which situation is an example of the use of evidence based practice in the delivery of client care

NCLEX-PN

NCLEX PN Test Bank

1. Which situation is an example of the use of evidence-based practice in the delivery of client care?

A. Encouraging a client who has had a stroke to consume thickened liquids and soft foods
B. Picking up a dislodged radiation implant with long-handled forceps and placing it in a lead container to minimize radiation exposure
C. Pouring 1 to 2 mL of sterile solution that will be used for wound cleansing into a plastic-lined waste receptacle before pouring the solution into a sterile basin
D. Blowing on a fingerstick site to dry it after cleaning the site with an alcohol swab

Correct answer: C

Rationale: Evidence-based practice is an approach that integrates client preferences, clinical expertise, and the best research evidence to deliver quality care. Pouring sterile solution into a plastic-lined waste receptacle before using it for wound cleansing reflects evidence-based practice by preventing the entrance of harmful bacteria into the wound. Option A is incorrect because encouraging a stroke client to consume thickened liquids and soft foods is appropriate, not thin liquids and foods that pose a choking risk. Option B is incorrect as picking up a radiation implant with long-handled forceps to minimize radiation exposure is a safety measure, not evidence-based practice. Option D is incorrect because blowing on a fingerstick site after cleaning can recontaminate the site, which goes against best practices in infection control.

2. Which of the following scenarios are considered violations of HIPAA laws?

A. Discussing discharge plans with a client in a multi-bed recovery room with the curtain drawn around the client's bed.
B. Looking up the medical information of a friend without permission.
C. Checking on your spouse's medical record because you are listed as her power of attorney.
D. Avoiding conversations about clients while in line in the cafeteria with a mutual caregiver of that client.

Correct answer: C

Rationale: Scenarios B and C are considered violations of HIPAA laws. Looking up the medical information of a friend who is not in your care, even with permission, is a violation of HIPAA as the friend is not your patient. Checking on your spouse's medical record, even as a power of attorney, is a violation unless it is directly related to caregiving decisions. Discussing discharge plans with a client in a multi-bed recovery room with the curtain drawn around the client's bed is not a violation of HIPAA. This scenario is considered an 'incidental disclosure' and is not a breach of HIPAA privacy rules. Avoiding conversations about clients while in line in the cafeteria with a mutual caregiver of that client is actually a good practice as it maintains client confidentiality.

3. Why might breast implants interfere with mammography?

A. They might cause additional discomfort.
B. They are contraindications to mammography.
C. They are likely to be dislodged.
D. They might prevent detection of masses.

Correct answer: D

Rationale: Breast implants can interfere with mammography by potentially preventing the detection of masses. The presence of implants can obscure a clear view of breast tissue, making it difficult to identify abnormalities such as masses that may indicate breast cancer. Choices A, B, and C are incorrect because discomfort, contraindications, and dislodgment are not primary reasons why breast implants interfere with mammography. The main concern is the impedance of detecting abnormalities accurately due to the implants.

4. An advance directive is written and notarized according to law in the state of Colorado. This document is legal and binding:

A. internationally.
B. in the state of Colorado only.
C. in the continental United States.
D. in the county of origination only.

Correct answer: B

Rationale: The correct answer is 'in the state of Colorado only.' Advance directive protocols and documents are specific to each state's laws and regulations. Choice A is incorrect as advance directives are not universally recognized internationally. Choice C is incorrect as the legal validity of an advance directive is limited to the state in which it was created. Choice D is incorrect as the legal reach of an advance directive typically extends throughout the state of origination, not just the county.

5. Which of the following lab values is elevated first after a client has a myocardial infarction?

A. LDH
B. troponin
C. CPK
D. SGOT

Correct answer: B

Rationale: The correct answer is troponin. Troponin levels are the most specific and sensitive markers for myocardial infarction, and they begin to rise within a few hours after the event. CPK, SGOT, and LDH are also enzymes that can indicate myocardial damage, but troponin is the earliest and most specific indicator. CPK typically rises 4-8 hours after an infarction, followed by SGOT (AST) at 8-12 hours, and LDH at 12-24 hours post-infarction.