chapter 2 med surg

A client with multiple sclerosis is unable to independently complete activities of daily living. Which recommendation will the nurse make when the spouse refuses to participate in providing the client's personal care? "It is not hard to do but does take time." "A personal caregiver might be a good idea." "It is something that you will have to do." "Watching me is one way to learn."

"A personal caregiver might be a good idea."

A nurse educator for a local home care company is teaching staff nurses on the use of the Outcome and Assessment Information Set (OASIS). What statement will the nurse include when teaching about the OASIS? "Demographic information remains confidential as required by HIPAA." "This document is optional but provides important data." "This document is required but is only used for reimbursement." "Results are used to improve overall quality improvement efforts."

"Results are used to improve overall quality improvement efforts."

The charge nurse is making assignments for a group of clients on a medical unit. When reviewing the acuity of the clients, the charge nurse assigns the RN to the clients with higher acuity levels. Why would the charge nurse assign the RN to the clients with a higher acuity? A higher acuity client requires a greater need for highly skilled care. Higher acuity clients request the services of an RN versus other care providers. LPNs do not understand how to care for clients with complex disorders. Assigning an LPN would allow them to provide care out of their scope of practice.

A higher acuity client requires a greater need for highly skilled care.

Discharge planning begins during which portion of a client's hospital stay? The shift before discharge By the third hospital day 24 hours before discharge Admission

Admission

A client was admitted with a history of ventilator use. The client had been living at home, but the adult children can no longer provide adequate care. What is the rationale for the client's admission to a long-term care facility? Clients with conditions that are potentially unstable but without rapid changes may receive care in a long-term acute care facility. Clients who need hospice care may be admitted to a long-term care facility for family convenience. Clients in stable condition but with the potential for rapid changes may receive care in a long-term acute care facility. Clients with rapidly changing conditions but without family members or friends to provide care may receive care in a long-term acute care facility.

Clients with conditions that are potentially unstable but without rapid changes may receive care in a long-term acute care facility.

A nurse working in the community is involved in secondary prevention. Which activity would most likely apply? Teaching about a nutritious diet Assisting with bowel retraining Health screening for diabetes risk Providing rehabilitation exercises

Health screening for diabetes risk Secondary prevention focuses on health maintenance and is aimed at early detection and prompt intervention to prevent or minimize loss of function and independence, including interventions such as health screening and health risk appraisal. Primary prevention focuses on health promotion and prevention of illness and disease, including interventions such as teaching about healthy lifestyles, for example, a nutritious diet. Tertiary prevention focuses on minimizing deterioration and improving the quality of life, including rehabilitation such as bowel retraining and exercise to assist clients in achieving their maximum potential.

The nurse is teaching a 42-year-old male client, who had surgical reduction of a fractured fibula, to walk with crutches. Drag the interventions the nurse will take when caring for a client with crutches to the box on the right.

If a client is to be discharged to home using crutches, the nurse needs to teach the client how to use them for the prescribed gait and to evaluate that the client can demonstrate safe use. To prevent slipping, crutches should have large rubber tips. To maximize stability, teach the client to use a tripod stance when standing, with the crutches to the front and the sides of the toes. When descending steps, instruct the client to advance the crutches to the lower step. The client will then advance the affected leg, followed by the unaffected leg. Crutches should be measured so they fit 2 in (5 cm) below the axilla when the client is standing. The hand grip should be adjusted so that there is a 20- to 30-degree flexion at the elbow

A community health nurse is helping develop teaching on the role of the community health nurse and how this discipline can help the community. What does the nurse describe as a key component of community-based care? Improving hospital compliance Improving hospital payer reimbursement Improving quality of life Improving quality improvement

Improving quality of life

According to the 2013 OASIS data study, which client would be at greatest risk for re-hospitalization? Male client with controlled congestive heart failure Male client who requires assistance to ambulate Female client with a live-in caregiver Female client with mild cognitive decline

Male client who requires assistance to ambulate

The nurse is completing passive range-of-motion exercises with a client recovering from an acute illness. A muscle spasm occurs in the client's left arm while exercising it. Which action will the nurse take? Ask the client to avoid the activity that causes the muscle spasm. Avoid application of pressure until after the pain stops. Move the joint slowly to the point of resistance and apply gentle pressure. Apply strong, direct pressure to determine the client's pain tolerance.

