Chapter 3, 4, 5, 12, 13, 19, 35, 43 (fundamentals final)
Lavender
A nurse is teaching a class about aromatherapy. The nurse should include that which of the following essential oils can promote sleep
Older adult clients frequently underreport pain
A nurse is teaching a class about pain management in older adult clients. Which of the following information should the nurse include?
True or False: The health care system is a culture of its own, with nursing being its largest subculture. A. True B. False
Answer: A. True. Rationale: The health care system is a culture of its own, with nursing being its largest subculture.
Family Functions - Affective and Coping
Comfort, establish identity
Unstageable
Dark and hard skin is in what stage
Family Functions - Economic
Financial Aid
5000 years ago
How many years ago was yoga first used
morbidity
frequency of disease
need
something essential met for emotional and physiologic health and survival
Beliefs of the International Association of Human Caring
• Caring is the human mode of being. • Caring is the essence of nursing and the moral imperative that guides nursing practice. • Caring is both spiritual and human consciousness that connects and transforms everything in the universe. • Caring in nursing is action and competencies that aim toward the good and welfare of others. • Caring in nursing is a special way of being, knowing, and doing with the goal of protection, enhancement, and preservation of human dignity. • Care is culturally diverse and universal, and provides the broadest and most important means to study and explain nursing knowledge and nursing care practices.
Community?
A specific population or group of people living in the same geographic area.
Benner
Caring is a basic way of being in the world Caring is central to human expertise, curing, and healing
Continuity of care?
Process where health care providers give proper, uninterrupted care & facilitate the patient's transition between different settings & levels of care
What is a patient advocate?
Protecting and supporting patient rights
Back massage
What can you delegate
Protects patient privacy
What is HIPPA for / do
The wife or husband cannot push the button for the Patient with the PCA
What is an aspect of the PCA that is CRUCIAL
Asking the patient if they would like to watch TV
What is not an implementation of music therapy?
Arthritis symptoms, flexibility, muscle tone and strength etc
What is one physical benefit of regularly using yoga as therapy
What is the goal of collaborative practice?
to deliberatively work together to build a safer and better patient-centered and community/population
Nuclear Family
traditional family; two parents and their children
Chronic Illness
-A broad term that encompasses many different physical and mental alterations in health -Usually has a slow onset and may have periods of remission (When the disease is present but the person does not experience any symptoms) and exacerbation (the symptoms of the disease reappear) -Examples: diabetes mellitus, lung disease, arthritis, lupus
Location of the clients belongings
A nurse is documenting postmortem care for a client. Which of the following information should the nurse include
Focus charting
A nurse is reviewing with another nurse a method of documentation that includes data, action, and response ( DAR) when charting client care. Which of the following methods of documentation is the nurse referring to ?
Identify other people involved with the event in the incident report
A nurse is teaching a newly licensed nurse about incident reports. Which of the following information should the nurse include
Clients are often afraid that opioid narcotics can result in addiction
A nurse is teaching a newly licensed nurse about pain management during the end of life. Which of the following statements should the nurse make?
Culture of poverty
Feelings of despair, resignation, and fatalism Day-to-day attitude toward life; no hope for future Unemployment and need for financial or government aid Unstable family structure; possibly characterized by abusiveness and abandonment Decline in self-respect and retreat from community involvement
Softly play music (? This is off her review)
Patient in the ER, headache with 7/10 pain, waiting for an order from doctor what do you do
Leaving AMA what happens?
Patient is legally free to leave. Choice carries a risk for increased illness or complications. Patient must sign a release form. Patient is informed of risks prior to signing form. Patient's signature must be witnessed. Form becomes part of medical record
quality
A nurse is caring for a client who reports abdominal pain. The nurse asks the client to describe what the pain feels like. The nurse is using which of the following components of the PQRST mnemonic
B. MAKE SURE THE PROCEDURE IS STERILE
Which of the following statements are true? Acupuncture stimulates the SNS Make sure the procedure is sterile It doesn't require that much training It makes you bleed heavily during the procedure
National Association for Holistic Aromatherapy
Which organization accredits aromatherapy programs? Alliance of International Aromatherapist National Association for Holistic Aromatherapy National Association for Health Aromatherapy International Federation of Professional Aromatherapists
The joint commission
Which organization audits charts regularly? The Joint Commission National League for Nursing American Nurses Association Sigma Theta Tau International
Document
You never ever ( what) an incident report
Our perception of pain decreases
What happens to as we age
High
A patient with a Braden scale of 12 is that high or low
Wrap bandage around stuff animal Show them how to do it
A toddler is having surgery on their right ear, what is most important for teaching
Lavender
Which essential oil is beneficial to sleep? Lavender Rosemary Peppermint Tea Tree
The Health-illness continuum
-Conceptualizes a person's level of health -Views health as a constantly changing state with high-level wellness and death on opposite sides of a continuum -Illustrates the dynamic (ever-changing) state of health
Primary
-directed toward promoting health and preventing the development of disease processes or injury. Examples are immunization clinics, family planning services, poison-control information, and accident-prevention education
A 4 DAY OLD INFANT WHO HAD A REPAIR OF A BIRTH DEFECT
A nurse in a pediatric unit is planning care for a group of clients. Which of the following clients should the nurse plan to use the Crying, Requries oxygen, increased vital signs, expression, sleeplessness ( CRIES) pain scale ??
The client reports a burning sensation
A nurse is assessing a client for manifestations of pain. Which of the following findings is a subjective indicator of pain?
The client grimaces when they move
A nurse is assessing a client for manifestations of pain. Which of the following findings is an objective indicator of pain ?
Decreased circulation
A nurse is assessing a client who has impaired mobility. The nurse should monitor the client for a pressure injury due to which of the following factors
Irregular respirations
A nurse is assessing a client who is at the end of life. Which of the following findings should the nurse expect?
Elevated blood pressure
A nurse is assessing a client who is nonverbal for acute pain. Which of the following findings is a manifestation of pain?
Infection
A nurse is planning care for a client who is scheduled for acupuncture. The nurse should plan to monitor the client for which of the following adverse effects of acupuncture
Rx received for CXR Stat
A nurse is reviewing the documentation of a newly licensed nurse. Which of the following entries demonstrate accurate documentation?
A person who is experiencing a productive cough and fever takes a sick day to recuperate and decide whether to make an appointment with the doctor. This person is said to be in stage 3 of illness behavior: assuming a dependent role. A. True B. False
Answer: B. False Rationale: A person who defines oneself as sick and self-medicates or visits a doctor is said to be in stage 2 of illness behavior: assuming the sick role.
Benefits of the nursing process *nurse*
Opportunity to work collaboratively with other health care workers Satisfaction of making a difference in lives of patients Opportunity to grow professionally
Taking renters open and keeping the eye open
Patient died, family wants to stay until the nursing home comes to pick them up what do you do
Culture conflict
People become aware of differences and feel threatened. Response—ridiculing beliefs and traditions of others to make themselves feel more secure
Idealisation
Person exaggerates of his dead father all the time what stage is this?
