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Management of Care – Part 2

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Management of Care – Part 2

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Question 1 of 30

1. Question

1. A case manager is planning a discharge for a patient after being admitted to the hospital for an exacerbation of COPD. What information would be a priority in identifying the home care needs for the patient?

A. Blood pressure.
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B. Ability to perform ADLs.
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C. Transportation to physician visits.
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D. Obtain pulse ox when ambulating.
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Hint

Hint: For COPD patients, evaluate functional oxygenation under stress—assessing for exertional desaturation during activity helps determine if supplemental oxygen or activity limitations are needed at home.
Question 2 of 30

2. Question

2. Match the abbreviation with the correct definition:

A. bid: at bedtime.
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B. tid: tomorrow.
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C. ac: before meals.
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D. pc: patient care.
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Hint

Hint: Recall the Latin abbreviation “ac” (ante cibum) used in medication orders to indicate timing related to meals; matching common nursing abbreviations to their Latin roots helps identify correct meanings.
Question 3 of 30

3. Question

3. Which is NOT an acceptable abbreviation?

A. D/C.
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B. tid.
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C. bid.
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D. qid.
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Hint

Hint: Consider abbreviations that are known to be ambiguous and on “do not use” lists—especially ones that can be misread as either “discontinue” or “discharge.”
Question 4 of 30

4. Question

4. You are taking Mr. D’s blood pressure. The first sound that you hear is at 162 and the second sound that you hear is at 86. You should document and report that the blood pressure is _____________.

A. 86/162.
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B. irregular and high.
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C. 162/86.
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D. normal for people of all ages.
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Hint

Hint: The first Korotkoff sound you hear is the systolic pressure and the second (or disappearance) is the diastolic; record blood pressure as systolic over diastolic in mm Hg.
Question 5 of 30

5. Question

5. Your elderly patient has a temperature of 98.5 degrees. Is there anything else that a nurse should do, in addition to documenting this temperature?

A. No, this temperature is within normal limits.
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B. No, this temperature is normally hyperthermic.
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C. Yes, this temperature is highly hyperthermic.
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D. Yes, this temperature is highly hypothermic.
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Hint

Hint: Remember normal oral temperature range and the clinical thresholds—fever is generally ≥100.4°F and hypothermia is <95°F—so determine whether 98.5°F meets those criteria.
Question 6 of 30

6. Question

6. The abbreviation ac is defined as _____________.

A. before the meal.
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B. with the meal.
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C. after the meal.
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D. ante corpis.
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Hint

Hint: Think about common medication-timing abbreviations derived from Latin—’ac’ tells you whether to administer the drug in relation to the patient’s meal time, so decide if it indicates before or after eating.
Question 7 of 30

7. Question

7. The abbreviation pc is defined as ________________.

A. before the meal.
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B. with the meal.
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C. after the meal.
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D. post corpi.
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Hint

Hint: Consider the Latin roots: “post” means after and “cibum” refers to food — pc indicates timing of medication in relation to meals, rather than during or before them.
Question 8 of 30

8. Question

8. At the beginning of the shift, a nurse receives report for her daily assignment. Which of the following situations should the nurse give first priority?

A. A diabetic client with a blood glucose level of 195 mg/dL.
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B. A family member of an elderly client who has questions.
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C. A client with COPD with an oxygen saturation of 84%.
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D. A client who requires assistance to use the bathroom.
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Hint

Hint: Use the ABCs—airway and breathing take priority; a markedly low oxygen saturation indicates acute hypoxemia that requires immediate intervention.
Question 9 of 30

9. Question

9. Elderly patients are more prone to dehydration than younger people because the elderly ___________.

A. drink more coffee and tea.
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B. have more stomach mucus production.
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C. have more saliva.
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D. have less sense of thirst.
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Hint

Hint: Consider age-related changes in homeostatic responses — older adults often have a reduced perception of thirst, so they may not drink enough to meet fluid needs.
Question 10 of 30

10. Question

10. Decide which of the following tasks may be delegated to unlicensed assistive personnel.

A. Cleansing a wound with peroxide.
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B. Irrigating a colostomy.
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C. Assisting with performing incentive spirometry.
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D. Removing a saline-lock IV.
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Hint

Hint: Consider delegation principles: UAPs may perform noninvasive, routine, and predictable tasks—think basic respiratory support for a stable patient rather than sterile or invasive procedures.
Question 11 of 30

11. Question

11. According to HIPAA, which of the following is considered an individual right for privacy of a client’s protected health information?

