Critical Thinking Nursing

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The nurse is prioritizing care for a client based on nursing diagnoses. If following Maslow's hierarchy of needs, select the order in which the nurse should provide care to the client. PLACE IN ORDER 1-6 Fatigue Anxiety Alteration in Perfusion Self-Care Deficit Deficient Knowledge Diarrhea

5. Fatigue 4. Anxiety 1. Alteration in Perfusion 3. Self-Care Deficit 6. Deficient Knowledge 2. Diarrhea High-priority nursing diagnoses should be addressed first. This means that Alteration in Perfusion would be the first priority. Medium-priority diagnoses should be addressed next, in order of the impact on physiologic processes. Diarrhea would be a priority over Self-Care Deficit; however, Self-Care Deficit would be a priority over Anxiety. Low-priority diagnoses would be addressed last, again in order of physiologic impact. Fatigue would be a priority over Deficient Knowledge.

After receiving the morning report, the nurse prioritizes care needed by several clients. Which factors should the nurse keep in mind when creating this priority list? Select all that apply. A. Time available B. Client preferences C. Client condition D. Nurse preferences E. Safety

A B C E

A nurse is preparing to conduct a research study and wants to do a literature search for relevant articles. Which of the following sections should the nurse expect to find in each search result? Select all that apply. A. References B. Funding C. Results D. Methods E. Abstract

A C D E

Which of the following would be considered sentinel events? Select all that apply. A. Homicide of a staff member while at the facility B. Administration of a compatible blood transfusion C. Homicide of a client while at the facility D. Delivery of radiation to the wrong body region E. Invasive surgical procedure at the wrong site

A C D E

A nurse researcher is preparing to give a presentation about evidence-based practice (EBP) to a group of nursing students. Which of the following statements would be appropriate for the nurse researcher to include in this presentation? A. "EBP focuses solely on research-based evidence, and it assumes that best practices for nursing care exist independent of client preferences." B. "EBP involves integrating research evidence, the nurse's own clinical expertise, and client values and preferences." C. "EBP is sometimes also referred to as translational research." D. "EBP is typically only associated with complex nursing tasks, such as preparing clients for surgery and monitoring for adverse effects."

The nurse is caring for a client with a chronic disease process. The client tells the nurse he recently read an article about funding for the National Institute of Nursing Research (NINR). He then asks the nurse why the U.S. Congress would fund such an organization. Which response by the nurse is most appropriate? A. "The government is interested in preventing chronic disease." B. "Nursing research is focused on prevention and health promotion, which will decrease healthcare costs." C. "The government is looking to the NINR for information about promoting health." D. "Funding the NINR is one cause of health cost increases in the country."

The nurse is participating in a quality improvement process related to improving care for clients at risk for skin breakdown. Which best describes the purpose of this process? A. To maintain accreditation B. To improve client outcomes C. To advance the nurse's career D. To fulfill legal requirements

B Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care, including overall outcomes. Participation may help the nurse advance in his or career, but that is usually accomplished by returning to school for a higher degree. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so. Although maintaining accreditation is important, it is not the primary reason for engaging in quality improvement processes.

Which statements best describe how a quality improvement process can contain healthcare costs? Select all that apply. A. "Use of computers increases the number of lawsuits." B. "High nurse-to-client ratios result in decreased readmission rates." C. "Promoting safety increases the cost of care." D. "Increased nursing staff has been linked to decreased infection rates." E. "Medication errors decrease the cost of care."

B D Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because readmission rates and infection rates, as well as client mortality, are reduced with RN care. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.

A nursing preceptor is working with a novice nurse on a medical-surgical unit. During client care, the novice nurse shares an evidence-based wound care technique that is being used with much success. Which of the following is being encouraged when the novice nurse shares this information with the preceptor? A. Use of existing unit modes of care B. Use of trial and error to gain knowledge C. Use of new knowledge gained through research D. Use of medical knowledge to perform care

The head nurse in a pediatrician's office is interested in incorporating more aspects of evidence-based practice (EBP) into the facility's regular nursing procedures and protocols. Which of the following resources would be most useful in helping the nurse achieve this goal? A. Documentation from the Centers for Disease Control and Prevention regarding recommended vaccinations for individuals who plan to travel abroad B. A journal article discussing the perceived versus actual effectiveness of various approaches to smoking cessation C. A report from the National Institutes of Health (NIH) describing a new sickle cell screening protocol D. An American Nurses Association (ANA) report about best practices for reducing the incidence of pressure ulcers

Which statement regarding standards of care in the hospital setting is inaccurate? A. "Standards of care are based on models of high-quality performance." B. "Outcome standards focus on the performance of a process." C. "Process standards focus on human resources, and general organizational structure." D. "Process standards focus on the steps used to lead to a particular outcome."

Which client should the nurse assess first after receiving the change-of-shift report? A. A client with hypertension with a blood pressure of 168/88 mmHg B. A client with a bowel obstruction who is complaining of nausea C. A client with heart failure who is complaining of shortness of breath D. A client with type 1 diabetes mellitus with blood glucose of 82 mg/dL

C Rationale: Using the ABCs (airway, breathing, and circulation) as a guide, the nurse should first assess the client with shortness of breath. This would take priority over a client complaining of nausea, a client with an elevated (but not critically elevated) blood pressure, and a client with a normal blood glucose reading.

A home health nurse who is visiting a client to complete a wound dressing notes that the client has a flat affect and is not as responsive as during previous visits. The nurse calls the client's primary healthcare provider for a psychiatric referral. By recognizing the signs and symptoms of possible depression, the nurse is exhibiting which concept associated with evidence-based practice? A. Advocacy B. Accountability C. Professional behaviors D. Clinical decision making

A nurse educator is interacting with a group of nurses who are working toward their graduate degrees. The members of the group are interested in replication studies. Which of the following replication studies would be most appropriate given the changing demographics in the United States? A. A study examining how new technology affects client care B. A study examining the ability of families to adapt to acute health problems C. A study examining how effective use of supplies affects the cost of care D. A study examining the ability of an aging population to care for itself

A nursing student who is providing care for an assigned client knows that the information documented in the client's nursing care plan could potentially be used in research to optimize client care. Which type of research is used to convert research knowledge into healthcare applications for improved outcomes? A. Qualitative research B. Quantitative research C. Transformational research D. Translational research

Prior to conducting research, nurse researchers must have their research protocols approved by which of the following bodies? A. The journal in which the researchers plan to publish their results B. The American Nurses Association C. The U.S. Department of Health and Human Services D. An institutional review board

The nurse is caring for a client who requires extensive wound care. The client has consented to participate in a nursing research study regarding the wound care. Which client statement indicates understanding of the research goal? A. "This research will not influence my care." B. "Nursing care is based solely on research." C. "I will be paid to participate in the research project." D. "I will be helping to validate nursing care."

What is one of the primary reasons that it is important for nurses to prioritize care? A. Nurses can accomplish more if they perform the easiest or fastest interventions first. B. Nurses need to plan how to accomplish all activities within one shift. C. Nurses should perform interventions related to client preferences early in the shift. D. Nurses only have a limited amount of time to perform nursing interventions.

Which of the following resources would be of least value to a nurse who hopes to employ evidence-based practice (EBP) in support of the Healthy People 2020 objectives for pregnant women? A. A report from the American Congress of Obstetricians and Gynecologists describing best practices for screening for gestational diabetes B. A document from the National Institutes of Health describing newly identified benefits of receiving vaccines during pregnancy C. A research study linking regular exercise during pregnancy with a reduced likelihood of cesarean section D. A report from the American Cancer Society regarding changes in the recommended schedule for mammograms

Which type of research investigates a question through narrative data that explores the subjective experiences of human beings and can provide nursing with a better understanding of clients' perspectives? A. Clinical research B. Thematic research C. Quantitative research D. Qualitative research

D Qualitative research investigates a question through narrative data that explores the subjective experiences of human beings and can provide nursing with a better understanding of the subjects' perspective. Goals of qualitative research include the identification of patterns and themes. In comparison, quantitative research uses precise measurement to collect data and analyze the data statistically for a summary and a description of the resulting findings or to test relationships among variables. Clinical research refers to any type of research (qualitative or quantitative) that seeks answers to questions that will ultimately improve patient care.

