Title: Exam 1 - Professional Accountability
Course: NUR 1008C Transition to Prof Nursing > Section: Module 2

Q: In caring for patients, it is important for the nurse to realize that evidence-based practice is
- The only valid source of knowledge that should be used.
- Secondary to traditional or standard care knowledge.
- Dependent on patient values and expectations.
- Not shown to provide better patient outcomes.
A: Dependent on patient values and expectations.
If right: Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience, or the standard, “It has always been done this way.” Although these sources have value, it is important to learn to rely more on research evidence than on non-research evidence. Patients who receive care based on the most recent and best evidence experience 28% better outcomes.
If wrong: Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience, or the standard, “It has always been done this way.” Although these sources have value, it is important to learn to rely more on research evidence than on non-research evidence. Patients who receive care based on the most recent and best evidence experience 28% better outcomes.

Q: To provide patient care of the highest quality, nurses utilize an evidence-based practice approach because evidence-based practice is
- A guide for nurses in making clinical decisions.
- Based on the latest textbook information.
- Easily attained at the bedside.
- Always right for all situations.
A: A guide for nurses in making clinical decisions.
If right: Evidence-based practice (EBP) is a guide for nurses to structure how to make accurate, timely, and appropriate clinical decisions. A textbook relies on the scientific literature, which is often outdated by the time the book is published and is not the most reliable source for EBP. Unfortunately, most of the best information in evidence never reaches the bedside. EBP is not to be blindly applied without using good judgment and critical thinking skills. It is not appropriate for all settings.
If wrong: Evidence-based practice (EBP) is a guide for nurses to structure how to make accurate, timely, and appropriate clinical decisions. A textbook relies on the scientific literature, which is often outdated by the time the book is published and is not the most reliable source for EBP. Unfortunately, most of the best information in evidence never reaches the bedside. EBP is not to be blindly applied without using good judgment and critical thinking skills. It is not appropriate for all settings.

Q: In collecting the best evidence, the gold standard for research is
- The randomized controlled trial (RCT).
- The peer-reviewed article.
- Qualitative research.
- The opinion of expert committees.
A: The randomized controlled trial (RCT).
If right: Individual RCTs are the gold standard for research. A peer-reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT. Expert opinion is on the bottom of the hierarchical pyramid of evidence.
If wrong: Individual RCTs are the gold standard for research. A peer-reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT. Expert opinion is on the bottom of the hierarchical pyramid of evidence.

Q: The first step in evidence-based practice is to ask a clinical question. In doing so, the nurse needs to realize that in researching interventions, the question
- Is more important than its format.
- Will lead you to hundreds of articles that must be read.
- May be easier if in PICO format.
- May be more useful the more general it is.
A: May be easier if in PICO format.
If right: The PICO format allows the nurse to ask questions that are intervention focused. Inappropriately formed questions will likely lead to irrelevant sources of information. It is not beneficial to read hundreds of articles. It is more beneficial to read the best four to six articles that specifically address the question. The more focused the question asked, the easier it will become to search for evidence in the scientific literature.
If wrong: The PICO format allows the nurse to ask questions that are intervention focused. Inappropriately formed questions will likely lead to irrelevant sources of information. It is not beneficial to read hundreds of articles. It is more beneficial to read the best four to six articles that specifically address the question. The more focused the question asked, the easier it will become to search for evidence in the scientific literature.

Q: Providing culturally congruent care means providing care that
- Fits the patient’s valued life patterns and set of meanings.
- Is based on meanings generated by predetermined criteria.
- Is the same as the values of the professional health care system.
- Holds one’s own way of life as superior to those of others.
A: Fits the patient’s valued life patterns and set of meanings.
If right: The goal of transcultural nursing is culturally congruent care, or care that fits the person’s valued life patterns and set of meanings. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Culturally congruent care is sometimes different from the values and meanings of the professional health care system. Ethnocentrism is a tendency to hold one’s own way of life as superior to those of others. It is not part of culturally congruent care.
If wrong: The goal of transcultural nursing is culturally congruent care, or care that fits the person’s valued life patterns and set of meanings. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Culturally congruent care is sometimes different from the values and meanings of the professional health care system. Ethnocentrism is a tendency to hold one’s own way of life as superior to those of others. It is not part of culturally congruent care.