TRUE
True or false: Acupuncture is utilized for pain treatment (arthritis, neck pain, muscle pain, menstrual cramps)
Tell me more about your pain
Two hours after receiving a pain medication, the client reports still suffering from pain. Which response is most appropriate? "Do you need your pain medication now?" "Have you ever had pain like this before?" :Tell me where your pain is located." "Tell me more about your pain."
Pills and teas
What forms do herbal meds come in ( herbs treat all of the above**)
risk factor
increases a person's likelihood for illness or injury
health disparity
type of health difference linked with social, economic, and/or environmental disadvantage
Hydromorphone
A 77-year-old woman is on the nurse's unit s/p left knee replacement. The client typically stools every morning but has not had a bowel movement in 3 days. The nurse knows that which medication places the client at increased risk for constipation? Hydromorphone Psyllium Acetaminophen Furosemide
Assisting the client to find an appropriate imagery tape to use
A nurse can best help a client who is undergoing chemotherapy and using guided imagery with this by doing which of the following? Helping the client learn about the different poses that can be performed. Assisting the client to find an appropriate imagery tape to use. Promoting the client's use of imagery only after a stressful event occurs. Explaining to the client that it is not a good idea to record their own imagery tape.
Put them in a shred bin
How do you get rid of patient papers
Bargaining
Patient who is questioning everything and experimental, what level is that?
Reporting
The nurse is sharing information about a client at change of shift. The nurse is performing what nursing action? Dialogue Documentation Reporting Verification
Document the finding
While providing a back massage, the nurse observes a reddened area on the client's sacral area. Which action by the nurse is appropriate? Document the finding. Apply a warm compress to the area. Massage the area using lotion. Stop the back massage immediately.
Intellectual dimension
cognitive abilities, educational background, and past experiences
4 concepts essential to patients within & across health care settings?
community-based nursing care, continuity of care, collaborative practice, & care coordination
Somatic pain
develops from injury to structures such as muscles, tendons, and joints, Blood vessels and nerves
health-belief model
focuses on what people perceive or believe to be true about themselves in relation to their health
primary health promotion
promoting health and preventing a disease process or injury development
Which patient need has the highest priority? A. A patient who needs to ambulate to prevent DVT B. A patient who is in isolation and feels lonely C. A patient who recently lost her husband D. An elderly patient who is at risk for falls
Answer: A. A patient who needs to ambulate to prevent DVT Rationale: Preventing DVT is a physiologic need and is the highest priority need. A patient in isolation might have unmet love and belonging needs (3rd in priority). A patient who lost a spouse might have unmet self-esteem needs (4th in priority). A patient who is at risk for falls might have unmet safety and security needs (2nd in priority).
A nurse who focuses attention on the strengths and abilities of patients rather than their problems is helping them to achieve which of Maslow's basic human needs? A. Self-actualization B. Self-esteem C. Love and belonging D. Safety and security E. Physiologic
Answer: A. Self-actualization Rationale: To meet patient self-actualization needs, nurses provide a sense of direction and hope, and maximize patient potential. Self-esteem needs are met by respecting patient values and beliefs and setting attainable goals for them. Love and belonging needs are met by including family and friends and establishing caring relationships with patients. Safety and security needs are met by encouraging spiritual practices and independent decision making. Physiologic needs are needs that must be met to maintain life.
True or False: Stereotyping occurs when people ignore differences in the cultures in which they live and proceed as if they do not exist. A. True B. False
Answer: B. False Rationale: Cultural blindness occurs when people ignore differences in the cultures in which they live and proceed as if they do not exist.
What is an example of a nursing activity that promotes secondary prevention as a level of preventive care? A. Conducting a smoking cessation class B. Performing a blood pressure screening at a local mall C. Performing range-of-motion exercises on a bedridden patient D. Promoting safer sex practices in school settings
Answer: B. Performing a blood pressure screening at a local mall Rationale: Secondary preventive care focuses on early detection of disease, such as heart disease in this example. Primary preventive care is directed toward promoting health and preventing diseases. Tertiary care begins after an illness is diagnosed to reduce disability and rehabilitate patients.
Which of the following occurs when members of a minority group, living with a dominant group, begins to blend in and lose the characteristics that made them distinct? A. Cultural imposition B. Cultural conflict C. Cultural assimilation D. Cultural shock
Answer: C. Cultural Assimilation Rationale: Cultural assimilation occurs when one's values are replaced by the values of the dominant culture. Cultural imposition is the belief that everyone should conform to the majority belief system. Cultural conflict occurs when people become aware of cultural differences, feel threatened, and act negatively. Cultural shock refers to the feelings a person experiences when placed in a different culture.
Which is an example of an acute illness? A. Diabetes B. Rheumatoid arthritis C. Pneumonia D. Osteoporosis
Answer: C. Pneumonia Rationale: Pneumonia is an acute illness that has a rapid onset of symptoms and lasts only a relatively short time. Diabetes, rheumatoid arthritis, and osteoporosis are chronic illnesses that cause a permanent change, require special patient education for rehabilitation, and require a long period of care or support.
Reservations of 8 is the priority patient
Four patients in a priority question
They are dissatisfied with conventional meds
Patients use complimentary therapy because ???
Benefits of the nursing process *patient*
Scientifically based, holistic individualized patient care Continuity of care Clear, efficient, cost-effective plan of action
The Health Belief Model (Rosenstock)
-Concerned with what people perceive to be true about themselves in relation to their health -Modifying factors for health include demographic, sociopsychological, and structural variables. -Based on three components of individual perceptions of threat of a disease Perceived susceptibility to a disease Perceived seriousness of a disease Perceived benefits of action
Characteristics of a Chronic Illness
-It is a permanent change. -It causes, or is caused by, irreversible alterations in normal anatomy and physiology. -It requires special patient education for rehabilitation. -It requires a long period of care or support. -Chronic illnesses are the leading health problem in the world -Of the 10 leading causes of death in the US, 7 are the result of chronic illnesses (heart dz, cancer, CVA, chronic lower respiratory disease, diabetes, Alzheimers dz, & kidney disease)
AGENT-HOST-ENVIRONMENT MODEL (LEAVELL AND CLARK)
-Views the interaction between an external agent, a susceptible host, and the environment as causes of disease in a person. -It is a traditional model that explains how certain factors place some people at risk for an infectious disease. -These three factors are constantly interacting, and a combination of factors may increase the risk of illness. -The use of this model is limited when dealing with noninfectious diseases.
Tertiary
-begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate patients to a maximum level of functioning Examples include teaching a patient with diabetes how to recognize and prevent complications, using physical therapy to prevent contractures in a patient who has had a stroke or spinal cord injury, and referring a woman to a support group after removal of a breast because of cancer.