Which statement best describes validity of research evidence? A. It is the study's ability to produce consistent results with each use. B. It is reflective of the study's application to clinical practice. C. It is used to determine the strengths and weaknesses of a study and its resulting evidence. D. It is the degree to which the study measured what it intended to measure.

D Rationale: Validity is the degree to which the study measured what it intended to measure. Reliability is the study's ability to produce consistent results with each use. Usefulness is reflective of the study's application to clinical practice. Critical appraisal is used to identify strengths and weaknesses of a study and its resulting evidence.

In which order should the steps of the quality improvement process be reviewed to determine whether it was completed correctly? Research factors that contribute to better outcomes. Compare outcomes to benchmarks. Identify areas for improvement. Analyze current protocols of care and associated outcomes. Implement changes to improve outcomes. Analyze client outcomes to determine effectiveness of changes.

1. Analyze current protocols of care and associated outcomes. 2. Compare outcomes to benchmarks. 3. Identify areas for improvement. 4. Research factors that contribute to better outcomes. 5. Implement changes to improve outcomes. 6. Analyze client outcomes to determine effectiveness of changes. Quality improvement involves analyzing current protocols of care and their associated outcomes, comparing those outcomes to leaders in high-quality care through benchmarking, identifying areas for improvement, researching factors that contribute to better outcomes, and implementing changes to improve outcomes. Client outcomes must then be analyzed to determine the effectiveness of the changes and identify areas for further improvement.

The nurse is prioritizing care for a client with several problems. Select the order in which the nurse should address the client's needs. PLACE IN ORDER 1-6 Bleeding through nasogastric tube Audible wheezes Not understanding how to complete the menu Requesting medication for arthritis pain Dyspnea Asking questions about teaching provided the other day

1. Audible wheezes 2. Dyspnea 3. Bleeding through nasogastric tube 4. Requesting medication for arthritis pain 5. Asking questions about teaching provided the other day 6. Not understanding how to complete the menu Setting priorities for nursing care always begins with assessment. Assessment includes making observations and asking questions to gather information necessary to make decisions. Helpful assessment data include knowing which clients have complex care issues, if any clients have particular medication times, and if any clients have safety issues that should be addressed. The number of licensed staff is not as important as knowing the number of unlicensed assistive personnel to whom the nurse can delegate client care activities. The time when attending physicians make rounds is not usually part of the criteria when prioritizing client care needs.

The nurse is responsible for continuous quality improvement at a rehabilitation hospital. Which internal client should the nurse interview for suggestions? (Select all that apply.) A. Clinical nurse specialist B. Physical therapist C. Client after hip replacement D. Parents of a child with spina bifida E. Head of Management of Information Systems

A B E Rationale: Internal clients are employees of the rehabilitation facility. They could be a physical therapist, the head of the MIS department, and a clinical nurse specialist. External clients include a client after hip replacement and parents of a child with spina bifida.

The nurse is prioritizing care activities that are to be completed for a group of clients. From highest to lowest priority, select the order in which the nurse should complete the listed activities. PLACE IN ORDER 1-6: Measure blood pressure before administering antihypertensive medication. Request dietary consult for gluten-free diet. Remove an intravenous access device infusing chemotherapy. Change a dressing on an arm wound. Call a family member to bring in shoes. Ambulate to the bathroom using a walker.

2. Measure blood pressure before administering antihypertensive medication. 5. Request dietary consult for gluten-free diet. 1. Remove an intravenous access device infusing chemotherapy. 3. Change a dressing on an arm wound. 6. Call a family member to bring in shoes. 4. Ambulate to the bathroom using a walker. The highest-priority action would be to remove an intravenous access device infusing chemotherapy because this could lead to significant tissue damage. Measuring blood pressure before administering antihypertensive medication is the next priority because this could be a timed intervention. Changing a dressing on an arm wound can occur anytime throughout the shift. Ambulating using a walker to the bathroom can be delegated to unlicensed assistive personnel. Requesting a dietary consult for gluten-free diet can also be done at any time and does not have a specific degree of urgency. Contacting family to bring in shoes can be completed at the end of the shift or delayed to the next shift.

The nurse is asked to participate in a record review to verify accuracy and proper use of certain interdisciplinary resources. Which best describes the nature of this process? A. Interdisciplinary audit B. Utilization review C. Peer review D. Benchmarking

A An audit is an examination of records to verify accuracy and proper use. Because this audit is focused on resources used by multiple disciplines, it would be classified as an interdisciplinary audit. A peer review is a professional critique of a colleague's work on the basis of predetermined standards. A utilization review analyzes the use of resources to identify areas of overuse, misuse, and underuse. Benchmarking is a method that is used to compare the performance of an individual or organization to industry standards.

The nurse is administering medications to a client. Which action is most likely to lead to an adverse event? A. The nurse combines medications with the same active ingredient. B. The nurse verifies tube placement prior to administering the medications. C. The nurse checks for known allergies prior to administering the medications. D. The nurse has a second nurse check the medication order.

A It is not appropriate to combine medications with the same active ingredient, as this is likely to increase medication errors. Verifying tube placement prior to administering medications, checking for known allergies prior to administering medications, and having a second nurse check the medication order are all appropriate actions and are considered methods to reduce medication errors.

The quality assurance officer notes that one particular nursing unit has received a higher-than-usual number of negative client responses about aspects of the nursing care during the previous quarter. Based on this data, to which benchmarking issue should the quality assurance officer pay particular attention during the review process? A. Process B. Structure C. Competency D. Outcome

A Process standards focus on the steps used to lead to a particular outcome, including whether a set of steps exists and whether those steps are being followed. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on organizational structure and resources. Outcome evaluation focuses on the performance of a process, such as the number of bedridden clients who develop a pressure injury.

The nurse working in a community clinic is reviewing the clients to be seen for the day. Which client should require more time in the schedule? A. A 75-year-old with recent cognitive decline B. A 32-year-old with newly diagnosed diabetes who is returning for a blood glucose recheck C. A 20-year-old who is being seen for evaluation of insulin pump management D. A 50-year-old who is being seen for blood pressure recheck

A Rationale: An older client with cognitive issues may require more time than do other clients due to both developmental and cognitive issues. Blood pressure rechecks, insulin pump follow-up, and blood glucose rechecks of young and middle-aged adults would not necessarily require more time.

The charge nurse is providing an educational seminar for a group of nurses. Which factor should the nurse expect to be discussed as an evidence-based practice topic for older adults that correlates with Healthy People 2020? A. Fall-related injuries B. Screening protocols for sickle cell C. Obesity prevention D. Transmission of infectious disease during travel

A Rationale: For older adults, Healthy People 2020 objectives address topics including increasing the number of individuals who are up to date on basic preventive care and decreasing the incidence of health alterations such as pressure ulcers and fall related injuries. For the general care of adults, goals associated with the promotion of global health include protecting the health of the national population as well as limiting the international transmission of infectious diseases during travel. Evidence-based resources related to newborns and infants address topics such as screening protocols for phenylketonuria and sickle cell disease.

The nurse administered blood pressure medications to the wrong client. Upon realizing the error, the nurse notes that the last blood pressure assessment of the client who received the wrong medication was 82/50 mmHg. Which level of urgency would be required to address this situation? A. Critical B. Acute C. Nonacute D. Imminent death

A Rationale: In this situation, a blood pressure medication was administered to the wrong client who has low blood pressure, creating a critical situation to which the nurse needs to respond quickly since the client's condition could become life threatening. This would not be an acute or nonacute situation, as it is a medium-high priority. It is not likely that this error would result in death of the client, so the choice of imminent death would not be appropriate.

The nurse organized a staff meeting to address morale issues and improve the level of care on the unit. Which assessment practice is the nurse demonstrating? A. Intraprofessional B. Utilization review C. Interprofessional D. Benchmarking

A Rationale: Intraprofessional assessment occurs within a group of individuals who have similar positions within a healthcare system, such as a group of nurses or a group of surgeons. Such an assessment is important for identifying areas of improvement at each level of care. Interprofessional assessment would take place if a different units provided feedback. Benchmarking is comparing outcomes of two different departments. A utilization review looks at areas of misuse, overuse, or underuse of resource, not a moral issue.