Q: Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care. These modes are “cultural care preservation or maintenance,” “cultural care accommodation,” and “cultural care repatterning.” When assessing patients during the admission process, the nurse utilizes
- These action modes in a distinct order.
- These action modes individually, one at a time.
- Only one action mode per patient.
- All these action modes simultaneously.
A: All these action modes simultaneously.
If right: Nurses are able to use any or all of these action modes simultaneously. These actions require that nurses have knowledge of the patient’s culture and have the willingness, commitment, and skills to work with patients and families in decision making. The outcome sought through these actions and decisions is meaningful, supportive, and facilitative care as judged by the patient.
If wrong: Nurses are able to use any or all of these action modes simultaneously. These actions require that nurses have knowledge of the patient’s culture and have the willingness, commitment, and skills to work with patients and families in decision making. The outcome sought through these actions and decisions is meaningful, supportive, and facilitative care as judged by the patient.

Q: The nurse is caring for a member of the Jewish faith who needs to undergo a critical procedure on Saturday. The patient is refusing the procedure because it is scheduled to be done on the Sabbath. The nurse impresses on the patient the urgency of the procedure, stating that delaying the procedure would put his life at risk. The patient continues to refuse. What should the nurse do?
- Cancel the procedure.
- Seek permission from the patient to contact the patient’s rabbi.
- Have a family member sign the permit.
- Have the procedure done against patient wishes.
A: Seek permission from the patient to contact the patient’s rabbi.
If right: Nurses need to identify and contact patients’ religious and spiritual leaders before problems occur. Nurses work with these leaders to mediate in times of crises. Canceling the procedure may occur, but not at this time. Doing so prematurely could lead to the patient’s death. A family member cannot make decisions for a competent patient. Having the procedure done against the patient’s wishes cannot be done.
If wrong: Nurses need to identify and contact patients’ religious and spiritual leaders before problems occur. Nurses work with these leaders to mediate in times of crises. Canceling the procedure may occur, but not at this time. Doing so prematurely could lead to the patient’s death. A family member cannot make decisions for a competent patient. Having the procedure done against the patient’s wishes cannot be done.

Q: The nurse is providing diabetic diet teaching to a Hispanic man and his wife. When the nurse is discussing foods that are acceptable, the wife continues to interrupt with statements like, “Oh, he doesn’t eat that,” or, “All he eats is rice and beans.” What should the nurse do?
- Ask the wife to leave so he/she can focus on teaching the patient.
- Explain how “rice and beans” are not acceptable foods on a diabetic diet.
- Provide a diet plan with only food alternatives selected by the patient.
- Refer the patient and his wife to a dietitian familiar with Spanish food choices.
A: Refer the patient and his wife to a dietitian familiar with Spanish food choices.
If right: The nurse should refer the patient to speak with a dietitian who is familiar with cultural food choices. If possible, he/she should develop a diet plan that includes the patient’s cultural diet preferences and can provide culturally sensitive teaching brochures that describe healthy food choices. Rice and beans may be acceptable alternatives in a balanced diet. The nurse should include people in the family who help shop for and prepare food in the home, along with the wife.
If wrong: The nurse should refer the patient to speak with a dietitian who is familiar with cultural food choices. If possible, he/she should develop a diet plan that includes the patient’s cultural diet preferences and can provide culturally sensitive teaching brochures that describe healthy food choices. Rice and beans may be acceptable alternatives in a balanced diet. The nurse should include people in the family who help shop for and prepare food in the home, along with the wife.

Q: The nurse finds it difficult to care for a patient whose advance directive states that no extraordinary resuscitation measures should be taken. Which step may help the nurse to find resolution in this assignment?
- Call for an ethical committee consult.
- Decline the assignment on religious grounds.
- Scrutinize her own personal values.
- Convince the family to challenge the directive.
A: Scrutinize her own personal values.
If right: Values develop over time and are influenced by family, schools, religious traditions, and life experiences. The nurse must recognize that no two humans have the same set of experiences, and so differences in values are more likely the norm than the exception. Closer inspection of one’s values may be a step in gaining understanding of another person’s perspective. Calling for a consult, declining the assignment, and convincing the family to challenge the patient’s directive are not ideal resolutions because they do not address the reason for the nurse’s discomfort, which is the conflict between the nurse’s values and those of the patient.
If wrong: Values develop over time and are influenced by family, schools, religious traditions, and life experiences. The nurse must recognize that no two humans have the same set of experiences, and so differences in values are more likely the norm than the exception. Closer inspection of one’s values may be a step in gaining understanding of another person’s perspective. Calling for a consult, declining the assignment, and convincing the family to challenge the patient’s directive are not ideal resolutions because they do not address the reason for the nurse’s discomfort, which is the conflict between the nurse’s values and those of the patient.