Secondary
-focus on screening for early detection of disease with prompt diagnosis and treatment of any found Examples are assessing children for normal growth and development and encouraging regular medical, dental, and vision examinations.
A medical record can be used as evidence in a court of law A nurse should ensure the documentation is organized and completed in a timely fashion Information recorded in the clients medical record must be accurate and complete is correct
A charge nurse is reviewing legal guidelines for documentation with a newly licensed nurse. Which of the following should the charge nurse include in the teaching?
The client seems to be more comfortable performing self - administration of insulin
A charge nurse is reviewing the documentation completed by a newly licensed nurse. Which of the following entries should the charge nurse recommend for revision?
A nurse can only access the records of clients they are actively caring for
A charge nurse is teaching a newly licensed nurse about accessing a client's medical records. Which of the following should the nurse include?
Healing touch does not use injections
A client asks the nurse about the use of healing touch. Which statement regarding healing touch is accurate? Healing touch is too expensive for most clients. Aromatherapy is used in healing touch. Supplemental music is used during healing touch. Healing touch does not use injections.
Ginger
A client who is receiving chemotherapy and experiencing significant nausea asks the nurse about using aromatherapy to help alleviate the nausea. Which essential oil would the nurse most likely suggest to address the client's nausea? Lavender Chamomile Ginger Cedarwood
The client is actively involved in pain management
A middle-age client with cancer has been prescribed patient-controlled analgesia (PCA). The nurse caring for the client explains the functioning of PCA. What is the main advantage of PCA? The client obtains pain relief slowly and steadily. The client requires less nursing care. The client is able to have long hours of rest. The client is actively involved in pain management.
Partial thickness skin loss with red tissue in wound bed
A nurse is assessing a client who has a stag 2 pressure injury. Which of the following findings should the nurse expect?
Depends on their friends for emotional support
A nurse is assessing an adolescent client whose parent has recently died. Which of the following findings should the nurse expect?
Acceptance
A nurse is caring for a client who has a terminal diagnosis and states, "I am ready to update my will." The nurse should identify that the client is experiencing which of the following Kubler-Ross stages of grief?
Bargaining
A nurse is caring for a client who has a terminal diagnosis and states, "If I get better, I promise to go to church every day." The nurse should identify that the client is experiencing which of the following Kubler-Ross stages of grief?
Provide the client with a high calorie diet
A nurse is caring for a client who is at risk for a pressure injury. Which of the following actions should the nurse take?
Continue to talk to the client as if they are awake
A nurse is caring for a client who is at the end of life and is unresponsive which of following actions should the nurse take
Schedule home visits with the client
A nurse is caring for a client who is at the end of life. Which of the following interventions is most effective in reducing the clients social isolation
Severity
A nurse is caring for a client who reports back pain. The nurse asks the client to rate the pain on a scale of 0 to 10. The nurse is using which of the following components of the PQRST mnemonic
Sedation
A nurse is caring for a client who was administered an opioid. The client reports constipation. What is another potential side effect of opioid use? sedation anxiety diarrhea insomnia
A client who is unresponsive to verbal commands and changes position occasionally
A nurse is caring for a group of clients. Which of the following clients should the nurse identify is at highest risk for developing a pressure injury
Charting by exception ( CBE)
A nurse is documenting client care including only unexpected findings related to the client's condition. Which of the following documentation methods is the nurse utilizing?
Intact skin with localized erythema
A nurse is documenting client care including only unexpected findings related to the client's condition. Which of the following documentation methods is the nurse utilizing?
Ondanestron 4 mg IV bonus for nausea and vomiting
A nurse is documenting in a client health record using the problem intervention evaluation charting model ( PIE). Which of the following information should be included in the intervention component
Increase skin thinning Decrease in subcutaneous tissue Decrease in skin hydration
A nurse is teaching a class about expected changes to the skin in older adults Which of the following information should the nurse i Louie
Nerve injury
A nurse is teaching a class about massage therapy. The nurse should include that which of the following is a possible adverse effect of massage therapy.
Meditation Yoga Biofeedback
A nurse is teaching a class about nonpharmacological therapies to decrease stress. The nurse should include which of the following therapies?
Allows health care team members to document client care
A nurse is teaching a class about pain management in older adult clients. Which of the following information should the nurse include?
Better sleep and rest Less anxiety Reduced muscle tension Improved sense of wellbeing
A nurse practitioner is conducting a presentation at a local community center about complementary health approaches. One of the participants asks the nurse practitioner, "Everybody is talking about relaxation. Just how does relaxation help a person?" The nurse responds, integrating which effect as being associated with relaxation? Select all that apply. Better sleep and rest Less anxiety Reduced muscle tension Lowered immune response Improved sense of well-being
A client who's spinal cord was injured in a motor vehicle accident
A nurse works in an office that follows the allopathic philosophy of medicine. For which client would this type of medicine be most effective? A client whose spinal cord was injured in a motor vehicle accident A client diagnosed with juvenile diabetes A client who has COPD A client who has rheumatoid arthritis
Somatic pain
A patient who has bone cancer is most likely experiencing which of the following types of pain
Return it to the pharmacy
A patients med is expired, what should you do
Minority group in society, smaller than dominant
A physical or cultural characteristic identifies the people as different from dominant group.
A person who keeps in touch with neighbors in an attempt to foster a "community feeling" is promoting one's emotional human dimension. A. True B. False
Answer: B. False Rationale: A person who keeps in touch with neighbors in an attempt to foster a "community feeling" is promoting one's sociocultural human dimension.
Which model of health and illness views health as a constantly changing state, with high-level wellness and death being on opposite ends of a graduated scale? A. Agent-host-environment model B. Health-illness continuum C. Health promotion model D. Health belief model
Answer: B. Health-illness continuum Rationale: The health-illness continuum measures a person's level of health on a graduated scale. The agent-host-environment model refers to the interaction of the agent, host, and environment creating risk factors that must be examined. The health promotion model illustrates how people react to their environment as they pursue health. The health belief model is concerned with what people believe to be true about their health.
Which term describes what occurs when a nurse believes that one's own ideas, beliefs, and practices are the best or superior to those of colleagues and patients? A. Cultural diversity B. Culture shock C. Stereotyping D. Ethnocentrism
Answer: D. Ethnocentrism Rationale: Ethnocentrism is the belief that one's ideas, beliefs, and practices are superior or preferred to those of others. Cultural diversity refers to the existence of diverse groups in society with varying cultural characteristics. Culture shock describes the feelings a person experiences when placed in a different culture. Stereotyping is the practice of assuming that all members of a cultural group act alike.
Elements of Cultural competence
Developing self-awareness Demonstrating knowledge and understanding of a patient's culture Accepting and respecting cultural differences Not assuming that the health care provider's beliefs and values are the same as the client's Resisting judgmental attitudes such as "different is not as good" Being open to and comfortable with cultural encounters Accepting responsibility for one's own cultural competency
What would you like to try to alleviate your pain
If the patient is in a lot of pain but in a lot of stress, what do you say
Document findings Start term precautions
If there is blanch able redness on the patient, what do you do?
