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WorksheetsS4 UNIT 1 REVIEW
Total questions: 138
Worksheet time: 1hrs 9mins
A nurse accepts an assignment that she believes is unsafe due to high acuity and lack of support staff. Which action best protects her nursing license under Texas law?
Refuse the assignment and leave the unit
Document concerns after the shift
Invoke Safe Harbor Peer Review before engaging in the assignment
Call the BON after the shift
Which task is within the RN scope of practice but NOT LVN scope?
Performing a focused assessment
Assisting in evaluation of patient response
Developing a nursing care plan
Implementing aspects of nursing care
A nurse witnesses another nurse diverting narcotics. What is the appropriate action?
Ignore unless patient harm occurs
Confront the nurse privately only
Report the violation as required by BON rules
Document in patient chart only
Which patient is an Emergency Severity Index (ESI) Level 1?
Abdominal pain needing labs
Chest pain stable
Prescription refill
Cardiac arrest
During the primary survey, which finding requires immediate intervention?
GCS of 14
Minor bleeding
Absent chest rise
Pain score 8/10
Which maneuver is used to open the airway in a trauma patient?
Head tilt–chin lift
Jaw thrust
Oropharyngeal airway insertion
Nasopharyngeal airway insertion
A mass casualty incident is best defined as:
Any disaster requiring CPR
Incident where patient casualties outnumber available resources
Any multi-car accident
Any ER crowding event
The FIRST priority in emergent burn management is:
Pain control
Fluid resuscitation
Airway protection
Wound debridement
A patient has 30% TBSA burns. Which IV access is expected?
One 22-gauge IV
PICC line only
Two large-bore IVs
No IV until UOP drops
Parkland formula for adults is:
2 mL × kg × TBSA
3 mL × kg × TBSA
4 mL × kg × TBSA
5 mL × kg × TBSA
When does Parkland fluid calculation timing begin?
At ED arrival
At IV start
At time of burn injury
After first void
A major complication during the emergent burn phase is:
Hypervolemia
Burn shock from fluid shifts
Sepsis
Renal stones
Circumferential chest burns can cause:
Improved ventilation
Decreased chest wall compliance
Bradycardia
Increased perfusion
A full-thickness burn is typically:
Moist and painful
Superficial and red
Pale/leathery and often painless
Only epidermal
Which urine output indicates adequate adult burn resuscitation?
10 mL/hr
20 mL/hr
30–50 mL/hr
80 mL/hr
A DNR order means:
No oxygen
No medications
No CPR
Stop all treatment
Palliative care differs from hospice in that palliative care:
Is only for dying patients
Focuses on symptom management at any stage of serious illness
Requires DNR
Excludes family
Which is an example of a violation of professional boundaries?
Providing emotional support
Lending a patient money
Explaining a procedure
Documenting objectively
Which statement reflects the nurse’s duty to the patient?
Follow facility policy first
Physician orders override nursing judgment
Patient safety supersedes facility policies
Refuse all unfamiliar tasks
Which situation is NEVER considered a minor incident?
Documentation error
Late medication
Error contributing to patient death
Minor delay in assessment
Which is a service provided by the Texas Board of Nursing (TBON)?
Salary negotiation support
Job placement services
Audit of continuing education hours
Conflict mediation between coworkers
Which is NOT a service provided by the Texas Board of Nursing (TBON)?
Licensing
Enforcement services
Legal referral services
Information services
A graduate nurse (GN) permit in Texas expires:
In 30 days
In 60 days
In 75 days
In 90 days
Texas continuing nursing education (CNE) requirements include:
10 hours every year
20 hours every 2 years
30 hours every 3 years
40 hours every 4 years
When is a nurse exempt from CE requirements in Texas?
Every renewal cycle
First-time license renewal
Every other renewal
If working full-time
How long should a nurse keep CNE records in Texas?
6 months
1 renewal cycle
Which criminal behavior must be disclosed to the BON?