A. The right to receive medical bills for care received.
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B. A copy of the organization's privacy practices.
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C. A right to change personal health information.
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D. An understanding that protected health information will only be used in regards to client treatments.
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Hint

Hint: Think about the HIPAA requirement that entities must inform patients about how their PHI will be used—specifically the patient’s right to receive a written notice outlining the organization’s privacy practices.
Question 12 of 30

12. Question

12. Which of the following clients is most likely ready to be dismissed from an inpatient care setting to home?

A. A 65-year old male with urine output of 60cc in the past four hours.
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B. A 2-month old female with a temperature of 100.6 rectally.
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C. A 38-year old female who transitioned from IV TPN to full liquids six hours ago.
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D. A 4-year old male with an oxygen saturation of 96% on room air.
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Hint

Hint: Consider which client demonstrates age‑appropriate, stable vital signs and can maintain adequate oxygenation without supplemental support—this is a key indicator of readiness for discharge to home.
Question 13 of 30

13. Question

13. The discharge planning team is discussing plans for the dismissal of a 16-year old admitted for complications associated with asthma. The client’s mother has not participated in any of the discharge planning process, but has stated that she wants to be involved. Which of the following reasons might prohibit this mother from participating in discharge planning?

A. The client is an emancipated minor.
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B. The mother has to work and is unavailable.
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C. The client has a job and a driver's license.
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D. The mother does not speak English.
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Hint

Hint: Consider legal status and decision-making authority of adolescents—if the youth has legal independence from their parents, parental participation in discharge planning may be limited despite parental desire to be involved.
Question 14 of 30

14. Question

14. Which of the following is an example of the intervention phase of the individualized nursing care plan for a client who receives a colostomy after a bowel resection?

A. Taking a health history and performing a physical exam prior to the procedure.
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B. Instructing the client about how to care for his colostomy stoma.
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C. Developing goals that state the client will ambulate three times a day.
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D. Determining that the client may need more support at home after dismissal.
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Hint

Hint: Intervention/implementation involves the nurse’s actual actions to help the patient meet goals—think hands-on care and teaching the patient specific self-care skills for their new condition.
Question 15 of 30

15. Question

15. Which of the following is an example of a living will?

A. A client's son has been appointed to make his healthcare decisions if he becomes incapacitated.
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B. A client has designated which of his children will receive his home and property before he dies.
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C. A client has instructions that he does not want to be resuscitated through chest compressions if his heart stops beating.
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D. A client designates what type of burial or cremation services he would want after his death.
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Hint

Hint: A living will is an advance directive that records a person’s preferences about life-sustaining medical treatments if they cannot communicate—think instructions about resuscitation and other end-of-life interventions.
Question 16 of 30

16. Question

16. What is involved with obtaining informed consent?

A. An explanation of the reasons for the procedure.
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B. A signature on a form that states the client agrees to the procedure.
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C. A statement affirming liability if complications arise during the procedure.
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D. Both a and c.
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Hint

Hint: Informed consent is a communication process that ensures the patient understands the purpose, risks, benefits, and alternatives of a procedure—documentation (a signature) records the process but is not the same as the consent itself.
Question 17 of 30

17. Question

17. A patient presents with vesicles covering the upper torso. Which of the following situations could cause this condition?

