Final 220 Exam
islam & illness
"for every illness, God has a cure" - care for sick & elderly
latino core beliefs
- most are roman catholic, respect (respeto), especially towards elderly - familism
african american languages
-african american vernacular english (AAVE), rooted in history and has ties to creole, can trigger discrimination in workplace, housing market and schools
peak of rapid acting insulin
1 hour
toddler development
1-3 years of age, physical growth slows after infant stage, heart and respiratory rate slows, most body systems are mature, can tolerate a variety of foods visual acuity improves, mobility: at 12 to 13 months begins to ambulate, by 2 child can walk up and down stairs
Kubler-Ross stages of grief
1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
when/what are the three checks of medication administration?
1. before you pour/mix/draw-up medication 2. after you prepared the drug 3. at the bedside
what are the six MUST HAVES of TPN?
1. central line 2. microfilter 3. change tubing every 24 hours 4. check blood sugar every 6 hours 5. label the tubing 6 must be checked by TWO nurses before running
three main checks for aspiration?
1. check for gag reflex 2. monitor coughing and gagging for meals 3. monitor for fever --> could indicate aspiration pneumonia
how many americans are injured by medication errors annually?
1.3 million
duration of long acting insulin
24 hours
0.25 mL syringe size can hold how many units?
25 units
Duration of rapid acting insulin
3 hours
what mL is typically administered into IM sites?
3 mL (for ventrogluteal)
onset of short acting insulin
30 mins
how many stages are included in piaget's developmental theory?
4 schemas
**how long does a patient need to be NPO prior to an upper GI series?
4-8 hours prior!!!
how long after eating should the patient be sitting up after eating?
45 mins
school-age years development
6-12 years old, express delight in developing new skills, enjoy competition and working with others to accomplish goals, become capable of making judgments based on reasoning, rather than on just what they see, develop the ability to classify objects, one of the biggest concerns is safety, active children are at risk for accidents, childhood obesity risk, and its side effects, bullying
What age is the concrete operational stage?
7-11 years
health literacy
A person's capacity to learn about and understand basic health information and services and use these resources to promote his or her health and wellness.
Eustress
A positive stress that energizes a person and helps a person reach a goal
regression
A reversion to immature patterns of behavior
Homeostasis
A tendency to maintain a balanced or constant internal state; the regulation of any aspect of body chemistry
Foley catheter
A tube inserted through the urethra to drain urine, often left in place
What does AMA stand for?
American Medical Association or against medical advice?
idosyncratic reaction
An abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.
what psychosocial phase of erikson's theory is age 18 months to 3 years?
Autonomy vs shame and doubt
What are the water soluble vitamins?
B and C
Hinduism food restrictions
Beef, pork, and some fowl Alcohol Garlic and onions by some Red-colored foods by some - NO COWS!!!!!
Which statement by the patient about herbs and prescription medications demonstrates understanding of education by the nurse? a. "I can stop taking my prescription medication when I begin an herbal preparation." b. "I know herbal preparations are highly regulated to prevent interactions with prescription medications." c. "I should check with my provider before beginning an herbal preparation." d. "I cannot ever take an herbal preparation while I am using prescription medication."
C
A nurse's role when communicating with a provider caring for a dying patient is: a. to make him/her see the situation correctly. b. to carry out his/her orders. c. to advocate for the patient's wishes. d. to suggest an appropriate course of action.
C.
The unique ability of the patient to understand and integrate health-related knowledge is known as: a. basic literacy. b. medical literacy. c. health literacy. d. consumer literacy.
C.
Who is able to give consent?
Competent adult, legal guardian, emancipated minor, parent/state/legal guardian of a child, court order
after evaluating a patient's external variables, the nurse concludes that health beliefs and practices can be influenced by: a. emotional factors b. intellectual background c. developmental stage d. socio-economic factors
D.
A 25-year-old female patient demands that her mother or father be present during all blood testing. Which defense mechanism could the nurse document as being used by this patient? a. Sublimation b. Repression c. Projection d. Regression
D.
what nursing diagnoses are for stress and coping?
Difficulty Coping, Anxiety, Caregiver Stress
* secondary prevention
EARLY IDENTIFICATION of illness to limit its impact on the individual - early intervention ex. screening - blood pressure screenings or routine blood sugar testing
Islam core beliefs
Five Pillars Declaration of faith, prayer, alms, fasting, and pilgrimage - belief in one God, Muhamed was the final prophet, God sent 124000 prophets, heaven and hell, the soul is eternal, material life = limited - teaching is the *Koran*
individuals that can give consent if patient is unable?
GUARDIAN! (number one always) Spouse An adult child Parent Adult sibling Grandparent Adult grandchild Friend
one-time/on-call order
Given only once at a specified time, often before a diagnostic or surgical procedure
Islam food restrictions
Halal food--> ex. unprocessed veggies, grains, fish NO:--> pork, pork products, blood, dead or unlawfully slaughtered animals - you can ignore restrictions if it has been 3 days without food - NO ALCOHOL
what are some types of parenteral drug administration?
IM, IV, SubQ, Intradermal, Intraosseous, Intrathecal, Epidural, Intra-articular, Intracardiac, Intra-arterial
what are the angles you administer IM, SubQ and ID injections?
IM: 90 SUBQ: 45, 90 ID: 15
Seriation (Piaget)
Includes knowledge that things can be arranged in logical series, ex. the toy rings
Sheldon stages of grief
Initial shock, pangs of grief, despair, adjustment
how does the nurse select the gauge of the needle?
based on the viscosity of the med to be injected and the route
who is the father of utilitarianism?
Jeremy Bentham
who is the big theorist for moral development theories?
Lawrence Kohlberg
Names of long acting insulin
Levemir, Lantis ("L"--> 'L'ong)
can UAPs administer medication?
NO
can assessment and delegation of a patient teaching plan be delegated?
NO
can you substitute one route of medication for another without an order?
NO
if the label is gone on a medication bottle or you cannot read it do you admin medication?
NO
is developmental level the same as education?
NO
should you administer a medication you did not prepare?
NO
judaism and illness
NO JELLO - watch out for male providers - be conscious of females and head coverings & wigs
is a healthcare representative personally responsible for the cost of the patient?
NO! that is paid for by patient's own expenses
is your driver's licence legal documentation of organ donation?
NO, consent for organ donation must be given in writing
who developed the health promotion model?
Nola Pender
emotional reactions to loss
Numbness, loneliness, sadness, sorrow, guilt, shock, anxiety, depression, anger, agitation, lack of interest or motivation, lower level of patience or tolerance
who is primarily responsible for patient education?
Nurses
what is the most common route of drug administration?
PO, or oral admin (also the safest, most convenient, and least expensive)
Palliative vs hospice care
Palliative care can be provided from the time of diagnosis. Palliative care can be given simultaneously with curative treatment. Both services have foundations in the same philosophy of reducing the severity of the symptoms of a sickness or old age.
Routine order
Physician orders preapproved by the medical staff which are preprinted and placed on the patient's record, drug is administered until discontinuation
islam holy days
Pilgrimage (Hajj) to Mecca and Ramadan
external strategies
Provide relief through mobilization of support, external involvement
insulin mixing pneumonic
RN--> regular to NPH (short to intermediate)
WHO definition of health
a state of complete physical, mental, and social well-being and *not merely the absence of disease or infirmity*
what conditions place you at risk for aspiration
Seizures CVAs Dementia GERD Cerebral palsy Muscular dystrophy MS Parkinson's disease
how/ where must TPN be given?
THROUGH A CENTRAL LINE!!
faylo's management model includes
informing, directing, controlling, planning and organizing
Algor Mortis
The cooling of the body after death, eyes will remain open and mouth will drop
Therapeutic effect
The desired or intended effect of a particular medication.
therapeutic effect
The desired or intended effect of an administered medication
discontinuous theory of development
Theory based on the belief that human development occurs through a series of distinct stages.
now order
When a medication is needed right away, but not STAT, usually given within 30 mins, only given once
accountability
Willingness to take credit and blame for actions.
ex of how a role affects health literacy and patient education
a 35 year old mother of two who just had a hysterectomy compared to a 67 year old retired woman, they require different teaching
what does a urine culture diagnose?
a UTI, as well as tells the provider what antibiotic to prescribe due to
what is the behavior of the initiative vs guilt phase?
a child explorers his or her world abilities, they begin to explore what kind of people they may become
loss
the absence of someone or something that a person has formed an attachment to
bedside commode
a device used for elimination when a person is able to get out of bed, but unable to walk to the bathroom; it consists of a chair-like frame with a toilet seat and a removable collection bucket
clear liquid diet
a diet that consists of foods that are liquid at room temperature and leave little residue in the intestine. Ex: Water, Sprite, Ginger Ale, all beverages without any residue, broth, Jello
medication
a drug specifically administered for its therapeutic effects on physiologic function & to prevent, improve, or reduce symptoms of disease
what is an emergency guardian?
a guardian granted in timesensitive case where emergency exists and decisions need to be made
Health Belief Model (HBM) & the three beliefs that influence behavior?
a non-stage theory that identifies three beliefs that influence decision making regarding health behavior: perceived susceptibility to a health threat, perceived severity of the disease or condition, and perceived benefits of and barriers to the behavior
Wellness
a process of self-care achieved by making choices leading to a healthy life
urine culture
a test to identify any bacteria present in a urine sample
embryo
a zygote after 3 weeks
what is the resolution of the crisis in the autonomy vs. shame and doubt phase?
achieve a balance between holding on and letting go
what is the resolution of crisis for the identity vs role confusion theory?
achieve a sense of self and personal identity, experiment with different roles
learning
acquiring knowledge or skills through instruction or experience
problem-focused coping
aimed at removing or altering the stressor
three components of the general adaptation model?
alarm resistance exhaustion
islam & health
allow privacy for prayer, following rituals is CRUCIAL - preference for same-sex health workers - family involved in decision making - imam (religious leader) can also be involved - NO PORK - everything in moderation
Drug Trough
amount of drug at its lowest level
grief
an emotional response to loss
IV pyelogram (IVP)
an xray study of the kidneys, bladders, ureters, and urethra, uses contrast media
drug
any substance that positively or negatively alters physiologic function
prn
as needed
For subcutaneous injections, the nurse should administer where?
at the site least commonly used, such as the lateral aspect of the upper arm if the patient commonly self injects in the abdomen
where are some common sub q sites?
back of arm, stomach, inner thigh, above butt
Holistic Health Model
based on the philosophy that a synergistic relationship exists between the body and the environment
what age is the sensorimotor stage?
birth to 2 years
melana
black, tarry stools; feces containing digested blood
hematuria
blood in the urine
toxic effect
build up or overdose
po
by mouth
sublimation (defense mechanism)
channeling threatening devices into acceptable outlets (e.g. working out) sublet-->outlet
african american pregnancy beliefs
childbirth and transition to motherhood is crucial for entire fam - less likely to attend classes but very active in pg
is intermediate insulin clear or cloudy?
cloudy
community assessment
collecting data on the social cultural and ethnic traditions that affect
what are some reasons there might be blood in the stool?