Q: The nurse questions a physician’s order to administer a placebo to the patient. The nurse’s action is based on which ethical principle?
- Autonomy
- Beneficence
- Justice
- Fidelity
A: Autonomy
If right: Autonomy refers to the freedom to make decisions free of external control. In this case, the nurse questions the physician’s order for a placebo because it supports the patient’s autonomy. Although beneficence, taking a positive action for others, has implications here, it is not the primary operating principle. Justice refers to fairness and is most often used in discussions about access to health care resources. Fidelity refers to the agreement to keep promises.
If wrong: Autonomy refers to the freedom to make decisions free of external control. In this case, the nurse questions the physician’s order for a placebo because it supports the patient’s autonomy. Although beneficence, taking a positive action for others, has implications here, it is not the primary operating principle. Justice refers to fairness and is most often used in discussions about access to health care resources. Fidelity refers to the agreement to keep promises.

Q: Ethical dilemmas are common occurrences when caring for patients. The nurse understands that dilemmas are a result of
- Presence of conflicting values.
- Hierarchical systems.
- Judgmental perceptions of patients.
- Poor communication with the patient.
A: Presence of conflicting values.
If right: Poor communication and the hierarchical systems that exist in health care, such as reporting structures within the hospital or the historically unequal relationship between physicians and nurses, may complicate dilemmas. The primary, underlying reason that ethical dilemmas occur is that there are no clear cut, universally accepted solutions to a problem when participating individuals do not share the same values. Without clarification of values, the nurse may not be able to distinguish fact from opinion or value, and this can lead to judgmental attitudes.
If wrong: Poor communication and the hierarchical systems that exist in health care, such as reporting structures within the hospital or the historically unequal relationship between physicians and nurses, may complicate dilemmas. The primary, underlying reason that ethical dilemmas occur is that there are no clear cut, universally accepted solutions to a problem when participating individuals do not share the same values. Without clarification of values, the nurse may not be able to distinguish fact from opinion or value, and this can lead to judgmental attitudes.

Q: When people work together to solve ethical dilemmas, individuals must examine their own values. This step is crucial to ensure that
- The group identifies the one correct solution.
- Fact is separated from opinion.
- Judgmental attitudes are not provoked.
- Different perspectives are respected.
A: Different perspectives are respected.
If right: Values are personal beliefs that influence opinions. To be able to negotiate differences in opinions, the nurse must first be clear about personal values, which will influence behaviors, decisions, and actions. Ethical dilemmas are a problem in that no one right solution exists.
If wrong: Values are personal beliefs that influence opinions. To be able to negotiate differences in opinions, the nurse must first be clear about personal values, which will influence behaviors, decisions, and actions. Ethical dilemmas are a problem in that no one right solution exists.

Q: A patient’s condition is slowly deteriorating. What actions should the nurse take to provide the best care possible? (Select all that apply.)
- Allow the nursing student to receive verbal orders from the physician in the room while the nurse is in the medication area down the hall.
- Document the patient’s status changes in the medical record in a timely manner.
- Document that the health care provider has been notified of the specific patient status, including date and time that messages were left.
- Check the chart for frequent orders.
- Omit charting what the health provider’s response is to notification of the patient’s status change.
A: Allow the nursing student to receive verbal orders from the physician in the room while the nurse is in the medication area down the hall.; Document the patient’s status changes in the medical record in a timely manner.
If right: Clear, concise, and timely communication is essential whenever charting in the patient’s medical record occurs. Nursing students are not permitted to receive verbal orders. Documentation regarding communication with the health care provider must contain what was communicated by the nurse and the health care provider, orders if given, date, time, and identification of who is documenting the situation.
If wrong: Clear, concise, and timely communication is essential whenever charting in the patient’s medical record occurs. Nursing students are not permitted to receive verbal orders. Documentation regarding communication with the health care provider must contain what was communicated by the nurse and the health care provider, orders if given, date, time, and identification of who is documenting the situation.