A. Knife fight.
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B. Auto accident.
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C. Sun burn.
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D. Fungal infection.
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Hint

Hint: Consider a diffuse blistering rash on sun‑exposed areas after intense UV exposure—thermal/UV injury can produce vesicles on the upper torso rather than trauma or infection patterns.
Question 18 of 30

18. Question

18. A client is being admitted to the stroke care unit of a rehabilitation center. Which of the following best describes the action of the nurse at admission?

A. Collect and arrange documents to be placed in the client's medical record.
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B. Prepare the client's identification bracelet.
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C. Identify pertinent health history data as well as current needs and limitations.
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D. Gather the client's valuables and place them in a locked container.
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Hint

Hint: On admission your first nursing action is a focused assessment to identify the client’s current status, functional limitations, and immediate care needs so an individualized plan can be made.
Question 19 of 30

19. Question

19. A client is refusing to undergo any more treatments in the hospital and wants to leave against medical advice. When the nurse requests the client sign an AMA order, the client refuses and leaves. What is the next action of the nurse?

A. Call security to hold the client until he will sign the order.
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B. Notify the physician to convince the client that he needs to stay.
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C. Speak with the client's spouse to persuade him to stay.
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D. Allow the client to leave and document the refusal in his chart.
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Hint

Hint: Remember the patient’s right to refuse treatment and leave; the nurse’s priority is to ensure safety and informed refusal, not to detain or coerce—document the event and the refusal thoroughly.
Question 20 of 30

20. Question

20. The case manager is determining the discharge needs of a patient on a medical-surgical floor in an acute care hospital. The patient is a 55 year old male that was admitted to the hospital following a fall at work in which he suffered a left femur fracture. His past medical history includes: CHF, COPD, DMII, and HTN. Which discipline’s assessment would be a priority in determining the level of care needs for this patient?

A. Nursing.
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B. Occupational therapy.
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C. Physical therapy.
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D. All of the above.
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Hint

Hint: For discharge planning with complex comorbidities and a major mobility-limiting injury, determine level of care by integrating assessments from nursing, mobility/functional specialists, and activities-of-daily-living evaluators rather than relying on a single discipline.
Question 21 of 30

21. Question

21. Which example best describes a nurse who exhibits moral courage?

A. A nurse feels angry when a parent refuses important treatment for his child.
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B. A nurse considers seeking help for depression when she feels she cannot meet the needs of her clients in the oncology unit.
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C. A nurse contacts a physician for further orders when he fails to order comfort measures for a client with a terminal illness.
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D. A nurse is frustrated when the laboratory is slow in responding to an order for a stat blood glucose.
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Hint

Hint: Moral courage in nursing often means advocating for a vulnerable patient by speaking up to ensure their needs and comfort are addressed, even if it requires challenging a colleague or provider.
Question 22 of 30

22. Question

22. Which method is most appropriate for managing moral distress in the workplace?

A. Recognizing that life is unfair and nurses cannot meet every need of every client.
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B. Declining to act when clients or visitors make requests that are not justifiable.
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C. Developing a new policy that would address the problematic situation.
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D. Both a and b.
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Hint

Hint: Think about strategies that address the root causes of recurring ethical conflicts in the workplace—system-level solutions like policy development and unit-wide ethics processes can reduce ongoing moral distress more effectively than individual resignation or refusal to act.
Question 23 of 30

23. Question

23. A nurse is required to float to another unit within the hospital where he is asked to care for a client on a ventilator. The nurse is uncomfortable with this assignment, as he has not had a ventilated client since nursing school. What is the nurse’s most appropriate response?

A. Explain to the nursing supervisor the level of discomfort and ask for a different assignment.
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B. State that the client's needs are outside the nurse's scope of practice and request a different assignment.
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C. Accept the assignment, asking for help when necessary.
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D. Request to return to the home unit and send another nurse who can perform the job.
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Hint

Hint: Prioritize patient safety and professional accountability by honestly communicating your limitations to your supervisor and requesting an assignment that matches your current competency rather than assuming or accepting beyond your skill level.
Question 24 of 30

24. Question

24. A nurse is asked to perform a task that she believes is outside her scope of practice. What is the appropriate response to this issue?