colon cancer, stomach ulcer, hemorrhoids, trauma
how should you determine if a patient is at risk for aspiration?
consult nutritional therapist consult speech therapist perform a swall study
the organizing principle involves
coordinating the care delivered to patients
In Hinduism, the dead body is disposed of by
cremation
nature vs nurture theory
development is predetermined (nature) or the child's environment (nurture) controls how development progresses
what type of theory is eriksons theory of development?
discontinuous as it goes in stages
Projection
disguising one's own threatening impulses by attributing them to others
Nonmaleficence
do no harm, requires compassionate care & weighing the benefits with the risks, challenging during end of life situations (euthanasia)
Adverse effects
drug effects that are not the desired therapeutic effects; may be unpleasant or even dangerous, unintended
preconventional level
earliest level of moral development; at this level, self-interest and event outcomes determine what is moral, obedience and punishment, individualism and exchange
what is the chin tuck method when eating?
encouraging the patient to put their chin to their chest when swallowing instead of looking up to the ceiling to swallow like they might feel inclined to
q
every
Lack of Knowledge nursing diagnosis
ex. a new onset of hyperglycemia
nocturia
excessive urination at night
latino family practices
familism--> valuing of family considerations, many families live together, patriarchal, machismo: husband is protector and provider - respect of elderly
core beliefs of those in poverty?
family friends and neighbors are held at a higher value, survival is the forefront of decisions
zygote
fertilized ovum, begins as a single cell
core beliefs of wealthy class?
financial, political and social connections influence decision making and goals
what do you do if a peg tube become occluded?
flush it with a small amount of air
medication is an administered drug for what two reasons?
for its therapeutic effect and to prevent, improve, or reduce symptoms of a disease
qid
four times a day
what are some diversity consideration in regards to ethnicity for development?
genetic disorders: ex. tay sachs disease for eastern europeans, and sickle cell anemia for african, southeast asian, and mediterranean
what are some nursing diagnosis' involved in grief and loss?
grief, chronic sadness, death anxiety
stat order
given immediately and only once, often in an emergency
Growth vs. Development
growth: the process of increasing in physical size - includes height and weight - proceeds in and ORDERLY and PREDICTABLE pattern from head to toe development: the progressive acquisition of various skills such as head support, seaking, learning, expressing feelings and relating to other people
peak plasma level
highest level of drug
postconventional level
highest stage of moral development; at this level, decisions about morality depend on abstract principles and the value of all life, social contract, individual rights, universal principles
Duration
how long the drug lasts
Names of rapid acting insulin
humaLOG, novoLOG (LOG)
what stage of erikson's theory is age 12-18 years?
identity vs. role confusion
what are some diversity consideration in regards to lifespan for development?
if you have a pregnancy over the age of 35 increased risk of a child with down syndrome
STAT
immediately
what do you do if blood is found in the stool or if you think your patient might have blood in their stool?
immediately notify their physician
teaching
imparting knowledge or giving instruction
tertiary prevention
implemented when a condition or illness is permanent and irreversible ex. rehab
vital signs & symptoms of a patient aspirating or who has aspirated?
increased BP, increased heart rate, increased respiration rate, slight fever - coughing or wheezing after eating - pain when swallowing
what is the target population of community based nursing?
individual clients or families (this is how it DIFFERS from public health, which looks at a population)
iv
intravenous
transferrin
iron transport protein
mechanical soft diet
is recommended for people with difficulty in chewing or swallowing, the goal is to eliminate chewing,
if a stool culture comes back negative, what does that mean the cause of the diarrhea is for the patient?
it means the cause is not due to parasites or bacteria in the stool, rather something else, such as an internal issue
who is the founder of the cognitive development theory?
jean piaget
The smaller the gauge, the _________ the diameter of the needle.
larger
buddhism daily practices
mediation (can be flower arranging, walking, archery, prayer) - belief that everyday life should be its own mediation - no multitasking! live in the moment
generic drug name
name assigned by US adopted names council (ex ibuprofen)
what do you document on the MAR after administering medication?
name of med, dose, route, date, time, nurse, name, initials
what are the components of a prescription order?
name of patient name of drug dose route time/frequency signature of the provider
what must the prescriber order include?
name, drug, dose, route, time/frequency, signature
moderate anxiety
narrows focus, DULLS perception, and may challenge the person to pay attention or use appropriate problem solving skills
do you need a microfilter for enteral tube feedings?
no
is administering medication a delegatable task?
no
judaism and pregnancy
no baby shower until after birth - life begins when first breath is taken, thus abortion is allowed in some sects
straight catheterization (in & out cath)
not a foley, just a single lumen device. May be used for collecting a urine sample or for draining residual urine, designed for one time or short term catheterization, catheter is left in place only long enough to drain the urine
complicated grief
occurs when a person is not able to progress through the normal stages of grieving
compassion fatigue
occurs when deeply caring and empathetic nurses become overwhelmed by the constant needs of patients and families, nurses with less experience or younger nurses are at a higher risk
dysuria
painful or difficult urination, commonly described as a "burning sensation" while urinating
exaggerated grief
persons are usually conscious of the relationship of the reaction to the death, but the reaction to the current experience is excessive and disabling.
Islam daily practices
prayer 5x a day, do not lie, cheat or steal
What is the Z-track technique?
pulling skin down, up, or to the side, inserting needle, aspirate, inject med slowly, remove needle, and release displaced tissue
what organs does a lower GI series visualize?
rectum, colon, and lower portion of the small intestines
Denial
refusing to believe or even perceive painful realities, ignoring aspects of reality that induce anxiety or contribute to a loss of self esteem
conditions that place patients at risk include
seizures, CVAs, dementia, gastroesophageal reflux disease, cerebral palsy, muscular dystrophy, multiple sclerosis, parkinson's disease,
Bowlby Model of Grief
shock and numbness, searching and yearning, disorganization and repair, reorganization
Posey bed
soft-sided, self-contained enclosed bed that is much less restrictive than chemical or physical restraints, still considered a restraint
bereavement
state of sorrow over the death or departure of a loved one
sl
sublingual
what do you always set up at the patient's bedside as a precaution if they are at risk of aspiration?
suction, this helps if patient actually does aspirate
Advocacy
supporting or promoting the interests of others or of a cause greater than ourselves
stool culture
test to identify microorganisms or parasites present in feces that are causing a gastrointestinal infection or diarrhea
loss
the absence of something to which the affected person has formed an attachment to, can involve, people, places, or things
anuria
the absence of urine formation by the kidneys
Resistance phase of GAS
the body tries to adapt and cope with its stressor by shutting down unnecessary processes such as digestion, growth, and the sex drive
fight or flight response
the initial reaction of the body to stress during the alarm stage
who is responsible for ensuring patient has received adequate information to be able to obtain informed consent?
the nurse
Equilibrium
the process by which a balance between present understanding and new experiences is restored
Hispanic/Latino American Death & Loss diversity considerations
the rosary is said, often at the home of the deceased
what are ethics?
the study of ethics considers the standards of moral conduct in society, they reflect a person's character
how can a nurse uses erikson's theory during assessment?
they can use the stages to assess whether an individual is in the appropriate stage for their age
tid
three times a day
what is the primary goal of community health nursing?
to enhance the capacity of individuals & their families to cope with their health needs
what is the purpose of home healthcare nursing?
to promote, maintain, or restore health at an optimal level of functioning
what stage is birth to 18 months in erikson's theory?
trust vs mistrust
bid
twice a day
how many nurses must check to see if a proper insulin dose has been drawn up?
two
latino pregnancy beliefs
viewed as natural, most are against birth control, more common to seek LATE prenatal care as women of family are often to do this - cuarentena (for 40 days postnatal)
stress appraisal
we see an event as a threat or a challenge... how we perceive it determines the amount of stress we experience threat: harm or loss challenge: possibility of benefit
onset
when the drug begins begins to work
how is teamwork and collaboration demonstrated by the nurse?
when the nurse recognizes and integrates the contributions of the primary healthcare provider, therapists, dieticians, and social workers
hinduism daily practices
yoga & meditation puja (worship)
when it comes to determining if you have the right patient, what do you check?
you check the patient ID band, and also ask the patient to state their name and DOB to compare to the band & the medication
Names of intermediate acting insulin
"NPH" (Humulin N, Novolin N)
islam & death?
- May wish to sit facing Mecca when dying - Muslim scripture, the Koran, may be recited over the dying person - Immediately after death, the body is covered and placed with the feet facing towards Mecca - Only another Muslim can prepare the body for burial - Burial is performed as soon as possible- no cremation - NO SUICIDE
who are those at risk for aspiration?
- stroke patients - seizures - dementia - GERD - cerebral palsy, muscular dystrophy, multiple sclerosis, parkinson's, other diseases involving mobility - endoscopy procedures - medication with sedative effects - feeding of patient by another person - eating too fast
what are 3 ways you can confirm proper positioning of your NG tube?
1. listen for an air bolus using your stethoscope 2. aspirate stomach contents and test ph on a ph strip 3. ** x- ray**!!
how to administer using a multidose insulin pen?
1. remove pen cap 2. ensure there is enough insulin for required dose 3. clean tip of pen with alcohol 4. remove protective tab on new needle 5. attach needle 6. prime the pen by dialing dose to 2 units and injecting into air (depress plunger until insulin shows at tip) 7. verify dial is at 0 units 8. clean injection site 9. insert needle with quick motion 10. depress plunger & hold for 10 seconds 11. remove pen, remove needs & dispose of needle in sharps container
Epi-Pen Administration
1. remove safety cap from auto injector 2. wrap hand around pen 3. point the tip towards the patient's thigh 4. dart device into thigh 5. hold in place for 10 seconds 6. remove pen & massage area for 10 seconds 7. seek emergency attention
Onset of rapid acting insulin
15 min
Duration of intermediate acting insulin
16 hours
A nurse must give 1 g of Keflex, PO, q 6 hr × 3 days. The supply on hand is 500 mg/capsule. How many capsules should the nurse administer at each dose?
2
What age is the preoperational stage?
2-7 years
judaism daily practices?
3 levels of observance - orthodox: most observant, special clothing, always keep kosher, men go to synagogue daily - conservative: most keep kosher, no special dress, go to synagogue weekly or on holidays - reform: often dont keep kosher, least strict, go to synagogue on the holidays
at what age can a child follow a moving object with eyes, smile at the sound of a caregiver's voice, smiles socially, and babbles?
3 months
preschool years development
3-5 years old, egocentric thought processes, have magical thinking, believe that events happen by simply wishing them to happen
at what age can a child roll from back to front, sit with support and then without it, transfer an object from one hand to another, respond to their own name, use voice to express pleasure, and find partially hidden objects?
7 months
duration of short acting insulin
8 hours
peak of intermediate acting insulin
8 hours
how long is emergency guardianship valid?
