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MNMC Nursing practice questions

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Question 1Professional Practice and Legal-Ethical Standards

A nurse employed in a long-term care facility witnesses a colleague diverting a resident's opioid medication. Under the duty to report, what is the nurse's most appropriate immediate action?

  1. Report the observed diversion through the facility's established reporting channels and applicable regulatory process Correct answer.
  2. Confront the colleague privately and require that the medication be returned before any documentation
  3. Wait to see whether the behaviour recurs before notifying anyone
  4. Discuss the observation with other staff members to confirm whether they have noticed the same pattern

Explanation

Nurses have a professional and often statutory obligation to report suspected medication diversion or impaired practice through formal channels, because resident safety and controlled-substance accountability are at stake. Reporting protects residents, triggers investigation, and shields the reporter from allegations of concealment. Informal confrontation or delay does not satisfy this duty.

Question 2Professional Practice and Legal-Ethical Standards

Which action best demonstrates the ethical principle of veracity in nursing practice?

  1. Withholding a poor prognosis because the client seems anxious
  2. Telling a client honestly that a procedure will be uncomfortable rather than saying it will be painless Correct answer.
  3. Documenting a medication as given before actually administering it to save time
  4. Keeping a client's diagnosis from the family at the family's request

Explanation

Veracity is the duty to tell the truth. Giving an honest description of expected discomfort respects the client's right to accurate information and supports informed decision-making. The other behaviours involve deception or misrepresentation.

Question 3Professional Practice and Legal-Ethical Standards

A competent adult client with a terminal illness refuses a blood transfusion that the care team believes is beneficial. How should the nurse respond?

  1. Ask the family to sign a consent overriding the client's decision
  2. Tell the client that refusal will result in discharge from the facility
  3. Administer the transfusion because it is medically indicated
  4. Respect the refusal and continue to provide comfort-focused care and information Correct answer.

Explanation

A competent adult has the legal and ethical right to refuse any treatment, even life-sustaining treatment. The nurse must honour the refusal, document it, and continue providing supportive care and education. Seeking family override or threatening discharge violates autonomy.

Question 4Professional Practice and Legal-Ethical Standards

Which situation requires the nurse to obtain a new informed consent signature rather than relying on an earlier consent form?

  1. A different nurse will be caring for the client postoperatively
  2. The surgeon adds a substantially different procedure to the planned operation Correct answer.
  3. The client asks a question that the nurse answers before signing
  4. The start time of the surgery is delayed by two hours

Explanation

Informed consent is specific to the procedure disclosed. If the surgeon adds a materially different procedure, the client must be re-informed and must sign a new consent. Scheduling changes or a change in nursing personnel do not alter the scope of consent.

Question 5Professional Practice and Legal-Ethical Standards

A client tells the nurse in confidence that she intends to harm her estranged partner. What is the nurse's most appropriate action?

  1. Document the statement and wait to see whether the client acts on the threat
  2. Notify the treatment team and appropriate authorities according to the duty-to-warn standard and facility policy Correct answer.
  3. Advise the client to seek legal counsel and take no further action
  4. Maintain confidentiality absolutely because the client disclosed in confidence

Explanation

When a client makes a credible threat of serious harm to an identifiable person, the duty to protect may override confidentiality. Nurses should follow facility policy and legal requirements to warn the intended victim and/or notify authorities. Absolute silence or passive waiting is unsafe.

Question 6Professional Practice and Legal-Ethical Standards

Which element is essential for a valid malpractice claim against a nurse?

  1. Proof that the client disliked the nurse's bedside manner
  2. Proof that the nurse's breach of the standard of care caused the client's injury Correct answer.
  3. Proof that the nurse documented the care in an electronic record
  4. Proof that the facility is accredited by a national body

Explanation

Negligence requires four elements: duty, breach of the standard of care, causation, and damages. The plaintiff must show that the breach caused actual harm. Bedside manner, documentation method, and accreditation status alone do not establish liability.