Q: A nurse works full-time on the oncology unit at the hospital and works part-time on weekends giving immunizations at the local pharmacy. While giving an injection on a weekend, the nurse caused injury to the patient’s arm and is now being sued. How will the hospital’s malpractice insurance provide coverage for this nurse?
- It will provide coverage as long as the nurse followed all procedures, protocols, and policies correctly.
- The hospital’s malpractice insurance covers this nurse only during the time the nurse is working at the hospital.
- As long as the nurse has never been sued before this incident, the hospital’s malpractice insurance will cover the nurse.
- The hospital’s malpractice insurance will provide approximately 50% of the coverage the nurse will need.
A: The hospital’s malpractice insurance covers this nurse only during the time the nurse is working at the hospital.
If right: Malpractice insurance provided by the employing institution covers nurses only while they are working within the scope of their employment at that institution. It is always wise to find out if malpractice insurance is provided by a secondary place of employment, in this case, the pharmacy, or the nurse should carry an individual malpractice policy to cover situations such as this.
If wrong: Malpractice insurance provided by the employing institution covers nurses only while they are working within the scope of their employment at that institution. It is always wise to find out if malpractice insurance is provided by a secondary place of employment, in this case, the pharmacy, or the nurse should carry an individual malpractice policy to cover situations such as this.

Q: A nursing student in the final term of nursing school is overheard by a nursing faculty member telling another student that she got to insert a nasogastric tube in the emergency department while she was working as a nursing assistant. What advice is best for the nursing faculty member to give to the nursing student?
- “Just be careful when you are doing new procedures and make sure you are following directions by the nurse.”
- “Review your procedures before you go to work, so you will be prepared to do them if you have a chance.”
- “The nurse should not have allowed you to insert the nasogastric tube because something bad could have happened.”
- “You are not allowed to perform any procedures other than those in your job description even with the nurse’s permission.”
A: “You are not allowed to perform any procedures other than those in your job description even with the nurse’s permission.”
If right: When nursing students work as nursing assistants or nurse’s aides when not attending classes, they should not perform tasks that do not appear in a job description for a nurse’s aide or assistant. The nursing student should always follow the directions of the nurse, unless doing so violates the institution’s guidelines or job description under which the nursing student was hired. The nursing student should be able to safely complete the procedures delegated as a nursing assistant, and reviewing those not done recently is a good idea, but it has nothing to do with the situation. This option does not address the situation that the nursing student acted outside the job description for the nursing assistant position. The focus of the discussion between the nursing faculty member and the nursing student should be on following the job description under which the nursing student is working.
If wrong: When nursing students work as nursing assistants or nurse’s aides when not attending classes, they should not perform tasks that do not appear in a job description for a nurse’s aide or assistant. The nursing student should always follow the directions of the nurse, unless doing so violates the institution’s guidelines or job description under which the nursing student was hired. The nursing student should be able to safely complete the procedures delegated as a nursing assistant, and reviewing those not done recently is a good idea, but it has nothing to do with the situation. This option does not address the situation that the nursing student acted outside the job description for the nursing assistant position. The focus of the discussion between the nursing faculty member and the nursing student should be on following the job description under which the nursing student is working.

Q: Conjoined twins are in the neonatal department of the community hospital until transfer to the closest medical center. A photographer from the local newspaper gets off the elevator on the neonatal floor and wants to take pictures of the infants. What initial action should the nurse take?
- Escort the cameraman to the neonatal unit while a few pictures are taken quietly.
- Tell the cameraman where the hospital’s public relations department is located.
- Ask the cameraman to wait while permission is obtained from the physician.
- Ask the cameraman how the pictures are to be used in the local newspaper.
A: Tell the cameraman where the hospital’s public relations department is located.
If right: In some cases, information about a scientific discovery or a major medical breakthrough or an unusual situation is newsworthy. In this case, anyone seeking information needs to contact the hospital’s public relations department to ensure that invasion of privacy does not occur. It is not the nurse’s responsibility to decide independently the legality of disclosing information. The nurse does not have the right to allow the cameraman access to the neonatal unit. This would constitute invasion of privacy. The physician has no responsibility regarding this situation and cannot allow the cameraman on the unit. It is not the nurse’s responsibility to find out how the pictures are to be used. This is a task for the public relations department.
If wrong: In some cases, information about a scientific discovery or a major medical breakthrough or an unusual situation is newsworthy. In this case, anyone seeking information needs to contact the hospital’s public relations department to ensure that invasion of privacy does not occur. It is not the nurse’s responsibility to decide independently the legality of disclosing information. The nurse does not have the right to allow the cameraman access to the neonatal unit. This would constitute invasion of privacy. The physician has no responsibility regarding this situation and cannot allow the cameraman on the unit. It is not the nurse’s responsibility to find out how the pictures are to be used. This is a task for the public relations department.

