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DOS II FINAL EXAM
QUESTIONS AND ANSWERS
What are the three types of authorizing mechanisms? a) Medical directives, MD orders, NP orders b) Standing orders, medical directives, delegation c) MD orders, NP orders, directives d) Order, initiation, delegation Correct answer- D When initiating a controlled act, an RN or RPN must : (put the following into the correct order as per the CNO document Authorizing Mechanisms)
- Assess the client and identify the problem
- Anticipate the management of potential outcomes
- Decide on a course of action
- Accept accountability for deciding the particular procedure is required and for ensuring that any potential outcomes are managed appropriately
- Weight the risks and benefits of each option, considering the clients condition
- Consider all of the available options to address the problem Correct answer- 1,6,5,3,2, The nurse provides immunizations to a primary school class of 40 patients Correct answer- Medical directive The nurse provides her patient with 500 mg of Tylenol to treat the patients headache Correct answer- Order The nurse goes through a formal process to allow a family member provide wound care to the client Correct answer- Delegation The nurse in the community independently decides it is the patients best interest to have an I/O catheter to address the patients urinary retention Correct answer- Initiation A patient needs to have emergent surgery. The patient will need intravenous access for the surgery. The RPN starts the patient's IV. What will she need to be able to do this? a) Nothing, she is able to initiate this procedure b) An order c) A medical directive d) Permission from the CNO Correct answer- B Which Controlled Acts are authorized to nurses?
- Performing allergy testing
- Dispensing a drug
- Treating by means of psychotherapy technique
- Putting a hand, instrument or finger beyond a natural or artificial opening of the body
- Managing labour, or conducting a delivery
- Performing a prescribed procedure below the dermis or mucous membrane
- Administering a substance by inhalation or injection Correct answer- 2,3,4,6, An RPN orders an RPN colleague to insert a urinary catheter for a newly admitted patient. a) Confirm RPN order with MD before proceeding b) Accept the order and proceed with the intervention c) Consult with an RN before proceeding d) Decline to accept the order Correct answer- D Shannon is an RN in an urban hospital and a preceptor for Mei, a nursing student on a clinical placement. Sharon has a client who requires urinary catheterization. Sharon introduces Mei to the client and asks for consent to allow Mei to perform the procedure. After the client agrees, Sharon supervises Mei as she inserts the catheter. It was appropriate for Sharon to allow to perform this controlled act. True or False? Correct answer- True A professional standard is an authoritative statement that sets out the legal and professional basis of nursing practice. All nurses are held to the same standard throughout their careers a) True b) False Correct answer- A Which of the following are NOT entry to Practice requirements? a) Successful completion of the nursing education requirements b) Proof of citizenship, permanent residency or authorization under the immigration protection act c) Obtain a minimum average of 70% on your academic record d) Successful of the jurisprudence exam Correct answer- C Which of the following is NOT considered one of the roles of the CNO in supporting Nursing Self Regulation? a) Establishing requirements for entry to practice b) Administering the QA program c) Developing and Reviewing Nursing Curriculum d) Articulating, Promoting, and Enforcing Standards of practice Correct answer- C The Registered Health Professions Act applies to all of the following except: a) Nurses b) Physiotherapists c) Paramedics d) Physicians Correct answer- C The purpose of entry to practice competencies are the following except: a) Inform the public about what they can expect from the nurses
The College of Nurses of Ontario assess the knowledge, skill and judgement of members by asking them to complete the CNO's Quality Assurance Program. The purpose of the QA program includes which of the following (select all that apply). a) Support nurses in practicing according to CNO's standards of practice b) Increase the public's confidence in the nursing profession c) Help nurses develop the practice areas in which they have identified learning need d) Ensure that nurses pay their registration each year to maintain their membership Correct answer- A,B,C Environmental factors that influence decision-making regarding RPN assignments include: a) Charge Nurse Qualifications b) Practice Supports c) Predictability of the Environment d) Experience of the Nurse e) Acuity of the Client Correct answer- B,C Nurses participate in the QA program a) Annually b) Every 3 years c) Upon graduation d) When called upon by the College Correct answer- A The three factor framework considers: a) Model of care of a particular hospital b) The relevance of the assignment c) Standardized policies of the community d) Predictability of the Client Correct answer- D The Quality Assurance Program includes all except: a) Practice Reflection b) Learning Goals c) Exam d) Learning Plan Correct answer- C Lucy is a RPN working on a medical unit. She is the Charge Nurse today and is formulating the assignments for the evening shift. Lucy knows she must consider the 3 factor framework when deciding Nursing assessment. Which of the following should she recognize? a) Environment is the most important factor in the 3 factor framework b) RPNs are expected to meet a wide range of nursing care needs for complex and unpredictable patients c) When consulting with a RN impacts the RPNs ability to provide efficient and appropriate care, then care should be transferred to the RN d) RPNs may autonomously care for clients for whom signs and symptoms of complications may be subtle Correct answer- C
