competence is the process of acquiring specific knowledge, skills, and attitudes that the ensure delivery of culturally congruent care. Culturally competent care includes knowledge, attitudes, and skills that support caring for people across different languages and cultures. Culture influences not only health practices but also how the healthcare provider and the patient perceive illness.

Option A: Knowledge is being cognizant of the culture base of those in the nurse’s service area, such as the shared traditions and values of that group. Being aware of the patients’ ethnicity—common genetic elements shared by people of the same ancestry—is also important.
Option C: It’s important to address attitudes to evolve into a culturally competent caregiver. Becoming aware of how culture influences individual behavior and thinking allows the nurse to plan the best care for the patients. Awareness of the rules of interactions within a specific cultural group, such as communication patterns and customs, division of roles in the family unit, and spirituality, will help the nurse better understand the attitudes of the patients.
Option D: Becoming aware of the nurse’s own attitudes and tendencies to stereotype with regard to different cultural groups allows her to provide genuine care and concern. Learn ways of communicating that best allow the patient to understand the plan of care. For example, developing cultural competency skills can involve assisting non–English-speaking patients with a translator or changing the phrases and words the nurse uses when explaining care. It also involves learning to adapt to new and different situations in a flexible way.

FNDNRS-08-047

Ethnocentrism is the root of:

A. Biases and prejudices.
B. Meanings by which people make sense of their experiences.
C. Cultural beliefs.
D. Individualism and self-reliance in achieving and maintaining health.

Correct Answer: A. Biases and prejudices.

Ethnocentrism can be defined as the judgment of different cultures based on standards of one’s own culture. Therefore, whilst providing care, it is important for nurses to avoid ethnocentrism as this approach can have negative consequences for the patient, and quality of care is jeopardized.

Option B: In the health profession, the diversity of people requires the ability to carefully, respectfully, and effectively provide care. For this reason, it is vital that the approach of care delivered to patients depends on each individual. This approach ensures patients receive the best quality of care possible and avoid situations that can potentially prevent the improvement of health status.
Option C: Generally, everyone has their own beliefs, practices, and values thus it becomes an issue for someone to impose their own views upon someone else. In terms of a nurse imposing their perspective on a patient, the patient’s reaction can differ from becoming passive, to being defiant to receiving care. Refusal of care potentially leads to a situation that could be harmful or detrimental to their health.
Option D: Ethnocentrism leads to assumptions and stereotypes that can cause nurses to fail in treating patients as an individual. Consequently, patient-centered care is neglected meaning individual care requirements are not met. Additionally, there would be negative feelings from patients towards nurses thus the relationship build is one that lacks trust.

FNDNRS-08-048

When action is taken on one’s prejudices:

A. Discrimination occurs.
B. Sufficient comparative knowledge of diverse groups is obtained.
C. Delivery of culturally congruent care is ensured.
D. People think/know you are a dumbass for being prejudiced.

Correct Answer: A. Discrimination occurs.

Discrimination is defined as a showing of partiality or prejudice in treatment; action or policies directed against the welfare of minority groups. Discrimination in the health sector is disturbing as it violates the basic principles articulated by care providers. Discrimination can be direct or indirect. Given the impact of unintentional discrimination based upon attitudes and stereotyping, all nurses must examine their biases and prejudices for indications of discriminatory actions.

Option B: People in socially disadvantaged groups face a myriad of challenges to their health. Discrimination, based on group status such as gender, immigration generation, race/ethnicity, or religion, are a well-documented health challenge. Nurses must seek out and support nursing practice environments that embrace inclusive strategies and promote civility and mutual respect regarding patients, coworkers, and members of the community.
Option C: Individuals who have experienced discrimination in the past may be more reluctant to seek health care, as they may perceive it as a setting of increased risk for discrimination (i.e., refusal of service or lower quality of care). This may be especially true for those who have experienced discrimination within the health care setting itself. Nurses must encourage all health care agencies to adopt and aggressively maintain policies, procedures, and practices that embrace inclusiveness, promote civility and mutual respect, contain methods for reporting violations, and require interventions to avoid recurrence.
Option D: Nurses must engage in a period of self-reflection regarding their personal and professional values regarding civility, mutual respect, and inclusiveness, and resolve any potential conflicts in ways that ensure patient safety and promote the best interests of the patient (ANA, 2015).

FNDNRS-08-049

The dominant value orientation in North American society is:

A. Use of rituals symbolizing the supernatural.
B. Group reliance and interdependence.
C. Healing emphasizing naturalistic modalities.
D. Individualism and self-reliance in achieving and maintaining health.

Correct Answer: D. Individualism and self-reliance in achieving and maintaining health.

The most important thing to understand about US Americans is probably their devotion to “individualism.” They have been trained from early in their lives to consider themselves separate individuals who are responsible for their own situations in life and their own destinies. They have not been trained to see themselves as members of a close-knit, tightly interdependent family, religious group, tribe, nation, or other groups.

Option A: US Americans are generally less concerned about history and tradition than are people from older societies. They look ahead. They have the idea that what happens in the future is within their control, or at least subject to their influences. They believe that people, as individuals or working cooperatively together, can change most aspects of the physical and social environment if they decide things to do and a schedule for doing them.
Option B: Americans have not been trained to see themselves as members of a close-knit, tightly interdependent family, religious group, tribe, nation, or other groups. People who grow up in a particular culture share certain values and assumptions. This means that most of them, most of the time, agree with each others’ ideas about what is right and wrong, desirable and undesirable.
Option C: Cultural, social, and family influences shape attitudes and beliefs and therefore influence health literacy. Social determinants of health are well documented regarding the conditions over which the individual has little or no control but that affect his or her ability to participate fully in a health-literate society.

FNDNRS-08-050

Disparities in health outcomes between the rich and the poor illustrates: a (an)

A. Illness attributed to natural, impersonal, and biological forces.
B. Creation of own interpretation and descriptions of biological and psychological malfunctions.
C. Influence of socioeconomic factors in morbidity and mortality.
D. Combination of naturalistic, religious, and supernatural modalities.

Correct Answer: C. Influence of socioeconomic factors in morbidity and mortality.

Disparities in health outcomes between the rich and the poor illustrate the influence of socioeconomic factors in morbidity and mortality. Social factors such as poverty and lack of universal medical insurance compromise the health status of the poor and unemployed. Health and health care disparities refer to differences in health and health care between groups that are closely linked with social, economic, and/or environmental disadvantage. Disparities occur across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation.