Q: A patient is being discharged home. Which information should the nurse include?
- Acuity level
- Community resources
- Standardized care plan
- Kardex
A: Community resources
If right: Discharge documentation includes medications, diet, community resources, follow-up care, and whom to contact in case of an emergency or for questions. A patient’s acuity level, usually determined by a computer program, is based on the type and number of nursing interventions (e.g., intravenous [IV] therapy, wound care, ambulation assistance) required over a 24-hour period. Acuity level can be used for staffing and billing. Some institutions use standardized care plans to make documentation more efficient. The plans, based on the institution’s standards of nursing practice, are preprinted, established guidelines used to care for patients who have similar health problems. In some settings, a Kardex, a portable “flip-over” file or notebook, is kept at the nurses’ station. Most Kardex forms have an activity and treatment section and a nursing care plan section, which organize information for quick reference.
If wrong: Discharge documentation includes medications, diet, community resources, follow-up care, and whom to contact in case of an emergency or for questions. A patient’s acuity level, usually determined by a computer program, is based on the type and number of nursing interventions (e.g., intravenous [IV] therapy, wound care, ambulation assistance) required over a 24-hour period. Acuity level can be used for staffing and billing. Some institutions use standardized care plans to make documentation more efficient. The plans, based on the institution’s standards of nursing practice, are preprinted, established guidelines used to care for patients who have similar health problems. In some settings, a Kardex, a portable “flip-over” file or notebook, is kept at the nurses’ station. Most Kardex forms have an activity and treatment section and a nursing care plan section, which organize information for quick reference.

Q: A nurse needs to begin discharge planning for a patient admitted with pneumonia and a congested cough. When is the best time the nurse should start discharge planning for this patient?
- Upon admission
- Right before discharge
- After the congestion is treated
- When the primary care provider writes the order
A: Upon admission
If right: Ideally, discharge planning begins at admission. Right before discharge is too late for discharge planning. After the congestion is treated is also too late for discharge planning. Usually the primary care provider writes the order too close to discharge, and nurses do not need an order to begin the teaching that will be needed for discharge. By identifying discharge needs early, nursing and other health care professionals can begin planning for home care, support services, and any equipment needs at home.
If wrong: Ideally, discharge planning begins at admission. Right before discharge is too late for discharge planning. After the congestion is treated is also too late for discharge planning. Usually the primary care provider writes the order too close to discharge, and nurses do not need an order to begin the teaching that will be needed for discharge. By identifying discharge needs early, nursing and other health care professionals can begin planning for home care, support services, and any equipment needs at home.

Q: A nurse is a member of an interdisciplinary team that uses critical pathways. According to the critical pathway, on day 2 of the hospital stay, the patient should be sitting in the chair. It is day 3, and the patient cannot sit in the chair. What should the nurse do?
- Focus charting using the DAR format.
- Add this data to the problem list.
- Document the variance in the patient’s record.
- Report a positive variance in the next interdisciplinary team meeting.
A: Document the variance in the patient’s record.
If right: A variance occurs when the activities on the critical pathway are not completed as predicted, or the patient does not meet expected outcomes. An example of a variance is when a patient develops pulmonary complications after surgery, requiring oxygen therapy and monitoring with pulse oximetry. A positive variance occurs when a patient progresses more rapidly than expected (e.g., use of a Foley catheter may be discontinued a day early). When a nurse is using the problem-oriented medical record, after analyzing data, health care team members identify problems and make a single problem list. A type of narrative format charting is focus charting. It involves the use of DAR notes, which include D—Data (both subjective and objective), A—Action or nursing intervention, and R—Response of the patient (i.e., evaluation of effectiveness).
If wrong: A variance occurs when the activities on the critical pathway are not completed as predicted, or the patient does not meet expected outcomes. An example of a variance is when a patient develops pulmonary complications after surgery, requiring oxygen therapy and monitoring with pulse oximetry. A positive variance occurs when a patient progresses more rapidly than expected (e.g., use of a Foley catheter may be discontinued a day early). When a nurse is using the problem-oriented medical record, after analyzing data, health care team members identify problems and make a single problem list. A type of narrative format charting is focus charting. It involves the use of DAR notes, which include D—Data (both subjective and objective), A—Action or nursing intervention, and R—Response of the patient (i.e., evaluation of effectiveness).