How many learning goals are nurses in the General Class (RNs & RPNs) required to develop and achieve each year? a) 2 b) 3 c) 5 d) 1 Correct answer- A Complaints regarding nursing practice are often made to the College of Nurses. Which of the following complaints must the College of Nurses address? (Select all that apply) a) Repeatedly not following the 8 rights of medication administration b) The facility where the nurse works is always short staffed c) A person observes a nurse sexually assaulting a patient d) The complaint is anonymous e) The nurse takes money from a sleeping patients personal belongings f) A witness saw a nurse cut someone off in traffic Correct answer- A,C,E The nurse restrains a patient without the patient's permission and without a physician's order. the nurse may be found guilty of what type of tort? a) Assault b) False imprisonment c) Invasion of privacy d) Neglect Correct answer- B Mandatory reporting requirements for the college of nurses apply to all regulated health care providers, employers and facility operators. a) True b) False Correct answer- B In the CBC article about Spencer Sullivan, his nurse Rose McKenzie was alleged to have committed all of the following acts, except: a) Over-medicating the patient by administering drugs ordered by 2 separate doctors without question b) Failing to monitor and document appropriately, leaving hours between checks c) Not recognizing that her IV fluids were mismanaged and putting Spencer into fluid volume excess d) Failing to respond quickly enough when Spencer stopped breathing Correct answer- C A nurse has been charge with negligence and a family is suing the nurse and hospital for damages. What must a lawyer prove for the nurse to be found guilty of negligence? a) Assault, battery, false imprisonment, or invasion of privacy b) Assault, battery, false imprisonment and invasion of privacy c) Carelessness, thoughtlessness and inattention d) Duty, Breech, Harm and Causation Correct answer- D What category of law does the Nursing Act fall under?
What is a nurse required to self report to the CNO? a) If (s)he makes a medication error b) If (s)he is diagnosed with a brain tumor c) If (s)he is off work due to illness for more than two weeks d) If (s)he has been charged with a crime in their jurisdiction or another jurisdiction Correct answer- D Complaints regarding nursing practice are often made to the CNO. Which of the following complaints must the CNO address? (Select all that apply) a) A person observes a nurse sexually assaulting a patient b) The facility where the nurse works is always short staffed c) The nurse takes money from a sleep patients personal belongings d) A witness saw a nurse cut someone off in traffic e) Repeatedly not following the 8 rights of medication administration f) The complaint is anonymous Correct answer- A,C,E If a nurse is found guilty of professional misconduct by the Disciplinary Committee, there can be several consequences to the nurse. Which of the following is NOT included in the list of the consequences the Disciplinary Committee can assign? a) Revoking a nurses license to practice b) Suspension for an assigned period of time c) Pay a fine to the CNO d) Appear before the Disciplinary Committee for a reprimand Correct answer- C Mandatory reporting requirements for the CNO apply to all regulated health care providers, employers and facility operators. a) True b) False Correct answer- B An employer is required to do mandatory reporting to the CNO about a nurse's professional negligence in another jurisdiction. a) True b) False Correct answer- B When a complaint is resolved through the Alternate Dispute Resolution all communication between parties and investigator must remain confidential and it is not made known to the public. a) True b) False Correct answer- A When addressing complaints investigators are used in the investigation process. When will an investigator be appointed? a) When the ICRC reviews a resolved complaint through the ADR and decides it needs an investigator b) Investigator will be appointed if the complaint is not appropriate for ADR
c) The nurse and college reach a resolution agreement d) Investigators are appointed for all professional misconducts Correct answer- B Which of the following health care professionals can administer a substance with the intent of causing medical assistance in death? a) Physicians, Physician Assistants & Nurse Practitioners b) Physicians & Nurses c) Physicians & Nurse Practitioners d) Nurses & Pharmacists Correct answer- C The nurse is caring for a patient who has requested to receive medical assistance in death. The patient must put their request in writing obtain two signatures of witnesses to their request. The nurse may act as a witness for this patient's request. a) True b) False Correct answer- B Our values systems stay fairly stable throughout life, however, if our value systems do change they do so as a result of education and exposure to clinical practice. a) True b) False Correct answer- B Once a patient has made the request for medical assistance in death, there is a mandatory waiting period between when they sign their request and when they can receive MAID. As per Bill C-14 (MAID Legislation) what is the waiting period that is required by law? a) 24 hours b) 5 days c) 10 days d) 2 weeks Correct answer- C Please match the ethical values with the correct definition.