Question 7Professional Practice and Legal-Ethical Standards

A nurse is served with a subpoena duces tecum requesting the client's medical record. What is the nurse's best action?

  1. Refuse to respond because the record is confidential
  2. Provide the record directly to the client's family instead
  3. Notify the facility's legal or risk-management department and follow its direction on producing the record Correct answer.
  4. Immediately mail a copy of the record to the requesting attorney

Explanation

A subpoena is a legal demand that must be handled through proper channels. The facility's legal or risk-management team verifies validity and ensures protected information is released appropriately. Personal release or refusal can create legal exposure.

Question 8Professional Practice and Legal-Ethical Standards

Which nursing action best protects client confidentiality under health privacy regulations?

  1. Sharing login credentials with a trusted coworker to speed documentation
  2. Logging out of the electronic health record before stepping away from a workstation Correct answer.
  3. Posting a de-identified clinical photo to a personal social media account
  4. Discussing a client's case in a public elevator using the client's full name

Explanation

Logging out prevents unauthorized access and is a core privacy safeguard. Sharing credentials, discussing identifiable information in public, and posting clinical images all risk breaching confidentiality even when names are removed.

Question 9Professional Practice and Legal-Ethical Standards

An adult client with decision-making capacity declines a recommended treatment. The client's adult child demands that the nurse proceed anyway. How should the nurse respond?

  1. Explain that the client's own decision takes precedence and continue to support the client's choice Correct answer.
  2. Follow the child's instruction because family members are the legal decision-makers
  3. Delay all care until the family resolves the disagreement
  4. Ask the child to sign the consent form on the client's behalf

Explanation

When a client has capacity, the client is the decision-maker; family members have no authority to override that decision. The nurse should support the client's autonomy and clarify the legal position to the family. Abandoning care or obtaining a surrogate signature is inappropriate.

Question 10Professional Practice and Legal-Ethical Standards

Which statement correctly describes the role of a durable power of attorney for health care?

  1. It automatically overrides a living will in every circumstance
  2. It authorizes the nurse to consent to any procedure without physician involvement
  3. It transfers all financial assets to a designated relative upon hospital admission
  4. It designates a person to make health care decisions if the client loses decision-making capacity Correct answer.

Explanation

A durable power of attorney for health care names a surrogate decision-maker who acts only when the client cannot decide. It is distinct from financial powers of attorney and does not empower nurses to consent to procedures.

Question 11Professional Practice and Legal-Ethical Standards

A client asks the nurse to witness an advance directive. Which action is most appropriate?

  1. Sign as the sole witness and also serve as the client's health care proxy
  2. Refuse to discuss advance directives because they are a physician responsibility
  3. Complete the form for the client based on the nurse's own preferences
  4. Follow facility policy and state law on who may witness, and confirm the client's understanding before signing Correct answer.

Explanation

Witnessing requirements are governed by state law and facility policy, and some jurisdictions restrict clinicians involved in care from serving as witnesses. The nurse should confirm the client's voluntariness and understanding and avoid conflicting roles.

Question 12Professional Practice and Legal-Ethical Standards

Which behaviour by a nurse constitutes professional boundary crossing that should be addressed?

  1. Accepting a large cash gift from a current client in exchange for preferential scheduling Correct answer.
  2. Attending a client's community fundraiser after discharge with the care team's knowledge
  3. Providing a client with a list of community resources during discharge planning
  4. Documenting a client's stated cultural preferences in the care plan

Explanation

Accepting significant gifts in exchange for preferential treatment exploits the power imbalance and creates a conflict of interest. Boundary crossings of this kind must be addressed. Appropriate resource sharing and culturally sensitive documentation are within professional practice.

Question 13Professional Practice and Legal-Ethical Standards

A nurse suspects that a colleague is practicing while impaired by alcohol. What is the priority action?