A. Contact the state board of nursing licensure to report the offense.
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B. Review the state scope of practice standards for nurses.
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C. Ask another nurse to perform the task to learn the procedure.
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D. Contact the house supervisor to make the decision as to whether the nurse should perform the task.
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Hint

Hint: When unsure about a task, first consult authoritative sources—confirm the nurse’s legal scope of practice and relevant state/facility regulations before performing, delegating, or escalating the issue.
Question 25 of 30

25. Question

25. The staff on a post-partum unit has been complaining to the nurse manager about certain nurses not fulfilling the required weekend shifts. To address the problem, the nurse manager implements new staffing guidelines that would require each nurse to work four weekend shifts per month. The implementation of these guidelines is an example of the following leadership style:

A. Laissez-faire leadership.
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B. Authoritarian leadership.
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C. Democratic leadership.
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D. Servant leadership.
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Hint

Hint: This style is characterized by top-down decision-making where the leader unilaterally sets rules and enforces compliance with little to no staff input.
Question 26 of 30

26. Question

26. A nursing unit is implementing a new electronic charting program for the nursing staff to use. Which of the following best describes a disadvantage of using electronic charting?

A. The information is more likely to be lost or used inappropriately.
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B. Any provider in the unit can have access to the client's medical records.
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C. The system diminishes communication between nurses and providers.
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D. The program may be confusing and difficult to implement.
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Hint

Hint: Consider common obstacles during technology adoption—think about usability, staff learning curve, and the need for training and support rather than long-term data security or access concerns.
Question 27 of 30

27. Question

27. A client has volunteered to take part in a research study. After participating for two months, he decides that he can no longer tolerate the study and decides to leave. What are the client’s rights in this situation?

A. The client has a right to be released from the study but must reimburse the researchers for charges incurred.
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B. The client has a right to be released from the study without any liability.
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C. The client has a right to be released from the study but is prohibited from participating in any future studies.
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D. The client does not have the right to be released from the study; he must finish his participation.
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Hint

Hint: Remember that informed consent in research includes voluntary participation and the unequivocal right to withdraw at any time without penalty or financial liability.
Question 28 of 30

28. Question

28. A pregnant client who is at 38 weeks’ gestation is seen for prenatal care at a community clinic. The nurse asks the client to lie down while waiting for the physician to arrive. After several minutes of lying on her back, the client becomes dizzy and lightheaded; she is agitated and states she feels she might faint. What is the next action of the nurse?

A. Call the physician to check the client immediately.
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B. Call 9-1-1 for an ambulance to transport the client to the labor and delivery unit of the hospital.
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C. Check the client's blood pressure and temperature.
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D. Assist the client to lie on her side.
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Hint

Hint: Consider supine hypotension from uterine compression of the inferior vena cava in late pregnancy—immediate repositioning (left lateral) relieves symptoms and restores circulation.
Question 29 of 30

29. Question

29. Which example best describes the concept of beneficence?

A. A client has an advanced directive in place stating that he does not want intubation if he needs CPR.
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B. A nurse provides pain medication for a client in the recovery room who is experiencing pain.
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C. At the request of the client, a nurse does not inform his family about his cancer diagnosis.
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D. A nurse withholds narcotic medication for a client in pain, knowing that he is currently disoriented.
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Hint

Hint: Beneficence is the ethical duty to actively promote a patient’s well‑being and relieve suffering—think which action directly provides care to improve the patient’s condition.
Question 30 of 30

30. Question

30. A nurse is at the beginning of her shift in a long-term care facility. Which of the following clients should she check on first?

A. A 91-year old man who needs help eating breakfast.
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B. An 86-year old man who has been incontinent in his bed.
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C. An 82-year old woman who needs IV antibiotics.
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D. A 75-year old man who is recovering from an injury who needs an ice pack.
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Hint

Hint: Prioritize time-sensitive, potentially clinically critical treatments—clients who require scheduled or urgent IV medications should be assessed before routine ADLs or comfort measures.

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