90 days
1. Which nursing diagnosis is appropriate if a patient expresses an interest in learning? a. Ready to Learn b. Lack of Knowledge c. Effective Information Processing d. Health-Seeking Behaviors
A
Before administering a dose of a prescribed medication, the nurse finds an unlabeled, filled syringe in the patient's medication drawer. What action by the nurse is most appropriate? a. Discard the syringe. b. Obtain a label for the syringe. c. Use the medication in the syringe. d. Verify the contents of the syringe with another nurse.
A
Two adult siblings are caring for their ill mother, who requires 24-hour care. She needs assistance with feeding, bathing, and toileting. One of the siblings takes time to exercise after work, whereas the other goes directly to the mother's home before and after work each day. The nurse recognizes that people may react differently to the same stressors depending on which factors? (Select all that apply.) a. Individual coping skills b. Type of identified stressor c. Amount of perceived stress d. Personal appraisal of the stressor e. Hair color, gender, and skin type
A,B,C,D
asian home remedies
ASK ABOUT HERBAL REMEDIES!!! - may not consider these to be medications
*what are the 4 As to help you rise above moral distress?*
ASK: am I or other team members feeling distressed or suffering? AFFIRM: validate your feelings with others and commit to taking care of yourself ASSESS: identify the specific sources of your distress, determine your readiness to make an action plan ACT: create and implement a plan of action, manage setbacks, preserve your integrity, and move toward resolving the concern
internal strategies
Address person's feelings associated with stress
Which nursing diagnoses are used in developing a patient teaching plan? (Select all that apply.) a. Moral Distress b. Ready to Learn c. Difficulty Coping d. Literacy Problem e. Anxiety
B, D 1. Ready to Learn and Literacy Problem are appropriate nursing diagnoses for use in developing a patient teaching plan. Moral Distress is a nursing diagnosis for those facing ethical decisions. Difficulty Coping is not a nursing diagnosis used in developing a teaching plan, but if a patient is not coping effectively, it may affect the ability to learn. A nursing diagnosis of Anxiety may affect the patient's ability to learn but is not directly related to developing a teaching plan.
While working with patients in a hospice setting, the nurse is aware that certain symptoms are particularly common among patients near the end of life. Which of the following health problems should the nurse anticipate among dying patients? a. Peripheral edema b. Dyspnea c. Anemia d. Peripheral neuropathy
B.
1. An active older patient has been frequently evaluated for minor problems at the clinic since the death of her husband 3 months earlier. During one of her visits, she states that she has no energy to get through the day and no desire to keep up with her Tuesday night bridge club. Which type of holistic health model intervention should the nurse employ to help the patient cope with the loss of her husband? a. Encouraging prn use of antianxiety medication ordered by her provider b. Sharing the value of music therapy to address anxiety about her loss c. Explaining that she will be over the loss of her husband in a few months d. Encouraging a gradual reentry into social interaction and activities with friends
B. (she may not be ready to reenter society)
Written instructions showing pictures of the steps necessary to test blood glucose, along with demonstration and a return demonstration of the steps, would most benefit which learners? a. Affective b. VARK c. Psychomotor d. Cognitive
C
The hormone used as a physiologic marker for stress is: a. ACTH. b. ADH. c. Cortisol. d. Aldactone.
C.
Which statement is true regarding advance directives? a. Advance directives apply only when the person has a chronic illness. b. Advance directives should be drawn up by family members of people who are incompetent. c. Discussion of advance directives is a nursing responsibility. d. Advance directives should be kept in a safety deposit box until the person dies.
C. Advance directives go into effect when a person has a terminal illness and is unable or incapable of making decisions for themselves.
A patient diagnosed with an aggressive cancer is estimated to have 6 months to live. Two months later, the patient's wife calls the nurse's office because she is upset that her husband has taken up motorcycle racing and has already been injured twice. The nurse knows that the patient is experiencing a behavioral change in which factor due to the prognosis of his illness? a. Spirituality b. Physical attributes c. Self-concept d. Personal affect
C. Self-concept is profoundly affected by the diagnosis of a terminal disease. The individual often tries to reinvent himself or herself and behaves in an uncharacteristic manner.
The nurse is providing home care to a 62-year-old woman who was recently diagnosed with insulin-dependent diabetes mellitus. What is the most important reason for the nurse to document the teaching session? a. The patient's insurance company requires documentation. b. The nurse's employer requires documentation of home care sessions. c. Other members of the health care team need to know the patient's progress. d. Insulin is a potentially dangerous medication and needs to be documented.
C. (other answers are true but this is the most true?)
palliative care
Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family, a patient does NOT have to be imminently dying!
behavioral reactions to loss
Crying, insomnia, restlessness, withdrawal, irritability, apathy, impaired work performance
The nurse has assessed that the patient has the confidence in the ability to take action. What is this concept is called? a. Perceived benefits b. Cues to action c. Perceived severity d. Self-efficacy
D
The nurse understands that medication absorption is affected by the administration route. Which route for medications has the fastest absorption rate? a. Cream applied to the skin b. Enteric-coated capsules c. Subcutaneous injection d. Intravenous injection
D
What action does the nurse take immediately after instilling the prescribed eye drops into the patient's eye? a. Apply a sterile eye patch to each eye receiving drops. b. Maintain light pressure on the lower eyelid to keep it pulled down. c. Wipe the eyelid toward the inner canthus area. d. Press gently on the inner canthus area.
D
As a nurse, you evaluate how an individual is progressing through the process of grief, loss, and mourning and understand that a grieving individual is functioning effectively if he/she is: a. using distraction as a coping mechanism while avoiding contact with former friends who have not experienced a loss. b. dealing with conflict by avoiding those family members who appear to be coping effectively. c. able to express his/her feelings of loss and grief to close friends only when in social situations. d. able to accept assistance and support of friends and family as needed during the time of loss and grief.
D.
The nurse knows when coordination between multiple health care disciplines is needed, which role should be utilized? a. dietitian b. social worker c. pastoral care d. case manager
D.
The nurse is providing care to an 88-year-old male patient who just returned from the recovery room after a right hip replacement. The nurse plans to teach the patient prevention techniques for deep vein thrombosis. What is the best time to provide teaching? a. Do it right before the patient's next intravenous pain medication. b. Wait until tomorrow morning because he is in too much pain today. c. Leave written materials on his over-the-bed tray that he can read at his convenience. d. Wait until 10 to 15 minutes after his next intravenous pain medication
D. (Patients in pain are unable to focus on learning)
A 65-year-old male patient has been a one-pack-per-day smoker for 40 years. He was recently diagnosed with chronic obstructive pulmonary disease (COPD) and would like to attend a smoking cessation class. The nurse recognizes smoking cessation as which level of prevention for this patient? a. Primary prevention b. Secondary prevention c. Statutory prevention d. Tertiary prevention
D. (this is to care for his permanent and irreversible disease)
The student describes the "3 A's of health information" identified by the National Action Plan to Improve Health Literacy. Which "A" demonstrates a need to review the information? a. Accessible b. Accurate c. Actionable d. Appropriate
D. Accessible, accurate and actionable are the 3 A's of health information as identified by the National Action Plan to Improve Health Literacy.
The term McEwan used to describe the burden of prolonged stress is a. homeostasis. b. distress. c. "fight or flight." d. allostatic load.
D. McEwan and Lasley proposed allostasis as an alternate term for the stress response. Allostatic load describes the burden of prolonged stress on the body.
who developed the health belief model?
Hochbaum, Rosenstock, and Kegels
latino pregnancy myths
PREGNANCY MYTHS • SAFETY PINS, ECLIPSE, RED UNDERWEAR • PROTECT YOUR CHILD FROM DISEASE, DEFORMITY OR LOSS BY WEARING RED GARMET/ SAFETY PIN DURING ECLIPSE • DON'T COLOR/ CUT HAIR DURING PREGNANCY • CUTTING YOUR HAIR IS LIKE CUTTING THE UMBILICAL CORD • COLORING/DYING YOUR CARE CAN CAUSE HARM TO BABY THROUGH THE CHEMICALS • EAT ALL THE THINGS YOU CRAVE OR ELSE .... • BABY WILL BE BORN W/ SPOTS, BUMPY SKIN, OR OPEN MOUTH. • ***GESTATIONAL DIABETEs
General Adaptation Syndrome (GAS)
Selye's concept of the body's adaptive response to stress in three phases—alarm, resistance, exhaustion.
african american home remedies
a common feature of the health and self management of older adults - a rich tradition, ex. epsom salt for diarrhea, stomach ache and blood pressure - rubbing alcohol, mineral oils, olive oils, fish oil, castor oil
The nurse is inserting an indwelling catheter into a male patient. While initially passing the catheter through the urethra, resistance is met. What action would the nurse take next? a. Withdraw the catheter and obtain a coude catheter. b. Straighten the penis and attempt to progress the catheter again. c. Remove the catheter and insert one with a smaller lumen. d. Inflate the balloon and wait for urine passage.
a. Coudé catheters are a special type of double-lumen, indwelling catheters that are slightly stiff and bent at the end, allowing the catheter to pass more easily through a partially constricted urethra
Justice
act fairly and equitably, all people may be treated impartially ex. How can fair decisions be made regarding who will receive the limited number of donor organs?
do you document meds before or after administration?
after
when would a stool culture be ordered
after a patient is experiencing diarrhea for several days, or when there is mucus found in the stool
Topical route of medication administration
applied to skin surface or mucous membrane
PRN order
as needed order, permits the nurse to give a medication when, in the nurse's judgment, the client requires it
Social media includes such sites as: (Select all that apply.) a. HIPAA. b. Twitter. c. Facebook. d. LinkedIn. e. WebMD.
b,c,d (lol)
The nurse is caring for an 8 year old who is receiving an intramuscular injection. The patient says, "You hurt me all the time. What did I do wrong?" What is the nurse's best response? a. "You didn't do anything wrong." b. "Why do you think you did anything wrong?" c. "Who told you that you did something wrong?" d. "It will only be a little bee-sting."
b.
The nurse is performing a health assessment on a 15-year-old female patient. Which is the best way to obtain accurate information regarding her sexual activity? a. Ask the mother about the girl's sexual activity. b. Privately ask the girl about her sexual activity. c. Warn the girl about the dangers of sexual activity. d. Ask the girl if she wants birth control.
b.