- Client well-being
- Client choice
- Veracity
- Fairness
- Respect for life a) Facilitating clients health and welfare, and preventing or removing harm b) Human life is precious and needs to be respected, protected and treated with consideration c) Allocating resources on the basis of objective health related factors d) Speaking or acting without the intent to deceive e) Self-determination to consent or refuse care Correct answer- 1. A
- E
- D
- C
- B
As an RPN I may delegate to an UCP all except a) Initiation of a dressing change b) Administration of puffers c) Family member changing a dressing at home d) Feeding of a patient Correct answer- A The three factor framework considers; a) Model of care of a particular hospital b) Standardized policies of the community c) The relevance of the assignment d) Predictability of client Correct answer- D When considering assignments in nursing the following should be considered; a) Stability, predictability, acuity b) Complexity, predictability, negative outcomes c) Stability, needs, negative outcomes d) Predictability, complexity, stability Correct answer- B Nurses participate in the QA program; a) Annually b) Upon graduation c) Every 3 years d) When called upon by the college Correct answer- A An RPN orders an RPN colleague to insert a urethral catheter into a newly admitted client. a) Confirm the order with MD before proceeding b) Consult with an RN before proceeding with the intervention c) Accept the order and proceed with the intervention d) Decline to accept the order Correct answer- D With respect to medications all are correct except; a) Nurses may prescribe certain medications b) May be found negligent if following an unclear order c) Must know purpose of the medications administered d) Responsibility to question unclear orders Correct answer- A What are the types of authorizing mechanisms? a) Medical directives, MD orders, NP orders b) Physician orders, MD orders, directives c) Standing order, medical directive, delegation d) Orders, delegation, directives Correct answer- D What is not an example of a medical directive? a) Order for acetaminophen when temp 38. b) Order for changing a dressing TID
c) Orders for managing hypoglycemia d) Orders for starting an IV in emerge Correct answer- B What is considered not to be a delegated controlled act to nursing? a) Administering puffers b) Dispensing a drug c) Applying energy d) Packing a wound Correct answer- C The QA program includes all except; a) Practice reflection b) Exam c) Learning plan d) Learning goals Correct answer- B A person utters a verbal threat. This would be considered; a) Assault b) Battery c) Unintentional tort d) Negligence Correct answer- A Fitness to practice concerns; a) Reported misconduct b) Misappropriating funds c) Mental and physical capacity d) Ability to practice Correct answer- C If there is a complaint to the college it could go to one of these except; a) Employer recommendation b) Alternative disputes committee c) Investigation d) Hearing Correct answer- A Jane, an RPN student, is telling her friend about the role of the PSW. What statement identifies that Jane understands the PSW's role when working alongside an RPN. a) The PSW role is to assist clients to accomplish the tasks of everyday living and administer oral and/or subcutaneous medications that are a part of their ADLs so that they can enhance their lives b) PSWs assist clients with personal care, home management, family responsibilities, social/recreational activities and tasks of everyday living to enhance their lives c) PSWs improve the client's quality of life by administering medications as delegated by a PSW/RPN/RN d) The role of PSWs are to provide care in a kind, sensitive and understanding manner, honor the client's right to confidentiality, delegates as needed for controlled acts II and III and displays empathy Correct answer- B
When caring for a client living with diabetes, a PSW may be permitted to administer insulin by injection if it meets which of the following conditions? a) The outcomes are predictable b) The PSW has been taught how to perform the procedure for that specific patient c) The outcomes are not yet established d) It is considered a routine activity of daily living e) The clients condition is stable Correct answer- A,B,D,E A new RPN is working in your unit and is asking if it would be ok for her to delegate a bed bath to one of the PSW's. You tell her it is not necessary to delegate this task because an RPN only needs to delegate tasks that involve one of the controlled acts. a) True b) False Correct answer- A Interprofessional Collaborative Practice is defined as "multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers, and communities to deliver the highest quality of care across settings." According to the CNA, what are implications of interprofessional collaborative practice? a) Reduced wait times b) Healthy workplaces c) Improved patient safety d) Lack of access to remote regions e) Community engagement f) Chronic disease management Correct answer- A,B,C,F Once taught how to perform a controlled act, an unregulated care provider can perform that act on any patient under their care, where the act is considered an activity of daily living. a) True b) False Correct answer- B When delegating to person support workers an RPN must remember all of the following except: a) The fact that each delegated task is client or resident specific should always be kept in mind b) Personal support workers (UCP) cannot perform a controlled act unless the authority is delegated to the support worker by a regulated health professional c) Once delegated, specific guidelines and outlines must be met and followed in order for the task to be continually performed d) If the personal support worker has the knowledge, skill and judgement they can perform the controlled act independently Correct answer- D What are the sources of conflict in healthcare? Check all that apply. a) Client or Family b) Technology