Parking ticket
Speeding ticket
Jaywalking
Pending felony charge
Which is excluded from criminal behavior disclosure requirements?
Pending DWI
Class C misdemeanor like speeding
Assault charge
Prescription fraud
Name badge requirements include which information?
First name only
Last name only
Name and licensure level
Name and GPA
Under the Nurse Licensure Compact (eNLC), the nurse must:
Follow only home state laws
Follow only the facility policies
Follow the laws of the state where currently practicing
Follow the laws of whichever state is stricter
When practicing in a remote compact state, violations are:
Handled only by the remote state
Not reported to the home state
Reported to the nurse’s home state board
Ignored if no patient harm occurred
Which statement best reflects "duty to the patient"?
Facility policy overrides nursing judgment
Physician order overrides the NPA
Nurse obligation to patient supersedes facility policy
The nurse has duty only when the provider is present
Which is true regarding Safe Harbor?
It protects from civil lawsuits
It protects the nurse’s license during unsafe assignments
It guarantees the assignment will be changed
It replaces peer review
If a situation improves after invoking Safe Harbor, the nurse may:
Withdraw the Safe Harbor request
Lose their license automatically
Be reported immediately to BON
Be required to resign
Mandatory overtime is NOT prohibited when:
Staffing is short on a regular day
The unit is busy
During a disaster
The nurse declines a lunch break
If a nurse believes they are being required to work prohibited mandatory overtime, the nurse should first report concerns to:
The media
Unit manager
The patient’s family
A coworker only
Texas NPA/BON rules:
Clearly define abandonment
Do not define abandonment
Define abandonment as leaving a job
Define abandonment as refusing overtime
If a nurse quits employment without accepting patient responsibility, this is primarily:
A BON violation
A licensure issue
An employment issue
A criminal offense
Which should the nurse do FIRST when concerned about a patient assignment?
Leave immediately
Clarify exactly what is being asked and why it feels unsafe
File a BON complaint
Tell the patient the assignment is unsafe
Minor incidents must be reported to peer review when they occur how many times in 12 months?
2
3
4
5
Which event is NEVER considered a minor incident?
A late assessment with no harm
A documentation error corrected quickly
An error contributing to death or serious harm
A delay in routine meds without injury
Peer review due process rights include:
No access to documents
No chance to respond
Opportunity to review documents and submit a response
Automatic termination
Which can lead to disciplinary action even if no patient injury occurs?
Only actions causing death
Acts are violations even without injury
Only actions reported by physicians
Only medication errors
If the BON finds a nurse at fault, remediation may include:
No education required ever
Remedial education and supervision
Immediate loss of license always
Permanent ban from nursing
The Texas Nursing Jurisprudence Exam is:
25 questions, must score 90%
50 questions, must score 75%
75 questions, must score 80%
100 questions, must score 70%
The jurisprudence exam must be passed:
After NCLEX
Before taking NCLEX
Only after first renewal
Only if the nurse is disciplined
During rapid assessment, AVPU stands for:
Airway, Ventilation, Pulse, Urine
Alert, Voice, Pain, Unresponsive
Assess, Verify, Protect, Update
Awake, Vitals, Pulse, Urgency
The primary survey includes which sequence?
OPQRST then SAMPLE
ABCs treated immediately if disrupted
Full head-to-toe assessment first
Pain management first
In the primary survey, "E" refers to:
ECG
Exposure and environmental control
Edema assessment
Evidence collection
The secondary survey includes:
AVPU only
SAMPLE history and OPQRST
Defibrillation first
Intubation always
Which airway technique is appropriate when trauma is suspected?