  1. Remove the colleague from direct client care and notify the supervisor according to policy Correct answer.
  2. Wait until the end of the shift to mention the concern to a peer
  3. Quietly cover the colleague's assignments for the remainder of the shift
  4. Confront the colleague in front of clients to gather witnesses

Explanation

Client safety is paramount. The nurse should ensure the impaired colleague is not providing direct care and report immediately to a supervisor so that formal evaluation and support can occur. Covering up or public confrontation risks harm and confidentiality breaches.

Question 14Professional Practice and Legal-Ethical Standards

Which action reflects appropriate delegation by a registered nurse to unlicensed assistive personnel (UAP)?

  1. Delegating the initial assessment of a newly admitted postoperative client
  2. Delegating the administration of a PRN opioid to a client in pain
  3. Delegating vital-sign collection on a stable client after confirming the UAP's training and competency Correct answer.
  4. Delegating evaluation of a client's response to a blood transfusion

Explanation

Delegation requires matching the task to the UAP's training and competency and retaining nursing responsibility for assessment, judgment, and evaluation. Stable vital-sign collection is commonly delegable; assessment, medication administration, and evaluation of responses are not.

Question 15Professional Practice and Legal-Ethical Standards

A nurse manager is reviewing staffing assignments. Which assignment is most appropriate under the nurse practice act?

  1. Assigning an unlicensed student to administer oral medications under no supervision
  2. Assigning a licensed practical nurse to independently develop the initial care plan for a critically ill client
  3. Assigning an RN to a client requiring complex wound assessment and titration of IV medications Correct answer.
  4. Assigning a UAP to perform the admission assessment for a new client

Explanation

Scope-of-practice laws reserve assessment, care planning, and complex interventions for appropriately licensed personnel. An RN is the correct assignee for complex assessment and IV titration. Delegating admission assessment or independent care planning to lesser-licensed staff exceeds their scope.

Question 16Professional Practice and Legal-Ethical Standards

Which action by a nurse best demonstrates the ethical principle of justice in resource allocation?

  1. Applying the same transparent triage criteria to all clients regardless of ability to pay Correct answer.
  2. Allowing staff members' relatives to bypass the waiting list
  3. Reserving scarce beds for clients with private insurance
  4. Giving priority to clients who make larger donations to the facility

Explanation

Justice requires fairness and consistent application of criteria without discrimination. Transparent, need-based triage respects equal worth and avoids preferential treatment based on payment or relationships.

Question 17Professional Practice and Legal-Ethical Standards

A client with limited English proficiency must sign a surgical consent. What is the nurse's best action?

  1. Use gestures and simplified English without an interpreter
  2. Ask the client's young bilingual child to interpret the conversation
  3. Have a bilingual housekeeping staff member interpret as a courtesy
  4. Arrange a qualified medical interpreter to interpret the consent discussion and document the process Correct answer.

Explanation

Informed consent requires comprehension, so a qualified medical interpreter must convey the discussion, and the use of interpretation should be documented. Children and untrained staff are inappropriate interpreters because of accuracy, confidentiality, and role conflicts.

Question 18Professional Practice and Legal-Ethical Standards

Which situation most clearly requires the nurse to report suspected abuse under mandatory reporting laws?

  1. An older adult reports occasional constipation despite dietary changes
  2. An older adult declines a recommended influenza vaccine
  3. An older adult has a stage 2 pressure injury on the sacrum
  4. An older adult presents with unexplained bilateral bruises in various healing stages and gives inconsistent explanations Correct answer.

Explanation

Unexplained injuries in different healing stages with inconsistent explanations are red flags for abuse and trigger mandatory reporting. Constipation, pressure injuries, and vaccine refusal are clinical issues that do not by themselves indicate abuse.

Question 19Professional Practice and Legal-Ethical Standards

A nurse discovers that a coworker accessed the medical record of a celebrity client out of curiosity. What should the nurse do?