Q: A nurse is using the source record and wants to find the daily weights. Where should the nurse look?
- Database
- Medical history and examination
- Progress notes
- Graphic sheet and flow sheet
A: Graphic sheet and flow sheet
If right: In a source record, the patient’s chart has a separate section for each discipline (e.g., nursing, medicine, social work, respiratory therapy) in which to record data. Graphic sheets and flow sheets are records of repeated observations and measurements such as vital signs, daily weights, and intake and output. In the problem-oriented medical record, the database section contains all available assessment information pertaining to the patient (e.g., history and physical examination, the nurse’s admission history and ongoing assessment, the dietitian’s assessment, laboratory reports, radiologic test results). In the source record, the medical history and examination contain results of the initial examination performed by the physician, including findings, family history, confirmed diagnoses, and medical plan of care. In the source record, the progress notes contain an ongoing record of the patient’s progress and response to medical therapy and a review of the disease process; it often is interdisciplinary and includes documentation from health-related disciplines (e.g., health care providers, physical therapy, social work).
If wrong: In a source record, the patient’s chart has a separate section for each discipline (e.g., nursing, medicine, social work, respiratory therapy) in which to record data. Graphic sheets and flow sheets are records of repeated observations and measurements such as vital signs, daily weights, and intake and output. In the problem-oriented medical record, the database section contains all available assessment information pertaining to the patient (e.g., history and physical examination, the nurse’s admission history and ongoing assessment, the dietitian’s assessment, laboratory reports, radiologic test results). In the source record, the medical history and examination contain results of the initial examination performed by the physician, including findings, family history, confirmed diagnoses, and medical plan of care. In the source record, the progress notes contain an ongoing record of the patient’s progress and response to medical therapy and a review of the disease process; it often is interdisciplinary and includes documentation from health-related disciplines (e.g., health care providers, physical therapy, social work).

Q: The nurse is working the night shift on a surgical unit and is making 4 AM rounds. She notices that the patient’s temperature is 96.8° F (36° C), whereas at 4 PM the preceding day, it was 98.6° F (37° C). What should the nurse do?
- Call the physician immediately to report a possible infection.
- Realize that this is a normal temperature variation.
- Provide another blanket to conserve body temperature.
- Provide medication to lower the temperature further.
A: Realize that this is a normal temperature variation.
If right: Body temperature normally changes 0.5° C to 1° C (0.9° F to 1.8° F) during a 24-hour period and is usually lowest between 1:00 and 4:00 AM, making this variation normal for the time of day. Unless the patient is complaining of being cold, there is no physiological need for providing an extra blanket or medication to lower the body temperature further. There is also no need to call a physician to report a normal temperature variation.
If wrong: Body temperature normally changes 0.5° C to 1° C (0.9° F to 1.8° F) during a 24-hour period and is usually lowest between 1:00 and 4:00 AM, making this variation normal for the time of day. Unless the patient is complaining of being cold, there is no physiological need for providing an extra blanket or medication to lower the body temperature further. There is also no need to call a physician to report a normal temperature variation.

Q: The nurse is caring for a patient who is being discharged from the hospital after being treated for hypertension. The patient is instructed to take his blood pressure three times a day and to keep a record of the readings. The nurse recommends that the patient purchase a portable electronic blood pressure device. The nurse also instructs the patient that the
- Patient can apply the cuff in any manner he chooses because the machine is designed to be used by nonprofessionals.
- Machine requires frequent calibration to ensure accuracy.
- Cuff can be placed over clothing if necessary.
- Machine is accurate when blood pressures are low.
A: Machine requires frequent calibration to ensure accuracy.
If right: Electronic devices are easier to manipulate but require frequent recalibration—more than once a year. Because of their sensitivity, improper cuff placement or movement of the arm causes electronic devices to give incorrect readings. Stationary blood pressure devices are often found in public places, and the cuff fits over clothing. The same is not true for portable devices. Electronic blood pressure measurement is not recommended when pressure is less than 90 mm Hg systolic.
If wrong: Electronic devices are easier to manipulate but require frequent recalibration—more than once a year. Because of their sensitivity, improper cuff placement or movement of the arm causes electronic devices to give incorrect readings. Stationary blood pressure devices are often found in public places, and the cuff fits over clothing. The same is not true for portable devices. Electronic blood pressure measurement is not recommended when pressure is less than 90 mm Hg systolic.

