A nurse moving to a new state wants to confirm which tasks a registered nurse is legally permitted to perform there. Where is the nursing scope of practice defined?
The state's nurse practice act
✓
The Joint Commission accreditation standards
The employing hospital's job description
A federal law passed by Congress
Correct Answer
The state's nurse practice act
Scope of practice is set at the state level: the state legislature passes a nurse practice act, and the state board of nursing writes and enforces the rules that carry it out. The Joint Commission accreditation standards address quality and safety in facilities, not what a nurse is licensed to do. The employing hospital's job description can narrow a nurse's duties but cannot expand the legal scope. A federal law passed by Congress does not set nursing scope, because licensure is a state matter.
Category: Nursing Roles and Scope
Question 2
Why does accreditation by The Joint Commission matter to a hospital's finances?
It exempts the hospital from all state licensing inspections
It shows the hospital meets federal Medicare and Medicaid requirements
✓
It replaces the hospital's need for malpractice insurance
It qualifies the hospital for nonprofit tax status
Correct Answer
It shows the hospital meets federal Medicare and Medicaid requirements
Joint Commission accreditation shows that a facility complies with Centers for Medicare and Medicaid Services requirements, which allows it to receive federal reimbursement. It exempts the hospital from all state licensing inspections is incorrect, because state oversight continues separately. It replaces the hospital's need for malpractice insurance is incorrect, because accreditation does not cover liability. It qualifies the hospital for nonprofit tax status is incorrect, because tax status depends on how the organization is structured.
Category: Nursing Roles and Scope
Question 3
A nurse reviews the unit's fall data, helps test a new hourly rounding routine, and tracks whether falls decrease. Which QSEN competency is the nurse demonstrating?
Informatics
Patient-centered care
Quality improvement
✓
Teamwork and collaboration
Correct Answer
Quality improvement
Quality improvement uses data to measure outcomes, test changes, and track whether care gets better, which is exactly what the nurse is doing with the fall data. Informatics centers on using information and technology to communicate and support decisions. Patient-centered care centers on the patient's values and preferences. Teamwork and collaboration centers on working effectively with other members of the care team.
Category: Nursing Roles and Scope
Question 4
Which nursing action is an example of patient-centered care during shift change?
Giving report at the nurses' station to save time
Planning the patient's bath for the most convenient staff time
Setting discharge goals before speaking with the patient
Inviting the patient's family to take part in bedside report
✓
Correct Answer
Inviting the patient's family to take part in bedside report
Patient-centered care treats the patient and family, as the patient defines it, as active members of the care team, and bedside report lets them hear and add to the plan. Giving report at the nurses' station to save time leaves the patient out of the conversation. Planning the patient's bath for the most convenient staff time puts staff needs ahead of patient preferences. Setting discharge goals before speaking with the patient ignores the patient's own priorities.
Category: Nursing Roles and Scope
Question 5
While calling a provider using the ISBAR format, the nurse says, "Based on the low urine output and dry mucous membranes, I believe the patient is becoming dehydrated." Which ISBAR component is the nurse giving?
Assessment
✓
Situation
Background
Recommendation
Correct Answer
Assessment
The assessment component is the nurse's own analysis of the findings, such as a judgment that a patient is becoming dehydrated. Situation is a brief statement of the current problem. Background gives a concise overview of the relevant history and context. Recommendation states the action the nurse suggests to address the problem.
Category: Team Communication
Question 6
In the NCSBN Clinical Judgment Measurement Model, which step immediately follows recognizing cues?
Prioritize hypotheses
Analyze cues
✓
Generate solutions
Take action
Correct Answer
Analyze cues
After recognizing relevant cues, the nurse analyzes them by linking the findings to the patient's condition and possible explanations. Prioritize hypotheses comes next, when possible explanations are ranked. Generate solutions follows, when the nurse identifies expected outcomes and interventions. Take action comes later, when the chosen interventions are carried out, and evaluating outcomes is the final step.
Category: Team Communication
Question 7
A patient with limited income needs help applying for insurance coverage and finding community support services before discharge. Which interprofessional team member is responsible for connecting the patient with these resources?