  1. Ignore the access because the coworker has system credentials
  2. Ask the coworker to share interesting details from the record
  3. Delete the coworker's access log to avoid conflict
  4. Report the unauthorized access to the privacy officer or supervisor as required by policy Correct answer.

Explanation

Accessing a record without a treatment, payment, or operations purpose is a privacy violation. Nurses must report known breaches through proper channels. Sharing details or altering logs compounds the violation.

Question 20Professional Practice and Legal-Ethical Standards

Which nursing action demonstrates fidelity to a client?

  1. Ending a shift without handing off essential client information
  2. Following through on a promise to return within ten minutes to assist with ambulation Correct answer.
  3. Sharing a client's private information with a friend who is curious
  4. Changing a care plan without informing the client

Explanation

Fidelity means keeping commitments and being trustworthy. Following through on a stated promise honours that duty. Breaching privacy, altering plans without communication, and incomplete handoff all betray client trust.

Question 21Professional Practice and Legal-Ethical Standards

A client is enrolled in a clinical research trial. Which statement best reflects the nurse's ethical obligation?

  1. Verify that informed consent was obtained and advocate for the client if concerns about understanding or coercion arise Correct answer.
  2. Withhold information about adverse effects to prevent the client from withdrawing
  3. Encourage the client to remain in the trial regardless of emerging discomfort
  4. Assume consent is valid because the principal investigator signed the form

Explanation

Nurses involved in research must confirm that valid informed consent was obtained and must advocate for participants' rights, including the right to withdraw. Coercion or withholding adverse-effect information violates research ethics.

Question 22Professional Practice and Legal-Ethical Standards

A nurse is asked to float to an unfamiliar unit with clients requiring equipment the nurse has never used. What is the most appropriate action?

  1. Accept the assignment and perform unfamiliar procedures without instruction
  2. Refuse all assignments on the unfamiliar unit regardless of client needs
  3. Ask an unlicensed assistive worker to perform the unfamiliar procedures
  4. Accept the assignment while clearly communicating learning needs and requesting orientation and support Correct answer.

Explanation

Nurses are accountable for practicing within their competence and must seek orientation and support when floated. Accepting with clear communication and supervision protects clients, whereas blanket refusal, unsafe independent practice, or improper delegation does not.

Question 23Professional Practice and Legal-Ethical Standards

A nurse receives a verbal order from a physician for a high-alert medication. Which action best reflects safe and legally sound practice?

  1. Ask a UAP to transcribe the order into the record
  2. Read back the order, verify it per policy, and document it with the prescriber's name and time Correct answer.
  3. Accept the order and administer without confirmation to avoid delay
  4. Implement the order and document it at the end of the shift from memory

Explanation

Verbal orders for high-alert medications require read-back verification and prompt documentation per policy to prevent error. Skipping confirmation, delegating transcription to unlicensed staff, or delaying documentation increases legal and safety risk.

Question 24Professional Practice and Legal-Ethical Standards

A nurse learns that a client's family plans to file a complaint. Which documentation practice best protects both the client and the nurse?

  1. Omit details that might be interpreted unfavourably
  2. Record objective, timely, factual entries and avoid defensive or speculative language Correct answer.
  3. Alter earlier entries to reflect the current understanding
  4. Add retrospective notes blaming other staff for the outcome

Explanation

The medical record is a legal document. Objective, contemporaneous, factual entries support continuity of care and are defensible in legal proceedings. Altering records, blaming others, or omitting relevant details undermines credibility and may be fraudulent.

Question 25Professional Practice and Legal-Ethical Standards

Which action by a nurse demonstrates appropriate use of the chain of command when a client's deteriorating condition is not being addressed?

  1. Wait for the next scheduled rounds to raise the concern
  2. Ask the client's family to call the physician directly
  3. Continue monitoring without further communication to avoid conflict
  4. Escalate the concern to the next level of authority in a timely manner and document the escalation Correct answer.