Move the joint slowly to the point of resistance and apply gentle pressure. Range-of-motion exercises are done to move a joint through full range in all appropriate planes. A joint should not be moved beyond its free range of motion. If a muscle spasm occurs, the joint is moved slowly until resistance is met and gentle, steady pressure is applied until the muscle relaxes. The activity does not need to be avoided. Strong, direct pressure to determine pain tolerance is not an appropriate action to address muscle spasms. Gentle pressure is applied once the point of resistance is met but not after the pain stops.

A nurse who is considering the possibility of becoming involved in home care asks a home care nurse about the characteristics needed for this practice area. Which of the following would the home care nurse be least likely to include? Respect for client's differences Nonjudgmental attitude Need for control over a situation Ability to improvise

Need for control over a situation

A novice nurse is learning the difference between community-based nursing and community-oriented nursing. Which scenario does the nurse recognize as a role of the community-oriented nurse? Nurse working at a wound care clinic performing irrigation of a chronic wound Pediatric nurse teaching a group of parents on the treatments for cystic fibrosis Occupational health nurse immobilizing a fractured extremity of an injured employee Nurse working a booth at a health fair performing blood pressure and glucose screenings

Nurse working a booth at a health fair performing blood pressure and glucose screenings

The nurse is providing a community education program about sexually transmitted infections for a group of 13- to 16-year-olds. What type of prevention is the nurse targeting? Secondary prevention Tertiary prevention Primary prevention Community prevention

Nurses in community-based practice provide preventive care at three levels: primary, secondary, and tertiary. Primary prevention focuses on health promotion and prevention of illness or disease, including interventions such as teaching about healthy lifestyles. Secondary prevention centers on health maintenance and is aimed at early detection, with prompt intervention to prevent or minimize loss of function and independence, including interventions such as health screening (Fig. 2-1) and health risk appraisal. Tertiary prevention focuses on minimizing deterioration and improving quality of life, including rehabilitation to assist patients in achieving their maximum potential by working through their physical or psychological challenges. Home care nurses often focus on tertiary preventive nursing care, although they also address primary and secondary prevention.

A client has experienced deconditioning while recovering from traumatic injuries and is now prescribed to begin ambulation. Which exercise focus will the nurse anticipate to prepare the client for ambulation? coordination stability arm leg

Regaining the ability to walk is a prime morale builder. However, to be prepared for ambulation, the client must strengthen the muscles required. Therefore, exercise is the foundation of preparation. Ambulation requires the quadriceps muscles that stabilize the knee joint and the gluteal muscles to be strengthened. Exercising the quadriceps muscles prevents flexion contractures of the knee. If assistive devices are to be used, the muscles of the upper extremities will need to be exercised and strengthened. The physical therapist will then design exercises to help the client develop the stability and coordination needed for ambulation.

Which safety precautions should the home care nurse implement? Select all that apply. Post the nurse's visit schedule at the agency. Become familiar with all exits from the client's home. Buy a new car to ensure reliable transportation. Perform all visits alone to allow for client privacy and confidentiality. Schedule visits during the day. Conduct the visit regardless of personal safety concerns.

Schedule visits during the day. Post the nurse's visit schedule at the agency. Become familiar with all exits from the client's home.

The nurse is caring for a patient who is to be discharged from the acute care facility to a rehabilitation unit after having a stroke. What type of prevention is this considered to be? Tertiary Secondary Primary Rehabilitation

Tertiary

A nurse works in a community setting that deals with a large number of homeless individuals. Which of the following would be most important for the nurse to understand? The homeless population experiences high rates of trauma but lower rates for other health conditions. The health problems faced by homeless people are often related to their living situation. The nurse's approach to the care of homeless clients is the same as for any client. The homeless population typically seeks health care when a need first arises.

The health problems faced by homeless people are often related to their living situation. Many of the health problems faced by the homeless population are related in large part to their living situation. Street life exposes people to the extremes of hot and cold environments, compounding their health risks. Additionally, the problems are made more difficult by living on the streets or discharge to a transitory, homeless situation with little or no follow-up care. Shelters are often overcrowded and unventilated, promoting the spread of communicable diseases. The homeless typically seek health care late in the course of the disease due to the numerous barriers. Homeless people have high rates of trauma, tuberculosis, upper respiratory infections, poor nutrition, anemia, lice, scabies, peripheral vascular disease, sexually transmitted infections, dental problems, arthritis, and other conditions. Nurses dealing with the homeless population must recognize that individualized treatment strategies are needed in a highly unpredictable environment.