Q: The nurse is caring for a patient who has a temperature reading of 100.4° F (38° C). His last two temperature readings were 98.6° F (37° C) and 96.8° F (36° C). The nurse should
- Call the physician and anticipate an order to treat the fever.
- Assume that the patient has an infection and order blood cultures.
- Wait an hour and recheck the patient’s temperature.
- Be aware that temperatures this high are harmful and affect patient safety.
A: Wait an hour and recheck the patient’s temperature.
If right: Waiting an hour and rechecking the patient’s temperature would be the most appropriate action in this case. A fever usually is not harmful if it stays below 102.2° F (39° C), and a single temperature reading does not always indicate a fever. In addition to physical signs and symptoms of infection, a fever determination is based on several temperature readings at different times of the day compared with the usual value for that person at that time. Mild temperature elevations enhance the body’s immune system by stimulating white blood cell production. Usually, staff nurses do not order blood cultures, and nurses should base actions on knowledge, not on assumptions.
If wrong: Waiting an hour and rechecking the patient’s temperature would be the most appropriate action in this case. A fever usually is not harmful if it stays below 102.2° F (39° C), and a single temperature reading does not always indicate a fever. In addition to physical signs and symptoms of infection, a fever determination is based on several temperature readings at different times of the day compared with the usual value for that person at that time. Mild temperature elevations enhance the body’s immune system by stimulating white blood cell production. Usually, staff nurses do not order blood cultures, and nurses should base actions on knowledge, not on assumptions.

Q: The nurse is caring for a patient who complains of feeling light-headed and “woozy.” The nurse checks the patient’s pulse and finds that it is irregular. The patient’s blood pressure is 100/72. It was 113/80 an hour earlier. What should the nurse do?
- Call the physician immediately.
- Perform an apical/radial pulse assessment.
- Apply more pressure to the radial artery to assess the pulse.
- Use his thumb to detect the patient’s pulse.
A: Perform an apical/radial pulse assessment.
If right: If the pulse is irregular, do an apical/radial pulse assessment to detect a pulse deficit. If pulse count differs by more than 2, a pulse deficit exists, which sometimes indicates alterations in cardiac output. The nurse needs to gather as much information as possible before calling the physician. The radial pulse is more accurately assessed with moderate pressure. Too much pressure occludes the pulse and impairs blood flow. Fingertips are the most sensitive parts of the hand to palpate arterial pulsations. The thumb has a pulsation of its own that interferes with accuracy.
If wrong: If the pulse is irregular, do an apical/radial pulse assessment to detect a pulse deficit. If pulse count differs by more than 2, a pulse deficit exists, which sometimes indicates alterations in cardiac output. The nurse needs to gather as much information as possible before calling the physician. The radial pulse is more accurately assessed with moderate pressure. Too much pressure occludes the pulse and impairs blood flow. Fingertips are the most sensitive parts of the hand to palpate arterial pulsations. The thumb has a pulsation of its own that interferes with accuracy.

Q: The patient has a temperature of 105.2° F. The nurse is attempting to lower his temperature by providing tepid sponge baths and placing cool compresses in strategic body locations. The nurse is attempting to lower the patient’s temperature through the use of
- Radiation.
- Conduction.
- Convection.
- Evaporation.
A: Conduction.
If right: Applying an ice pack or bathing a patient with a cool cloth increases conductive heat loss. Radiation is the transfer of heat from the surface of one object to the surface of another without direct contact between the two. Evaporation is the transfer of heat energy when a liquid is changed to a gas. Convection is the transfer of heat away from the body by air movement.
If wrong: Applying an ice pack or bathing a patient with a cool cloth increases conductive heat loss. Radiation is the transfer of heat from the surface of one object to the surface of another without direct contact between the two. Evaporation is the transfer of heat energy when a liquid is changed to a gas. Convection is the transfer of heat away from the body by air movement.