Explanation

When a client's condition is deteriorating and concerns are not addressed, the nurse must escalate promptly through the chain of command and document the action. Passive waiting or shifting responsibility to the family delays essential care.

Question 26Professional Practice and Legal-Ethical Standards

A registered nurse is caring for an adult client who has capacity and refuses a prescribed blood transfusion for religious reasons. The nurse disagrees with the decision. Which action is legally and ethically correct?

  1. Request that the charge nurse administer the transfusion without informing the client
  2. Administer the transfusion because the provider's order takes legal precedence
  3. Ask the client's spouse to sign a consent form overriding the refusal
  4. Document the refusal, notify the provider, and continue to provide all other nursing care Correct answer.

Explanation

A competent adult has the legal right to refuse any treatment, including life-sustaining treatment, and the nurse must respect that autonomous decision. The nurse's duty is to verify capacity, ensure the refusal is informed, document it, notify the provider, and continue providing care without abandonment. Overriding a valid refusal without legal authority constitutes battery.

Question 27Professional Practice and Legal-Ethical Standards

A nurse is documenting care in the electronic health record. Which entry best meets legal standards for nursing documentation?

  1. Client was very demanding about pain medication again today.
  2. Client stated pain 7/10 at 1400; morphine 2 mg IV given at 1415 per order; reassessed at 1445, pain 3/10. Correct answer.
  3. Client seemed uncomfortable this shift, will monitor and let the next nurse know.
  4. Gave the usual dose of pain medication around 2 pm as ordered.

Explanation

Legally sound documentation is objective, factual, timely, and includes the client's report, the intervention, and the response to it. Specific times, doses, and reassessment data create a defensible record. Vague, judgmental, or incomplete entries weaken the record and can be used against the nurse.

Question 28Professional Practice and Legal-Ethical Standards

A client tells the nurse in confidence that they intend to leave the hospital against medical advice and asks the nurse not to tell anyone. The client's condition carries a serious risk of deterioration. How should the nurse respond?

  1. Explain that the care team must be informed for safety, and notify the provider while arranging an informed against-medical-advice process Correct answer.
  2. Tell the client that security will physically restrain them if they attempt to leave
  3. Honour the request completely and take no further action because confidentiality is absolute
  4. Ask the client to sign a release form and then allow them to leave without notifying anyone

Explanation

Confidentiality is not absolute; the nurse has a duty to protect the client from foreseeable harm and to involve the care team in an informed against-medical-advice process. The nurse should explain the limits of confidentiality and the risks of leaving, then notify the provider. This balances respect for autonomy with the professional duty of care.

Question 29Professional Practice and Legal-Ethical Standards

A nurse is asked to accept a telephone order for a chemotherapy regimen from a pharmacist who is not the prescribing provider. Which action is most appropriate?

  1. Write the order as a verbal order and obtain the provider's signature within 24 hours
  2. Accept the order and have another nurse co-sign it as a witness
  3. Decline the order and ask the pharmacist to have the prescribing provider issue and authenticate the order Correct answer.
  4. Accept the order because the pharmacist is a licensed professional who can prescribe

Explanation

A nurse may only accept orders from practitioners legally authorized to prescribe, and chemotherapy requires the prescribing provider's order. Accepting an unauthorized order exposes the client to harm and the nurse to liability. The nurse should clarify the order with the authorized prescriber and follow facility policy for authentication.

Question 30Professional Practice and Legal-Ethical Standards

A nurse on a medical-surgical unit is told by the charge nurse to "cover" for a colleague by signing the colleague's medication administration record for doses the colleague says were given. Which analysis best describes the legal exposure for the nurse who complies?

  1. The nurse is protected because the colleague confirmed the doses were given
  2. The nurse commits a falsification of the record and may face licensure discipline and personal liability for any resulting harm Correct answer.
  3. The nurse is protected because the charge nurse directed the action
  4. The nurse has no exposure because signing for another nurse is a routine staffing practice

Explanation

Signing for care that another person provided falsifies the health record and violates licensure obligations, regardless of who directed it. Following a supervisor's directive is not a legal defence, and the nurse who signs assumes personal accountability for the accuracy of the entry. This conduct can result in board discipline, termination, and civil liability.