Cultural blindness
Ignores differences and proceeds as if they did not exist
Comfortable position Quiet environment Focus of attention
In prenatal classes, the nurse teaches pregnant clients to use meditation during labor contractions to ease the pain. Which elements of meditation are important for the nurse to emphasize? Select all that apply. Comfortable position Quiet environment Focus of attention Closed attitude Massaging abdomen
What does a patient and family educator do?
Increases the patient's ability to provide self care and the caregiver's ability to care for the patient
Admission to ambulatory care setting
Patient receives health care services but does not remain overnight. Goal: provide care to those who are able to provide self-care at home In most offices and clinics, patients complete a short health history & sign HIPPA acknowledgment In same-day surgery facilities, screening tests, teaching, and admission take place before patients enter the setting.
Ethnicity
Sense of identification with a collective cultural group Largely based on group's common heritage One can belong to an ethnic group through birth or adoption of characteristics of that group. Groups share unique cultural and social beliefs and behavior patterns. Largely develops through day-to-day life with family and friends within the community.
Culture
Shared system of beliefs, values, and behavioral expectations Provides social structure for daily living Defines roles and interactions with others and in families and communities Apparent in the attitudes and institutions unique to the culture
Stereotyping
The assumption that all members of a culture or ethnic group act alike May be positive or negative: negative includes racism, ageism, and sexism
Excess sugar increases demand on the pancreas
The client who is newly diagnosed with diabetes mellitus type 2 is concerned about eating products with sugar in them. What information does the nurse explain to the client regarding the use of sugar? Excess sugar increases demand on the pancreas. Healthy amounts of sugar are usually consumed Sugar increases natural bacterial flora in the GI tract. Sugar assists with cellular absorption of nutrients.
Holistic care
The mind and body are connected in the provision of care. This statement describes: homeopathic care. holistic care. altruistic care. allopathic care.
A nurse is handing off a patient to a nurse in an extended-care facility using the ISBARQ framework of communication. Which step is performed correctly?
The nurse discusses the patient's background
Encourage deep breathing. Play the client's favorite music. Promote a restful environment.
The nurse is developing a plan of care for a client in acute pain. Which nursing interventions should be included? (Select all that apply.) Encourage deep breathing. Play the client's favorite music. Promote a restful environment. Encourage increased protein. Encourage the use of a sitter.
Use massage and heart application to the lower back
The nurse is employing gate theory in the care of a client with pain in the lower back. What actions by the nurse may assist in pain relief for the client? Use massage and heat application to the lower back Administer opioid analgesics Have the client perform active exercises to stretch the back muscles Encourage the client to have an epidural steroid injection
Medical history Prealbumin level Diabetes mellitus
The nurse is reviewing the clients medical record. Which of the following findings places the client at risk for delayed wound healing
I should only take medication when my pain is intense
The nurse is teaching a client how to manage postoperative pain through a patient controlled analgesia (PCA) pump. The nurse determines that additional teaching is needed when the client make which statement? "This will allow me to control my own pain medication." "I should only take medication when my pain is intense." "I give myself the pain medication by pushing the button." "The pump is programmed to limit the chance of overmedicating."
Dementia
What is not a disease that can benefit from massage therapy
pain medication
What is the most critical documentation
Do you take any vitamins or minerals and if so what?
When obtaining information for a database, which of the following represents a nurse commitment and interest in reflected integrative medicine (CAM)? "Which types of foods do you consume in 24 hours?" "Do you take any vitamins or minerals, and if so, what?" "Which prescription medications do you take daily?" "Which diseases do you suffer from and what are your allergies?"
A client with shingles affecting her entire torso
Which medical client is most likely to be experiencing diffuse pain? A client who is undergoing diagnostic testing for appendicitis A client with shingles affecting her entire torso A client who has presented to the emergency department with a stab wound A client who has been prescribed antibiotics for the treatment of strep throat
A. To promote sleep B. To soothe patients D. To enhance skin integrity
Which of the following are reasons why nurses perform massage for their patients A. To promote sleep B. To soothe patients C. For the patients fun D. To enhance E. T0 bruise patients
health-risk assessments
assessment of the total person which focuses on lifestyle and behaviors
Dynamic
great interaction and overlapping among the 5 steps
Holistic care
health care that takes into account the whole person interacting in the environment
Emotional dimension
how the mind affects body function and responds to body conditions
Extended Family
includes aunts, uncles, and grandparents
mortality
number of deaths from disease
self efficacy
own belief in the ability to reach goals and complete tasks
Roles of the community based nurse?
patient advocate coordinator of services patient and family educator
Remission
period in a chronic illness when the disease is present, but the person does not experience symptoms of the disease
exacerbation
period in chronic illness when the symptoms of the disease reappear
Blended Family
two parents and their unrelated children from previous relationships
Ayurveda (Ayurveda is an Indian medical system that is based on establishing balance between the body, mind, and spirit to cleanse the body of substances that can cause illnesses)
A nurse is teaching a class about alternative medicine. The nurse should include that which of the following practices is based on a balance of the body, mind, and spirit to prevent disease?
Allows client access to their medical record electronically at any time
A nurse is teaching a client about the benefits of an electronic health record. Which of the following information should the nurse include in the teaching
Helps to increase the effects of parasympathetic nervous system on the mind and body
A nurse is teaching a client experiencing stress about how relaxation helps to reduce the effects of stress on the body. Which underlying concept would the nurse integrate into the explanation about how relaxation works? Helps to increase the effects of parasympathetic nervous system on the mind and body Increases the body's natural immunity Activates natural pleasure centers Slows circulation throughout the body
Hospice care is restricted to clients who are terminally ill
A nurse is teaching a newly licensed nurse about hospice care. Which of the following information should the nurse include
Surgical incision
A nurse is teaching a newly licensed nurse about pain. Which of the following is an example of acute pain?
Strained muscle
A nurse is teaching a newly licensed nurse about pain. Which of the following is an example of nociceptive pain
Palliative care can be provided while a client is receiving a curative treatment
A nurse is teaching a newly licensed nurse about palliative care. Which of the following information should the nurse include
Respite care
A nurse is teaching newly licensed nurse about end of life care. The nurse should include that which of the following services provides support for a clients caregiver?
Establish whether the clients grieving is healthy or complicated
A nurse is planning to use the nursing process to care for a client who is experiencing grief. Which of the following actions should the nurse take first
Wash the clients body
A nurse is providing postmortem care for a client. Which of the following actions should the nurse take?