Head tilt–chin lift
Jaw thrust
Trendelenburg
Heimlich maneuver
A nasopharyngeal airway is appropriate when the patient:
Has a gag reflex
Has no gag reflex
Has no spontaneous respirations
Is post-intubation
C-spine management should be considered with:
Minor ankle sprain
Trauma with AMS or loss of consciousness
Mild nausea
Chronic back pain only
During cardiac arrest, the top priority is:
IV access
Intubation
Immediate, continuous high-quality chest compressions
Temperature management first
Reversible causes of cardiac arrest include:
Only hypoglycemia
H’s and T’s
Only infection
Only stroke
Targeted Temperature Management (TTM) is initiated after:
Any fever
Post-arrest ROSC
Any seizure
Any hypotension
TTM should be started within ____ and maintained for at least ____ with goal temp ____ °C.
12 hours; 48 hours; 36–38
6 hours; 24 hours; 32–36
24 hours; 72 hours; 30–32
2 hours; 12 hours; 35–37
Heat-related emergencies include:
Hypothermia only
Heat cramps, heat exhaustion, heatstroke
Frostbite only
Avalanche injury only
Cold-related emergencies include:
Heatstroke
Heat cramps
Frostbite and hypothermia
Snake bite and tick bite
Antivenom used for North American pit viper bites includes:
Narcan
CroFab
Epinephrine
Activated charcoal
In toxicology emergencies, the nurse should determine FIRST:
The patient's insurance
What the toxin is, amount, time, route
The patient’s past surgical history
The patient’s allergies only
A mass casualty incident (MCI) is:
Any event involving blood
Any incident where casualties outnumber available resources
Any triage in the ED
Any code blue
Burns are caused by injury from:
Heat only
Chemicals only
Electrical current only
Heat, chemicals, electrical current, or radiation
A key principle of chemical burn management is:
Neutralize with the opposite chemical immediately
Decontaminate first and flush with copious water
Apply ointment immediately
Cover tightly and transport without flushing
Chemical burn flushing should last at least:
2 minutes
5 minutes
10 minutes
20 minutes
Alkali burns are typically more severe because they cause:
Coagulation necrosis
Liquefaction necrosis
No tissue damage
Only superficial injury
Acid burns primarily cause:
Liquefaction necrosis
Coagulation necrosis
No cellular injury
Muscle spasm only
Hydrofluoric acid exposure may require treatment with:
Magnesium sulfate
Calcium gluconate
Sodium bicarbonate
Normal saline
Electrical burns are concerning because they can cause:
Only skin damage
Dysrhythmias and cardiac arrest
Only local redness
Only itching
Alternating current (AC) electrical injury is most associated with:
Asystole
Ventricular fibrillation
Bradycardia only
No cardiac issues
AC injuries often cause inability to pull away due to:
Muscle contractions
Paralysis from cold exposure
Severe itching
Low blood pressure
Direct current (DC) electrical injury is often associated with:
V-fib
Asystole
No cardiac effect
Only tachycardia
A major risk with full-thickness or major electrical burns is:
Hypercalcemia
Myoglobinuria leading to acute kidney injury
Hypoglycemia
Fluid overload always
Dark brown or red urine after a major electrical burn suggests:
Dehydration only
Hematuria unrelated
Myoglobinuria
Normal finding
In burn resuscitation, the MOST reliable guide to fluid needs is:
Blood pressure alone
Urine output
Heart rate alone
Temperature
Adult urine output goal for burn resuscitation is typically:
5–10 mL/hr
15–25 mL/hr
30–50 mL/hr
80–100 mL/hr always
When hourly urine output goals are not met, the nurse should anticipate:
Stop fluids
Increase IV fluid rate
Administer a diuretic
Maintain current fluid rate
Succinylcholine is contraindicated after major burns because of:
Decreased acetylcholine receptors
Upregulation of acetylcholine receptors in injured tissue
Hypokalemia risk only
It causes pain at injection site only
Escharotomy is performed to:
Reduce fever
Restore circulation/improve chest expansion
Remove blisters
Prevent nausea
The emergent (resuscitative) phase of burns lasts:
1 hour
First 24 hours after injury
Until grafting begins
Until discharge
The acute phase of burn care begins when:
Patient arrives to ED
Fluid resuscitation ends
Diuresis begins and wounds start healing
First dressing change occurs
The rehabilitative phase focuses on:
Fluid replacement
Airway stabilization
Restoring function and mobility
Shock prevention
Burn shock is primarily caused by:
Infection
Pain
Massive capillary leak and fluid shift to interstitial space
Dehydration from sweating
Increased capillary permeability in burns results in:
Hypervolemia
Hemoconcentration and hypovolemia
Hypoglycemia
Bradycardia
A burn >20% TBSA places the patient at high risk for:
Hyperkalemia only
Burn shock
Hypothermia only
Stroke
Which electrolyte abnormality is common early after major burns?