Option A: A complex and interrelated set of individual, provider, health system, societal, and environmental factors contribute to disparities in health and health care. Individual factors include a variety of health behaviors from maintaining a healthy weight to following medical advice. Provider factors encompass issues such as provider bias and cultural and linguistic barriers to patient-provider communication.
Option B: Health and health care disparities are commonly viewed through the lens of race and ethnicity, but they occur across a broad range of dimensions. For example, disparities occur across socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation.
Option D: A “health care disparity” typically refers to differences between groups in health insurance coverage, access to and use of care, and quality of care. Health and health care disparities often refer to differences that are not explained by variations in health needs, patient preferences, or treatment recommendations and are closely linked with social, economic, and/or environmental disadvantage.

FNDNRS-08-051

Culture strongly influences pain expression and the need for pain medication. However, cultural pain:

A. May be suffered by a client whose valued way of life is disregarded by practitioners.
B. Is more intense, thus necessitating more medication.
C. Is not expressed verbally or physically.
D. Is expressed only to others of like culture.

Correct Answer: A. May be suffered by a client whose valued way of life is disregarded by practitioners.

Nurses need not assume that pain relief is equally valued across groups. Cultural pain may be suffered by a client whose valued way of life is disregarded by practitioners. The relationship between pain and ethnicity is shaped by experience, learning and culture. A cultural group’s expectations and acceptance of pain as a normal part of life will determine whether pain is seen as a clinical problem that requires a clinical solution.

Option B: Experience, learning and culture shape the relationship between pain and ethnicity rather than any fundamental neurological differences. The distinction between race and ethnicity is particularly important for pain research based on the biopsychosocial model. This model suggests the experience of pain is derived via the interaction of biological, psychological, and social factors.
Option C: Chronic pain affects approximately 1 in 5 adults in Europe resulting in substantial healthcare costs. Evidence that cultural influences have an impact on pain is readily available from the UK where the pain is the most common symptom encountered by the medical profession.
Option D: Mistaken beliefs about the nature of pain and disability, resistance to treatment-seeking, reluctance to comply with treatment, and failure to accept responsibility for the treatment outcome are not culturally or sub-culturally specific obstacles to pain management.

FNDNRS-08-052

The dominant values in American society on individual autonomy and self-determination:

A. Rarely has an effect on other cultures.
B. Do have an effect on health care.
C. May hinder the ability to get into a hospice program.
D. May be in direct conflict with diverse groups.

Correct Answer: D. May be in direct conflict with diverse groups.

The dominant value in American society of individual autonomy and self-determination may be in direct conflict with diverse groups. Advance directives, informed consent, and consent for hospice are examples of mandates that may violate client’s values. Culture influences health care at all levels, including communications and interactions with doctors and nurses, health disparities, health care outcomes, and even the illness experience itself. People in some cultures believe illness is the will of a higher power, and may be more reluctant to receive health care.

Option A: Culture plays a huge role in medical interactions. It influences how an individual might view an illness or treatment, for example, and affects how a physician should address an older patient. Culture may also affect the decision-making process. Cultural beliefs can affect how a patient will seek care and from whom, how he or she will manage self-care, how he will make health choices, and how she might respond to a specific therapy.
Option B: Literacy and language barriers may play a role in poor communication between doctors and patients from different cultures. The communication gap can prevent some seniors and families from getting the health information they need to make informed decisions. They may not know where to access information in another language, or they may not know how to find a health care provider that speaks the language.
Option C: While family caregiving is the norm in the Hispanic community and in other cultures, it is not always a viable option. Some older individuals may not have family living nearby, for example, or the family may be overwhelmed with children or other responsibilities.

FNDNRS-08-053

In the United States, access to health care usually depends on a client’s ability to pay for health care, either through insurance or by paying cash. The client the nurse is caring for needs a liver transplant to survive. This client has been out of work for several months and does not have insurance or enough cash. A discussion about the ethics of this situation would involve predominantly the principle of:

A. Accountability, because you as the nurse are accountable for the well being of this client.
B. Respect of autonomy, because this client’s autonomy will be violated if he does not receive the liver transplant.
C. Ethics of care, because the caring thing that a nurse could provide this patient is resources for a liver transplant.
D. Justice, because the first and greatest question in this situation is how to determine the just distribution of resources.

Correct Answer: D. Justice, because the first and greatest question in this situation is how to determine the just distribution of resources.

Justice refers to fairness. Health care providers agree to strive for justice in health care. The term often is used during discussions about resources. Decisions about who should receive available organs are always difficult. All patients have a right to be treated fair and equally by others. Justice involves how people are treated when their interest competes with others. A current hot topic that addresses this is the lack of healthcare insurance for some. Another example is with patients in rural settings who may not have access to the same healthcare services that are offered in metropolitan areas.

Option A: As a nurse, it’s inherent that accountability for all aspects of care aligns with responsible decision making. Use of authority must be professional and about all aspects of individualism and patient, ethical concerns. Nursing decisions must be well thought, planned, and purposefully implemented responsibly. Any delegation of nursing activities or functions must be done with respect for the action and the ultimate results to occur.
Option B: Each patient has the right to make their own decisions based on their own beliefs and values. This is known as autonomy. A patient’s need for autonomy may conflict with care guidelines or suggestions that nurses or other healthcare workers believe is best. A person has a right to refuse medications, treatment, surgery, or other medical interventions regardless of what benefit may come from it.
Option C: The patient should always be a first and primary concern. The nurse must recognize the need for the patient to include their individual thought into care practices. Any conflict of interest, whether belonging to external organizations, or the nurse’s habits or ideals that conflict with the act of being a nurse, should be shared and addressed to not impact patient care.

FNDNRS-08-054

The Code of Ethics for nurses is composed and published by:

A. The National League for Nursing
B. The American Nurses Association
C. The Medical American Association
D. The National Institutes of Health, Nursing Division

Correct Answer: B. The American Nurses Association

The ANA has established widely accepted codes that professional nurses attempt to follow. The Code of Ethics for Nurses developed by the American Nurses Association (ANA) makes explicit the primary goals, values, and obligations of the profession. Ethics is an integral part of the foundation of nursing. Nursing has a distinguished history of concern for the welfare of the sick, injured, and vulnerable and for social justice. This concern is embodied in the provision of nursing care to individuals and the community.