How do you best provide spiritual care to an infant? a. Meet basic feeding needs. b. Hold and rock the infant. c. Play with the infant using brightly colored soft objects. d. Set regular sleeping schedules.
b. (promote love & compassion)
Which description is an example of data? a. A print-out of a patient's history and physical examination b. A patient's blood pressure and pulse rate c. The nurse's knowledge of a disease d. A nurse's interpretation of a change in the patient's condition
b. Data are facts, observations, and measurements such as blood pressure and pulse rate
swallow study
barium is mixed with food and you watch an image to see if food goes into the lungs, a test that shows what the patient's throat and esophagus do while they swallow
hinduism & illness
belief that illness = a build-up of toxins - external or internal, goal = to get rid of, may involve fasting
what are the essential principles of ethics in nursing?
beneficence, nonmaleficence, respect for autonomy, veracity, justice, accountability, advocacy, confidentiality, fidelity, responsibility
what is a safe practice alert for SIDS?
best way to reduce risk is to put babies to sleep on their backs
Newborn Development
birth to three months of age, the newborn is cuddling, sleeping, and feeding for the first few months, might be able to follow your face with your eyes, can focus on objects 8-14 inches away from their face, movements are still random and jerky
exhaustion phase of GAS
body's resistance collapses, creating damage that can include susceptibility to infection, tumor growth, aging, irreversible organ damage, or death
mild anxiety
can be motivational, foster creativity, and actually increase the ability to think clearly
what are some other functions of an NG tube?
can be used to allow the bowel to rest, or to decompress the stomach (can be used for nutrition or elimination)
CT scan (computed tomography) can be used for what regarding the urinary system?
can be used to view the kidneys, ureters, and bladder. to look for blockages, can be used with or without contrast (LOOK OUT FOR ALLERGIC REACTIONS TO THE DYE)
what is the main focus of public health nursing?
care of populations, normally involves targeted populations
chronic illness
characterized by loss or abnormality of body function that lasts longer than 6 months and requires ongoing care, may be characterized by periods of wellness and exacerbation
delayed grief
characterized by suppression of the grief reaction while the grieving person consciously or unconsciously avoids the pain that has occurred with the loss
what are the three checks for aspiration precautions?
check for gag reflex monitor coughing & gagging monitor for fever--> could indicate aspiration pneumonia
what do you check before/while you pour, mix, or draw-up medication?
check the pt's medical history on the MAR -then remove the medication -verify the client's identifiers match the MAR -compare label against MAR -calculate/ check proper dosage -check expiration -check and make sure drug makes SENSE
when it comes to ensuring that you have the right dose, what do you do?
check the recommended range of the dose, calculate the needed dose
safe practice alert for car saftey?
children from birth to 3 years old travel in the back seat in a rear facing seat until they meet the height and weight limit, NOT AN AGE
what is the behavior of industry vs inferiority?
children take pride in accomplishments
what post-mortem care can be delegated to a UAP?
cleaning of the body taking off personal belongings *they cannot* - call doctor - determine time of death - take out tubes
Is short-acting insulin clear or cloudy?
clear
pureed diet
clear and full liquids + food and fluids that have been pureed to a thick liquid form [e.g., pureed meats, fruits, scrambled eggs]
full liquid diet
clear liquids + liquid dairy products, all juice, strained fruits, vegetables, and cereals
when you mix insulin you go _______to _________
clear to cloudy
When mixing insulins, which type would be drawn into the syringe first?
clear!! Clear before cloudy
ethics committee
committee made up of individuals who are involved in a patient's care, including health care practitioners, family members, clergy, and others, with the purpose of reviewing ethical issues in difficult cases
A female patient has had frequent urinary tract infections. Which statement by the patient indicates that the nurse's teaching on prevention has been effective? a. "I will limit my fluid intake to 40 ounces per day." b. "I will use only organic bath bombs when bathing." c. "I will wait to wear my tight jeans until after my urine is clear." d. "I will wipe from the front to back after voiding."
d.
What snack choice would be the best suggestion by the nurse for a patient on a renal diet? a. Peanut butter b. Bananas c. Diet cola d. Carrot sticks
d. (restricts potassium, sodium, protein & phosphorus intake)
beneficence (essential nursing principle of ethics)
defined as doing good, focuses on the patient's needs and concerns even if they differ significantly from those of the nurses, states that nurses are required to care for all people in all circumstances
Health Promotion Model
defines health as a positive, dynamic state, not merely the absence of disease, behavior is motivated by the DESIRE to do well, & increase well being & optimize health status
what ethics theory is the nursing code of ethics founded on?
deontology
what can demands of workplace stress lead to in nursing?
depression, compassion fatigue, burnout, decreased job satisfaction **nurses must take time for themselves!**
asian pregnancy beliefs
different traditional practices for the 1 month after birth to revive and replenish, there are even facilities to allow mother to replenish after birth where child is taken care of
Native American Death & Loss diversity considerations
different tribes have different belief systems
what is a safe practice alert for breastmilk?
do not warm in microwave, check the temperature on wrist by squirting a few drops
how do you document PRN meds in the MAR?
document what, when, where, and why you gave the medication, evaluate and document the patient response
Beneficence
doing good, focusing on the patients needs even if they differ from those of the nurse ex. treating a criminal the same as another patients regardless of their crime
Asian American Death & Loss diversity considerations
dying at home may be considered "bad luck"
emotion focused coping
ease the emotional stress associated with a stressful condition, avoidance
side effects
effects of drugs other than the desired medical effects, nontherapeutic but expected
african american daily practices
elaborate rituals & ceremonies that are a significant part of ancestral culture
what type of coping strategies should be used with a problem or stressor that may not have a solution?
emotion-focused coping strategies
psychosocial theory of development
emphasizes social nature in development, he believed that as people grow they go through a series of psychosocial crises that shape their personality: - 8 stages
psychosocial theory of development is founded by
erik erikson
what organs are visualized in an upper GI series?
esophagus, stomach, duodenum
what organs does an endoscopy visualize?
esophagus, stomach, duodenum
chronic grief
excessive in duration and never comes to a satisfactory conclusion
polyuria
excessive urination or urine volume
what are some cons of TPN
expensive, more complications, air embolism, central line associated bloodstream infections
Rationalization
explaining one's actions in a way that enhances one's own self image
what do most stressors for middle adults involve?
family, health, economics, politics, culture
Buddhism core beliefs
four noble truths - life is suffering - origin of suffering is want - cessation of suffering is to not want (moderation or middle path) - think right in terms of intention, speech, conduct, livelihood, endeavor, mindfulness & meditation (eightfold path)
if a urinary diagnostic exam requires the use of contrast, what should you do after?
give the patient IV fluids to flush the dye
what type of patients require total parenteral nutrition (TPN)?
given through a PICC line or a central line using a pump, given to patients with a non-functional GI tract or patients who cannot digest or absorb vital nutrients, crohn's diseases, ulcerative colitis, GI obstruction, diarrhea, diarrhea, abdominal trauma, burns or post op status
parenteral nutrition
giving nutrients through a catheter inserted into a vein, BYPASSESS THE GI TRACT, used for patients with a non-functioning GI tract
what type of approach to health and wellness does Maslow's Hierarchy take?
humanistic
Buddhist Death & Loss diversity considerations
incense is lit in the room
bereavement
includes both grief & morning
Psychomotor Domain of Learning
incorporates physical movement and the use of motor skills into learning, ex. teaching a newly diagnosed patients with how to check blood sugar
Latino daily practices
incorporation of faith into health and understanding daily activities, rice and beans with a tortilla w every meal
drug tolerance
increase dosage if patient becomes tolerant
what should you watch for when administering IV meds?
infiltration, thrombophlebitis
Mintzberg's 3 levels of management
information, people, and action
primary prevention
instituted before disease becomes established by removing the causes or increasing resistance ex. a vaccination
child maltreatment
intentional harm to or avoidable endangerment of anyone under 18 years of age, can be intentional, physical, emotional, and sexual
what are the four main injection sites ?
intradermal, subcutaneous, intramuscular, intravenous
im
intramuscular
you need a ________ pump for feeding solutions through an NG tube
kangaroo
fidelity
keeping promise to ourselves & our patients, promising pain meds asap and delivering asap
if high amounts of protein are found in the urinalysis, what could that indicate?
kidney disease, fever, exercise, pregnancy
Cognitive Domain of Learning
knowledge, comprehension, application, analysis, synthesis, and evaluation, MEMORIZATION & RECALL
Psychomotor Domain of Learning
learning & incorporating physical movement & the use of motor skills
Affective Domain
learning recognizes the emotional component of integrating new knowledge, includes taking in account patient's feelings, motivations, attitude
what is the resolution of crisis for the industry vs inferiority?
learning to cope with social and academic demands
advanced directive (living will)
legal documents that allow individuals to communicate their wishes about what type of medical care they would like to receive at the end of life
is percutaneous endoscopic gastronomy (PEG tube) used for long-term or short-term nutritional support?
long-term
what type of patients require an percutaneous endoscopic gastrostomy?
long-term nutritional therapy, in patients who are neurologically impaired, have a condition that affects the stomach and its normal function, esophageal cancer, traumatic injury to nose and mouth
what patients would qualify for an PEG tube?
long-term nutritional therapy, neurologically impaired patients, pts who have a condition that affects stomach & normal function - esophageal cancer - traumatic injury to mouth & nose
what do most stressors for older adults involve?
loss & grieving
What do most stressors for older adults involve?
loss and grieving
Plateau
maintained levels of drug
Utilitarianism ethical theory
maintains that behaviors are determined to be right or wrong solely based on their consequences, focuses on the greatest happiness for the greatest number of people, NOT ON THE INDIVIDUAL, "the ends justify the means"
what happens if there is no spouse, but the patient has three adult children who cannot agree on a course of treatment? how are decisions made?
majority rules if there is a odd number of children, (ex. if 2/3 vote for specific treatment), if even, court rules on decision (this is time sensitive so decision will be made within the day)
what is the most important part of informed consent?
make sure the doctor AND staff DOCUMENT that the patient has be given informed information and has granted informed consent that is documented
Asian daily practices
many older adults go to parks and public spaces to dance, exercise, and socialize, tai chi, calligraphy with water, sing
asian illness practices
many prefer asian clinicians or a clinic that has accommodations
what is the objective of medicine
max benefit with minimum harm
Buddhism food restrictions
most are vegetarian, do not believe in taking a life, however if the food is given they will not deter as they do not want to waste that life - no intoxicants-->conserving the mind is most important
moderate anxiety
narrows focus, dulls perception, and may challenge the person to pay attention or use appropriate problem solving skills
Buddhism and pregnancy?
no real guidelines or rituals, contraception and abortion are allowed
can enteral feeding be delegated?
no! only oral feeding can be delegated
should you allow your patient who is ambulatory but doesn't want to get up and walk to the bathroom use a bedpan?
no! patients should be up and moving if they are able
conception
occurs with fertilization and implantation
therapeutic drug monitoring aims to promote ________ drug treatment by maintaining serum drug concentration within a ________ ________
optium, therapeutic range
Enteral route of administration
oral, sublingual, rectal, THROUGH GI TRACT so NOT inhaled
what three drug routes are NOT considered parenteral?
oral, topical, inhalation
24 hour urine collection
ordered to determine how much creatinine is cleared by the kidneys, assess kidney function, tallies total urine volume
Upper Endoscopy (EGD)
patient is lightly sedated, and provided with numbing medication in the throat, a scope is then placed down the esophagus to get a visual of the esophagus, stomach, and duodenum
**what are the dietary restrictions when it comes to IVP?
patient must be NPO at least 8-12 hours prior
**what are the dietary restrictions when it comes to a CT for the urinary system?
patient must be NPO for 8-12 hours prior
what sort of patients cannot sit up to eat, thus are NPO
post spinal injury, patients that are lying down, hip fracture patients
what are the five nutritional lab tests?
prealbumin, albumin, transferrin, hemoglobin & HCT, BUN & creatinine
what are the three levels of kohlberg's theory?