c) High levels of resources d) Visitors e) Healthcare team or colleagues f) Management Expectations/Values Correct answer- A,D,E,F The CNO refers to conflict as "a power struggle in which a person intends to harass, neutralize, injure or eliminate a rival." What are the two types of conflicts that can occur? a) Intrapersonal: deriving from within an individual; Interpersonal: represents a clash between two or more people b) Relationship conflict: a clash between two or more people; Intrapersonal Conflict: deriving from within an individual c) Intrapersonal represents a clash between two or more people; Interpersonal: deriving from within an individual d) Internal conflict: between a character and an outside force; External conflict: within the character's mind Correct answer- A The College of Nurses of Ontario has created a Practice Guideline for Conflict Prevention & Management. What statement does NOT identify the correct prevention and management strategy for nurse-client conflict? a) Ask open-ended questions to establish the underlying meaning of the client's behaviour; remain calm and encourage the client to express his/her concerns; avoid arguing, criticizing, defending or judging b) Reflect to understand how her/his behaviour and values may negatively affect the client; address conflict directly rather than avoiding or postponing its resolution c) Acknowledge the client's concerns about the health care system and his/her experiences as a client; respect and address the client's wishes, concerns, values, priorities and point of view d) Use open body language and display to calm, respectful and attentive attitude; involve the client, the client's family and the health care team members in assisting with the behaviour and developing solutions to prevent or manage it Correct answer- D A nurse arrives late for each shift. What statement identifies that the Charge Nurse uses the CARE approach effectively? a) Identifies the problem of arriving late to colleague; Reports colleague to management; documents why arriving late is a problem; encourages the nurse to change b) Clarify that arriving late is a problem; documents why the behaviour is a problem; request management to get involved in the problem behaviour; encourage change c) Charge nurse clarifies to his colleague that arriving late is a problem; he articulates why arriving late is a problem; request a change in arriving late; and encourages the nurse to change d) Charge nurse identifies that the behavior of arriving late is a problem; articulates why arriving late is a problem; request for a change in unit; demands the nurse to change Correct answer- C You and your peer, Juan, have been assigned to work together on a nursing presentation. You both have different approaches on how to do the presentation; however, each
The Thomas-Kilmann model illustrates the options we have when handling conflicts. There are two dimensions in the model. Which statement illustrates the co-operativeness dimension? a) The co-operativeness dimension is on the horizontal axis and is concerned with conflict responses based on our attempt to get what we want b) This dimension is on the vertical axis and is concerned with responses based on helping others get what they want c) This dimension is on the horizontal axis and is concerned with responses based on helping others get what they want d) The Co-operativeness dimension is on the vertical axis and is concerned with conflict responses based on our attempt to get what we want Correct answer- C What statement does NOT correctly identify when conflicts can occur? a) When there are hidden messages b) Feelings stated mildly will usually cause a defensive reaction c) Feelings are projected onto others; feelings are denied d) Emotions distorts the issue Correct answer- B What are the key components of assertive communications? Check all that apply. a) Make clear statements and use "I" statements b) Speak in a soft tone, using moderate pitch c) Assume responsibility for your feelings and wants d) Ensure verbal and nonverbal messages are incongruent e) Address only issues related to the current conflict f) Be tactful, demonstrating awareness for the other Correct answer- A,C,E,F Each of the following are reasons for nurses to engage in political activity and be politically aware, with the exception of: a) Nurses need to fight for equality with other interprofessional team members b) Nurses have a unique perspective and knowledge of health related issues c) Nurses are successful advocates d) Nurses have creditability with the public Correct answer- A Quality improvement processes would be an example of what type of change? a) Revolutionary change b) Evolutionary change c) Adaptation change d) Personal change Correct answer- B Lewin's model of change defines driving forces as the energy used to motivate change. Which of the following would be considered a driving force? a) Provincial funding for decreased wait times b) Continuing the status quo c) Professional restraint d) Staff skills to complete a task Correct answer- A
Nurses play a significant role in change, due to their inherent responsibility to the public. Therefore, they must be involved in advocating for change politically as well as being involved in advocating for both professional and clinical issues. a) True b) False Correct answer- A According to the Lewin's Management Change Model articles, some practical steps for using the framework include the following for change: a) Empower action, ensure strong support from senior management, dispel rumours, and determine what needs to change b) Communicate often, dispel rumours, empower action, and involve people in the process c) Dispel rumours, involve people in the process, empower action, promote support and training d) Communicate often, anchor the change, empower action, and involve people in the process Correct answer- B One of the factors that make nurses more politically aware is knowledge of the issue. What question could you ask yourself regarding knowledge of the issue? a) What needs are currently being met? b) Who will be disadvantaged? c) Is it economically feasible? d) Is the change reasonable, acceptable & realistic? Correct answer- A Political action is defines as the process of influencing a change in policy by affecting change in the workplace regarding clients and the allocation of clients' resources. a) True b) False Correct answer- B Align each step of Lewin's Change Model with the appropriate response from the change agent.