Option A: Dedicated to excellence in nursing, the National League for Nursing is the premier organization for nurse faculty and leaders in nursing education. The NLN offers professional development, networking opportunities, testing services, nursing research grants, and public policy initiatives to its 40,000 individual and 1,200 institutional members.
Option C: Founded in 1847, the American Medical Association (AMA) is the largest and only national association that convenes 190+ state and specialty medical societies and other critical stakeholders. Throughout history, the AMA has always followed its mission: to promote the art and science of medicine and the betterment of public health.
Option D: The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the nation’s medical research agency — making important discoveries that improve health and save lives. Thanks in large part to NIH-funded medical research, Americans today are living longer and healthier. Life expectancy in the United States has jumped from 47 years in 1900 to 78 years as reported in 2009, and disability in people over age 65 has dropped dramatically in the past 3 decades. In recent years, nationwide rates of new diagnoses and deaths from all cancers combined have fallen significantly.

FNDNRS-08-055

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

A. Seek out the nursing supervisor in conflicting situations.
B. Work to understand the law as it applies to the client’s clinical condition.
C. Assess the client’s point of view and prepare to articulate this point of view.
D. Document all clinical changes in the medical record in a timely manner.

Correct Answer: C. Assess the client’s point of view and prepare to articulate this point of view.

Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client’s point of view. Nurse advocates support the patient’s best interests while respecting the family’s important role. They attend healthcare team meetings with the patient and family to clarify any communication problems and ensure information from the healthcare team is complete and correct.

Option A: Throughout the treatment process, the nurse follows the progress of the patient and acts accordingly with the patient’s best interests in mind. The care provided by a nurse extends beyond the administration of medications and other therapies. They are responsible for the holistic care of patients, which encompasses the psychosocial, developmental, cultural, and spiritual needs of the individual.
Option B: Nurses are also responsible for ensuring that patients are able to understand their health, illnesses, medications, and treatments to the best of their ability. This is of the essence when patients are discharged from then hospital and need to take control of their own treatments.
Option D: A nurse is directly involved in the decision-making process for the treatment of patients. It is important that they are able to think critically when assessing patient signs and identifying potential problems so that they can make the appropriate recommendations and actions.

FNDNRS-08-056

Successful ethical discussion depends on people who have a clear sense of personal values. When many people share the same values it may be possible to identify a philosophy of utilitarianism, with proposes that:

A. The value of people is determined solely by leaders in the Unitarian church.
B. The decision to perform a liver transplant depends on a measure of the moral life that the client has led so far.
C. The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician.
D. The value of something is determined by its usefulness to society.

Correct Answer: D. The value of something is determined by its usefulness to society.

A utilitarian system of ethics proposes that the value of something is determined by its usefulness. Utilitarianism is a theory of morality, which advocates actions that foster happiness or pleasure and opposes actions that cause unhappiness or harm. When directed toward making social, economic, or political decisions, a utilitarian philosophy would aim for the betterment of society as a whole.

Option A: Utilitarianism is a theory of morality, which advocates actions that foster happiness and opposes actions that cause unhappiness. Utilitarianism promotes “the greatest amount of good for the greatest number of people.”
Option B: As patient advocates, it’s our duty to ensure that our patients receive all of the necessary information, such as potential risks, benefits, and complications, to make well-informed decisions. The healthcare team can then formulate care in compliance with the patient’s wishes. Family members should refrain from making decisions for the patient or inflicting undue pressure to alter his or her decisions unless the patient is incapacitated or found to be legally incompetent.
Option C: Paternalism provides the power for healthcare professionals to make decisions to reveal or conceal a diagnosis, potential treatment modalities, or expected prognosis. An example of paternalism is when we admit an adolescent with multiple complete cervical spine fractures whose family is stating that the teen needs to participate in a state basketball championship in 3 months. The benefit of sharing the anticipated prognosis of quadriplegia at this time is far outweighed by the potential emotional trauma it may cause the family.

FNDNRS-08-057

The philosophy sometimes called the code of ethics of care suggests that ethical dilemmas can best be solved by attention to:

A. Relationships
B. Ethical principles
C. Clients
D. Code of ethics for nurses

Correct Answer: A. Relationships.

The ethic of care explores the notion of care as a central activity of human behavior. Those who write about the ethics of care advocate a more female-biased theory that is based on understanding relationships, especially personal narratives.

Option B: Normatively, care ethics seeks to maintain relationships by contextualizing and promoting the well-being of caregivers and care-receivers in a network of social relations. Most often defined as a practice or virtue rather than a theory as such, “care” involves maintaining the world of, and meeting the needs of, yourself and others.
Option C: It builds on the motivation to care for those who are dependent and vulnerable, and it is inspired by both memories of being cared for and the idealizations of self. Following in the sentimentalist tradition of moral theory, care ethics affirms the importance of caring motivation, emotion, and the body in moral deliberation, as well as reasoning from particulars.
Option D: The Code of Ethics for Nurses developed by the American Nurses Association (ANA) makes explicit the primary goals, values, and obligations of the profession. Nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups, and communities. Individuals who become nurses are expected not only to adhere to the ideals and moral norms of the profession but also to embrace them as a part of what it means to be a nurse.

FNDNRS-08-058

In most ethical dilemmas, the solution to the dilemma requires negotiation among members of the health care team. The nurse’s point of view is valuable because:

A. Nurses have a legal license that encourages their presence during ethical discussions.
B. The principle of autonomy guides all participants to respect their own self-worth.
C. Nurses develop a relationship with the client that is unique among all professional health care providers.
D. The nurse’s code of ethics recommends that a nurse be present at any ethical discussion about client care.

Correct Answer: C. Nurses develop a relationship to the client that is unique among all professional health care providers.

When ethical dilemmas arise, the nurse’s point of view is unique and critical. The nurse usually interacts with clients over longer time intervals than do other disciples. It is important to advocate for patient care, patient rights, and ethical consideration of practice. Ethics inclusion should begin in nursing school and continue as long as the nurse is practicing.