Hypokalemia
Hyperkalemia from cell destruction
Hyponatremia only
Hypercalcemia
Later in burn recovery, potassium levels often:
Stay elevated
Drop due to diuresis and fluid shifts
Become irrelevant
Cause arrhythmias only
Circumferential extremity burns can cause:
Improved circulation
Compartment syndrome and impaired distal perfusion
Decreased edema
Bradycardia
Signs of impaired perfusion in a burned limb include:
Warm skin and bounding pulse
Paresthesia, pallor, decreased pulse
Sweating
Redness only
Burn wound care staff should wear PPE because of:
Patient comfort
Risk of infection transmission
Hospital policy only
Pain control
Burn wound cleansing typically involves:
Vigorous scrubbing
Gentle cleansing and debridement
Alcohol irrigation
Hydrogen peroxide only
Silver sulfadiazine is used in burns for:
Pain control
Moisturizing
Antimicrobial effect
Scar prevention only
Before burn dressing changes, the nurse should:
Offer fluids
Administer pain medication 30 minutes prior
Remove IVs
Limit oxygen
IV route is preferred for burn pain control because:
It lasts longer
It prevents addiction
It provides the fastest onset of action
It reduces infection risk
Tetanus prophylaxis is important in burns because:
Burns decrease immunity
Burn wounds are prone to infection from spores
It reduces pain
It prevents shock
Nutrition therapy in burns is important because burns cause:
Reduced metabolism
Hypermetabolic state and high protein needs
No calorie changes
Hypoglycemia only
A major infection risk in burn patients is due to:
Excess sweating
Loss of skin barrier protection
Low oxygen
Too much IV fluid
Which sign may indicate burn wound infection?
Pink granulation tissue
Fever and purulent drainage
Clear serous drainage
Mild itching
A full-thickness burn will NOT heal by re-epithelialization because:
It is superficial
All epithelial elements are destroyed
It has intact dermis
It is always painful
Burn rehabilitation includes early:
Bed rest only
Physical and occupational therapy
Fluid restriction
Antibiotics only
Positioning burned extremities helps prevent:
Shock
Contractures and loss of mobility
Hypothermia
Pain only
Emotional needs of burn patients often include:
No psychological effects
Guilt, fear of dying, body image concerns
Only pain management
Only sleep issues
Palliative care focuses on:
Cure of disease only
Comfort and symptom management at any stage of serious illness
Only the last 6 months of life
Withdrawal of all treatment
Hospice care is generally for patients with a prognosis of:
1 year
6 months or less if disease runs its usual course
2 years
Any chronic illness
A Do Not Resuscitate (DNR) order means:
No oxygen
No medications
No CPR in the event of cardiac or respiratory arrest
Stop all care
A patient on palliative care can still receive:
No treatments
Curative or life-prolonging treatments alongside comfort care
Only morphine
No IV fluids
Primary goal of end-of-life care is:
Cure disease
Prolong life at all costs
Dignity, comfort, and quality of life
Reduce staffing needs
Which symptom is common at end of life and requires management?