Question 31Patient Safety and Quality Improvement

A nurse notices that a colleague consistently skips hand hygiene before entering a patient room. Which action best reflects the principle of speaking up for safety?

  1. Wait until the next staff meeting to raise the concern anonymously.
  2. Report the colleague to the manager without any prior discussion.
  3. Document the observation in the patient record after the shift ends.
  4. Respectfully address the colleague directly at the moment and offer a reminder. Correct answer.

Explanation

Speaking up for safety means addressing a risky behavior promptly and respectfully at the point of care, which prevents immediate harm and supports a just culture. Direct, nonpunitive feedback is the first-line response before escalation. Delaying or bypassing the colleague leaves the patient at risk.

Question 32Patient Safety and Quality Improvement

Which element is essential to a culture of safety in a clinical unit?

  1. Restricting incident reporting to senior nursing staff.
  2. Punishing staff who report errors to discourage carelessness.
  3. Nonpunitive reporting of errors and near misses. Correct answer.
  4. Limiting error reports to those that cause patient harm.

Explanation

A safety culture depends on nonpunitive reporting so that errors and near misses surface and can be analyzed for system causes. Reporting must be broad, including near misses, and open to all staff. Punitive responses suppress reporting and hide risk.

Question 33Patient Safety and Quality Improvement

A patient is found on the floor next to the bed with no injury. What is the nurse's priority first action?

  1. Assess the patient for injury and vital sign changes. Correct answer.
  2. Move the patient back into bed immediately.
  3. Notify the risk management department.
  4. Complete an incident report before touching the patient.

Explanation

After a fall, the immediate priority is patient assessment for injury, neurological change, and vital sign instability before any repositioning or paperwork. Incident reporting and notification follow the clinical assessment. Moving the patient before assessment risks worsening an occult injury.

Question 34Patient Safety and Quality Improvement

Which two patient identifiers are acceptable for verifying identity before medication administration?

  1. Diagnosis and attending physician.
  2. Full name and date of birth. Correct answer.
  3. Wristband color and age.
  4. Room number and bed position.

Explanation

Accreditation standards require at least two patient-specific identifiers, commonly full name and date of birth, verified against the wristband and the order. Room or bed location is not a unique identifier. Diagnosis and physician do not uniquely identify the patient.

Question 35Patient Safety and Quality Improvement

A nurse is preparing to administer a high-alert medication. Which practice is a recognized independent double-check?

  1. The pharmacy label is read aloud by the administering nurse.
  2. A second qualified clinician independently verifies the drug, dose, and pump settings. Correct answer.
  3. The same nurse verifies the calculation twice.
  4. The charge nurse signs the medication record after administration.

Explanation

An independent double-check requires a second qualified person to verify the drug, dose, route, and pump programming without being influenced by the first nurse's conclusions. Self-checking by one nurse does not provide independence. Retrospective signing does not prevent the error.

Question 36Patient Safety and Quality Improvement

Under the Joint Commission's Universal Protocol, when must the time-out occur?

  1. Before the patient is transported to the procedure area.
  2. Immediately before the procedure begins, with the team present. Correct answer.
  3. During the procedure after the first incision.
  4. At the preoperative consent signing.

Explanation

The time-out is a final verification conducted immediately before the procedure begins, with all team members present and actively participating. It confirms patient, site, and procedure. It is not a preoperative or post-incision activity.

Question 37Patient Safety and Quality Improvement

A nurse receives a verbal order for a high-alert medication. What is the safest practice?

  1. Write down the order, read it back to the prescriber, and confirm. Correct answer.
  2. Ask a colleague to remember the dose for later documentation.
  3. Wait until the prescriber writes it in the chart before any action.
  4. Accept the order and administer the drug immediately.