Client reports chest pain after mowing lawn this morning
A nurse is documenting in a clients health record using the subjective, objective, assessment, and plan ( SOAP) charting model. Which of the following information should be included in the subjective component
Prescription received for MSO4 4.0 mg PRN pain
A nurse is evaluating the documentation of a newly licensed nurse. The nurse should identify that which of the following entries requires intervention
BMI of 20 Peripheral neuropathy Immobility Hypoperfusion
A nurse is performing a pressure injury risk assessment for a client. Which of the following findings increases the clients risk of a pressure injury?
Provide the nurse administering mediation with an identifying vest
A nurse is teaching a class about reducing the risk of medication errors which of the following information should the nurse include
Intravenous
A nurse is teaching a class about routes of medication administration. The nurse should include that which of the following routes has the fastest rate of adsorption
Spirituality can increase the quality of the life
A nurse is teaching a class about spirituality in clients who are near the end of life. Which of the following information should the nurse include
Ask the boy to draw a cartoon about the color or shape of his pain
A nurse is treating a young boy who is in pain but cannot vocalize this pain. What would be the nurse's best intervention in this situation? Ignore the boy's pain if he is not complaining about it. Ask the boy to draw a cartoon about the color or shape of his pain. Medicate the boy with analgesics to reduce the anxiety of experiencing pain. Distract the boy so he does not notice his pain.
Therapeutic Touch ( TT)
A nurse who "unblocks" and "clears" congested areas of energy in a client's body to promote comfort is applying the phenomenon known as: "Unruffling" touch Interpersonal touch Tactile manipulation Therapeutic Touch (TT)
True or False: Culture includes the beliefs, habits, likes and dislikes, and customs and rituals learned from one's family.
A. True. Rationale: Culture is defined as a shared system of beliefs, values, and behavioral expectations that provides social structure for daily living. It includes the beliefs, habits, likes and dislikes, and customs and rituals learned from one's family.
Women, ages 35-50, with a college degree, former smokers
According to survey results, who are the most prevalent users of complementary or alternative therapies? Women, ages 35-50, with college degree, former smokers Men, ages 50-65, with some high school, who smoke Women, ages 25-40, with high school degree, who smoke Men, ages 30-45, with college degree, who recently stopped smoking
Documentation
According to the Canadian Nurses Association (CNA), what is the primary source of evidence to measure performance outcomes against standards of care? Documentation Accreditation Psychomotor skills Clinical judgment
RISK FACTORS FOR ILLNESS - TABLE 3-1
Age-school aged children, menopause-hx Genetic factors - hx of cancer Physiologic factors - obesity, pregnancy Health habits - smoking, poor nutrition Lifestyle - multiple sexual relationships Environment - hazardous materials
A. MS D. PAIN E. ANXIETY F. PTSD
Although acupuncture has been used for pain management in the west, many Eastern countries have used it for preventing and treating which disorders? Select all that apply A. MS B. The flue C. Tuberculosis D. Pain E. Anxiety F. PTSD
Assist the client to enter state of calmness
Why is Zen meditation effective for a client with generalized anxiety disorder? Helps client forget issue causing stress Used to reduce hyperactivity in group therapy Includes yoga exercise for stress relief Assists client to enter state of calmness
Understand how you feel about death and dying
You are assigned to a dying patient , how do you prepare
Teach the patient to tell you when the pain is not stopping
You tach the patient to ( what) if the pain is not stopping
Portal that allows clients to interact with providers
A charge nurse is providing teaching to newly licensed nurse on the advantages of electronic documentation. Which of the following information should the nurse include in the teaching
Yes
Can herbal meds cause harmful interaction
Subjective
Is pain subjective or objective
Find out the previous experience
To best assist in the grieving processes, what's the best thing to do?
Characteristics of the Nursing Process
• Systematic: part of an ordered sequence of activities • Dynamic: great interaction and overlapping among the five steps • Interpersonal: human being is always at the heart of nursing • Outcome oriented: nurses and patients work together to identify outcomes • Universally applicable: a framework for all nursing activities
Problem oriented method
A nurse documents the following data in the client record according to the SOAP format: Client reports unrelieved pain; client is seen clutching the side and grimacing; client pain medication does not appear to be effective; Call in to primary care provider to increase dosage of pain medication or change prescription. This is an example of what charting method? Source-oriented method PIE charting method Problem-oriented method Focus charting method
A client who is home bound and needs skilled nursing care
A nurse is arranging for home care for clients and reviews the Medicare reimbursement requirements. Which client meets one of these requirements? a client who is homebound and needs skilled nursing care a client whose rehabilitation potential is not good a client whose status is stabilized a client who is not making progress in expected outcomes of care
A client who is home bound and needs killed nursing
A nurse is arranging for home care for clients and reviews the Medicare reimbursement requirements. Which client meets one of these requirements? a client who is homebound and needs skilled nursing care a client whose rehabilitation potential is not good a client whose status is stabilized a client who is not making progress in expected outcomes of care
Have the right to copy their health records
According to the Health Insurance Portability and Accountability Act (HIPAA) passed in 1996, clients: have the right to copy their health records. need to obtain legal representation to update their health records. can be punished for violating guidelines. are required to obtain health record information through their insurance company.
It provides quick access to abnormal findings
Nurses at a health care facility maintain client records using a method of documentation known as charting by exception (CBE). What is a benefit of this method of documentation? It documents assessments on separate forms. It records progress under problems, intervention, and evaluation. It provides and refers to a client's problem by a number. It provides quick access to abnormal findings.
The patients sense of loss can be lessened if they allow her to do all they can do as an individual
Patient with lung cancer and family does all her ADLs, what rationals should the nurse teach
Only authorized persons are allowed to access client records
The nurse is caring for a client whose spouse wishes to see the electronic health record. What is the appropriate nursing response? "Let me get that for you." "Only authorized persons are allowed to access client records." "The provider will need to give permission for you to review." "I am sorry I can't access that information."
Disruption of tissue integrity
What causes acute pain
Comfort treatment and controlling symptoms
What does hospice do
18 or greater ( the lower you go the higher the risk)
What is a normal Braden scale
Showing the patient has made all standard requirements ( only charting what's wrong)
What is charting by exception
Mind, body, and spirit
What is complementary therapy used for
30 mins to 1 hour
What is not crucial for decision making
Feet and their circulation They need to wear shoes
What is priority with diabetic patients
Open communication Active listening
What is the best way for the nurse to build a trusting relationship
Respiratory
Which is the priority assessment for a nurse caring for a client with a Patient Controlled Analgesia (PCA) pump? Respiratory Cardiovascular Peripheral Vascular Neuromuscular
Yoga Harmonizing yourself
Which one is an alternative med for various postures
If the client declines the dose, the nurse does not have to document this on the MAR
Which statement is not true regarding a medication administration record (MAR)? If the client declines the dose, the nurse does not have to document this on the MAR. The MAR distinguishes between routine and "as needed" medications. The MAR identifies routine times for medication administration. After using an electronic MAR, the nurse should log off.
becuase if there is a lawsuit the lawyer would tear it apart
Why do you never document an incident report
Guarding of the chest area
A client comes to the emergency department complaining of a shooting pain in his chest. When assessing the client's pain, which behavioral response would the nurse expect to find? Decreased heart rate Guarding of the chest area Increased respiratory rate High blood pressure
Referred pain
A client describes pain in the lower leg and has been diagnosed with a herniated lumbar disk. The pain in the leg is what type of pain? acute pain chronic pain referred pain limited pain
The dose that is delivered when the client activates the machine is preset
A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system? The dose that is delivered when the client activates the machine is preset. Thorough client education is necessary to prevent overdoses. Use of opioid analgesics in a PCA is contraindicated due to the risk of respiratory depression. An antidote is automatically delivered if the client exceeds the recommended dose.