Euphoria
Dyspnea and pain
Hypertension
Hyperactivity
Opioids are used in end-of-life care primarily for:
Sedation only
Pain and dyspnea relief
Lowering BP
Improving appetite
Family involvement in end-of-life care is important to:
Replace nurses
Support emotional and spiritual needs
Speed up death
Reduce medication use
Advance directives allow patients to:
Choose hospital meals
Document healthcare wishes if they cannot speak for themselves
Refuse all medications
Select nursing staff
A living will addresses:
Financial decisions
Medical care preferences in terminal or incapacitating illness
Funeral planning
Insurance
Durable power of attorney for healthcare designates:
A lawyer
A family spokesperson
A person to make medical decisions if patient is unable
The primary nurse
A common spiritual need at end of life is:
Isolation
Meaning-making and reconciliation
Avoiding family
Increased appetite
When caring for a dying patient, the nurse should:
Avoid talking about death
Provide honest communication and presence
Focus only on vitals
Limit family visits
Signs of approaching death may include:
Increased appetite
Decreased level of consciousness and irregular breathing
Hypertension
Hyperactivity
Cheyne-Stokes respirations are:
Normal sleep breathing
Alternating apnea and deep breathing seen near death
A seizure
Anxiety breathing
After death, postmortem care includes:
Immediate discharge of body
Respecting cultural and religious practices
Removing all lines immediately without order
Withholding information from family
Grief is best described as:
A mental illness
A normal response to loss
Avoidable
Short-lived only
Complicated grief differs from normal grief because it:
Resolves quickly
Causes prolonged, severe dysfunction
Is rare in families
Is always psychiatric
The nurse’s role in supporting grieving families includes:
Avoiding emotions
Providing presence and listening
Giving false reassurance
Discussing only paperwork
Organ donation discussion should occur:
After discharge
According to facility protocol when appropriate criteria are met
Only if family asks
Before patient death always
Brain death is defined as:
Coma
Irreversible cessation of all brain activity including brainstem function
Persistent vegetative state
Deep sedation
Ethical principle guiding palliative care is:
Justice only
Beneficence and nonmaleficence (relieve suffering)
Autonomy only
Fidelity only
When a family member says “Don’t tell them they’re dying,” the nurse should:
Agree and withhold information
Clarify the patient's wishes and advocate for honest communication
Avoid the family
Transfer care
A key communication skill in end-of-life care is:
Giving false hope
Active listening and presence
Avoiding silence
Changing topic
Which indicates good palliative symptom control?
Patient reports comfort and reduced distress
BP normalization only
Increased appetite
Normal labs
Family-centered care at end of life includes:
Limiting visitation
Including family in care planning and decision-making
Excluding family from treatment discussions
Restricting family presence to set hours only
Withdrawal of life-sustaining treatment is:
Assisted suicide
Ethical when aligned with patient wishes and comfort goals
Illegal
Nurse decision
Which medication is commonly used for terminal agitation?
Insulin
Haloperidol or benzodiazepines
Antibiotics
Diuretics
"Total pain" includes physical, emotional, social, and:
Financial
Spiritual components
Legal
Occupational
Comfort measures at end of life may include:
Stopping repositioning
Oral care and skin care
Fluid restriction always
Removing oxygen
If a dying patient refuses food, the nurse should:
Force feeding
Respect refusal and focus on comfort
Start TPN immediately
Report to BON
Which is an expected change near death?
Increased urine output
Decreased appetite and thirst
Hyperactivity
Improved cognition
Cooling extremities near death occurs due to:
Infection
Circulatory shutdown and reduced perfusion
Fever
Dehydration only
Family may benefit from bereavement support:
Only before death
Before and after the patient’s death
Only if requested
Never
The nurse should document end-of-life care focusing on:
Only medications
Symptom management, comfort, and patient/family wishes
Staff feelings
Billing codes
The ultimate goal of end-of-life nursing care is:
Extend life
Avoid emotional conversations
Provide a peaceful, dignified death with comfort and support
Reduce hospital stay