preconventional, conventional, and postconventional
defense mechanisms
predominantly unconscious, protective coping methods that people may apply in response to a perceived THREAT
islam & pregnacy
pregnancy is the work of the divine - child = living after 120 days in womb, abortion is prohibited after - allah breathes spirit into child
Albumin
protein in blood; maintains the proper amount of water in the blood
what should a child be able to do at 3 months?
raise head and chest when prone -bring hand to mouth -follow moving object with eyes - smile at sound of caregiver's voice - smile socially - babble
what do you check at the bedside before adminstering the drug?
recheck label on container before returning it to storage, check against client identifier and inform client before administration
Displacement
redirecting negative emotions perceived as unacceptable or threatening to a safer focus
oliguria
reduced urine output , less than 400 mL daily
how often should the patient be reevaluated for their restraints, and when should the written order for the restraints be renewed?
reevaluated every 24 hours, written order renewed every 24 hours
Hinduism core beliefs
ritual bathing, karma, reincarnation God: Brahma (creator) below him: - Vishnu - shiva
Islam Death & Loss diversity considerations
ritualistic washing of the body by person of the same gender
upper GI series
series of radiographic images taken of the pharynx, esophagus, stomach, and duodenum after the contrast agent barium has been administered orally
children can cope with a _________ stressor event
single
oral drugs have a slower or faster onset than parenteral?
slower
what is the behavior of the identity vs. role confusion theory?
teens attempt to determine a sense of who he or she is, coincides with adolescence
therapeutic range
that concentration of drug in the blood serum that produces the desired effect without causing toxicity
what is the resolution of the crisis for the initiative vs guilt phase
the ability to initiate activities without fear of reprimand from caregivers
physical reactions to loss
tightness in chest and throat, oversensitivity to noise, breathlessness, muscular weakness, lack of energy, fatigue, sleep disturbances, changes in appetite
* primary prevention
to PREVENT disease or disability before they happen - fitness class - nutrition & diabetes education - immunizations
justice
to act fairly & equitably
why is an ultrasound of the bladder and kidneys performed?
to assess the size, shape, and location of the kidneys, ureters, and bladder
what is a colonoscopy performed for?
to visualize inflamed tissue, ulcers, and abnormal growths, can also help diagnose colorectal cancer
what should be documented about a teaching session in the EHR?
topics and skills reviewed, materials used, patient's progress, goals, how they were taught, patient's reaction to teaching
fetus
two months after conception
african american illness beliefs
typically African American have higher body mass index, are more sedentary, smoke cigarettes receive less prenatal care, have more low-birth-weight babies, have higher infant mortality from heart disease, hypertension, stroke, cancer, type 2 diabetes, and HIV/AIDS
drug allergy
unpredictable immune response, ranges from minor to anaphylaxis
what are personal ethics influenced by?
values, societal norms, and practices, family, friends, beliefs, education, culture, socioeconomic status
what affects absorption of topical administration?
vascularity to the skin, uneven distribution, and composition of drug (cream, spray, ointment, suppository, solution)
what are the vitals of a patient who is aspirating & what will they look like?
vitals: Coughing Wheezing Dyspnea Apnea Bradycardia Hypotension Slight fever visually: coughing or wheezing after meal pain when swallowing trouble speaking after eating
what is important to ask when getting a patient's drug history?
what OTC meds they are taken as well as any herbal and dietary supplements (to assess for misuse as well as drug interactions)
asian death practices
white = the color of death, not black, there is a holiday to honor and remember family members who have passed, typically around early spring
Accountability
willingness to accept responsibility for one's actions, a personal attribute that does not require the encouragement of others to be expressed, tested when a nurse makes a mistake, nurses who exhibit this are honest, accept the consequences of their actions and. initiate the best nursing practices based on EBR
what is the gold standard to ensure proper NG tube placement?
x-ray! can also confirm by aspirating contents or listening for an air bolus, but X-ray= needed
can assisting a patient with meals be delegated to UAPs and CNAs?
yes
do teaching sessions have to be documented?
yes
is aseptic technique used for parenteral drug administration?
yes
is emptying a urine bag or collecting a urine specimen a delegatable task?
yes!
do you document meds you did not give or a patient refused in the MAR?
yes! document what medications were not given & why
Can defense mechanisms be healthy?
yes! on a short-term basis they can potentially PREVENT harm, but long term coping strategies that involve defense mechanisms can prevent healthy growth and development
is an ultrasound of the bladder and kidneys safe for pregnant women?
yes! there are no special considerations before, thus it is safe
what do you check as you are preparing the drug?
you compare the drug label to the MAR when preparing
names of short acting insulin
"Regular" (Humulin R, Novolin R)
Parenteral routes of administration
(Injection of medication into the body tissues) 1. Intradermal (ID) 2. Subcutaneous (SubQ) 3. Intramuscular (IM) 4. Intravenous (IV) *requires aseptic technique*
adolescent development
- Rapid physical growth and change - Peers become almost more important than parents - End of adolescence is unclear: Adulthood only begins when established adult relationships and adult work patterns - have high caloric and protein needs due to *puberty*, avoid letting adolescents skip meals - encourage healthy dietary habits (NO FAD DIETS OR SKIPPING MEALS), discuss healthy eating habits -a false sense of invincibility
Judaism health care beliefs
- balance between god and medicine - observance of Sabbath important - treatments are sometimes refused on Sabbath (Saturday) - no rule or restriction is more important than health, and some may be uncomfy with opposite sex
african american religious practices
- baptist, catholicism, islam - most are spiritual and have strong church affiliations - tribal worship - ancestral worship
african american death and dying beliefs
- believe in higher power, death and dying is attributed to God - some think those dying should be cared for at home, others say this is bad luck - cremation is avoided - advance directives encouraged
Factors that affect implementation and evaluation of learning?
- environment ( should be comfortable, when patient is focused and aware) - pace (sessions should focus on one thing at a time and be short) - data integration - repetition and demonstration - documentation
african american health beliefs
- illness can be viewed as punishment by god or witchcraft - health= harmony with nature and culture - sick individual expects familial attention but maintains independence. - teas, herbs, warm medications - family centered approach is ideal in sensitive medical issues
what are some patient behaviors that may indicate poor health literacy?
- info on forms is incomplete or inaccurate, patient wants to take written documents home - "i left my glasses at home" - patient misses appointments - patient does not follow through with lab testing - patient is noncompliant with med and treatment regimens - pt claims to be following treatment regime, but labs differ
what are some factors associated with medication errors?
- knowledge of drug and its application to drug therapy - knowledge of pt and history - dosage calculation - drug nomenclature
latino health beliefs
- prayer, herbal medication, prescription medication obtained from a friend, prescription medication from MD or NP, *faith is a large component regardless of source of care* - fear of addiction (no chronic medications)
what can you do as a nurse to prevent aspiration?
- set patients at 45 degrees or higher when feeding & for 45 mins after - keep head of bed at 30 degrees at all times - encourage slow eating patterns - do not eat or drink 2/3 hours before bedtime - oral care before and after eating - correctly fitting dentures - make sure patient can SEE YOU - alternate between bites of food & liquid - NO STRAWS - use the chin tuck method - observe for pocketing
daily practices of those in poverty
- solving problems minute by minute, day by day, with limited resources
Judaism death rituals
- someone stays with the body until it is buried which occurs within 24 hours of death - cremation is allowed but uncommon - organ donation is allowed - shiva for 7 days after death - unveiling of tombstone 1 yr after death - yahrzeit lit at holidays
latino languages
- spanish - many times use children or family members as translators
characteristics of school-age children?
-fear of being hurt -enjoy competition -active children are at risk for accidents -sedentary=risk of obesity -bullying
what are some signs that a patient might be health illiterate?
-information on forms is incomplete or inaccurate - patient wants to take written documents home - patient misses appointments - patient does not follow thru with tests or referrals - patient is noncompliant with medication/treatment regimens - patient reports compliance, but tests say otherwise
asian family practices
-males are usually dominant and the household head -grandparents typically care for their grandchildren -used to be communal living for the families - kids typically care for parents, although this is a huge concern right now due to one child policy, a child is in charge of four adults, there are more push for nursing homes etc
latino and illness
-prevent/ promotion = not as well valued - imbalance between hot & cold
what should a child be able to do at 7 months?
-roll front to back back to front -sit w support & then w/o -transfer objects from one hand to another -respond to own name -use voice to express pleasure -find partially hidden objects
what should a child be able to do at 12 months ?
-sitting without assistance -crawls forward on belly using arms and legs -assumes hands & knees position -uses pincer grasp -says dada &mama - tries to imitate words
what are the checks for TPN?
1. central line 2. microfilter 3. change tubing every 24 hours 4. check blood sugar every 6 hours 5. label the tubing 6. must be checked by TWO nurses before running
what are the three main checkpoints for aspiration?
1. check for gag reflex 2. monitor coughing and gagging for meals 3. monitor for fever --> could indicate aspiration pneumonia
what five topics must be discussed with a patient with the *PHYSICIAN OR NP* doing the procedure before informed consent can be given?
1. exact details of the treatment 2. necessity of the treatment 3. all known benefits and risks involved 4. available alternatives 5. risks of treatment and refusal
5 components of informed consent?
1. general nature of pt condition is described 2. proposed treatment, procedure, exam, or test is described 3. expected outcome of the treatment, procedure, exam, or test is described 4. risks and benefits are disclosed 5. reasonable alternatives are disclosed
who are individuals capable of giving informed consent if the patient is unable IN ORDER?
1. guardian 2. spouse 3. adult child 4. parent 5. adult sibling 6. grandparent 7. adult grandchild 8. friend who has maintained regular relationship with the patient
Patient's Bill of Rights
1. high quality hospital care 2. a clean and safe environment 3. protection of their privacy, help when leaving the hospital, help with their billing claims
preparing the body for the morgue
1. leave in dentures 2. take off jewelry & watch 3. leave tubes in if autopsy is occuring 4. body should be treated with respect & dignity 5. wash body 6. ensure signature of death certificate 7. follow through with organ donation 8. leave id band in place. 9. personal items not taken by family are documented & identified
what are the three documents advanced directives are composed of?
1. living will 2. durable power of attorney 3. health care proxy (durable power of attorney for health care)
what are the two major roles as a nurse for end of life care?
1. provide accurate information regarding the disease process and treatment options 2. offering support for the patient and family without interjecting personal opinions instill AUTONOMY, let the patient make their own decisions
purpose of ethics committees?
1. provide educational resources on ethical issues to committee members and institutional staff 2. establish policies that govern health care decision making 3. review cases in which clarity is needed 4. identify sets of values relevant to cases requiring consultation 5. determine any values conflicts that might exist 6. provide unbiased input that is not possible from a patient, family member, or close caregiver 7. clarify potential legal implications of the medical or nursing interventions
what are the six rights of drug administration?
1. right patient 2. right medication 3. right dose 4. right route 5. right time 6. right documentation
what are the four steps you should perform when assisting your patient with a bedpan?
1. sit the patient upright & roll over to side to place bedpan under patient 2. close the curtain 3. cover the patient with bed linens 4. place the call light within reach
what should a diabetic do if a flu-like illness occurs?