Option A: Nurses have a responsibility to themselves, their profession, and their patients to maintain the highest ethical principles. Many organizations have ethics boards in place to review ethical concerns. Nurses at all levels of practice should be involved in ethics review in their targeted specialty area.
Option B: Each patient has the right to make their own decisions based on their own beliefs and values. This is known as autonomy. A patient’s need for autonomy may conflict with care guidelines or suggestions that nurses or other healthcare workers believe is best. A person has a right to refuse medications, treatment, surgery, or other medical interventions regardless of what benefit may come from it.
Option D: Ethical dilemmas arise as nurses care for patients. These dilemmas may, at times, conflict with the Code of Ethics or with the nurse’s ethical values. Nurses are advocates for patients and must find a balance while delivering patient care.

FNDNRS-08-059

Ethical dilemmas often arise over a conflict of opinion. Once the nurse has determined that the dilemma is ethical, a critical first step in negotiating the difference of opinion would be to:

A. Consult a professional ethicist to ensure that the steps of the process occur in full.
B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.
C. List the ethical principles that inform the dilemma so that negotiations agree on the language of the discussion.
D. Ensure that the attending physician has written an order for an ethics consultation to support the ethics process.

Correct Answer: B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma.

Each step in the processing of an ethical dilemma resembles steps in critical thinking. The nurse begins by gathering information and moves through assessment, identification of the problem, planning, implementation, and evaluation.

Option A: To address health inequity factors, nurses are encouraged to be aware of health disparities that could impair treatment outcomes. They can then refer patients to social workers, case managers, and other healthcare team members for additional services. Nurses should be mindful of the social and economic factors that affect patient and community health.
Option C: Nurses make decisions based on the information available to them in the current situation. The more relevant information they have, the more likely their decision will have a positive outcome. When a nurse’s decision leads to a negative outcome, the question becomes: What critical pieces of information were lacking at the time of the decision? Nurses must take responsibility for their decisions and strive to understand why some decisions have negative outcomes.
Option D: Even the most extensive code of ethics can’t account for all the potential dilemmas that nurses may encounter in their work. That’s the reason that one of the duties stated in the nursing code of ethics is to seek the advice and counsel of others whenever a nurse is uncertain about a medical decision’s ethical aspects.

FNDNRS-08-060

The Nurse Practice Acts are an example of:

A. Statutory law
B. Common law
C. Civil law
D. Criminal law

Correct Answer: A. Statutory law

The NPA is then interpreted into regulations by each state and territorial nursing board with the authority to regulate the practice of nursing care and the power to enforce the laws. Fifty states, the District of Columbia and 4 United States (US) territories, have state boards of nursing (BON) that are responsible for regulating their individual NPA.

Option B: Common law results from judicial decisions made in courts when individual legal cases are decided. Examples of common law include informed consent, the patient’s right to refuse treatment, negligence, and malpractice.
Option C: Civil laws protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrongs or violations occur (Garner, 2006). The consequences of civil law violations are damages in the form of fines or specific performance of good works such as public service. An example of a civil law violation for a nurse is negligence or malpractice.
Option D: Criminal laws protect society as a whole and provide punishment for crimes, which are defined by municipal, state, and federal legislation (Garner, 2006). There are two classifications of crimes. A felony is a crime of a serious nature that has a penalty of imprisonment for longer than 1 year or even death. A misdemeanor is a less serious crime that has a penalty of a fine or imprisonment for less than 1 year. An example of criminal conduct for nurses is a misuse of a controlled substance.

FNDNRS-08-061

The scope of Nursing Practice, the established educational requirements for nurses, and the distinction between nursing and medical practice is defined by:

A. Statutory law
B. Common law
C. Civil law
D. Nurse Practice Acts

Correct Answer: D. Nurse Practice Acts

Option A: Statutory Law is the term used to define written laws, usually enacted by a legislative body. Statutory laws vary from regulatory or administrative laws that are passed by executive agencies, and common law, or the law created by prior court decisions.
Option B: Common law results from judicial decisions made in courts when individual legal cases are decided. Examples of common law include informed consent, the patient’s right to refuse treatment, negligence, and malpractice.
Option C: Civil laws protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrongs or violations occur (Garner, 2006). The consequences of civil law violations are damages in the form of fines or specific performance of good works such as public service. An example of a civil law violation for a nurse is negligence or malpractice.

FNDNRS-08-062

The client’s right to refuse treatment is an example of:

A. Statutory law
B. Common law
C. Civil laws
D. Nurse practice acts

Correct Answer: B. Common law

Common law results from judicial decisions made in courts when individual legal cases are decided. Examples of common law include informed consent, the patient’s right to refuse treatment, negligence, and malpractice.

Option A: Statutory Law is the term used to define written laws, usually enacted by a legislative body. Statutory laws vary from regulatory or administrative laws that are passed by executive agencies, and common law, or the law created by prior court decisions.
Option C: Civil laws protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrongs or violations occur (Garner, 2006). The consequences of civil law violations are damages in the form of fines or specific performance of good works such as public service. An example of a civil law violation for a nurse is negligence or malpractice.
Option D: The NPA is then interpreted into regulations by each state and territorial nursing board with the authority to regulate the practice of nursing care and the power to enforce the laws. Fifty states, the District of Columbia and 4 United States (US) territories, have state boards of nursing (BON) that are responsible for regulating their individual NPA.

FNDNRS-08-063

Even though the nurse may obtain the client’s signature on a form, obtaining informed consent is the responsibility of the:

A. Client
B. Physician
C. Student nurse
D. Supervising nurse

Correct Answer: B. Physician

It is the obligation of the provider to make it clear that the patient is participating in the decision-making process and avoid making the patient feel forced to agree to the provider. The provider must make a recommendation and provide their reasoning for said recommendation.

Option A: Informed consent is the process in which a health care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention. The patient must be competent to make a voluntary decision about whether to undergo the procedure or intervention.
Option C: Members of the healthcare team, such as nurses and patient care assistants, should also be educated about all potential adverse reactions so that they are able to identify them and notify a provider so that any immediate intervention that is needed can be performed in a timely manner.
Option D: Members of the healthcare team involved with the care of a patient should also be informed about procedures and interventions as they may be used as witnesses in obtaining informed consent. They would be able to evaluate whether all necessary information was given to the patient and provide any information the provider obtaining informed consent may have forgotten.

FNDNRS-08-064

The nurse is obligated to follow a physician’s order unless:

A. The order is a verbal order.
B. The physician’s order is illegible.
C. The order has not been transcribed.
D. The order is an error, violates hospital policy, or would be detrimental to the client.

Correct Answer: D. The order is an error, violates hospital policy, or would be detrimental to the client.

