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 Question 11 The nurse manager is holding educational sessions to improve staff nurse competency in providing culturally sensitive care. Which myths will the manager identify in these sessions? 1. Cultural competence increases the cost of the nursing care provided. 2. Cultural competence is difficult to achieve when working with patients who are victims of trauma or violence. 3. Cultural competence is focused on providing sensitive care to minorities. 4. The first step of cultural competence is self-awareness. 5. The nurse who provides the same level of care to every patient is providing culturally competent care.   Question 12 Which interventions would the nurse use to help the patient get at least 2 hours of uninterrupted REM sleep? 1. Work with ancillary services such as physical therapy to establish a predictable routine. 2. Keep the lights in the unit dim at all times. 3. Turn alarms down or off during sleep periods. 4. Restrict visitation to a short time in the morning, the afternoon, and evening. Question 13 A patient has decided to explore palliative care. After this decision is announced, the nurse notices that not all of the disciplines of the health care team seem to be supportive of the decision. What action by the nurse is indicated? 1. Contact the physician to report the discrepancies in the plan of care. 2. Discuss the patient’s wishes in the next multidisciplinary meeting. 3. Develop a plan of care and distribute it to the other disciplines of the health care team. 4. Advise the patient to contact the social services department. Question 14 The family of a critically ill patient reports to the nurse concerns that none of the health care team members seem to be listening to their wishes. Which nursing response is indicted? 1. “You have to stand up for yourself and for your loved one.” 2. “It is time for us to meet in a patient care conference.” 3. “I will talk to the hospital administrator about your complaint.” 4. “I know this whole thing has been very hard on your family.” Question 15 The charge nurse on a busy high-acuity care unit is reviewing the plan of care for four patients. The nurse would evaluate that which patient is at highest risk for sensory perceptual alterations (SPAs)? 1. 52-year-old male patient who has been hospitalized for complications related to diabetes 2. 41-year-old female patient admitted with severe abdominal pain 3. 65-year-old male patient diagnosed with pulmonary embolism. 4. 79-year-old female patient who is unresponsive after a stroke Question 16 The nurse manager is planning an educational program to address noise levels on the unit. What information should be given about the recommended noise levels? 1. It is recommended that noise levels in the hospital should be below 45 dBA during daytime hours. 2. Normal conversation exceeds the recommended daytime noise level. 3. At night it should be quieter, no more than 35 dBA are recommended. 4. The recommended noise levels in high-acuity areas are higher due to increase noise from alarms and machines. 5. The biggest patient complaint about noise is in regard to staff conversation. Question 17 The wife of a critically ill patient asks the nurse for help in making end-of-life care decisions for her husband. What action by the nurse is indicated? 1. Encourage the wife to recall any discussions with her husband about his wishes. 2. Encourage the wife to discontinue aggressive medical treatments as soon as possible. 3. Tell the wife what most other families have done in similar situations in the past 4. Refer the wife to social services for information about end of life. Question 18 The nurse has been assigned to care for a patient who is unresponsive. The patient has no living will and the family has requested no resuscitative measures be implemented. No “do not resuscitate” order has been written and the nurse feels confident that life saving measures would likely be successful if implemented. What action by the nurse is indicated if this patient suffers a cardiopulmonary arrest? 1. Begin resuscitation interventions. 2. Discuss the situation with the unit manager. 3. Contact the hospital attorney. 4. Tell the family that resuscitation efforts are indicated and would likely be successful.   Question 19 A patient has decided to forgo additional treatments for his terminal disease. The patient has presented a valid living will. The family is unhappy and tells the nurse they think the patient made the decision as a result of his depression. What response by the nurse is indicated? 1. “You need to let him make his own decisions.” 2. “Do you think if we talked to him he would change his mind?” 3. “My role is to assure your loved one’s wishes are followed.” 4. “You need to talk to his physician about revising the do not resuscitate order.” Question 20 A nurse manager has recently held an educational program regarding palliative care for newly hired nurses on the high-acuity care unit. Which statement by a participant indicates the need for further education? 1. “The goals of medical care should be included in the palliative plan of care.” 2. “Advanced directives are not included in the palliative plan of care.” 3. “The plan of care should ensure the wishes of the patient at the time of death.” 4. “The palliative care plan should seek to ensure the patient and family understands the disease status.”

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