Dietitian
Pharmacist
Social worker
✓
Physical therapist
Correct Answer
Social worker
A social worker assesses finances, housing, and support networks and connects patients with insurance help and community resources. A dietitian plans nutrition therapy. A pharmacist reviews and manages medications. A physical therapist works on mobility, strength, and function.
Category: Team Communication
Question 8
A nurse learns that a coworker forgot to report and document a patient's sudden rise in blood pressure, and the coworker refuses to correct the omission. What should the nurse do?
Stay quiet to protect the working relationship
Chart the reading under the coworker's name
Tell the patient's family about the mistake
Report the omission to the nursing supervisor
✓
Correct Answer
Report the omission to the nursing supervisor
Patient safety outweighs a working relationship, so when a coworker will not report and document a missed finding, the nurse reports it to the nursing supervisor. Stay quiet to protect the working relationship leaves a safety risk unaddressed. Chart the reading under the coworker's name falsifies the record. Tell the patient's family about the mistake bypasses the proper reporting channel and does not get the problem fixed.
Category: Health Policy and Ethics
Question 9
An experienced medical-surgical nurse is reassigned to another unit and asked to perform a skill the nurse has never been trained to do. What should the nurse do?
Notify the supervisor and request guidance or an experienced helper
✓
Leave the unit and refuse the reassignment
Attempt the skill alone and document afterward
Ask the patient to wait until the next shift
Correct Answer
Notify the supervisor and request guidance or an experienced helper
A nurse who lacks the competence for an assignment notifies the supervisor, asks for guidance or an experienced helper, and moves up the chain of command if needed, which protects the patient while still meeting the need. Leave the unit and refuse the reassignment can amount to abandoning patients. Attempt the skill alone and document afterward puts the patient at risk from an untrained nurse. Ask the patient to wait until the next shift delays needed care.
Category: Health Policy and Ethics
Question 10
Which protection was a central goal of the Affordable Care Act?
Free prescription drugs for every adult
Coverage for people with preexisting conditions
✓
A single government insurer for all residents
Federal licensure for all nursing assistants
Correct Answer
Coverage for people with preexisting conditions
The Affordable Care Act expanded coverage and protected people with preexisting conditions from being denied insurance, while also guaranteeing essential benefits such as preventive care. Free prescription drugs for every adult was not part of the law; prescription coverage is an essential benefit, not a free entitlement. A single government insurer for all residents describes a single-payer system, which the law did not create. Federal licensure for all nursing assistants is unrelated, since credentialing is handled by states.
Category: Health Policy and Ethics
Question 11
Evidence-based practice combines the best current research with which other elements?
Hospital tradition and cost data
Insurance rules and staffing levels
Clinical expertise and patient values
✓
Expert opinion and textbook rules
Correct Answer
Clinical expertise and patient values
Evidence-based practice blends the best available research with the clinician's expertise and the patient's values and preferences to guide care decisions. Hospital tradition and cost data reflect habit and budget rather than evidence and the patient. Insurance rules and staffing levels are system constraints, not parts of the definition. Expert opinion and textbook rules can inform care but leave out both clinical judgment and the patient's preferences.
Category: Evidence-Based Practice
Question 12
A nurse asks, "In adults after hip surgery, does walking on the day of surgery compared with bed rest reduce pneumonia during the hospital stay?" In this PICOT question, what does bed rest represent?
Intervention
Outcome
Population
Comparison
✓
Correct Answer
Comparison
In PICOT, the comparison is the alternative the intervention is measured against, which here is bed rest. Intervention is the action being tested, early walking. Outcome is what is measured, pneumonia. Population is the group studied, adults after hip surgery.
Category: Evidence-Based Practice
Question 13
A nurse researcher interviews patients to describe what living with a new ostomy is like from their own point of view. Which research design is this?
Phenomenology
✓
Quasi-experimental
Correlational
Randomized controlled trial
Correct Answer
Phenomenology
Phenomenology is a qualitative design that describes a phenomenon as the people living it experience it, often through interviews. Quasi-experimental research tests an intervention without random assignment. Correlational research uses statistics to examine relationships between variables. Randomized controlled trial is a quantitative experiment that randomly assigns participants to groups.
Category: Evidence-Based Practice
Question 14
In the plan-do-study-act cycle, what happens during the Act step?