The court held that nurses have a duty to question a physician’s order if they think it is in the patient’s best interest to do so and to delay discharge if they believe discharge deviates from acceptable standards of care.

Option A: The term physician’s orders has outlived its appropriateness. Nurses have an ethical duty to be members of collaborative teams. Communication, consultation, and interdisciplinary cooperation are the benchmarks for quality outcomes. Other professionals communicate without issuing orders to each other—by continuing to use this phrase, nurses support a linguistic and symbolic discounting of their autonomous and accountable practice.
Option B: Begin with asking a physician for the prescriptions rather than the orders when admitting a patient. At the next nursing meeting or roundtable in the institution, ask for the replacement of “physician orders” with “prescriptions” on the admission screen or at the next printing of forms. Acknowledge that these prescriptions aren’t just from physicians, but are also from NPs and physician assistants.
Option C: Nurses take no such oath, and are legally and ethically bound to question an inappropriate order from a physician. In fact, many actions described in physician’s orders are simply nursing practices that are fundamental to health maintenance: turn and position every two hours, oral hygiene, side rails up.

FNDNRS-08-065

The nursing theorist who developed transcultural nursing theory is

A. Dorothea Orem
B. Madeleine Leininger
C. Betty Newman
D. Sr. Callista Roy

Correct Answer: B. Madeleine Leininger

Madeleine Leininger developed the theory on transcultural theory based on her observations on the behavior of selected people within a culture. In the Transcultural Nursing theory, nurses have a responsibility to understand the role of culture in the health of the patient. Not only can a cultural background influence a patient’s health, but the patient may be taking home remedies that can affect his or her health, as well.

Option A: Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.’” Her theory defined Nursing as “The act of assisting others in the provision and management of self-care to maintain or improve human functioning at the home level of effectiveness.”
Option C: In Betty Neuman’s nursing theory, patients are cared for from a holistic perspective in order to ensure they are cared for as people and not simply ailments. The Neuman Systems Model is based on the patient’s relationship to stress, reaction to it, and reconstitution factors that are dynamic. The Neuman Systems Model is universal in nature, which allows it to be adapted to a variety of situations, and to be interpreted in many different ways.
Option D: Sr. Callista Roy’s Adaptation Model of Nursing was developed by Sister Callista Roy in 1976. The prominent nursing theory aims to explain or define the provision of nursing. In her theory, Roy’s model sees the individual as a set of interrelated systems that maintain a balance between these various stimuli.

Questions related to Cultural Diversity and Health Practices

FNDNRS-08-066

An American nurse tries to speak with a Korean client who cannot understand the English language. To effectively communicate to a client with a different language, which of the following should the nurse implement?

A. Have an interpreter to translate.
B. Speak slowly.
C. Speak loudly and closely to the client.
D. Speak to the client and family together.

Correct Answer: A. Have an interpreter to translate.

Having an interpreter would be the best practice when communicating with a client who speaks a different language. When nurses and their patients don’t speak the same language, providing quality medical care and making the patient feel comfortable and cared for can be exponentially more challenging. It can be difficult to inform a patient or be confident about consent given when the patient primarily communicates in their mother tongue.

Option B: Language barriers exacerbate all other challenges nurses face when providing care for culturally diverse patients. To effectively communicate with a patient to ask them about their health history or to educate them about a procedure, the language barrier must be broken in some way.
Option C: Ask the facility if a translator is available. Most hospitals do have translators on-staff, but a smaller doctor’s office may not. Explore translation technology — while it may not be 100% accurate, it can help the nurse better understand patients and the patients better understand their nurse.
Option D: Use pictures or hand gestures to communicate when necessary, and remember to be patient. Language barriers are frustrating for both the nurse and the patient, but the patient is at a distinct disadvantage. If there’s a language barrier, a translator can help. Essentially, this will help the nurse determine how much of what she is saying has been understood and how she might be able to change the way she communicates to improve the patient’s understanding.

FNDNRS-08-067

Which of the following clients has the lowest risk of diabetes mellitus and stroke?

A. A 45-year-old African-American woman.
B. A 35-year-old Native-American man.
C. A 30-year-old Hispanic-American man.
D. A 25-year-old Asian-American woman.

Correct Answer: D. A 25-year-old Asian-American woman.

Among the choices, Asian Americans have the lowest risk of diabetes mellitus and stroke due to their health and dietary practices. But people of Asian descent have less muscle and more fat than other groups and often develop diabetes at a younger age and lower weight. That extra body fat tends to be in the belly (visceral fat).

Option A: T2DM varies among ethnic groups and is 2 to 6times more prevalent in African Americans, Native Americans, Pima Indians, and Hispanic Americans compared to Whites in the United States. While ethnicity alone plays a vital role in T2DM, environmental factors also greatly confer risk for the disease.
Option B: Recent data from the Centers for Disease Control and Prevention (CDC) and Indian Health Service (IHS) show that in some American Indian and Alaska Native communities, diabetes prevalence among adults is as high as 60%. One in six American Indian and Alaska Native adults has diagnosed diabetes—more than double the prevalence rate for the general U.S. population.
Option C: In the United States, T1DM rates rose in most age and ethnic groups by about 2% yearly, and rates are higher in Hispanic youth. The exact reason for this pattern remains unknown. However, some metrics, such as the United States Military Health System data repository, found plateauing over 2007 to 2012 with a prevalence of 1.5 per 1000 and incidence of 20.7 to 21.3 per 1000.

FNDNRS-08-068

The nurse is providing instructions to a Chinese-American client about the frequency and dosages of the take home medicines. When conducting the teaching, the client continuously turns away from the nurse. The nurse should do which of the following appropriate actions?

A. Walk around the client so that the nurse can constantly face the client.
B. Call the attention of the client by speaking loudly.
C. Continue with the instructions, then confirming the client’s understanding.
D. Hand over a written instruction and discuss only what the client doesn’t understand.

Correct Answer: C. Continue with the instructions, verifying client understanding.

Most Chinese maintain a formal personal space with others, which is a form of respect. Most Chinese are uncomfortable with face-to-face communications, especially when eye contact is direct. If the client turns away from the nurse during a conversation, the most appropriate action is to continue with the instructions. Many cultures have very different ways of thinking about healthcare and may have traditions that go against the grain of Western medicine.