Which factor that inhibits evidence-based practice would be considered an external factor? A. Lack of support by management B. Thoughts that the process doesn't work C. Resistance to change D. Personal aversion to the idea

A Rationale: Nurses need to assess the obstacles that inhibit them from using EBP more frequently. These may include internal factors, such as beliefs or misconceptions, or external factors, such as lack of management support. Resistance to change, a personal aversion to the idea, and a thought that the process doesn't work are all examples of internal factors.

A nurse researcher is designing a study intended to explore how certification exam preparation courses affect nursing students' success rates in passing the exam. Which element best reflects the nurse's use of a randomized control trial (RCT) design? A. Compare the exam performance of a control group of graduate nurses who did not complete any certification exam preparation course with a group of graduate nurses who completed a specific certification exam preparation course prior to taking the exam. B. Examine a group of studies on graduate nurses who completed certification exam preparation courses and then combine and analyze the results as if they were from one large study. C. Interview five graduate nurses who completed a certification exam preparation course and detail their experiences with the course and then identify the number of graduate nurses who successfully completed the certification exam. D. Compare graduate nurses who successfully passed the certification exam with graduate nurses who did not pass the exam in order to determine whether or not completing a certification exam preparation course was a variable that contributed to test performance.

A Rationale: Randomized control trials (RCTs) are designed to illustrate a cause-and-effect relationship by using a control group and an experimental group. An RCT is best illustrated by comparing the exam performance of a control group of graduate nurses who did not complete any certification exam preparation course with a group of graduate nurses who completed a specific certification exam preparation course prior to taking the exam. A meta-analysis examines a group of studies on a given topic and combines and analyzes the results as if they were from one large study; this design is best reflected by examining a group of studies on graduate nurses who completed certification exam preparation courses and then combining and analyzing the results as if they were from one large study. A case study is specific to one individual, issue, or event; this design is best reflected by interviewing five graduate nurses who completed a certification exam preparation course and detailing their experiences with the course, as well as identifying the number of graduate nurses who successfully complete the certification exam. Case-control studies compare individuals with and without a specific condition to identify predictive variables; this design is best reflected by comparing graduate nurses who successfully passed the certification exam with graduate nurses who did not pass the exam to determine whether or not completing a certification exam preparation course contributed to the success rates.

The nurse is critically appraising a research study. Which statement is reflective of an appraisal of the study's reliability? A. "The original study was repeated three times, but it did not produce consistent results." B. "Although the study was supposed to measure the client's wound healing, it really measured the client's satisfaction with care." C. "The study's results are not applicable to clinical practice." D. "The study's results are applicable to clinical practice."

A Rationale: Reliability is the study's ability to produce consistent results with each use. Validity is the degree to which the study measured what it intended to measure. Usefulness is reflective of the study's application to clinical practice.

The nurse is reviewing yearly national patient safety goals. For which organization is the nurse retrieving this information? A. The Joint Commission B. Institute for Safe Medical Practices C. The American Medical Association D. The Food and Drug Association

A Rationale: The Joint Commission is the organization that identifies client safety goals every year for medical facilities to focus on. The goals include, but are not limited to, ensuring clients are identified safely, improving staff communication, using alarms safely, and preventing infections. The American Medical Association (AMA) promotes the betterment of public health by enhancing the delivery of care and enabling physicians and healthcare teams to partner with clients to achieve better health. The Institute for Safe Medication Practice (ISMP) maintains a list of high alert medications such as look-alike, sound-alike medications to assist clinicians with identifying medications that can either look similar or have similar names, but that have very different chemical properties that can cause harm to the client if the medications are mixed up. The Food and Drug Administration (FDA) is responsible for advancing the public health by helping to speed innovations that make medical products more effective, safer, and more affordable and by helping the public get the accurate, science-based information they need to use medical products and foods to maintain and improve their health.

A homeless client presents to the emergency department (ED) complaining of severe chest pain. The client is well known to the ED, coming in frequently for various minor complaints. Which ethical principles should be most important for the nurse to consider? A. Justice and fairness B. Nonmaleficence and beneficence C. Accountability and responsibility D. Privacy and confidentiality

A Rationale: The principle of justice guides nurses in making decisions about setting priorities. Additionally, nurses must show fairness in treating individuals as equals. In this scenario, the nurse must treat the homeless client like any other client seeking care for chest pain. Accountability, responsibility, privacy, confidentiality, nonmaleficence, and beneficence are all important ethical considerations for the nurse but are not directly relevant to the situation.

A hospital administrator wants to improve quality care and workflow process within the organization by involving the whole organization, suppliers, and customers in the process. Which quality management program should the nurse understand the manager is using? A. Total quality management B. Six Sigma C. Lean Six Sigma D. Continuous quality improvement

A Rationale: Total quality management (TQM) is a comprehensive management philosophy that is used to improve quality and productivity by using data and statistics to improve systems processes. TQM involves teamwork throughout the organization, involving all departments and employees and including both suppliers and customers. Its essential elements include communication, feedback, fact-based decision making, and a focus on continual improvement.

The nurse manager is concerned that a staff nurse is having difficulty prioritizing client care needs. Which did the manager observe the nurse perform that caused these concerns? Select all that apply. A. Not completing an assessment B. Doing easiest tasks first C. Relying on another nurse's assessment D. Asking unlicensed assistive personnel to perform complicated care E. Reviewing the medication administration record

A B C D

Which action by the nurse can help to avoid pitfalls that can result in client harm? (Select all that apply.) A. Prioritizing client care appropriately B. Following ethical care practices C. Incorporating client preferences as possible when prioritizing care D. Knowing client healthcare concerns E. Delegating care only when absolutely necessary

A B C D Rationale: To avoid common pitfalls when providing care, the nurse should follow ethical care practices, know client healthcare concerns, prioritize care appropriately, and incorporate client preferences as possible when prioritizing client care. Appropriate delegation can be helpful to the nurse when prioritizing care, so it should not be avoided but used appropriately.

As head of continuous quality improvement at a hospital, the nurse wants to interview external customers. Which customer should the nurse include? (Select all that apply.) A. Hospital volunteers B. Clients who seek healthcare C. Insurance companies D. Billing specialist E. Durable medical equipment suppliers

A B C E Rationale: External customers include the individuals who seek healthcare as well as their family members and significant others. External customers also include other individuals and entities with which internal clients interact, such as insurance companies, managed care organizations, equipment or material suppliers, social service agencies, and law enforcement officials. Internal customers include employees of a healthcare organization, such as nurses, healthcare providers, therapists, medical records staff, billing specialists, and other employees.

Which response is an example of a background question? (Select all that apply.) A. Why isn't long-acting insulin administered via the IV route? B. What is the pathophysiology of left ventricular heart failure? C. How does acupuncture compare with pain medication for treating chronic knee pain? D. How does incentive spirometry help prevent collapse of the small airways in the lungs? E. What is the link between healthcare providers' stethoscopes and healthcare-acquired infections?

A B D Rationale: Background questions are knowledge based and seek more information about a topic, such as medications or diseases. Answers to background questions can be found in textbooks, drug guides, medical dictionaries, and other education resources. Foreground questions are practice based and, compared with background questions, they are narrower in scope. Foreground questions focus on a specific clinical issue and their answers identify useful information about direct client care that may guide the formulation of nursing interventions that improve client outcomes.

The nurse is discussing social determinants addressed by Healthy People/Healthy Communities. Which factor should the nurse include? (Select all that apply.) A. Public safety B. Availability of resources to meet daily needs C. Physical barriers, especially for people with disabilities D. Social norms and attitudes, such as discrimination E. Exposure to toxic substances and other physical hazards

A B D Rationale: Healthy People/Healthy Communities is another aim the U.S. Department of Health and Human Services (HHS) has developed to improve the health of the population. The aim's focus is to health. Examples of social determinants include, but, are not limited to: (1) availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods; (2) social norms and attitudes, such as discrimination; (3) social support and social interactions; (4) socioeconomic conditions, such as concentrated poverty; (5) quality schools; (6) transportation options; and (7) public safety.