Explanation

Verbal orders carry high risk, so the read-back process is required: the receiver writes the order, reads it back to the prescriber, and receives confirmation. This closes the communication loop and reduces errors. Immediate administration without verification is unsafe.

Question 38Patient Safety and Quality Improvement

Which action best demonstrates closed-loop communication during a rapid response?

  1. The order is written on the whiteboard for reference.
  2. The nurse nods to acknowledge the instruction.
  3. The receiver repeats the message back to the sender, who confirms it. Correct answer.
  4. The team leader repeats the order to the room generally.

Explanation

Closed-loop communication requires the receiver to repeat the message back and the sender to confirm it was heard correctly. This verifies understanding and prevents miscommunication in high-stress events. Nodding or general repetition does not confirm receipt.

Question 39Patient Safety and Quality Improvement

A patient with a documented penicillin allergy is prescribed amoxicillin. What should the nurse do first?

  1. Administer the drug and monitor closely for a reaction.
  2. Ask the patient whether they want the medication.
  3. Hold the medication and clarify the order with the prescriber. Correct answer.
  4. Give half the dose to test for a reaction.

Explanation

A documented allergy to a prescribed drug is a stop-and-clarify situation. The nurse should withhold the medication and contact the prescriber to reconcile the allergy with the order. Administering or test-dosing an allergen is unsafe.

Question 40Patient Safety and Quality Improvement

Which measure is most effective for preventing central line-associated bloodstream infections (CLABSI)?

  1. Daily review of line necessity and adherence to insertion and maintenance bundles. Correct answer.
  2. Changing the dressing only when it appears soiled.
  3. Prophylactic antibiotics for all patients with a central line.
  4. Routine replacement of the central line every 72 hours.

Explanation

CLABSI prevention relies on bundle adherence for insertion and maintenance plus daily assessment of whether the line is still needed. Removing unnecessary lines reduces infection risk. Scheduled routine replacement and prophylactic antibiotics are not recommended.

Question 41Patient Safety and Quality Improvement

A nurse is caring for a patient at high risk for falls. Which intervention is most appropriate?

  1. Apply physical restraints to prevent wandering.
  2. Encourage the patient to remain in bed at all times.
  3. Raise the bed to the highest position for easier transfers.
  4. Implement hourly rounding and keep the call light within reach. Correct answer.

Explanation

Fall prevention emphasizes proactive rounding, easy access to assistance, and a safe environment. Hourly rounding addresses toileting and comfort needs that often precipitate falls. Restraints and bed elevation increase risk, and prolonged bed rest causes deconditioning.

Question 42Patient Safety and Quality Improvement

A nurse notices a discrepancy between the counted narcotic volume and the documentation at shift change. What is the correct action?

  1. Wait until the end of the shift to investigate.
  2. Correct the count to match the record and continue.
  3. Ask the oncoming nurse to sign off without resolving it.
  4. Report the discrepancy immediately and follow the facility's controlled substance procedure. Correct answer.

Explanation

Controlled substance discrepancies must be reported immediately and investigated per policy to protect patients and staff. Falsifying counts or delaying resolution conceals potential diversion. Both nurses should resolve the discrepancy before the handoff is complete.

Question 43Patient Safety and Quality Improvement

Which statement best describes a just culture?

  1. Errors are investigated only when a patient is harmed.
  2. All errors, regardless of cause, result in disciplinary action.
  3. Staff are never held accountable for their actions.
  4. Human error is consoled, at-risk behavior is coached, and reckless behavior is disciplined. Correct answer.

Explanation

Just culture distinguishes human error, at-risk behavior, and reckless behavior, responding to each with consolation, coaching, or discipline respectively. This balance encourages reporting while maintaining accountability. It is neither blame-free nor uniformly punitive.

Question 44Patient Safety and Quality Improvement

A patient is receiving a blood transfusion and develops fever and chills. What is the nurse's first action?