Results from the 2013 OASIS data study revealed that data from the study can be used to identify individuals at greatest risk for readmission to the hospital. Using this data, what can the nurse determine will decrease the readmission rate of hospitalizations? The shift of resources to the community Additional paid staff in the home Longer hospital stays Shift of funds to the hospital

The shift of resources to the community

A community health nurse understands the importance and impact of cultural competence when caring for clients in the community. In what situation will the nurse find that cultural competence is particularly important? When the nurse works in a larger city versus a small community When members of the community request religious resources When the nurse is new to the job and the role within the community When members of the community share a heritage that is unfamiliar to the nurse

When members of the community share a heritage that is unfamiliar to the nurse

What statement made by the student nurse about discharge planning indicates that the student needs additional teaching? "Discharge planning involves a multidisciplinary team." "Discharge planning involves the client." "Discharge planning occurs when the patient is discharged." "Discharge planning begins once the client is on the unit."

client." "Discharge planning occurs when the patient is discharged."

A male client recovering from a stroke is receiving anticoagulant therapy. Which item will the nurse instruct the client to use for self-care? long-handle shoe horn hard-bristled toothbrush electric razor loofah sponge

electric razor

A client receiving home care observes the visiting nurse place a bag on a paper barrier at the beginning of the visit. To avoid misunderstanding, what does the nurse teach the client about the practice of placing the supplies on the barrier? The placement of the barrier is an example of insect-based precautions. The placement of the barrier is to follow universal precautions. The placement of a barrier is a method to prevent the spread of droplet infections. The placement of the barrier is a method to prevent the spread of blood-borne illness.

Establishing a barrier between a potentially contaminated surface and the health care provider's equipment is an example of universal precautions. A paper barrier will not prevent the spread of blood-borne illnesses, nor is it sufficient for insect-based precautions. Precautions such as wearing a mask stop the spread of droplet-borne infections.

A nurse is working as part of a team developing a community-based care program for the local homeless population. Which of the following would be important to keep in mind when developing the program? Select all that apply. The homeless population is a relatively homogenous group. Health problems are often related to a person's living situation. Homeless people often have no or insufficient health insurance. Most homelessness is chronic. Ill homeless people often deteriorate more rapidly than those who are not homeless.

Homeless people often have no or insufficient health insurance. Health problems are often related to a person's living situation. Ill homeless people often deteriorate more rapidly than those who are not homeless

A client in an acute care facility is assigned a case manager to oversee and coordinate care. What important function does a case manager have? Provide early, thorough discharge planning. Make home visits to see that the client is taken care of after discharge. Provide care to the client who is terminally ill and has less than 6 months to live. Make sure the client is administered medications.

Provide early, thorough discharge planning.

A public health nurse describes the role of the nurse in public health to a group of community stakeholders during a budget meeting. Which category of care will the nurse place public health nursing? Comprehensive population nursing Community-based nursing Community-oriented nursing Specialty population nursing

Public health nursing combines the discipline of public health with community nursing and is considered a specialty practice within community-oriented nursing.

After making the initial home visit, a nurse develops a plan of care for a client with diabetes. As part of the plan of care, the nurse identifies the nursing diagnosis "deficient knowledge related to daily insulin administration for diabetic self-care." Which outcome would be most appropriate? The client will state the proper steps for insulin administration. The client will demonstrate independence in daily insulin self-administration. The client will give himself an insulin injection. The client will improve his ability to self-administer insulin.

The client will demonstrate independence in daily insulin self-administration.

A client is admitted to an acute care facility after having a stroke. The client will require a variety of healthcare services throughout the hospital stay as well as coordination of care prior to discharge. What referral would be a priority for overseeing the client's care? Case management Physical therapy Dietary services Occupational therapy

The person responsible for overseeing the client's care, usually an RN with a bachelor's or master's degree or another highly experienced health professional, is called the case manager. Physical therapy, occupational therapy, and dietary services are all important care disciplines but do not encompass all of the client's needs.