Option A: Walking around to the client so that the nurse faces the client is in direct conflict with the cultural practice. Healthcare providers who are unfamiliar with cultural traditions surrounding medical care may have difficulty connecting with the patient or the patient may not feel safe and recognized, which is key to treatment acceptance.
Option B: Calling attention and speaking loudly is viewed as a rude gesture. It’s important that nurses avoid making assumptions about cultures they aren’t familiar with. This can lead to a breakdown of trust and rapport between the nurse and their patient and reduce treatment acceptance.
Option D: Discussing only what the client cannot understand is not an acceptable practice of a nurse. When communicating with a patient, ask them to repeat back to you what you said, in their own words. If there’s a language barrier, a translator can help. Essentially, this will help you determine how much of what you are saying has been understood and how you might be able to change the way you communicate to improve the patient’s understanding.

FNDNRS-08-069

The ambulatory care nurse is discussing preoperative procedures with a Japanese American client who is scheduled for surgery the following week. During the discussion, the client continually smiles and nods his head. How should the nurse interpret this nonverbal behavior?

A. An acceptance of the treatment.
B. Client understanding of the preoperative procedures.
C. Reflecting a cultural value.
D. Client agreement to the required procedures.

Correct Answer: C. Reflecting a cultural value.

Nodding or smiling by a Japanese American client may reflect only the cultural value of interpersonal harmony. This nonverbal behavior may not be an indication of acceptance of the treatment, agreement with the speaker, or understanding of the procedure. It’s important that nurses avoid making assumptions about cultures they aren’t familiar with. This can lead to a breakdown of trust and rapport between the nurse and their patient and reduce treatment acceptance.

Option A: If unsure about something, simply ask. Most people of different cultures will happily educate a healthcare provider who is willing to listen and understand their cultural differences. When asking questions, make sure the body language communicates openness and an intent to truly hear the patient versus listening to respond.
Option B: In reality, healthcare only reaches its full potential when the whole patient is considered, including their family, their day to day life, and their culture. Make an effort to learn about those cultures by becoming immersed in them. Visit the area where that culture is dominant and read about the culture from reputable books and online sources.
Option D: It’s essential for nurses to build trust with their patients, regardless of ethnic or racial backgrounds. However, treating culturally diverse patients requires a heightened level of trust to be established, which can become even more difficult when there’s a language barrier.

FNDNRS-08-070

The nurse identifies low-risk therapies to a client and should include which therapy(s) in the discussion, except?

A. Acupuncture
B. Relaxation
C. Touch
D. Prayer

Correct Answer: A. Acupuncture

Low-risk therapies are therapies that have no adverse effects and when implementing care, can be used by the nurse who has training and experiences in their use. It includes meditation, relaxation techniques, imagery, music therapy, massage, touch, laughter and humor, and spiritual measures, such as prayer. Acupuncture is a form of treatment that involves inserting very thin needles through a person’s skin at specific points on the body, to various depths. Research suggests that it can help relieve pain, and it is used for a wide range of other complaints.

Option B: For centuries cultures have incorporated strategies that recognize the power of engaging the mind in the process of healing. In this century, relaxation training (RT) is a skill that has been repeatedly validated by nursing, medical and psychology researchers as a complementary intervention that is effective for a wide range of clinical situations. Relaxation can be employed by nurses and patients to offset the negative effects of stress, illness, and surgery while promoting healing and self-efficacy.
Option C: Some researchers have found there is a significant increase in the patient communication response when physical touch is used; they suggest nurse-patient touch represents an important and effective communication tool.
Option D: Prayer may benefit both the nurse and the patient; both may find comfort in prayer. Prayer may also help patients and their families adjust emotionally to their illness or life events and support the patients’ spiritual health. Unfortunately, nurses may not know the prayers of different faiths.

FNDNRS-08-071

A clinic nurse is preparing to examine a Hispanic child who was brought by the mother for his first physical check-up. While assessing the child, the nurse would avoid doing which of the following?

A. Weighing the client.
B. Asking the mother questions about the child.
C. Having an interpreter if necessary.
D. Admiring the child.

Correct Answer: D. Admiring the child.

Admiring a Hispanic-American child during the first encounter with a stranger should be avoided since this may give the child the “evil eye” (the child will get sick). If this is done, it can be avoided by touching the child afterward. Beliefs about illnesses affecting the child and infants include mal de ojo (evil eye)/illness affecting children caused by admiration of others.

Option A: Latinos have disproportionately higher rates of obesity and diabetes mellitus. Approximately 43 percent of Mexican Americans older than 20 years are obese, compared with 33 percent of the non-Latino white population. Diabetes and hypertension are closely linked with obesity; 11.8 percent of Latinos older than 20 years have type 2 diabetes (13.3 percent of Mexican Americans), making it the foremost health issue in this population.
Option B: Spanish language handouts are a better option. However, the most useful technique is “teach back” or “show me”: having patients repeat their care instructions until they do it correctly. The extra time necessary for this technique is justified by the prospect of much better understanding and adherence.
Option C: There is ample evidence that Latinos, especially those of Mexican and Central American origin, face significant obstacles to obtaining health care, especially language barriers. Many hospitals and offices lack trained interpreters and rely on ad hoc interpretation by bilingual staff or even the children of patients.

FNDNRS-08-072

A nurse is preparing to deliver a food tray to a Jewish client. The nurse checks the food on the tray and notes that the client has received a hamburger and whole milk as a beverage. Which is the appropriate action for the nurse?

A. Ask the dietary department to replace the hamburger with crabs.
B. Replace the whole milk with fat-free milk.
C. Call the dietary department and ask for a new meal tray.
D. Deliver the designated food tray to the client.

Correct Answer: C. Call the dietary department and ask for a new meal tray.

“You may not cook a young animal in the milk of its mother” -Torah says (Ex.23:19). From this, it is derived that milk and meat products may not be combined together. Not only may they not be cooked together, but they may not be served together on the same table and surely not eaten at the same time. This rule is followed observantly by the Jewish people so the appropriate nursing action is to call the dietary department to change the meal tray of the patient.

Option A: Jewish dietary laws are known as kashrut and food that adheres to these standards is called kosher. Many mandates of the kosher diet are similar to those found in Islam. The only type of fish that may be eaten are those that have fins and scales. Therefore, shellfish, such as lobster, shrimp, oysters and crab, are prohibited.
Option B: Certain parts of permitted animals may not be eaten. In the case of forbidden animals, their eggs and milk also cannot be consumed. Eating any pork or pork products, including animal shortening, is prohibited.
Option D: Dairy products and meat products cannot be eaten together, because this is considered unhealthy. Cooking equipment and eating utensils that have come into contact with dairy products cannot be used with meat, and vice versa.