Biofeedback
A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as: biofeedback. transcutaneous electrical nerve stimulation (TENS). hypnosis. Therapeutic Touch (TT).
Legal policy requires nursing practice to be permanently integrated into the clients record
A nurse asks a nurse manager why staff nurses on the unit cannot document in a separate record (instead of the client record) to make it easier to find information on nursing-specific actions. What is the best response by the nurse? "Legal policy requires nursing practice to be permanently integrated into the client record." "It would be easier to do it that way. You could develop a tool to use." "The facility requires us to document client care this way because of the computer application used." "The electronic health record we use does not allow us to use different formats."
Visceral pain ( which is poorly localized and originates in body organs in the thorax, cranium, and abdomen)
A nurse is caring for a client who complains of an aching pain in the abdomen. The nurse also noted that the client is guarding the area. The client is experiencing: visceral pain. cutaneous pain. somatic pain. neuropathic pain.
"The client had a good deal of anxiety last night and requested to be turned and repositioned frequently."
A nurse is providing a change-of-shift report on a client who has had a restless night, is experiencing anxiety, and requires frequent repositioning. Which statement indicates a correct way of conducting an effective handoff at change of shift? "No medical issues overnight that require immediate attention." "The unlicensed assistive personnel turned the client every 2 hours last night, but the client should continue to be repositioned during the day." "The client had a good deal of anxiety last night and requested to be turned and repositioned frequently." "The client was very restless last night so you may need to call the health care provider today to get a prescription for the client's anxiety."
It will allow for us to see the client and possibly increase client participation in care
A nurse is requesting to receive the change-of-shift report at the bedside of each client. The nurse giving the report asks about the purpose of giving it at the bedside. Which response by the nurse receiving the report is most appropriate? "It will allow for us to see the client and possibly increase client participation in care." "It will let me see everything that has been done and things that need to be done." "It makes our client feel like we care, especially if we start the day off with a clean room." "It will give me a better sense of what my workload will be today."
Guided imagery Relaxation
A women i labor, refusing pain meds, what do you do to relieve pain
Discuss decreased muscle tone being normal at the end of life
Caring for a patient with terminal illness, they ask the nurse when they will expire what should you include
Verbally say it back to the doctor for verification
If you call a doctor in the middle of the night trying to get an order what do you request
Right after actin was taken
In order to reduce error when do you charting you do it when?
Creating a schedule for pain meds
Patient is postoperative what's important for teaching
Teaching how to administer
Required epinephrine, what is the highest priority of teaching
One hour prior to the procedure
The emergency room nurse is caring for a client who will need a lumbar puncture. The health care provider prescribes lidocaine 2.5% and prilocaine 2.5% cream (EMLA) to decrease the pain associated with the procedure. When should the nurse administer the cream? Just prior to the procedure Thirty minutes prior to the procedure One hour prior to the procedure Immediately after the procedure
A client who has a sprained ankle
The nurse is performing assessments for clients admitted in the emergency department. Which client is most likely experiencing somatic pain? A client suspected to have a perforated peptic ulcer A client who has a sprained ankle A client with chest pain who is having a myocardial infarction A client who has appendicitis
Nursing home
What care setting is music therapy most used
Neuropathic pain
is experienced days, weeks, or even months after the source of the pain has been treated and resolved
Basic Human Needs
Peoples behaviors and feelings about self relate to physiologic and psychosocial needs
Acute Illness
-Generally has a rapid onset of symptoms and lasts only a relatively short time -Examples: appendicitis, pneumonia, diarrhea, common cold
Qualities of the community based nurse?
-knowledgeable and skilled -independent in making decisions -accountable
Verify the meds with all 3 doctors
A patient has 3 doctors and multiple meds, what do you do ?
Sterile saline solution and cover the area
After surgery, patient reports a pop after coughing, the suture was opened, what do you do
Which factors are non-modifiable? (select all that apply)
Age Gender Race
5 major categories of race
American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White
Holistic
Aromatherapy aligns with what type of nursing care? Mental Holistic Physical
True
Aromatherapy reduces nausea especially in patients who are undergoing radiation due to cancer.
Factors that affect culturally diverse interactions
Cultural background of each participant Expectations and beliefs of each person about health care Cultural context of the encounter Degree of agreement between the sets of beliefs and values of the two persons Andrews & Boyle, 2008
A nurse's personal moral code is to assist all patients to the best of one's ability. What blended skill would the nurse use when seeking out special services for a homeless patient with a diabetic foot ulcer? A. Cognitive B. Technical C. Interpersonal D. Ethical/Legal
D. Ethical/Legal
Swanson
Defined caring as "a nurturing way of relating to a values other toward whom one feels a personal sense of commitment and responsibility" 5 caring processes of: knowing, being with, doing for, enabling, and maintaining belied
Guidelines for providing culturally competent nursing care
Develop cultural self-awareness. Develop cultural knowledge. Accommodate cultural practices in health care. Respect culturally based family roles. Avoid mandating change. Seek cultural assistance.
you give them promotion of health and illness prevention
Getting the flue vaccine, what education are you providing
15 to 20 minuets
How long after IV meds do you need to check on the patient
Watson
Humans are to be values, cared for, respected, nurtures, understood, and assisted
Internal part of the hospital
Incident reporting is a ( blank) part of the hospital
Precise
It is important to make sure documentation is
Subculture
Large group of people who are members of a larger cultural group Members have certain ethnic, occupational, or physical characteristics not common to the larger culture.
Risk factors for altered family health?
Lifestyle Psychosocial Environmental Developmental Biologic
The Human Dimensions Affecting Health
Physical dimension Emotional dimension Intellectual dimension Environmental dimension Sociocultural dimension Spiritual dimension
Stage 1 of illness behavior
Stage 1: Experiencing symptoms (pain, cough) - last for a short time, if relieved by self-care, the person takes no further action. If the symptoms continue.....
Stage 2 of illness behavior
Stage 2: Assuming the sick role - focus on symptoms, seeks out treatment, becomes a patient
Return demonstration
Teaching to cough and deep breath
Culture shock
The feelings a person experiences when placed in a different culture May result in psychological discomfort or disturbances
Models of Health and Illness
The health belief model The health promotion model The health-illness continuum The agent-host-environment model
Stage 3
We are give a picture and the answer is
ALL of the above
What is Aromatherapy used for? Promoting the harmonization of emotional, physical and spiritual health Strengthen recovery Holistic healing Relieve stress, andziety, and depression All of the above
Eating yogurt is better than eating cake
What represents feed back
Pain scale
What's the best action to assess pain
When can patients be discharged?