- Unfreezing
- Moving
- Re-freezing a) Positive feedback, encouragement & constructive criticism b) Time & communication c) Trust, education, motivation & enthusiasm Correct answer- 1C, 2B, 3A Susan, the nurse manager, had a staff meeting to inform the nurses of a new change in documentation. She spoke about resistance to change and that it is natural and expected due to anxiety, uncertainty, fear of failure and lack of understanding. a) True b) False Correct answer- A Match the type of change with the example provided.
- Personal change
b) False Correct answer- A The difference between leaders and managers is: a) Managers inspire a shared vision b) Mangers have followers c) Leaders handle daily issues with ease d) Leaders challenge the process Correct answer- D Which of the following leadership styles contributes to a supportive work environment? a) Autocratic leadership b) Permissive leadership c) Transformational leadership d) Transactional leadership Correct answer- C The difference between a democratic leadership style and an autocratic leadership style is that the leader works with management to make decisions offering guidance and allows for participative decision making. a) True b) False Correct answer- B Nurse leaders use transformational leadership practices to create and sustain healthy work. What statement identifies transformational leadership practices? a) Building relationships and trust, creating an empowering work environment b) Creating a culture that supports development of integrity and integration c) Focusing on leading change only d) Balancing competing values, ethics, goals and priorities Correct answer- A Good leaders have which type of attributes? a) Firm structure b) Loyalty c) Shared vision d) Knowledge of others Correct answer- C Which of the following are some common principles for transcribing orders? Identify all that apply. a) Orders may be legible b) Write in red or blue ink only c) All orders must be verified by a nurse d) Write an letter (eg. K, M or EC) beside your orders to identify what orders have been transcribed and where Correct answer- A,C,D The following order is an example of what type of order: Ampicillin 500mg IV q8h x 10 days a) STAT order b) One-time or Short series order c) Standing or Continuous order
d) Standing or Continuous order PRN Correct answer- B Sarah, a nursing student discovers with her friend why critical thinking is important to nursing. What statement by Sarah identifies that she understands the importance of critical thinking in nursing. a) Critical thinking is important to nursing because it is a set of skills that is central to the nursing practice. As critical thinker we do not reflect on our situation but we must look beyond the obvious b) Critical thinking is important to nursing because nurses must respond to unexpected situations, adapt and change as things happen, be able to prioritize and solve problems. As well as, advocate when necessary for their clients. c) Critical thinking is important because it is central to nursing practice and focuses only on being purposeful and using reflective reasoning. d) In nursing, critical thinking allows nurses to properly use their critical thinking skills to effectively respond to unexpected situations. However, critical thinking does not involve advocating for clients. Correct answer- B A nurse is completing the transfer of accountability (hand-off report) to the nurse on the next shift. Which information is critical for the nurse to report? a) The patient has a new pain medication, hydrocodone bitartrate and acetaminophen (Lortab) b) The patient had a good day with no complaints c) The family is poor and had to go on welfare d) The family is demanding and argumentative Correct answer- A Complex Critical Thinking is one of the three levels of critical thinking in nursing. At this level nurses analyze and examine choices more independently, consider other options and realize what conflicting solutions may exist. a) True b) False Correct answer- A SBAR is a framework for giving report. What does SBAR stand for? a) Solution, Background, assessment & Response b) Situation, Background, Assessment & Recommendation c) Situation, Background, Administration of medication & Response Correct answer- B The process to effective critical thinking includes the following three steps: Take information, Explain information and Use information. a) True b) False Correct answer- B Samantha says to a colleague, "I don't think those new blood pressure electronic machines will work. I'm going to keep using the manual cuffs." What barrier to critical thinking does Sarah's statement illustrate? a) Face-saving b) Conformity