The nurse is prioritizing client care as low, medium, or high priority for the current assignment. Which client should the nurse identify as having a high-priority circumstance? (Select all that apply.) A. A client who is receiving warfarin (Coumadin) B. A client with emphysema and a pulse oximeter reading of 88 C. An extremely confused older client D. A client who is experiencing extreme bouts of diarrhea E. A client with congestive heart failure and shortness of breath

A B E Rationale: High-priority circumstances include clients with a risk for bleeding, such as a client receiving warfarin (Coumadin), clients with ineffective breathing patterns, and clients with impaired gas exchange. A confused client and a client with diarrhea would have medium-priority circumstances.

In a professional development seminar, the educator shares barriers that they may encounter as they try to implement evidence-based practice (EBP) into their care. Which statement most accurately describes these potential barriers? (Select all that apply.) A. Client workload demands B. Nursing misperceptions about EBP C. Providing accountability for nursing care D. Ensuring credibility of the nursing profession E. Lack of access to continuing education programs

A B E Rationale: Potential barriers to implementation of evidence-based practice (EBP) include lack of access to continuing education programs, nursing misperceptions about EBP, and client workload demands. Benefits of EBP include providing accountability for nursing care and ensuring credibility of the nursing profession.

The nurse conducting a research study needs to determine if an individual qualifies to be a participant. Which criteria must be met for inclusion? (Select all that apply.) A. The individual meets all the inclusion criteria. B. The individual has been given informed consent. C. The individual receives payment for participation. D. The individual must waive the right to anonymity. E. The individual is informed of all aspects of the study.

A B E Rationale: Research participants are defined as volunteers for a specific study project who meet all the inclusion criteria, have been informed of all aspects of the study, and have given informed consent. Adherence to the ethical principle of justice requires protection of the research participant's anonymity. Payment is not a mandatory condition of participation in research.

Which National Quality Strategy should the nurse understand focuses on the community? (Select all that apply) A. Healthy living B. Effective prevention and treatment C. Affordability D. Care coordination E. Client safety

A C Rationale: Affordability covers the community as the healthcare industry works to make healthcare more affordable to individuals, families, employers, and governments. Healthy living also covers the community because this strategy's main aim is to work with communities to promote wide use of best practices to promote healthy living. Client safety, care coordination, and effective prevention and treatment are all more focused on the individual client.

The nurse is preparing to present the goals of risk management. Which should the nurse include? (Select all that apply.) A. Prevent adverse events B. Occurs on a monthly basis C. Minimize damage from adverse events D. Prevent breach of care E. Conduct root cause analysis

A C Rationale: Risk management is the process of identifying vulnerabilities to minimize the consequences of adverse client outcomes. Risk management includes both proactive components to prevent adverse events and reactive components to minimize damage from adverse events. Risk assessment must occur daily, and all individuals must be dedicated to keeping clients safe from harm.

An organization is using Six Sigma to determine why discharge instructions given to a group of clients were below national standards. Which step should the nurse understand applies to this quality management process? (Select all that apply.) A. Improving the knowledge level of the staff unit-by-unit B. Standardizing the discharge process with the healthcare providers C. Improving the knowledge level of the staff with one-on-one training D. Standardizing and simplifying the discharge instruction process E. Meeting with the discharge planners

A C D Rationale: Six Sigma is a quality improvement program that aims to produce a near-perfect product. Sigma is used to measure deviation from a standard. In this system, a defect is defined as anything that could lead to client dissatisfaction. Defects in healthcare could range from relatively minor problems to major problems. Six Sigma primarily uses the Define, Measure, Analyze, Design, and Verify system to improve outcomes. For this instance, the organization is aiming to increase the percentage of heart failure clients for compliance.

The nurse is preparing to present the benefits of evidence-based practice (EBP) as it relates to nursing to colleagues. Which benefit should the nurse include? (Select all that apply.) A. Receiving the best client outcomes B. Increasing the accuracy of charting C. Contributing to the knowledge of nursing D. Increasing teamwork in healthcare facilities E. Assisting in the delivery of high-quality nursing care

A C E Rationale: Some basic activities can provide a foundation for implementing EBP. These strategies can spark the necessary stimulus to engage in behaviors that encourage best practice. Participating in EBP contributes to the knowledge of nursing and client care in today's healthcare systems and delivery of high-quality nursing care for best outcomes. Utilizing EBP doesn't increase the accuracy of charting, as that is all dependent on the nurse and the knowledge of what they add to the record. EBP governs nursing practice, but teamwork is something that needs to be encouraged by management in each individual healthcare facility.

A nurse manager is encouraging staff on the unit to go back to school and "become professionals, not just workers" by "increasing" their knowledge through education and networking. Which criteria for nursing to be recognized as a profession is the nurse manager highlighting? Select all that apply. A. Having autonomy B. Following a code of ethics C. Having specialized education requirements D. Conducting ongoing research E. Joining professional organizations

A C E Although all of the answer choices are criteria for nursing to be recognized as a profession, in this situation, the nurse manager is highlighting the importance of specialized education and joining professional organizations through networking. Having autonomy is implied, because more education leads to more autonomy.

The nurse working in a blame-free environment provides medication to a client at the wrong time. No harm came to the client as a result of the nurse's error, and the nurse files a report about the medication error. Which action by the risk management team should the nurse anticipate? A. Reporting to the board of nursing. B. Taking disciplinary action C. Suggesting system changes to prevent future errors D. Monitoring all nurses on the unit.

Which best describes the desired outcome of decreased readmission rates? A. An increase in client care supplies B. A decreased cost of care C. A decrease in client satisfaction D. An increased use of overtime

B Research has shown that an increase in RN staff decreases a unit's readmission rate. Because readmission is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase in RN staff. Decreasing readmission rates will likely decrease the use of client care supplies, not increase it.

The nurse is planning the day on a general medical unit. Which activity should the nurse prioritize as "must do" and not advisable to be delegated to unlicensed assistive personnel (UAP)? A. Collecting vital signs on assigned clients B. Health teaching for a client being discharged poststroke C. Assisting clients with hygienic care activities D. Ambulating a stable client to the bathroom

B Rationale: "Must do" activities carry the highest priority for completion and should not be delegated. Health teaching and discharge teaching must be done by the nurse. Collecting vital signs, ambulating a stable client to the bathroom, and assisting clients with hygienic activities can all be safely delegated to unlicensed assistive personnel (UAPs).

The client satisfaction rate is at 60% for two consecutive months, and staff morale is at its lowest. The nurse manager decides to plan changes that will improve conditions on the unit. Which should be the priority action? A. Developing a strategic action on how to deal with these concerns B. Calling for a staff meeting placing this issue on the agenda C. Seeking help from another manager D. Ignoring the issues since these will be resolved naturally

B Rationale: Calling for a staff meeting to address the issue will allow for the participation of every staff member in the unit. If they contribute to the solutions of the problem, they will own the solutions; hence the chance for compliance would be greater. Ignoring the issue with a perception that these will be naturally resolved is not a correct approach. Developing strategic action on dealing with these concerns and seeking help from his manager will be the next steps, or can wait for some time at this juncture.

The nurse manager is proactive when conducting risk management for a unit. Which key factor of risk management should be the nurse's primary concern? A. Affordable care B. Client satisfaction C. Client communication D. Proper care and treatments

B Rationale: Client satisfaction is a key factor in risk management because a dissatisfied client presents a higher risk for liability than a satisfied client, which should be the concern for a manager. A nurse who becomes aware of client dissatisfaction should take steps to communicate with the client to clarify misunderstandings, advocate for the client to receive better care, and notify a supervisor about potential problems. Client communication, proper care and treatment, and affordable care are the concerns of the healthcare providers and respective departments.