1. still take pills or insulin 2. take blood sugar EVERY 4 HOURS 3. drink extra liquids & eat normally (if you cannot then substitute carbs) 4. take DAILY WEIGHT 5. take temp every morning and night 6. CALL ER IF - too sick to eat for 6 hours - diarrhea for 6 hours - lose 5 pounds or more - have a 101.4 temp for four hours - trouble breathing or feel foggy
5 stages of Erikson's theory
1. trust vs mistrust (birth - 18mo) 2. autonomy vs shame & doubt (18 mo - 3 years) 3. initiative vs guilt (3-6yrs) 4. industry vs inferiority (6-12 years) 5. identity vs role confusion (12-18 years)
what syringe do you use to draw up and give insulin?
1/2 inch needle insulin syringe
you should not use a bedpan for longer than_______ minutes due to skin breakdown.
10
what age is the formal operational stage?
11 and up
at what age can a child sit without assistance, crawl forward on belly, assume hand-and-knees position, uses pincer grasp, say da-da & ma-ma, tries to imitate words?
12 months
at what age did children begin to ambulate?
12-13 mos
onset of intermediate acting insulin
2 hours
onset of long acting insulin
2 hours
peak of short acting insulin
2 hours
at what age can children walk up the stairs?
2 years
Teaching a patient to use an incentive spirometer by demonstration, with a return demonstration by the patient is an example of teaching based on which domain of learning? a. Psychomotor b. Affective c. Psychosocial d. Cognitive
A Affective domain learning integrates new knowledge by recognizing an emotional component. Cognitive domain learning is based on knowledge and material that is remembered, memorized, and recalled.
masked grief
A type of grief reaction when the person experiences symptoms and behavior which causes them difficulty, but they do not see or recognize the fact that these are related to the loss
delayed grief
A type of grief which is suppressed and or postponed is
what are the fat soluble vitamins?
A, D, E, K
The nurse conducting community wellness events recognizes that which elements contribute to an individual's health and wellness? (Select all that apply.) a. Age b. Genetics c. Access to health care d. Culture e. Environmental f. Health policies
A,B,C,D,E,F
A nurse is determining the health literacy of a patient who is preparing to go home from the hospital. Which of the following attributes or abilities contribute to health literacy? (Select all that apply) a. Able to schedule appointments. b. Identifies credible health information. c. Advocates for appropriate care. d. Owns a source of technology to access information. e. Asks appropriate questions of providers.
A,B,C,E efining characteristics of good health literacy include: being able to schedule appointments, able to identify credible health information, advocate for appropriate care, ask appropriate questions of providers, understand numbers as they apply to one's own case, fill out forms, gather records, navigate complex insurance systems, and use technology to access information.
Which statements by a patient would indicate the use of effective coping strategies? (Select all that apply.) a. "Each month, my wife and I attend a support group for parents of children with autism." b. "Talking with my spiritual adviser may challenge my thinking on how best to handle this situation." c. "I've invited my son to join me for drinks at the bar each night on his way home from work so that we can spend more time together." d. "We are looking into joining the new health club facility in our neighborhood." e. "After working all day, I eat dinner in front of the television while my family sits at the kitchen table."
A,B,D
Which of the following defense mechanisms are defined correctly? (Select all that apply.) a. Displacement: redirecting unacceptable, threatening negative emotions to a safer focus b. Regression: blocking unaccepatble thoughts and feelings from consciousness c. Sublimation: channeling unacceptable emotions into acceptable actions d. Compensation: focusing on strengths instead of perceived weaknesses e. Denial: ignoring aspects of reality that are distressful
A,C,D,E
The nurse cares for dying patients and understands that "nearing death awareness" is a phenomenon evident by which patient statement(s)? Select all that apply. a. "Where are my shoes? I need to get ready for the trip." b. "Is my daughter from California going to come and visit before I die?" c. "When do you think that I am going to die?" d. "I was just talking to my daughter (deceased)." e. "How much longer can I live without food or water?"
A,D People experiencing this "nearing death awareness" may appear confused, but they may actually be making the transition from life to death. All of the other options are questions that dying people may ask, but they do not represent nearing death awareness.
1. Three weeks after delivery, a patient started a diet of 800 calories per day and started jogging 2 miles twice per day. The nurse recognizes the patient's behavior may be most influenced by which motivating factor? a. Body image b. Environment c. Illness behavior d. Chronic illness
A.
A nurse approached an overweight patient about lifestyle modifications to reduce the risk for heart disease. The patient demonstrates lack of perceived susceptibility by making which statement? a. "I'm only a little overweight; there is no way I can have a heart attack." b. "I should lose a few pounds and try to exercise more often." c. "I don't think a little weight loss is related to heart disease." d. "I will investigate the online Weight Watchers programs that helped me in the past."
A.
The nurse is orienting new staff to a clinical unit that provides palliative care. A new employee asks what "grief" is exactly. Which statement indicates that the nurse has correctly defined grief? a. The emotional response to a loss b. The outward, social expression of a loss c. The depression felt after a loss d. The loss of a possession or loved one
A.
The nurse is providing discharge teaching to a who had a gallbladder removal yesterday. The nurse should consider further health literacy-related assessment when the patient states: a. "Can you read that to me? My spouse took my glasses home." b. "I don't understand what you are saying about what I can eat." c. "Do I have to take the pain medicine even if I don't feel I need it?" d. "Do I still need to use that breathing exerciser when I get home?"
A.
The nurse sees information from a VARK assessment and asks the mentor what the acronym stands for. What response from the mentor is best? a. Verbal, aural, read/write, and kinesthetic. b. Verbal, aural, readiness, and kinesthetic. c. Verbal, auditory, readiness, and kinesthetic. d. Verbal, auditory, read/write, and kinesthesia.
A.
The patient has just been told that he has cancer. When the nurse assesses the patient at shift change, his heart rate and respirations are elevated. What type of response is this to stress? a. Physiologic b. Psychological c. Somatic d. Neurologic
A.
The stages of Selye's General Adaptation Response are: a. alarm, resistance, and exhaustion. b. excitement, adaptation, and coping. c. activation, coping, and adaptation. d. appraisal, reaction, and resolution.
A.
Which following factor should be considered first when developing a teaching plan? a. The patient's priorities b. The patient's stability c. The patient's insurance coverage d. The patient's economic resources
A.
Which short-term goal would be most appropriate for a patient with the nursing diagnosis Anxiety with supporting data, including upcoming diagnostic tests, expressions of concern, and pacing around the room? a. Patient will discuss specific aspects of concern. b. Nurse will administer prescribed antianxiety medication. c. Patient will understand diagnostic test procedures. d. Nurse will describe test procedures in detail to allay concerns.
A. (none of the other goals are both patient centered, measurable, AND realistic)
A male patient is told that he may have colon cancer. Which response by the patient best indicates that his initial appraisal of the situation is primarily a challenge to be met? a. Requesting information on various treatment options b. Demanding to see another physician immediately c. Storming out of the gastroenterologist's office d. Yelling at the nurse who is scheduling his colonoscopy
A. Demanding, angry behavior indicates that the patient feels threatened rather than challenged.
The home health nurse is called for a consultation on a patient with memory problems who is having difficulty remembering to take multiple medications prescribed to be taken throughout the day. What can the nurse do to help the patient remember to take the medications as prescribed? a. Arrange for the medications to be put in a pill organizer by week. b. Make a chart showing times when medications should be taken. c. Ask a family member to come over each day to administer medications. d. Ask the patient to set an alarm clock for when medications are due.
A. Pills can be organized by the day for a week at a time in a multi-section container. Empty sections serve as a reminder that medications have been taken already to help prevent duplication of doses. A chart will be confusing for the patient with cognitive deficits as it requires ongoing decisions throughout the day. Asking family members to administer medications may put an unrealistic burden on them, and family may not be in the area to help on a daily basis. An alarm may not trigger that medications are due to the patient with cognitive deficits, nor does it identify which medications are due at that time
A patient recognizes that a family history of a terminal disease predisposes him to the same disease. The nurse recognizes this realization as which component of the Health Belief Model? a. Perception of susceptibility b. Likelihood of action c. Modification of factors d. Adherence to factors
A. The first component of the Health Belief Model (HBM) is an individual's perception of susceptibility, that he/she can actually acquire a given disease. The second component of the HBM is the perception of the severity of the disease, and the third is the likelihood the individual will take action.
What are the five rights of delegation?
A. Right task B. Right circumstance C. Right person D. Right direction or communication E. Right supervision
Which activity best illustrates the use of the Health Promotion Model (HPM) by the nurse to increase the level of well-being for a patient immediately after surgery? a. Holding a pillow across his chest when coughing and deep breathing b. Encouraging the patient to eat his entire evening meal c. Changing his surgical dressing daily as ordered by the physician d. Asking his family to step out of the room during dressing changes
A. The HPM describes an individual's interaction with his environment as he engages in behaviors that promote health. The patient using a pillow as a splint is interacting with his environment to prevent atelectasis and infection.
A nurse providing preventive care to an overweight patient with a family history of diabetes should engage in which priority care-planning activity for this patient? a. Calculating the patient's body mass index (BMI) and recommending a daily exercise routine b. Instructing the patient to perform blood glucose monitoring once daily c. Giving the patient a month's supply of insulin needles and syringes d. Suggesting the patient participate in diabetes education classes offered at a local health facility
A. The patient does not have diabetes but is overweight and at risk due to a family history of diabetes. The best way to prevent diabetes is to keep the BMI in the optimal range (<25).
A 61-year-old man is undergoing an emergency cardiac catheterization when the nurse gives his wife a packet of registration paperwork and asks her to complete the forms. Which observed actions may indicate a health literacy issue? (Select all that apply.) a. Putting on glasses before beginning the paperwork. b. Asking someone in the waiting area to read the forms to her "because I need to get new glasses—these just don't work." c. Waiting until her daughter arrives to begin the paperwork so that her daughter can complete the forms. d. Setting the clipboard aside and staring tearfully out the window. e. Returning the forms only partially filled out, with missing or inaccurate information.
B, C, E Needing glasses does not correlate directly with health literacy. A tearful spouse requires additional assessment to see whether health literacy is a problem. The wife may be overwhelmed and feel unable to complete the forms, or she may need to collect her thoughts in the midst of a stressful time.
A nurse manager is concerned about compassion fatigue among the nursing staff. Which signs and symptoms would alert the nurse to this problem? select all that apply. a. nurses begin working more overtime b. nurses become very emotionally upset without an apparent cause c. nurses start to avoid caring for certain patients. d. nurses start to call in sick more often e. nurses have difficulty showing empathy for patients.
B,C,D,E
A 58-year-old man is admitted for a small-bowel obstruction late Saturday night. The nurse obtains admitting orders, which include the need to place a nasogastric (NG) tube to low intermittent suction. During the assessment, the nurse determines that the patient does not speak English. Which action(s) should the nurse do before placing the NG tube? a. Take two additional staff members into the room when placing the tube so the patient can be restrained if needed. b. Request an interpreter per facility protocol. c. Do not place the NG tube because the physician would not want to frighten the patient. d. Document the inability to place the NG tube due to lack of ability to communicate.