FNDNRS-08-073

A clinic nurse is performing an admission assessment for an African-American client scheduled for an emergency appendectomy. Which of the following questions would be inappropriate for the nurse to ask for the initial evaluation?

A. Do you have any allergies to medicines?
B. When did the pain start?
C. Do you have any difficulty breathing?
D. How close is your family during these situations?

Correct Answer: D. How close is your family during these situations?

For African-Americans, asking personal questions during the initial encounter is prohibited since it may be viewed as a way of interfering with them. Negative encounters from healthcare professionals can greatly affect African Americans’ decision to seek medical attention (McNeil, Campinha-Bacote, Tapscott, & Vample, 2002). One study reported that 12% of African Americans, compared to 1% of Caucasians, felt that health care practitioners treated them unfairly or with disrespect because of their race (Kaiser Family Foundation, 2001).

Option A: When interacting with African Africans, it is important to know that most prefer to be greeted formally, such as Doctor, Reverend , Pastor, Mr., Mrs., Ms., or Miss. They prefer their surname because the “family name” is highly respected and connotes pride in their family heritage.
Option B: African-American communication has been described as high context (Cokley, Cooke, & Nobles, 2005). They tend to rely on fewer words and use more non-verbal messages than what is actually spoken. The volume of African Americans’ voices is often louder than those in some other cultures; therefore, nurses must not misunderstand this attribute and automatically assume this increase in tone reflects anger.
Option C: Cultural skill is the ability to collect relevant cultural data regarding the patient’s presenting problem, as well as accurately perform a culturally based, physical assessment in a culturally sensitive manner (Campinha-Bacote, 2007). African-American speech is dynamic and expressive. They are also reported to be comfortable with a closer personal space than other cultural groups.

FNDNRS-08-074

A nurse is caring for a Chinese client who is hospitalized due to pneumonia. Based on their culture, which of the following is believed to be the cause of the illness?

A. An illness is cast by an enemy.
B. An illness is a result of punishment for sins.
C. An illness may be attributed to overexertion.
D. An illness may be given by someone who did not want it.

Correct Answer: C. An illness may be attributed to overexertion.

Illness for Chinese people may be attributed to prolonged sitting or lying or to overexertion. Health is maintained through a balance between “yin” (cold) and “yang” (hot) forces. A lack of “chi” (energy) causes illness. The body is viewed as a gift and must be valued through proper care.

Option A: When there is disharmony and imbalance of the functional entities, the cardinal functions cannot be not well-performed and as a result, the body becomes ill. Illness then is ultimately viewed as arising from an imbalance of qi and yin-yang, rather than a purely physical phenomenon.
Option B: When a person is ill, he or she will manifest different disease symptoms. Given that everything has Wu Xing, a pattern of disharmony can be identified by a trained doctor. Because all the functional entities are interconnected, accurately pinpointing patterns of illness is considered to be one of the most challenging aspects for aspiring acupuncturists.
Option D: As such, illness can be identified as to how the functional entities are imbalanced. At the most basic level, this is measured as there is an excess (vacuity) or deficiency (stagnation) in one of the entities.

FNDNRS-08-075

A nurse is caring for a client who has symptoms of chills, fever, no sweating, headache, nasal congestion, and stiffness and pain in the shoulders, upper back, neck, and back of the head that are common in Chinese culture and are called as syndromes of Wind. This is an example of which of the following?

A. Culture shock
B. Culture-bound syndrome
C. Cultural awareness
D. Culture biased

Correct Answer: B. Culture-bound syndrome

Culture-bound syndrome is a combination of psychiatric and somatic symptoms that are common in one culture group or not another. A culture-bound syndrome is a collection of signs and symptoms that is restricted to a limited number of cultures by reason of certain psychosocial features. Culture-bound syndromes are usually restricted to a specific setting, and they have a special relationship to that setting.

Option A: Culture shock is a sense of anxiety, depression, or confusion that results from being cut off from a familiar culture, environment, and norms when living in a foreign country or society. Those experiencing culture shock go through distinct phases of euphoria, discomfort, adjustment, and acceptance.
Option C: Cultural awareness is sensitivity to the similarities and differences that exist between two different cultures and the use of this sensitivity in effective communication with members of another cultural group.
Option D: Cultural bias is the interpretation of situations, actions, or data based on the standards of one’s own culture. Cultural biases are grounded in the assumptions one might have due to the culture in which they are raised.

FNDNRS-08-076

A nurse is caring for a Native American client who experiences emotional distress due to a family problem. In anticipating pharmacological treatment for the client, the nurse understands that they would most likely:

A. Establish the trust of the health care provider first before accepting the treatment.
B. Call a clergy to ask for the religious preference of the treatment.
C. Manage the emotional distress on their own to avoid disgrace.
D. Resort with the use of herbal medicines with healing properties.

Correct Answer: D. Resort with the use of herbal medicines with healing properties.

Native American cultures often use a variety of herbs or other plant and root remedies. Not only were American Indians the first to discover the healing properties of many of the medicinal herbs native to North America that we’ve come to know so well. In an era before antibiotics and knowledge of the causes of infectious diseases, Native American herbal wisdom provided a crucial foundation for the building of a new nation.

Option A: Usually Northern European American people value medicine and primary health care hence already having an established health care provider. Traditional Western medicine, favored by most European Americans in Minnesota, is characterized by methods developed according to medical and scientific traditions and rigorous safety protocols with treatments and medications that must pass a strict review before they can be used for patient care. Western medicine’s greatest strength is in trauma care and therapies for acute problems, such as surgery, medications, chemotherapy, radiation, and physical therapy.
Option B: Latin Americans offer to call clergy because of the significance of religious preference related to any illness. Churches are central to the life of the family and community, hence can be important resources in planning and delivering services. Faith and church remain powerful sources of hope and strength in the Hispanic community, especially in times of sickness.
Option C: Asian American culture views mental illness as shameful and will keep the stress on their own to manage it. Saving face—the ability to preserve the public appearance of the patient and family for the sake of community propriety—is extremely important to most Asian groups. Patients may not be willing to discuss their moods or psychological states because of fears of social stigma and shame.