When expected outcomes of care are met When the patient and/or caregiver has the necessary knowledge & skills to provide care When the patient is able to transition from a dependent role to a more independent role
What is collaborative practice?
When multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality of care
Gaston
Who is the father of music therapy
Universally applicable
a framework for all nursing activities
Administer an opioid narcotic to the client
a nurse is caring for a client who is at the end of life and is experiencing Dyspnea. Which of the following actions should the nurse take ? C
1. A nurse has volunteered to give influenza immunizations at a local clinic. What level of care is the nurse demonstrating? a. Tertiary b. Secondary c. Primary d. Promotive
a. Tertiary
Illness
abnormal process in which any aspect of the person's functioning is altered (in comparison to the previous condition of health)
•Family:
any group of people who live together and depend on one another for physical, emotional, and financial support
tertiary health promotion
begins after an illness is diagnosed and treated
illness prevention
behavior of a person motivated by a personal desire to increase well-being and health potential
Community based care?
care provided to those who live within a specific geographic area
Environmental dimension
housing; sanitation; climate; pollution of air, food, and water
Self-concept
how one feels about oneself (self-esteem) & the way you perceive your physical body (body image)
Interpersonal
human being is always at the heart of nursing
secondary health promotion
screening for early detection of disease with prompt diagnosis and treatment
Spiritual dimension
spiritual beliefs and values
Health
state of optimal functioning or well-being
cutaneous pain
the discomfort originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma ( ** think skin**)
Problem Solving and the Nursing Process
• Trial-and-error problem solving • Scientific problem solving • Intuitive problem solving • Critical thinking: intuitive, logical, or both?
Guidelines for discharge planning
Assess and identify health care needs. Set goals with patient. Teach patient and family. Provide home health care referrals Evaluate discharge planning effectiveness
Cultural imposition
Belief that everyone should conform to the majority belief system
Culturally competent Nursing care-patient in pain
Recognize that each person holds various beliefs about pain and that pain is what the patient says it is. Respect the patient's right to respond to pain in one's own fashion. Never stereotype a patient's responses to pain based on the patient's culture. Be sensitive to nonverbal signals of discomfort, such as holding or applying pressure to the painful area or avoiding activities that intensify the pain.
Family Structures - Physical
Safe environment
The client reports that on a scale of 0 to 10 the current pain is a 3
The nurse is reassessing a client after pain medication has been administered to manage the pain from a bilateral knee replacement procedure. Which statement most accurately depicts proper documentation of pain assessment? The client is receiving sufficient relief from pain medication, stating no pain in either knee. The client appears comfortable and is resting adequately and appears to not be in acute distress. The client reports that on a scale of 0 to 10, the current pain is a 3. The client appears to have a low tolerance for pain and frequently reports intense pain.
Family Functions - Socialization
Transmits attitudes, values, coping skills
A nurse assesses patients in a physicians office who are experiencing different levels of health & illness. Which statements best defines the concepts of health & illness? Select all the apply. a. Health & illness are the same for all people b. Health & illness are individually defined by each person c. People with acute illnesses are actually healthy d. People with chronic illnesses have poor health e. Health is more than the absence of illness f. Illness is the response of a person to a disease
b. Health & illness are individually defined by each person e. Health is more than the absence of illness f. Illness is the response of a person to a disease
Sociocultural dimension
economic level, lifestyle, family, and culture
Physical dimension
genetic inheritance, age, developmental level, race, and gender
Historical Development of the Nursing Process
• 1955: Nursing process term used by Hall • 1960s: Specific steps delineated • 1967: Yura and Walsh published first comprehensive book on nursing process • 1973: ANA Congress for Nursing Practice developed Standard of Practice • 1982: State board examinations for professional nursing uses nursing process as organizing concept
10 Guiding Principles of Person-Centered Care
• All team members are considered caregivers. • Care is based on continuous healing relationships. • Care is customized and reflects patient needs, values, and choices. • Knowledge and information are freely shared between and among patients, care partners, physicians, and other caregivers. • Care is provided in a healing environment of comfort, peace, and support. • Families and friends of the patient are considered an essential part of the care team. • Patient safety is a visible priority. • Transparency is the rule in the care of the patient. • All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient. • The patient is the source of control for one's care.
Potential Errors in Decision Making
• Bias • Failure to consider the total situation • impatience
QSEN Competencies
• Person-centered care • Teamwork and collaboration • Evidence-based practice • Quality improvement • Safety • Informatics
Maturational loss
A daughter gets married and moves away what type of loss is this
Cognitive
A patient has a normal heart beat, in what domain did learning take place
Ethnocentrism
Belief that one's ideas, beliefs, and practice are the best or superior, or are most preferred to those of others
Which statement accurately describes part of the process involved when a patient leaves AMA?
The patient's signature must be witnessed, and the form becomes part of the patient's record.
Referred pain
When pain can originate in 1 part of the body but is perceived in an area distant from its point of origin
Submitting a written notice to all clients identifying the uses and disclosures of their health information
Which action by the nurse is compliant with the Health Insurance Portability and Accountability Act (HIPAA)? Disclosing client health information for research purposes after obtaining permission from the client's health care provider Releasing the client's entire health record when only portions of the information are needed Submitting a written notice to all clients identifying the uses and disclosures of their health information Obtaining only the client's verbal acknowledgement of having been informed of the disclosure of information
Reject allopathic medicine and embrace CAM practices
Which principle does not encompass the basic goals of integrative medicine? Reject allopathic medicine and embrace CAM practices. Establish a partnership between client and practitioner. Facilitate the body's innate healing abilities. Focus on promoting health and preventing illness, as well as treating disease.
If the client declines the dose, the nurse does not have to document this on the MAR
Which statement is not true regarding a medication administration record (MAR)? If the client declines the dose, the nurse does not have to document this on the MAR. The MAR distinguishes between routine and "as needed" medications. The MAR identifies routine times for medication administration. After using an electronic MAR, the nurse should log off.
Cross it out then initial it and then write the correct thing
With paper charting, if you mess up what do you do
The Health Promotion Model (Pender)
-Developed to illustrate how people interact with their environment as they pursue health -Incorporates individual characteristics and experiences and behavior-specific knowledge and beliefs, to motivate health-promoting behavior -Personal, biologic, psychological, and sociocultural factors are predictive of a certain health-related habit. -Health-related behavior is the outcome of the model and is directed toward attaining positive health outcomes and experiences throughout the lifespan.