B.
A patient is seeking information about leading indicators that show the importance of health promotion and illness prevention in the United States. To which government-sponsored resource would the nurse refer the patient for the best comprehensive source of information? a. The American Cancer Society website b. The Healthy People 2020 website c. The Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report d. The American Association of Hospitals home page
B.
In caring for a dying patient, what is an appropriate nursing action to increase family involvement? a. Insisting that all bedside care be performed by the family b. Asking family members what they would like to do for their loved one and allowing them to participate c. Expecting the family to be able to perform the patient's daily needs and to meet them consistently d. Refusing all assistance from the family, to decrease family stress
B.
In which scenario is hospice care provided? a. Only in the homes of the terminally ill b. For any terminal illness that requires symptom control c. For cancer patients only in their last weeks of life d. Only in hospital settings based on the seriousness of the illness
B.
Mr. S. has recently lost his wife of 56 years after she had been diagnosed with terminal pancreatic cancer. Which of the following focused assessment questions is appropriate to ask when you suspect that Mr. S. may be experiencing dysfunctional grief? a. "How would you describe your feelings about the loss of your wife?" b. "Do you feel that your sense of loss has gotten worse over the last year?" c. "Do you have any religious or spiritual beliefs that have helped you during this time of loss?" d. "What types of support do you have during this time?"
B.
The nurse has been assigned the same patients for the past 4 days. Two of the patients demand a great deal of attention, and the nurse feels anxious and angry about being given this assignment again. What action would demonstrate the most effective way for the nurse to cope with the patient care assignment? a. Share complaints about the assignment with the nurse manager. b. Prioritize the patients' needs, and identify a specific time period for care for each patient. c. Talk with the patients, and explain that they cannot expect so much personal attention. d. Trade assignments with another nurse who is unaware of the concerns regarding the patient assignment.
B.
Which is true about patient teaching sessions? a. Present all of the information so the patient can learn all that is needed. b. Present the patient with one idea at a time. c. Ensure the presence of a family member at each session. d. End with a written quiz to ensure understanding of the information.
B.
While caring for a female patient with advanced multiple sclerosis, the nurse is discussing the difference between hospice and palliative care. Which statement by the patient indicates understanding of the difference between hospice care and palliative care? a. "I will need to get hospice care if I want my symptoms controlled." b. "I can get palliative care right now—even though I am not going to die anytime soon." c. "My doctor has to make the decision if I have hospice care." d. "I can't get any other treatments, even if they are experimental if I choose palliative care."
B.
In addition to age, nutritional status, and genetic inheritance, which additional factor influences the expression of the stress response and reflects the complex psychological processing involved? a. The amount of stress b. The individual's appraisal of the stressor c. The context of the stressful event d. The type of stressor
B. Stress appraisal, the affected person's attribution of meaning to a stressful event, influences the expression of this stress response and reflects the complex psychological processing involved.
The nurse enters a patient's room and notices that the patient has not been out of bed since the previous day. The patient states that his condition has made him bedridden, although the nurse knows that he is capable of independent ambulation. Which type of reaction is the patient exhibiting? a. Ambivalence to symptoms b. Illness behavior c. Diminished functional ability d. Overreaction to illness
B. The patient is defining and interpreting his disease symptoms according to his beliefs about illness and how to respond to it. The patient's ability to ambulate is intact. Overreaction to illness is a subjective anomaly, and the patient is not ambivalent about his diagnosis.
A patient is newly diagnosed with diabetes and requires insulin injections. He requests information about classes offered by the diabetes educator. Which type of coping technique is this patient using? a. Emotion-focused b. Problem-focused c. Avoidance d. Denial
B. (aimed at altering or removing a stressor)
Which of the following older adult patients is most appropriate for hospice care? a. A patient who is immobilized due to injuries and unable to afford specialized nursing care b. A patient who experienced a stroke and has been given 3 months to live c. A patient with cancer who is living with uncontrolled persistent pain d. A patient with HIV infection who is on Medicaid.
B. (this patient has 6 months or less to live)
Mr. Jones' young daughter died in a tragic car crash 1 year ago. Mr. Jones states that he still looks for his daughter when he drives by the playground of her former school and that he often misses work because of lack of sleep and intense feelings of grief. As a nurse, you understand that the type of grief Mr. Jones is experiencing is identified as: a. anticipatory grief. b. complicated grief. c. delayed grief. d. disenfranchised grief.
B. Complicated grief is characterized by distressing symptoms lasting at least 6 months following the death of a significant loved one and occurs with a sudden, unexpected death
The nurse is caring for a 6-year-old patient in the emergency department who just had a full left leg cast placed for a fracture. As the nurse is reviewing the discharge instructions with the patient's mother, she states, "You don't have to go over those—I'll read them at home." What should the nurse do? a. Contact the physician immediately. b. Consider the possibility of health literacy limitations and assess further. c. Stop the teaching, because the mother obviously has taken care of casts before. d. Explain to the mother that reading the instructions with her is required.
B. The patient's mother may have limited reading skills or health literacy and should be further assessed. Contacting the physician in this situation would not be appropriate because ensuring the patient and family understand discharge instructions is the responsibility of the nurse. Assuming that the mother has taken care of casts in the past may be inaccurate. Stating that reading the instructions with the nurse is a requirement does not ensure that the patient or mother comprehends the instructions.
The nurse is selecting a site to administer a medication by the intramuscular route. The nurse chooses to avoid which site due to the high risk for injury? a. Vastus lateralis b. Ventrogluteal c. Dorsogluteal d. Deltoid
C The dorsogluteal site has the highest risk of injury related to the close proximity to blood vessel, bone, and the sciatic nerve pathway. The vastus lateralis site is not near large nerves or blood vessels and is the preferred site for infants age 7 months and younger. The ventrogluteal site is the preferred IM injection site for people older than 7 months. The deltoid site is a safe option for smaller volume injections.
Several theorists have identified stages of the grieving process. The nurse understands these stages and knows that people progress through them in an individualized manner. Which statements are true regarding the steps of the grieving process? Select all that apply. a. There is a definite "timetable" or period of time specific to each stage of the grieving process. b. Nursing interventions are generalized across all stages of the grieving process. c. Tasks to be achieved at each stage have been identified by each theorist. d. There is a common stepwise progression through each stage of the grieving process. e. Not all individuals will experience all stages of grief.
C,E
When using a stress assessment tool with a patient from another culture, what factors must the nurse take into consideration? (Select all that apply.) a. Specific methods of managing stress are revealed in using stress assessment tools. b. Stress assessment tools should be used only for persons living in North America. c. Stress assessment tools may not be appropriate for all people of all ages. d. Resistance resources become evident when stress assessment tools are analyzed. e. Adaptations may need to be made to the assessment tool based on circumstances
C,E Stress assessment tools identify only stressors that the person is experiencing and not methods of managing stress or the person's resistance resources
A person's first response to grief and loss if often one of: a. bargaining b. acceptance c. denial or shock d. depression
C.
An 8-year-old girl is newly diagnosed with type 1 diabetes. The nurse may expect fear and crying when teaching the child how to self-administer insulin injections due to which influencing factor? a. Self-concept b. Self-esteem c. Developmental level d. Hierarchy of needs
C.
George is a junior college student. Recently he has felt anxious and jittery. He decides that he will swim during his lunch hour. After several days he notices a decrease in feeling anxious. What type of stress management did George use? a. Guided imagery b. Biofeedback c. Exercise d. Progressive muscle relaxation
C.
In the immediate postoperative period after open-heart surgery, a patient who is not a diabetic has elevated blood glucose levels. What physiologic stress response best describes the rationale for the patient's increased blood sugar? a. Release of epinephrine b. Circulation of endorphins c. Increase in corticosteroids d. Secretion of corticotropin-releasing hormone (CRH)
C.
Rather than simply providing physical care to patients, hospice was designed to: a. reduce hospital bills for families. b. provide better psychosocial care. c. improve a patient's quality of life. d. allow families control over the decision making for alert elders.
C.
The best way for a new nurse to cope with his/her own feelings related to death, loss, and grief while caring for patients is to: a. emotionally distance him/herself from dying patients and their families immediately after death has occurred. b. provide ongoing bereavement support to families of patients who have died. c. develop a beginning awareness of his/her own fears, feelings, responses, and reactions to death and dying. d. discuss feelings of loss with family members and friends as a way to cope with loss in the workplace.
C.
The domain of learning directly related to a patient's motivation to learn is: a. cognitive. b. psychomotor. c. affective. d. dependent on their reading level.
C.
The mother of two children, 8 and 10 years of age, has just experienced the death of her mother, the children's grandmother. The mother is concerned about the emotional impact attending the funeral may have on her children. She asks the nurse what she should do in relation to her children attending the funeral. What is the nurse's best response? a. "Take them to the funeral—they need closure, and seeing their grandma in the casket will assist them in knowing that she has died and will not return. Many children attend funerals in today's society." b. "Do not take them to the funeral—they are too young to be exposed to the emotions that are demonstrated at funerals. Many children who attend funerals have adverse psychological reactions." c. "Talk to your children about how they feel about attending the funeral and encourage them to ask questions and talk about their concerns. If they want to go, they will need to be prepared for what will happen at the funeral." d. "Talk to your children about what your mother meant to you and how much she cared for them as her grandchildren, and then see if they really want to attend the funeral. If they want to go it is okay to take them."
C.
Which intervention would be most appropriate for the nurse to include in the care plan for a patient who is experiencing constipation and increased heart and respiratory rates? a. Time management b. Decreased grain intake c. Relaxation therapy d. Regimented exercise
C.
The nurse has been caring for a 65-year-old male patient who has just died. In planning for follow-up bereavement care, the nurse knows that which person is at risk for disenfranchised grief? a. A daughter who lives in a different state b. The son who was with the client when he died c. An estranged ex-wife of the patient who lives nearby d. The 16-year-old grandchild of the patient
C. (disenfranchised grief occurs with any loss that is not validated or recognized)
Which ICNP nursing diagnosis is most appropriate for a young immigrant who expresses concern for the safety of his family members who were unable to relocate with him out of a war zone? a. Risk for Spiritual Distress b. Impaired Role Performance c. Impaired Family Process d. Difficulty Coping
C. A key factor in Impaired Family Process is a situational crisis that causes a change in communication and emotional and mutual support, which all are present in this case. None of the information provided indicates a spiritual crisis, ineffectiveness of coping, or impairment of role performance.
A nurse is caring for a patient in the acute care setting who has a do-not-resuscitate order in place. The family approaches the nurse as he/she is walking down the hall and says, "I think my mother has died." To facilitate acceptance of the death by the family, an important nursing intervention is to: a. notify the physician that death has occurred while in the room with the family. b. ask another nurse to come into the room to confirm that death has occurred. c. assess the patient for pulse, respirations, or blood pressure with the family present. d. check that the cardiac monitor that was in place still has the appropriate leads attached.