Which evidence-based resource would be appropriate for the nurse to integrate into the care of a pregnant client? A. Teaching pamphlets on circumcision B. Information on breastfeeding from Healthy People 2020 C. Safety instructions from a car seat manufacturer D. Consequences of illegal drug use from the local police department

B Rationale: Evidence-based resources use current best evidence in making decisions about the care of individual patients. Healthy People 2020 provides science-based benchmarks to track and monitor progress towards health to motivate individuals. While there are multiple opportunities for educational topics, only those based in the science can be considered evidence-based. Healthy People 2020 strives to identify nationwide health improvement priorities. As such, breastfeeding information from this source would be considered evidence-based, while other teaching pamphlets or information from local agencies or manufacturers may not.

Evidence-based practice (EBP) is very prescriptive across the lifespan. Which client would be the focus for decreasing the incidence of pressure ulcers as presented in Healthy People 2020? A. A 35-year-old who is in a rehab facility following neck fusion surgery B. A 65-year-old client who is bedridden in a nursing home C. A 12-year-old whosleeps 10-12 hours a day D. A 16-year-old who is hospitalized after knee surgery

B Rationale: For older adults, Healthy People 2020 objectives address topics including increasing the number of individuals who are up to date on basic preventive care and decreasing the incidence of health alterations such as pressure ulcers and fall related injuries. The older adult who is bedridden would be the focus of pressure ulcer prevention due to thinner skin and no mobility. Lying in the bed put pressure on the bony prominences.

Which should the nurse recognize as being the best resource to keep abreast to the changes of the insurance and healthcare laws? A. American Medical Association B. U.S. Department of Health and Human Services C. American Nurses Association D. Physicians' groups

B Rationale: Keep abreast of the changes in healthcare and insurance laws by visiting the U.S. Department of Health and Human Services. Physicians' groups, the American Nurses Association (ANA), and the American Medical Association (AMA) are not the best place to keep oneself up-to-date about the changes in insurance and healthcare laws.

The medical surgical nurse is planning the day immediately after receiving report. Which should be the primary nursing intervention when prioritizing care? A. Ascertaining interventions B. Assessing client situations C. Assigning staff to clients D. Analyzing collected data

B Rationale: The first step when prioritizing care is assessment. Assessment is the process of gathering information to make decisions. Assessment includes knowing individual clients' health statuses to prepare for anticipated or unanticipated changes. Ascertaining interventions would occur after the assessment. Analyzing collected data would occur after an assessment. Assigning staff to clients would occur after knowing the number and level of caregivers available to provide care.

The nurse is discussing the purpose of utilization review with colleagues. Which statement should the nurse include? A. Contacting the insurance company to facilitate payment for services B. Ensuring that the client's medications and treatments are appropriate for his or her diagnosis C. Working with a social worker to make sure the client's family has resources for care D. Working with members of the interdisciplinary team to provide comprehensive care for the client

B Rationale: The utilization review nurse's role is designed to ensure that a client is receiving the necessary treatments and procedures for his or her condition without undergoing any unnecessary therapies. By reviewing these terms, the utilization review nurse saves the healthcare center money by avoiding payments on expensive treatments that are unwarranted. The nurse's role also saves the client from undergoing possibly painful and expensive tests and procedures that are not needed. All the other options are not a part of the utilization review process.

The nurse prioritizes care for a client with diabetes mellitus using Maslow's hierarchy of needs. Which need is identified as the priority for this client? A. The nurse teaches the client proper home safety techniques to prevent diabetic wounds. B. The nurse teaches the client how to properly change dressings on the right-leg amputation site. C. The client attends classes to deal with body image after amputation of the right leg. D. The client joins the local American Diabetes Association support group.

B Rationale: When prioritizing care based on Maslow's hierarchy of needs, physiological needs will come before safety, social, and esteem needs. Caring for an amputation site is meeting a physiological need. Attending a class to deal with body-image issues addresses an esteem need. Teaching the client about safety techniques to prevent diabetic wounds addresses a safety need. Joining a support group meets an esteem need.

Which question is most appropriate for the nurse to consider when evaluating the impact of evidence-based practice (EBP) on client outcomes? (Select all that apply.) A. Is the new practice beneficial to the nurse? B. Is the new practice being implemented correctly? C. Does the change in practice yield the intended results? D. Is the practice in accordance with the state's nurse practice act? E. Does the practice adhere to the American Nurses Association (ANA) standards of nursing care?

B C Rationale: Evaluation seeks to answer questions including, "Is the new practice being implemented correctly?" and "Does the change in practice yield the intended results?" Nurses are legally bound to practice in accordance with their state's nurse practice act and to provide care that adheres to the ANA standards of nursing care; these concerns must be addressed before implementing care. The practice is intended to be beneficial to the client.

A nurse is participating in an intradisciplinary assessment as part of a quality improvement process. Which of the following should the nurse anticipate will be included in this assessment? Select all that apply. A. Performance appraisals B. Outcomes management C. Audits D. Peer review E. Utilization reviews

B C D

Which statement best reflects the nurse's correct understanding of principles related to evidence-based practice (EBP)? (Select all that apply.) A. "Client choices do not affect evidence-based practice." B. "Client-centered care is an outcome of evidence-based practice." C. "The nurse's level of expertise influences evidence-based practice." D. "Evidence-based practice promotes individualization of client care." E. "Evidence-based practice requires application of all research evidence about a given topic."

B C D Rationale: Evidence-based practice (EBP) combines the best evidence from the most current research available, the nurse's clinical expertise, and the client's preferences, including needs, values, and choices. EBP promotes individualization of client care and provides best practice for client-centered care.

Several medication errors occurred at a facility. Which method should the nurse anticipate being suggested to avoid future errors? (Select all that apply.) A. Combine medications with the same active ingredient. B. Double-check the "seven rights" every time medication is administered. C. Use smart infusion pumps for intravenous medications. D. Conduct medication reconciliation at every transition in care. E. Have a second nurse check the medication order.

B C D E Rationale: The correct answers to avoid such errors are (1) double-check the "seven rights" every time medication is administered, (2) conduct medication reconciliation at every transition in care, (3) use smart infusion pumps for intravenous medications, and (4) have a second nurse check the medication order. Combining medications with the same active ingredient is incorrect and is not a method in reducing medication errors.

The nurse researcher is explaining evidence-based practice (EBP) to a group of nurses. Which statement is appropriate to include in the explanation? (Select all that apply.) A. "EBP promotes generalization of client care." B. "EBP incorporates the nurse's clinical expertise." C. "EBP considers the client's needs, values, and choices." D. "EBP tests hypotheses about health-related conditions." E. "EBP is reflective of the best evidence from current research."

B C E Rationale: Evidence-based practice (EBP) combines the best evidence from the most current research available, the nurse's clinical expertise, and the client's preferences, including needs, values, and choices. EBP promotes individualization of client care. Nursing research tests hypotheses about health-related conditions and nursing care.

The nurse working in a community hospital is caring for a client who does not seem to be responding well to the current plan of care that has been implemented by the nursing team. Given this information, which actions by the nurse are appropriate? Select all that apply. A. Trying a different approach to care even though it breaches hospital policy B. Networking online with other nurses who are giving similar care C. Accessing research journals for evidence that would support a change in the plan of care D. Proposing a nursing research project to the unit manager E. Asking the doctor for a new nursing approach to care

B C A nurse in a community hospital may not have immediate access to the latest in nursing research. In order to improve care, this nurse might access research journals or network with other nurses to determine whether there is any evidence that would support changes in the client's nursing care. The nurse should not breach hospital policy even if the client were to benefit. Proposing a research project is an excellent way to improve client care, but this nurse needs a more immediate solution to the client's problems. The physician is not involved in solving nursing problems.