Factors Influencing Health Disparities
-Health disparity is " a particular type of health difference that is closely linked with social, economic, & /or environmental disadvantage" - influenced -Racial and ethnic groups -Poverty -Gender; age -Mental health -Educational level -Disabilities -Sexual orientation -Basic human needs (Maslow's Hierarchy) -The human dimensions -Risk factors for illness or injury
Steps in Concept Mapping
1. Develop a basic skeleton diagram. 2. Analyze and categorize data. 3. Analyze nursing diagnoses relationships. 4. Identify goals, outcomes, and interventions. 5. Evaluate patient's responses.
Administer analgesic medication Apply heat to the pelvic area Recommend avoidance of sugar Provide chamomile tea Encourage exercise
An adolescent client is experiencing menstrual pain. Which action(s) will the nurse take to assist the client with decreasing pain? Select all that apply. Administer analgesic medication Apply heat to the pelvic area Recommend avoidance of sugar Provide chamomile tea Encourage exercise
Five Steps of the Nursing Process
Assessing: collecting, validating, and communicating patient data • Diagnosing: analyzing patient data to identify patient strengths and problems • Planning: specifying patient outcomes and related nursing interventions • Implementing: carrying out the plan of care • Evaluating: measuring extent to which patient achieved outcomes
2015
At 8:15 p.m., a client reports pain, and the nurse administers the prescribed analgesic. When documenting this intervention using military time, which time would the nurse use? 0815 0945 1945 2015
Which step of the nursing process is a nurse using when analyzing patient data to determine a patient's strengths following a CVA? A. Assessing B. Diagnosing C. Planning D. Implementing E. Evaluating
B. Diagnosing
Which of the following characteristics of the nursing process describes the interaction and overlapping of steps within the process itself? A. Systematic B. Dynamic C. Interpersonal D. Universally Applicable
B. Dynamic
cultural assessment/area nurses need to understand
Beliefs, values, traditions and practices of a culture Culturally defined, health-related needs of individuals, families, and communities Culturally based belief systems of the etiology of illness and disease and those related to health and healing Attitudes toward seeking help from health care providers
Legal document
Besides being an instrument of continuous client care, the client's health care record also serves as a(an): assessment tool. legal document. Kardex. incident report.
What does the coordinator of services do?
Directs the various services toward a common goal of improving the patients health and promoting independence
Revise the plan of care
During hospitalization, the client has developed shortness of breath with edema. What action should the nurse take? Review the nursing care plan. Implement changes in the current interventions. Involve the family in changes. Revise the plan of care.
true or false In same-day surgery clinics, screening tests and teaching take place upon admission to the clinic.
False (in same-day surgery clinics, screening tests and teaching take place prior to admission to the clinic)
true or false Planning for discharge begins when the patient receives discharge orders from the physician in charge of care
False (planning for discharge begins on admission)
Anticipating grief
Family member of dying patient tells nurse that she will not be coming anymore, what type of grief of this?
Dominant Group in society
Group has the most authority to control values and sanctions of society
Faces pain chart
How do you assess a child's pain ?
SOAP SOPIE PIE FOUCS CHARTING
List four different formats the nurse could write her progress in and what each format stand for
Maslow's Hierarchy of Human Needs
Lower Level Needs: Physiologic (first priority - ADL's), safety and security Higher-level needs: Love and belonging, self esteem, self actualization
Single Parent Family
May be separated, divorced, widowed, or never married
Cultural assimilation (acculturation)
Minorities living within a dominant group lose the characteristics that made them different. Values replaced by those of dominant culture
Transfer within hospital setting
Move patient's personal belongs to a new room. Transfer patient chart, Kardex, care plan, and medications. Notify other hospital departments of the move (can be done electronically) Give verbal report to the nurse in the new area.
Making sure the patient eats every meal
Nurse tech cares for dying patient, when would intervene
Patient-controlled analgesia ( talking to the patient)
PCA is what ( how do you know it's working)
PT with a 10 pain and a new order
Pain meds priority
Enhancing quality of life
Palliative care team is caring for a dying patient what action takes priority
Systematic
Part of an ordered sequence of activities
Cultural influences on health care
Physiologic variations Reactions to pain Mental health Gender roles Language and communication Orientation to space and time Food and nutrition Family support Socioeconomic factors
Health Promotion and Illness Prevention
Primary, secondary and tertiary
ANA Definitions of Nursing
Provision of a caring relationship that facilitates healthand healing Attention to the range of human experiences and responses to health and illness within the patient's physical and social environments Integration of assessment data with knowledge gained from an appreciation of the patient or group's subjective experience Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking Advancement of professional nursing knowledge through scholarly inquiry Influence on social and public policy to promote social justice Assurance of safe, quality, and evidence-based practice
How can nurses help family health?
Recall that each member has their own definition of health
Community factors affecting health?
Social support systems Economic resources Community health care structure Environmental factors
Stage 3 of illness behavior
Stage 3: Assuming a dependent role - accepts the dx & follows the prescribed plan
Stage 4 of illness behavior
Stage 4: Achieving recovery and rehabilitation
False
TRUE OR FALSE Lavender promotes more energy and helps reduce stress and anxiety.
Remind the UAP about the clients right to privacy ( rationale: all actions are appropriate but do not immediately protect the clients privacy)
The nurse hears an unlicensed assistive personnel (UAP) discussing a client's allergic reaction to a medication with another UAP in the cafeteria. What is the priority nursing action? Remind the UAP about the client's right to privacy. Report the UAP to the nurse manager. Notify the client relations department about the breach of privacy. Document the UAP's conversation.
The anesthesiologist/ pain management team should be notified immediately if the clients respiratory rate is below 10 breaths / min
The nurse is caring for a client whose pain is being treated with epidural analgesia. Which nursing action is most appropriate? If the client develops a headache, an opioid analgesic may be administered along with the epidural analgesia. The anesthesiologist/pain management team should be notified immediately if the client's respiratory rate is below 10 breaths/min. If a client is experiencing adverse effects, a peripheral IV line should be inserted to allow immediate administration of emergency drugs, if warranted. The nurse should expect slight resistance during the removal of the epidural catheter.
Tell whether the following statement is true or false. Concept mapping is an instructional strategy that requires learners to identify, graphically display, and link key concepts.
True
Allopathic medicine (or conventional medicine)
Type of medicine that is evidence-based practice that includes remarkable advances in biotechnology, surgical interventions, pharmaceutical approaches, and diagnostic tools
Race
Typically based on specific characteristics: skin pigmentation, body stature, facial features, hair texture
Cultural diversity
Varying cultures Racial and ethnic origin Religion Physical size, age, and gender Sexual orientation Disability Socioeconomic and occupational status Geographical location
Dry needling
Which of the following is not a type of massage therapy ? A. Sports massage B. Reflexology C. Deep Tissue Massage D. Dry needling
Wellness
an active state of being healthy by living a lifestyle promoting good physical, mental, and emotional health
Outcome oriented
nurses and patients work together to identify outcomes
