A patient is admitted with chest pain, and his electrocardiogram shows elevated ST segments. The nurse bases her plan of care on the nursing diagnosis of pneumonia. Which of the following would best describe the possible type of negligence present?
a. Assessment failure c. Implementation failure
b. Planning failure d. Evaluation failure
B
Basing nursing care on an erroneous diagnosis is a failure in planning. Standards of care include assessment, the collection of relevant date pertinent to the patient's health or situation; diagnosis, analysis of the assessment data in determining diagnosis and care issues; implementation, coordinating care delivery and plan and using strategies to promote health and a safe environment; and evaluation, evaluation of the progress of the patient toward attaining outcomes.
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What term should the nurse use to document paralysis of all four extremities?
a. Paraplegia b. Quadriparesis c. Hemiparesis d. Quadriplegia
When auscultating the anterior thorax of a pregnant woman, the nurse notices the presence of a murmur over the second, third, and fourth intercostal spaces. The murmur is continuous but can be obliterated by pressure with the stethoscope
or finger on the thorax just lateral to the murmur. The nurse interprets this finding to be: a. Murmur of aortic stenosis. b. Most likely a mammary souffle. c. Associated with aortic insufficiency. d. Indication of a patent ductus arteriosus.
Although the NCLEX-RN® exam has new formats for questions, the most common format is the:
a. fill-in-the-blank item, because candidates are not provided with clues from distracters. b. multiple-choice question item, which allows candidates to select the one correct answer. c. multiple-response item, because these questions require a higher level of critical thinking. d. hot-spot item, because these questions are written at the application level of Bloom's analysis.
A patient learns that her husband has been laid off and the health benefit is being terminated immediately. Which of the following should the nurse do to help this patient?
1. Contact social services to help with health insurance coverage. 2. Suggest to the health care provider that the patient should be discharged. 3. Find out which treatments can be reduced. 4. Ask the patient if her husband is eligible for unemployment benefits.