The nurse is preparing to triage victims of a train derailment who are being transported to the emergency department. Which victims would need immediate care? Select all that apply. A. Walking with a slight limp, asking for something to drink B. Respiratory rate of 8 and irregular C. Holding broken arm, sitting in a chair D. Bleeding from fractured limb with a blood pressure of 78/40 mmHg E. Bleeding from superficial facial wounds and talking to family

B D

The nurse is prioritizing care needed for a group of clients according to urgency. Which care should the nurse identify as being medium priority? Select all that apply. A. Performing endotracheal suction B. Removing splints and providing complete skin care every 2 hours C. Administering 2 units of fresh frozen plasma D. Performing passive range of motion every 4 hours E. Instructing on changing ostomy appliance

B D

A nurse is planning a research project comparing the use of fingerstick blood glucose testing with the use of alternative sites for adult male clients. Which elements of the PICOT formulation of the clinical question still need to be defined? Select all that apply. A. Comparison B. Outcome C. People D. Time E. Issue

B D The people in this study are adult men with diabetes. The issue is effective testing for blood glucose levels. The comparison is between adult men using different testing sites. According to the PICOT formulation, the clinical question still needs to specify an outcome (i.e., it needs to state a hypothesis about the two groups) and a time frame for the study.

A client in the clinic is being asked to participate in a research study. The client asks why a nursing research study is necessary given that research on this subject has already been published by the American Medical Association (AMA). Which of the following responses should the nurse offer in reply to the client's question? A. "This study is useful because it validates nursing through medical research." B. "This study is useful because it supports products used in nursing care." C. "This study is useful because it validates nursing care, not medical care." D. "This study is useful because it supports the medical profession."

The nurse manager for a medical-surgical nursing unit is talking to a group of nursing students. The nurse manager is explaining the types of nursing research studies that are conducted on the unit. Which statement by the students indicates understanding of the nature of nursing research? A. "Nursing research is used to enhance medical treatment." B. "Nursing research does not include nursing education or nursing leadership." C. "Nursing research impacts nursing by adding knowledge and changing nursing practice." D. "Nursing research does not include the study of nurses themselves."

What major nursing concept has the strongest relationship to the identification of areas for quality improvement, such as tracking data on healthcare-associated infections? A. Safety B. Ethics C. Informatics D. Evidence-based practice

C Informatics can be used to identify areas for improvement, such as tracking healthcare-associated infections. Without informatics, tracking adverse outcomes would be time-consuming and potentially cost-prohibitive. With the advent of technology and informatics, statistics and client outcomes are easier to track, making quality improvement more efficient. Ethics, safety, and evidence-based practice can all contribute to quality improvement, but not by easily tracking poor client outcomes.

The nurse is working in a healthcare setting that has implemented Lean Six Sigma. Which of the following should the nurse anticipate with regard to this model? A. Ordering extra supplies B. Replacing licensed with unlicensed personnel C. Decreasing staff when the census is low D. Shorter breaks

C Lean Six Sigma focuses on eliminating waste and improving process flow. Thus, when a unit's census decreases, the unit's manager would decrease the number of staff. Replacing licensed staff members with unlicensed personnel may not be safe. The unit would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered reducing waste.

Which federal initiative contains the three broad aims of better care, healthy people/healthy communities, and affordable care? A. Patient Safety and Quality: An Evidence-Based Handbook for Nurses B. National Patient Safety Goals C. National Quality Strategy D. National Database of Nursing Quality Indicators

C To improve the health of the population, the USDHHS has developed the National Quality Strategy, which contains three broad aims: better care, healthy people/healthy communities, and affordable care. The National Database of Nursing Quality Indicators (NDNQI), Patient Safety and Quality: An Evidence-Based Handbook for Nurses, and the National Patient Safety Goals by the Joint Commission aim to collect and provide data that identify areas for improvement and encourage facilities to meet quality goals.

The home care nurse is planning the order of clients for the day. Which client should the nurse prioritize as needing to be seen first? A. A client with daily dressing change, normally done at 0800 per client preference B. A client being seen poststroke for rehabilitation and education about poststroke care C. A newly diagnosed diabetic client who is administering morning insulin independently for the first time D. A client requiring indwelling catheter change due to leakage

C Rationale: A newly diagnosed client who is administering insulin independently for the first time creates a time constraint. The nurse would see this client first to ensure that the insulin is being administered properly. While client preferences are an important consideration, the time constraint of the insulin would be a higher priority. A client being seen poststroke for rehabilitation and education as well as a client with a leaking indwelling catheter would also be lower priorities when planning the order of clients for the day.

The nurse is assessing a client's peripheral circulation after cardiac catheterization. Which finding is the highest priority? A. The femoral site is soft and free of hematoma or bleeding. B. The client's toes are warm and pink. C. The client is experiencing numbness in the toes. D. Pulses are palpable and bounding.

C Rationale: After cardiac catheterization, a finding that the client is experiencing numbness may indicate a complication of the procedure, thus it would be the highest priority. Warm and pink toes, palpable, bounding pulses, and a femoral site free of hematoma and bleeding are all normal findings.

Which activity should the nurse recognize as a way for state and local entities to make healthcare more affordable? A. Require hospitals to track readmission rates for low-income clients B. Coordinate care through the use of effective communication C. Offer basic health coverage for all citizens living in their state D. Develop new healthcare delivery models

C Rationale: Developing new healthcare delivery models is a state and local initiative that can lower healthcare costs. Coordinating care through effective communication would be the responsibility of the healthcare institution. States and local entities are not required to provide affordable healthcare to all their citizens. Local hospitals are not just responsible to track the readmission rates, but are encouraged to actively try to reduce readmission rates through broad based teaching and follow-up as a way to lower costs.

The nurse working on a busy medical surgical unit is caring for five clients. As the nurse is preparing to administer routine medications to the assigned clients, she is informed that a new admission will be arriving to the unit shortly. Which type of situation challenges the nurse's time management and organizational skills? A. Pitfall B. Urgent C. Pop-up D. Emergent

C Rationale: Events such as new admissions that are unexpected and require that nurses take time and attention away from their plan for the day are referred to as pop-ups. Pitfalls are unforeseen situations that harbor consequences for nurses and can result in client harm. Urgent and nonurgent events are methods of triaging and setting priorities for care.

The nurse caring for a client with diabetes mellitus receives a report from another nurse that the client is experiencing a hypoglycemic episode. The nurse immediately prepares to administer 50 mL of D50 IVP. Upon entering the room, the nurse notes that the client seems alert and does not have any current complaints and decides not to administer the D50. Which pitfall was avoided by the nurse in this situation? A. Incomplete assessment B. Poor time management C. Relying solely on another's assessment D. Failure to do periodic assessments

C Rationale: In this situation, the nurse prepared to administer D50 IVP based on the other nurse's assessment. Using this information to set priorities could have resulted in a negative client outcome. The potential pitfall in this situation was not created by an incomplete assessment, poor time management, or failure to do periodic assessments.

The nurse researcher is encouraging a nurse to incorporate evidence-based practice (EBP) into client care. Which action should the researcher encourage the nurse to do? A. Looking at past data B. Speaking with the hospitalist C. Participating in a research project D. Reviewing a client's record

C Rationale: It would be beneficial for the graduate nurse to participate in a research project to be a part of an EBP process, so they could see firsthand how the process works in action. Reviewing a client's chart may be a way to look at what treatment was performed, but it would not reveal if it was evidence based. Looking at past data will not provide a look at evidence-based practice. A hospitalist may be able to share their opinion of evidence-based practice, but that does not expose the nurse to the process.

To address client complaints of disrupted sleep due to noise on the floor, the nurse manager formed three teams who implemented various processes to reduce the noise. Another team is collecting sleep data from the clients and analyzing the effectiveness of the solution, based on which they intend to develop better methods and improve the facility. Which quality improvement process is the manager implementing? A. Benchmarking B. Performance improvement C. Six Sigma D. Continuous quality improvement

C Rationale: Six Sigma considers factors leading to client dissatisfaction as "defects." Disrupted sleep qualifies as a defect. Defect is not a concept used in continuous quality improvement or performance improvement. Benchmarking uses industry standards, which do not exist for disrupted sleep.

A client presents to the emergency department (ED) complaining of pain and burning on urination. The client also tells the triage nurse that she noted blood in the urine the past few times she urinated, so she thought she should come to the emergency department. In which category should the nurse classify the client's problem to prioritize care in relation to other clients in the ED? A. Emergent B. Urgent C. Nonurgent D. Immediate

C Rationale: Symptoms indicate that this client may be experiencing a urinary tract infection, which would be considered nonurgent since a delay in treatment would not result in a life-threatening situation. It would not meet the criteria for urgent or emergent/immediate.