  1. Administer an antipyretic and continue the transfusion.
  2. Slow the transfusion rate and continue monitoring.
  3. Document the reaction and complete the transfusion.
  4. Stop the transfusion and maintain intravenous access with normal saline. Correct answer.

Explanation

A suspected transfusion reaction requires immediately stopping the transfusion while keeping the IV line patent with normal saline to preserve access. The provider and blood bank are notified and the unit is returned per policy. Continuing the transfusion risks a severe hemolytic reaction.

Question 45Patient Safety and Quality Improvement

Which practice reduces the risk of wrong-site surgery at the preoperative stage?

  1. Marking the surgical site by the circulating nurse in the OR.
  2. Relying on the consent form alone to confirm the site.
  3. Confirming the site only after anesthesia induction.
  4. Site marking by the surgeon with patient involvement before transfer. Correct answer.

Explanation

Universal Protocol requires the surgeon to mark the operative site with the patient involved whenever possible, before transfer to the procedure area. Site marking by another team member or reliance on paperwork alone undermines verification. Confirmation after induction removes the patient's ability to participate.

Question 46Patient Safety and Quality Improvement

A nurse manager wants to evaluate whether a new hand hygiene initiative improved compliance. Which approach best reflects quality improvement methodology?

  1. Survey staff opinions once after the initiative.
  2. Collect baseline and post-intervention data using a defined measure and compare over time. Correct answer.
  3. Review a single day of observations and declare success.
  4. Rely on anecdotal reports from one unit.

Explanation

Quality improvement uses defined measures, baseline data, and comparison over time to determine whether a change produced improvement. Single observations, one-time surveys, and anecdotes lack reliability. Systematic measurement supports valid conclusions.

Question 47Patient Safety and Quality Improvement

Which is an example of a nursing-sensitive indicator?

  1. Number of physician admissions.
  2. Hospital-wide mortality rate.
  3. Rate of hospital-acquired pressure injuries. Correct answer.
  4. Average length of emergency department wait.

Explanation

Nursing-sensitive indicators reflect the quality of nursing care, such as pressure injury rates, falls with injury, and catheter-associated infections. Hospital mortality and ED wait times are influenced by many factors beyond nursing. Physician admissions are unrelated to nursing quality.

Question 48Patient Safety and Quality Improvement

A root cause analysis (RCA) is best described as which of the following?

  1. A process to assign individual blame after a sentinel event.
  2. A financial audit of the affected department.
  3. A structured team review to identify system failures underlying a sentinel event. Correct answer.
  4. A disciplinary hearing for staff involved in an error.

Explanation

An RCA is a structured, team-based method to identify underlying system causes of a sentinel event and recommend changes to prevent recurrence. Its focus is systems, not individual blame. It is not a disciplinary or financial process.

Question 49Patient Safety and Quality Improvement

A nurse is administering a medication via a smart infusion pump. Which action best supports safe use of the device?

  1. Selecting the drug from the approved library and verifying the programmed rate. Correct answer.
  2. Bypassing the drug library to save time.
  3. Relying on the pump to calculate the dose without verification.
  4. Disabling the dose-error reduction software.

Explanation

Smart pumps reduce error when the clinician selects the drug from the approved library and verifies the programmed rate against the order. Bypassing the library or disabling dose-error reduction software removes the safety features. The pump does not replace independent verification.

Question 50Patient Safety and Quality Improvement

During handoff, which approach best supports safe transfer of patient information?

  1. Handing over the chart without discussion.
  2. A brief verbal summary without written documentation.
  3. A recorded message left at the desk.
  4. A structured handoff tool with opportunity for questions and read-back. Correct answer.

Explanation

Structured handoff tools such as SBAR standardize the information transferred and allow the receiver to ask questions and clarify. Two-way communication and read-back reduce omissions. Written-only or one-way methods lack interaction and verification.