The team compares results with its prediction
The team adopts, adapts, or abandons the change
✓
The team identifies stakeholders and members
The team puts the intervention into place
Correct Answer
The team adopts, adapts, or abandons the change
In the Act step, the team decides what to do with the change: adopt it, adapt it for another cycle, or abandon it. The team compares results with its prediction during the Study step. The team identifies stakeholders and members during the Plan step. The team puts the intervention into place and collects data during the Do step.
Category: Quality Improvement
Question 15
A unit begins tracking how often staff clean their hands before entering patient rooms. Which type of quality measure is this?
Outcome measure
Structure measure
Process measure
✓
Balancing measure
Correct Answer
Process measure
A process measure tracks whether staff carry out a practice as intended, such as hand hygiene compliance. An outcome measure tracks results, such as hospital-acquired infection rates. A structure measure tracks resources, such as whether sanitizer dispensers are available. A balancing measure tracks unintended effects of a change, such as skin irritation in staff.
Category: Quality Improvement
Question 16
Screening mammography, which aims to find breast cancer early so it can be treated before it progresses, is an example of which level of prevention?
Primary prevention
Tertiary prevention
Quaternary prevention
Secondary prevention
✓
Correct Answer
Secondary prevention
Secondary prevention detects disease early and treats it to slow or stop progression, which is the purpose of screening. Primary prevention stops disease before it occurs, as with immunization. Tertiary prevention reduces the impact of an established illness, as with rehabilitation after a stroke. Quaternary prevention protects patients from unnecessary or excessive medical intervention, which does not describe screening.
Category: Health-Care Delivery
Question 17
Which care setting sends nurses and therapists to provide skilled care and physical therapy in the patient's own residence?
Home health agency
✓
Adult day care center
Assisted living facility
Ambulatory surgery center
Correct Answer
Home health agency
A home health agency provides skilled nursing care along with physical and occupational therapy in the patient's home. An adult day care center provides supervised daytime care at a center and gives caregivers relief. An assisted living facility is a residence that offers help with daily activities, such as bathing and medication reminders, rather than skilled care delivered in the patient's own home. An ambulatory surgery center performs procedures without hospital admission.
Category: Health-Care Delivery
Question 18
The Institute for Healthcare Improvement's Triple Aim seeks a better patient experience of care, better health for populations, and what else?
More hospital beds in each region
Lower per capita cost of care
✓
Higher payments to providers
Shorter nursing education programs
Correct Answer
Lower per capita cost of care
The Triple Aim pursues better patient experience, better population health, and a lower per capita cost of care at the same time. More hospital beds in each region does not appear in the framework, which aims to address problems upstream before acute care is needed. Higher payments to providers would raise costs rather than lower them. Shorter nursing education programs are not part of the framework.
Category: Health-Care Delivery
Question 19
A registered nurse is deciding which tasks to hand off to a nursing assistant. Which task can the nurse delegate?
Creating the care plan for a newly admitted patient
Teaching a patient how to use an inhaler
Measuring routine vital signs on a stable patient
✓
Evaluating a patient's response to pain medication
Correct Answer
Measuring routine vital signs on a stable patient
Measuring routine vital signs on a stable patient is a standard task with a predictable result, so the nurse can delegate it to a nursing assistant while remaining accountable for the patient's care. Creating the care plan for a newly admitted patient requires nursing judgment and stays with the registered nurse. Teaching a patient how to use an inhaler requires the nurse's knowledge and judgment, so it is not delegated to a nursing assistant. Evaluating a patient's response to pain medication requires clinical reasoning, which cannot be delegated.
Category: Nursing Roles and Scope
Question 20
A nurse groups a patient's blood pressure readings from several days into a chart and sees a steady upward trend. In nursing informatics, what is this organized, meaningful form of the readings called?
Data
Knowledge
Wisdom
Information
✓
Correct Answer
Information
Information is data that has been processed and organized so it has context and meaning, such as readings arranged to show a trend. Data are the raw, unprocessed facts, such as a single blood pressure reading. Knowledge is the synthesis and interpretation of information to reach conclusions that guide care planning. Wisdom adds experience and ethical considerations, such as patient preferences, to that knowledge.
Category: Systems and Informatics