The nurse is doing a case study on a client with long-term cardiovascular disease.Which would be the best way to target health promotion for treatment as it relates to evidence-based practice? A. Looking at the hospital data B. Following federal regulation C. Genomic standpoint D. Examining cultural views

C Rationale: Targeting health promotion from a genomic standpoint allows for more accurate risk prediction, diagnosis, and treatment of a variety of health alterations, such as heart disease, stroke, cancer, diabetes, and Alzheimer disease (HHS, 2016e). Goals associated with the promotion of global health include protecting the health of the national population as well as limiting the international transmission of infectious diseases during travel. Evidence-based resources related to global health and genomics are emerging.

The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief for clients discharged after a specific surgical procedure. Which term best describes the nurse's activity of this review process? A. Concurrent audit B. Root cause analysis C. Retrospective audit D. Utilization review

C Rationale: The nurse is conducting a retrospective audit by looking back in time. A retrospective audit compares care provided to clients with similar conditions, and recommendations are made to change procedures if needed. A concurrent audit takes place when clients are still hospitalized. Utilization review looks at the use of resources, not documentation. A root cause analysis is triggered by a sentinel event, rather than by routine client care documentation.

Which action should the nurse take to best involve hospitalized clients in their care and avoid pitfalls related to not involving clients in their own care? A. Orienting the client and family to the hospital facility and routines B. Informing clients of the daily schedule of care C. Observing client behaviors for cues about preferences D. Asking the client's family about usual patterns of behavior

C Rationale: To avoid pitfalls related to not involving clients in their own care, the nurse should observe client behaviors for cues about preferences. Informing clients about the daily schedule of care and orienting clients and families to the hospital routine do not provide information about client preferences. While a family may be able to provide information concerning client preferences, it is best to ask or observe the client to determine preferences.

Governmental agencies and the healthcare industry have partnered to improve the quality of care. Which action should the nurse recognize is aimed at providing better care? A. Delivering care to underserved clients B. Reducing the cost of quality healthcare to all consumers C. Making healthcare more client-centered, reliable, accessible, and safe D. Addressing behavioral, social, and environmental determinants of health

C Rationale: To improve the health of the population, the U.S. Department of Health and Human Services (HHS) has developed the National Quality Strategy, which contains three broad aims. One of the aims is Better Care to improve the overall quality by making healthcare more client centered, reliable, accessible, and safe. The other two aims are Healthy People/Healthy Communities and Affordable Care.

A client is admitted to the emergency department with a rash on the trunk and extremities. The client reports difficulty breathing, chest tightness, and weakness. Respirations are 24 breaths/min and even, pulse is 90 beats/min and thready, and blood pressure is 96/70 mmHg. The client reports a recent history of a urinary tract infection and having been on sulfasalazine for the past 5 days. Which is the priority nursing assessment for this client? A. Urine discoloration B. Gastrointestinal disturbances C. Airway patency D. Peripheral edema

C Rationale: Using the ABCs (airway, breathing, and circulation) to establish priority nursing interventions, the nurse would first establish airway patency based on the client's symptoms of difficulty breathing. This would take priority over assessment for edema, urine discoloration, and gastrointestinal disturbances.

The nurse is working with a client who has agreed to participate in a research study. Which actions would constitute a violation of the client's right to full disclosure? Select all that apply. A. Suggesting that participating in the study would greatly benefit the client's financial situation B. Telling a mutual friend about the client's involvement in the study C. Giving the client false information about his or her participation in the study D. Withholding information about the study from the client E. Providing the client's name as a participant in the study

C D Withholding information and giving false information would both violate the client's right to full disclosure. Telling a mutual friend about the client's involvement would violate the client's right to confidentiality, as would providing the client's name as a study participant, but neither of these actions would affect the client's right to full disclosure. Suggesting that study participation would benefit the client financially could be viewed as a form of coercion or undue influence and thus be considered unethical, but it would not affect the client's right to full disclosure.

The nurse is preparing to provide care to a group of clients. On which specific areas should the nurse focus in order to prioritize the clients' care needs? Select all that apply. A. Noting number of licensed staff assigned for the shift B. Noting time when the attending physicians make rounds C. Noting which clients have particular safety needs D. Identifying clients with specific medication times E. Asking if any clients have complex issues

C D E Setting priorities for nursing care always begins with assessment. Assessment includes making observations and asking questions to gather information necessary to make decisions. Helpful assessment data include knowing which clients have complex care issues, if any clients have particular medication times, and if any clients have safety issues that should be addressed. The number of licensed staff is not as important as knowing the number of unlicensed assistive personnel to whom the nurse can delegate client care activities. The time when attending physicians make rounds is not usually part of the criteria when prioritizing client care needs.

The nurse is designing a nursing clinical research study. Which research question is most appropriate for this type of study?(Select all that apply.) A. What factors influence an individual's choice to enroll in online nursing education? B. How do communication styles influence the nurse's perception of nurse educators? C. How do environmental noise levels affect the client's pain perception postanesthesia? D. Is there a relationship between acupressure and incidence of nausea in clients who are receiving chemotherapy medications? E. What is the relationship between the duration of nurse-client interaction and the client's level of satisfaction with nursing care?

C D E Rationale: Nursing research is a systematic and strict scientific process that tests hypotheses about health-related conditions and nursing care; as an extension of nursing research, nursing clinical research seeks answers that will ultimately improve client care.

The nurse is discussing some barriers that they have encountered with a journal club related to the topic. Which statement by the nurse describes potential barriers? (Select all that apply.) A. I am an administrator." B. "I work in a nursing home." C. "I don't have time to do those trainings." D. "I have been in nursing 20 years; I do not need more training." E. "The hospital I work at stopped professional development based on funds."

C D E Rationale: When a healthcare facility makes cuts, it has been seen that educational programs and trainings go by the wayside. The other barrier would be not making time for the staff to attend trainings that are offered. The overconfident, stuck-in-their-ways nurse is a difficult person to educate on change and an alternate way of thinking. Being an administrator or working in a nursing home is not a barrier to promoting evidence-based practice in a healthcare facility.

Which of the following would be considered a foreground question when included in a nursing research project? A. "Who is at greatest risk for the development of gestational diabetes?" B. "What organisms most commonly cause bacterial pneumonia?" C. "How does use of behavioral interventions compare to use of pharmacological therapies in treating hypertension?" D. "What are the side effects of this class of antipsychotic medications?"

C Foreground questions are somewhat narrow in focus and are about specific clinical issues. They are useful for finding nursing interventions that improve patient outcomes; in other words, they identify useful information about direct patient care. Of the questions listed, only the one comparing behavioral and pharmacological interventions for hypertension would be considered a foreground question. All the other choices are examples of background questions, which are general questions that seek more information about a topic, such as diseases or medications. These questions serve to fill gaps in knowledge about a specific topic and often take the form "What is. . . ?" or "What does. . . ?"

Which of the following measures would be most directly aimed at upholding the principle of respect for persons? A. A policy stating that a research project must be immediately suspended should any of the participants experience an unexpected adverse event B. A policy stating that all data gathered during research must be stripped of information that links it to individual research subjects C. A policy requiring that any research involving pediatric subjects undergo an extra level of ethical scrutiny prior to approval D. A policy requiring that all participants in a research effort receive financial compensation

C The principle of respect for persons involves acknowledging and protecting the autonomy of all individuals, including individuals whose capacity to exercise autonomy is diminished because of disability, illness, circumstances that restrict liberty, or immaturity. Thus, this principle would underlie a policy providing extra protection for pediatric research subjects. A policy requiring the removal of personally identifying information would be more closely linked to the concept of justice, and a policy requiring the suspension of a research project following unforeseen adverse effects would be more closely linked to the principle of beneficence. It is unlikely that an organization would have a policy requiring financial compensation for all research subjects, as this might be considered a form of undue influence.