FNDNRS-08-077

A nurse is conducting an assessment of an American Indian woman who has come to the clinic complaining of a headache. The patient tells the nurse that the medicines prescribed by the tribal healer have done some good. What is the appropriate response of the nurse at this time?

A. Tell me about these medicines and how often you are using them.
B. I advise you to refrain from taking those medicines from the tribal healer.
C. Could these medicines cause your headaches?
D. Maybe you should increase the frequency of the healer’s medicines.

Correct Answer: A. Tell me about these medicines and how often you are using them.

Asking the patient about the nature of these medicines and how often the client uses them allows the nurse to collect data about the medicines and their uses, to learn more about the practices used by this patient to improve her health, and to check for a potential drug interaction before prescribing other medications or treatment.

Option B: Advising the client to stop taking any nonprescription medicines is inappropriate until the nurse knows the details about all medicines used by the client. Health, for the individual Native American and/or the tribe or family, depends on proper actions and interactions with the spirit world. Well-being or wholeness comes about through walking in harmony with the forces of nature and the universe. Illness is a sign of having fallen out of step with those forces thus causing disharmony in spirit, mind, and body.
Option C: Suggesting the client’s headaches are caused by the healer’s medicines is inappropriate until the nurse knows details about the medicines. Native Americans consider healing a sacred calling. If one is called into the healing ministry one must use that gift to help others. Native healers use healing places and natural means to cure people during illness. Healing power comes from the natural forces of the earth, which can be reached through the saying of prayers.
Option D: Telling the patient to increase the frequency of the healer’s medicines is not within the practice of a nurse. During times of illness, many Native Americans will call upon a medicine man or woman or shaman. In most cases, the medicine person is also considered a holy person because it is the belief that they do all of their healing with the Creator’s help and guidance. Many Native Americans today will call upon both modern medicine and traditional healing ceremonies to achieve wellness.

FNDNRS-08-078

A nurse is preparing a plan of care for a client who is a Jehovah’s Witness. The client has been told that surgery is necessary. The nurse considers the client’s religious preferences in developing the plan of care and documents that:

A. Giving any medication is not allowed.
B. Surgery is strictly prohibited.
C. Blood products can not be administered.
D. Alternative medicines can be advised.

Correct Answer: C. Blood products can not be administered.

Among Jehovah’s Witnesses, the administration of blood and blood products is prohibited. Jehovah’s Witnesses believe that it is against God’s will to receive blood and, therefore, they refuse blood transfusions, often even if it is their own blood. The willing acceptance of blood transfusions by Jehovah’s Witnesses has in some cases led to expulsion from and ostracisation by their religious community.

Option A: Jehovah’s Witnesses accept medical and surgical treatment. They do not adhere to so-called “faith healing” and are not opposed to the practice of medicine. They are deeply religious and believe that blood transfusions are forbidden for them by such Biblical passages.
Option B: In the case of elective treatment or surgery, a medical practitioner who believes that a blood transfusion may be necessary may refuse to treat or perform surgery on a Jehovah’s Witness patient who has refused to consent to a blood transfusion being administered, provided that the practitioner is not already involved in the ongoing treatment of such patient, in which case a unilateral refusal to continue with the treatment could be viewed as breach of contract.
Option D: Witnesses do not observe special rituals that are to be performed for the sick or those dying. Every reasonable effort should be made to provide medical assistance, comfort and spiritual care needed by the patient. Each patient who is a Jehovah’s Witness will decide what is appropriate for him or her according to his or her circumstances and the provisions of the law.

FNDNRS-08-079

A Chinese-American client experiencing cough with clear white phlegm, which is believed to be a yin disorder, is likely to treat it with:

A. Foods considered being yin.
B. Foods considered being yang.
C. Aromatherapy.
D. Touch therapy.

Correct Answer: B. Foods considered to be yang.

In the yin and yang theory, health is believed to exist when all aspects of the person are in perfect balance. Yin foods are cold and yang foods are hot. One eats cold foods when hot has a hot illness and one eats hot foods when one has a cold illness.

Option A: Foods considered yin include dark leafy greens like spinach, lotus root, radish, dandelion greens, cucumbers, bamboo shoots, seaweed, watermelon, green tea, chamomile tea, mint tea, clams, crab and tofu.
Option C: Aromatherapy is a holistic healing treatment that uses natural plant extracts to promote health and well-being. Sometimes it’s called essential oil therapy. Aromatherapy uses aromatic essential oils medicinally to improve the health of the body, mind, and spirit. It enhances both physical and emotional health.
Option D: In touch therapy, practitioners use their hands to manipulate and direct the flow of energy — known as the biofield — throughout the body in order to promote healing and restore the body’s ability to heal itself.

FNDNRS-08-080

Which of the following food items would be appropriate for a Jewish client who follows a kosher diet?

A. Shrimp and mussels.
B. Beef and pork.
C. Tuna and salmon.
D. Cheese and milk.

Correct Answer: C. Tuna and salmon.

In the Jewish religion, only fish that have scales and fins are allowed such as tuna and salmon. Certain animals may not be eaten at all, including pigs, shellfish, rabbits, and reptiles. Fish must have fins and removable scales to be considered kosher. The Jewish dietary laws explain the rules for choosing kosher animal products, including the prohibition of what is considered “unclean” animals and the mixing of meat and dairy.

Option A: Shellfish such as shrimps, crabs, mussels, and lobsters are forbidden. The laws of kashrut, also referred to as the Jewish dietary laws, are the basis for kosher observance. These rules were set forth in the Torah and elucidated in the Talmud. The Hebrew word “kasher” literally means “fit,” and the kosher laws concern themselves with which foods are considered fit to eat. Those who keep kosher follow Jewish dietary laws.
Option B: Meats that are allowed include animals that are vegetable eaters, cloven-hoofed, and ritually slaughtered. Any meat (the flesh of birds and mammals) cannot be eaten with dairy. Utensils that have come into contact with meat (while hot) may not be used with dairy and vice versa. In addition, utensils that have come into contact with non-kosher food (while hot) may not be used with kosher food.
Option D: Cheese and milk coming from animal fat are prohibited. Milk and eggs from kosher animals are kosher. Eggs must generally be checked to ensure they do not contain blood, which is not kosher.

Fundamentals of Nursing NCLEX Practice Questions Quiz #8 | 80 Questions

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