While preparing a client for surgery, the nurse marks the arm that is to be amputated and participates in a "time out" procedure before the surgery begins. Which sentinel event is this action intended to prevent? A. The client being mildly oversedated B. Ineffective control of the client's pain C. The lack of healing of the stump D. The removal of the wrong arm

Which statement correctly describes quality management? A. Quality management provides clients with appropriate service in a technically competent manner. B. Quality management is the degree to which health services increase the likelihood of desired health outcomes. C. Quality management refers to systematic actions that lead to improvements in healthcare services. D. Quality management compares nursing processes to accepted standards to prevent errors in treatment.

D Quality management includes evaluation of medical and nursing processes for quality and effectiveness compared to accepted standards in order to correct problems before they harm clients and to prevent errors in treatment. Quality improvement refers to systematic actions that lead to improvements in healthcare services. Quality is the degree to which health services increase the likelihood of desired health outcomes. High-quality care provides clients with appropriate service in a technically competent manner.

The nurse is delivering a presentation about evidence-based practice (EBP). Which statement best reflects the nurse's correct understanding of EBP? A. "EBP incorporates clinical knowledge, expert opinion, or information resulting from research." B. "EBP is the gathering of objective facts and information to advance knowledge about a specific topic." C. "EBP uses a systematic and strict scientific process to test hypotheses about health-related conditions and nursing care." D. "EBP involves combining quality research, clinical expertise, and client preferences to achieve the best client outcomes."

D Rationale: Evidence-based practice (EBP) seeks to achieve optimal client outcomes by combining the best evidence from the most current research available, the nurse's clinical expertise, and the client's preferences, including needs, values, and choices. Research involves gathering objective facts and information to advance knowledge about a specific topic. Nursing research is a systematic and strict scientific process that tests hypotheses about health-related conditions and nursing care. Evidence can be defined as clinical knowledge, expert opinion, or information resulting from research.

A 2-year-old child with cerebral palsy may benefit from the model known as a medical home. Which goal from Healthy People 2020 does the nurse identify for the client? A. Paying for their medication B. Paying the mortgage for the home C. Limiting who lives in the home D. Coordinating their healthcare services

D Rationale: Healthy People 2020 objectives include reducing child mortality rates as well as decreasing the incidence of transmission of preventable diseases among children. Increasing access to a medical home (which is a model of care that promotes physician-led, client-centered, coordinated health services) for children with special needs is also an objective. The services do not provide financial backing nor do they limit who lives in the home.

The nurse in an emergency department (ED) shares with a fellow nurse that, due to the busy pace of the day, he has not even been able to go to the bathroom since he arrived for his shift 6 hours ago. Which response by the fellow nurse should best address this situation? A. Discussing better ways to prioritize and manage time with the nurse so that in the future he will be able to take needed breaks B. Encouraging the nurse to let the supervisor know so that appropriate actions can be taken C. Listening to the nurse's concerns and offering verbal encouragement to make it through the rest of the shift D. Offering to oversee the nurse's clients so that a 15-minute break can be taken

D Rationale: It is important that nurses take quick 15-minute breaks to refresh, reenergize, and take care of bodily functions, so the best response by the fellow nurse would be to cover for the nurse to allow this break to occur. Encouraging the nurse to let the supervisor know, listening to the nurse's concerns, and discussing better ways to manage time and prioritize would not provide the much-needed break for the nurse.

The nurse manager calls for a meeting to identify and discuss the cause of a recent problem in the facility so that the incident does not happen again. Which term should the nurse use to describe this process? A. Reducing medical errors B. Resource utilization C. Blame-free environment D. Root cause analysis

D Rationale: Root cause analysis is the correct answer. The goals of the root cause analysis are to identify the reasons for failures or problems and to develop an action plan for improvement to decrease the likelihood of future adverse events. Reducing medication errors involves interventions specifically help nurses prevent medication errors. Resource utilization is increasing the value of healthcare by reducing costs. A blame-free environment is established to maintain or improve the quality of care in which healthcare providers can report errors or near misses without the fear of punishment.

A new graduate nurse is having difficulty prioritizing care and leaving the shift in a timely manner. The nurse manager notes that the new nurse rarely delegates tasks to the unlicensed assistive personnel (UAP) since a recent incident in which the new nurse delegated an inappropriate task to a UAP. Which action by the nurse manager should best help to address this situation? A. Reminding the nurse that she will quickly burn out if she does not delegate some care to the UAP B. Encouraging the nurse not to let the recent experience impact future actions C. Having the UAP discuss with the nurse appropriate activities that he can do to assist the nurse with client care D. Reviewing state and facility guidelines concerning delegation with the nurse

D Rationale: To avoid pitfalls concerning delegation of activities, the nurse should be aware of state and facility guidelines. Thus, the best action of the nurse manager would be to discuss these guidelines with the new nurse. Encouraging the nurse not to let past experience guide future actions would not help the nurse to understand appropriate guidelines for delegation. Reminding the nurse that she will burn out quickly if she does not delegate tasks does not help the nurse learn to delegate tasks appropriately. Nurses should not rely solely on UAPs to indicate which tasks can appropriately be delegated; they should follow state and facility guidelines.

The nurse is providing care for several clients with neurologic dysfunction. Which client should be placed closest to the nurses' station? A. A 72-year-old client who is 2 days postoperative for a carotid endarterectomy B. A preoperative 68-year-old client who was diagnosed with an astrocytoma C. An 80-year-old client with viral meningitis who was admitted 3 days ago D. A newly admitted 65-year-old client who experienced an acute subdural hematoma

D Rationale: When prioritizing care, the nurse needs to consider all relevant factors. A newly admitted client with a recent subdural hematoma would be considered a high priority due to risk for seizures, stroke, brain herniation, and so forth and should be placed closest to the nurses' station. A client 3 days postmeningitis, a preoperative client, and a client who is 2 days postoperative for a carotid endarterectomy would have more stability and less priority than a newly admitted client with a subdural hematoma.

The nurse is organizing care for the day for the assigned clients. Which client should the nurse give highest prioritization to ensure appropriate medication administration? A. A client with diabetes requiring insulin coverage QID B. A client with unstable vital signs receiving multiple blood pressure medications C. A client who is receiving daily dialysis D. A client receiving several intravenous antibiotics, each to be infused over 30-60 minutes

D Rationale: When the nurse is caring for multiple clients, setting of priorities is determined by the significance of the interventions for the clients. In this situation, the client receiving several intravenous antibiotics, each of which need to be infused over a specific time frame, would need to be prioritized to ensure adequate medication administration. QID insulin coverage, regularly scheduled blood pressure medications, and daily scheduled dialysis would not have higher prioritization than would the client receiving multiple intravenous antibiotics that must be administered in the correct order over the appropriate time frame.

The rehabilitation department is conducting an audit on the efficacy of a new treatment protocol by examining the client report and status upon discharge. Which type of audit is the department conducting? (Select all that apply.) A. Retrospective audit B. Utilization review C. Interprofessional assessment D. Concurrent audit E. Intraprofessional assessment

D E Rationale: An audit is an examination of records to verify accuracy and proper use. If the audit is focused on one discipline, it is an intraprofessional assessment. If the audit is focused on multiple disciplines, it becomes an interprofessional assessment. A concurrent audit is performed while the client is still undergoing care at the healthcare facility. A retrospective audit is performed after a client's discharge. A utilization review analyzes the use of resources to identify areas of overuse, misuse, and underuse.

A nurse working in a home health agency is asked to participate on a committee that is looking to incorporate evidence-based nursing care. What should be the committee's first step in implementing evidence-based practice (EBP)? A. Suggest that individual staff members try new means of delivering care. B. Evaluate the results of different research projects. C. Research evidence-based practices that can be implemented. D. Compile a list of questions.

D Following committee formation, the next step in the EBP implementation process would be to compile a list of clinical questions that are relevant to nursing practice within the agency. Suggesting that staff nurses try new methods of care may violate the agency's policies; also, new care methods should be tried and evaluated in an orderly fashion. It is not appropriate to research specific nursing practices until pertinent clinical questions have been asked. Results cannot be evaluated until research has been reviewed and practice has been changed.

Critical Thinking Nursing

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