C. listening for heart sounds while assessing for any respiratory effort can act to confirm, thus facilitate the acceptance of death by family members who may have been present at the time of death.
The nurse has been caring for a patient who has just died. What is the preferred outcome in caring for the body after death? a. Make sure the body is sent to the morgue within an hour after death. b. Have the family members participate in the bathing and dressing of the deceased. c. Notify in person or by phone all family and team members immediately after the patient's death. d. Demonstrate respect for the body and provide a clean, peaceful impression of the deceased for the family.
D.
What are advanced directives? a. Provide relief from pain and other distressing symptoms, affirm life and regard dying as a normal process, and intend to neither hasten nor postpone death. b. Authorize someone to make decisions about property after the person is deceased. c. Are programs that provide comfort and supportive care for terminally ill patients and their families. d. Are legal documents that allow people to communicate their wishes about what type of medical care they would like to receive at the end of life.
D.
Which following environmental situation would be the most beneficial in which to hold a patient teaching session? a. Waiting room of the provider's office b. The nurse's station c. The patient's room d. The family visiting room
D.
Which of the listed basic needs identified by Maslow must be addressed first when providing nursing care? a. Self-esteem b. Love and belonging c. Self-actualization d. Nutrition and elimination
D.
The nurse is caring for a 16-year-old boy receiving chemotherapy for testicular cancer. He says that his parents are religious and left a cross next to his bed for "good luck." What is the most appropriate response by the nurse? a. "Would you like to talk with a chaplain?" b. "Sounds like you are not very religious." c. "How well do you get along with your parents?" d. "What helps you get through tough times?"
D. Asking an open-ended question is the best response that the nurse can make to this patient's comment. It will encourage the patient to share what he thinks would be most supportive at this time.
A patient undergoing chemotherapy for bone cancer states that using guided imagery in conjunction with pain medications helps in tolerating bone marrow aspirations. The nurse recognizes guided imagery as a component of which health promotion model? a. The Health Function Model b. Lifestyle Fatality Model c. Model for Human Disease Progression d. Holistic Health Model
D. Guided imagery, music therapy, reminiscence, and relaxation therapy are all examples of therapies used in holistic health models. (involve non-medication approaches to healing)
According to Maslow's hierarchy of needs, the nurse understands that which element(s) must be maintained first before a patient can reach self-actualization? a. Self-esteem b. Safety c. Love and belonging d. Nutrition
D. nutrition, then safety, then love and belonging, then self esteem
if your patient is experiencing adverse effects from a medication, what do you do with that drug?
DISCONTINUE IT
if a patient refuses medication, what MUST you do?
DOCUMENT THIS! you must ask the patient why they are refusing the medication, this could lead to discovering potential adverse effects or drug interactions, cant label patient non-compliant if you dont know the reason why they didnt take
Formal patient education
Delivered throughout the community in the form of media, in a variety of educational and group settings, or in planned, goal-directed, one-on-one session with a patient in the acute care setting, usually has goals set by the educator
secondary prevention
Efforts to limit the effects of an injury or illness that you cannot completely prevent -examples: communicable disease screening and case finding; early detection and treatment of diabetes; exercise programs for older adult clients who are frail
secondary prevention
Efforts to limit the effects of an injury or illness that you cannot completely prevent, undertaken in cases of latent disease
primary prevention
Efforts to prevent an injury or illness from ever occurring, BEFORE DISEASE= ESTABLISHED
Judaism Core Beliefs
First major monotheistic religion, covenant between God (one God) and Abraham (the chosen people), there is ONE god and messiah has yet to come, pray to GOD ALONE (no prophets, saints, etc)
Health Promotion Model (HPM)
Focus is toward increasing clients level of well-being through health promoting behaviors ~individual characteristics and experiences ~behavioristic knowledge and affect ~behavioral outcomes
Buddhism holy days
Hanamatsuri: april 8th, buddha's bday Rohatsu: dec. 8th, buddha's enlightenment
Understanding basic information and services needed to make appropriate health decisions is an important part of a patient's?
Health Literacy
what stage of erikson's theory is age 3 to 6 years?
Initiative vs guilt
Judaism food restrictions
KOSHER 1. no pork or pork-related products, seafood, fish without fins or scales 2. Dairy food are not consumed with meat or animal-related foods (may use two sets of dishes, one for each food type) 3. 6 hrs between consumption of meat and dairy consumption 4. Meat prepared by kosher ritual (blood drained and carcass rinsed and treated with salt) 5. Fasting for 24 hr during Yom Kippur 6. No leavened bread during 8 day Passover
should you put a foley catheter in a patient who is incontinent ?
NO, not unless they have a wound in coccyx area that could be infected
peak of long acting insulin
NONE!
cognitive reactions to loss
Preoccupation with the deceased, forgetfulness, preoccupation with the loss, inability to concentrate or to retain information, disorganization, feeling confused
What does the Z track technique do?
Prevents leakage of medications into the SQ from an IM injection
judaism holy days
Rosh Hashanah, Yom Kippur, Pesach (passover), Shavuot (pentecost), Sukkot (tabernacle), Yom Kippur (FAST)
if you are flushing a peg tube with water and you meet resistance, what do you do?
STOP FLUSHING
Responsibility
The concept of being dependable and reliable, follows the orders of physicians and nurse practitioners, nature of responsibility depends on the specific role in which an individual is functioning, ex. the responsibilities of nurses caring for older adults are very different from those practicing in the delivery room
livor mortis
The pooling of the blood in tissues after death resulting in a reddish color to the skin
continuous theory of development
Theory based on the belief that human development progresses smoothly and gradually from infancy to adulthood.
VARK learning styles
Visual, Aural, Read/Write, Kinesthetic
what is the gold standard for checking the positioning of an NG tube?
X-ray!! (radiographic confirmation)
what forms do you need as a healthy 20 year old should you end up in the hospital unconscious to designate who makes your healthcare decisions?
a health care representative appointment form
ex. of how timing affects patient teaching
a patient cannot focus if they are in pain, or just received a life-changing diagnosis, or if a caregiver wants to attend the teaching
who should you NOT provide massage therapy to?
a patient with DVT, burns/wounds, severe osteoporosis, thrombocytopenia
what is a "no interruption zone"
a policy that states a nurse cannot be interrupted when administering medication in order to prevent errors
how does the health promotion model define health?
a positive, dynamic state of well being, rather than the absence of disease in the physiologic state
hospice
a program that provides comfort and supportive care for terminally ill patients and their families, either directly or on a consulting basis with the patient's physician or another community agency
lower GI series
a series of X-rays using a barium enema to show the large intestine and rectum. This procedure can be used to identify problems such as diverticulitis/diverticulosis, and tumors.
who performs a swallow study?
a speech pathologist
compassion fatigue
a state of exhaustion experienced by medical and psychological professionals, as well as caregivers, which leaves the individual feeling stressed, numb, or indifferent, internalizing emotions about what a patient is going through
anticipatory grief
a syndrome characterized by the presence of grief in anticipation of death or loss; the actual death comes as a confirmation of knowledge of a life-limiting condition, EXPECTED DEATH
difference between a threat and a challenge?
a threat evokes the possibility of loss, where as a challenge hold the possibility of benefit
Prealbumin
a thyroxin-binding protein measured to evaluate the nutrition status of critically ill patients who are at high risk for malnutrition
The nurse is caring for a critically ill patient. What are the contraindications for administering medications by the oral route for this type of patient? (Select all that apply.) a. Vomiting b. Unconsciousness c. Diarrhea d. Penicillin allergy e. Intubation
a, b, e
Which statements reflect the practice of transcultural nursing? (Select all that apply.) a. May be considered a general and specialty practice area b. Focuses on the world view rather than patient needs c. Challenges traditional ethnocentric nursing practice d. Aims to identify individual patient care preferences e. Focuses patient care on the nurse's cultural norms
a, c, d
Prior to discharge, the nurse teaches the patient the proper techniques for applying an ostomy pouch. When evaluating the teaching, the nurse observes the patient apply a new ostomy pouch without cleansing the skin underneath. What actions would the nurse implement following this patient's return demonstration? (Select all that apply.) a. Repeat the demonstration to show the patient how to clean the ostomy site. b. Document that the patient performed the initial return demonstration accurately and safely. c. Offer positive reinforcement regarding the need to cleanse the site to prevent skin breakdown below the appliance. d. Discharge the patient with written instructions and illustrations that demonstrate the correct procedure. e. Notify the health care provider that a repeat demonstration of the ostomy appliance procedure is needed.
a, c, d (healthcare provider doesnt need to be notified??)
The nurse is caring for an elderly patient who has weakness on the right side as the result of a cerebrovascular accident (CVA). The nurse is correct in reporting dysphagia when the patient exhibits which symptoms? (Select all that apply.) a. Incomplete lip closure b. Presence of a normal gag reflex c. A change in voice quality after eating d. Difficulty speaking, with a slow, weak voice e. Abnormal movements of the mouth, tongue, and lips
a, c, e
A patient has been using herbal medication as part of her daily routine. Which actions should the nurse take? (Select all that apply.) a. Document the herbs as part of the medication history. b. Recommend a reputable company from which to buy herbs. c. Allow the patient to self-administer the herbs with her morning medications. d. Inform the primary care provider of the findings. e. Identify possible adverse effects of the herbal medications.
a, d, e
A nurse assigned to the neonatal intensive care unit (NICU) has spent most of a day working with a critically ill infant, with the mother standing by. The infant experiences a cardiac arrest and does not survive. The mother spends an hour crying and holding the baby, saying good-bye. Which spiritual care interventions are most appropriate for the nurse to implement? (Select all that apply.) a. If desired, briefly hold the baby to say good-bye after the mother leaves. b. Follow procedures to prepare the body for transport to the morgue. c. Visit the mother the next day to see how she is doing. d. Call the family spiritual adviser or the chaplain. e. Ask the mother if you could call a family member or friend to be with her.
a, d, e Although it is critical that the nurse follow procedures in preparing bodies for the morgue, it is not considered spiritual care.
A nurse manager has evaluated a new hire's informatics literacy and gave a rating of "beginner". What observations did the manager make to justify this rating? (Select all that apply.) a. Has adequate keyboarding skills. b. Documents well in the EHR. c. Understands data relationships. d. Conducts research using technology. e. Demonstrates skill in information management.
a,b
Which factor(s) is/are likely to influence the transition from adolescence to adulthood? (Select all that apply.) a. Cultural beliefs b. Societal values c. Personal beliefs and expectations d. Governmental rules e. Societal expectations
a,b,c
Which factors are biological variations that should be assessed by the nurse when conducting a transcultural assessment? (Select all that apply.) a. Susceptibility to illness b. Body frame and structure c. Existence of genetic disease d. Social and work time orientation e. Cultural health practices
a,b,c Social orientation and work orientation are in the time domain. Cultural health practices are in the environmental control domain.
When emptying a patient's catheter drainage bag, the nurse notes that the urine appears to be discolored. The nurse understands that what factors may change the color of urine? (Select all that apply.) a. Taking the urinary tract analgesic phenazopyridine b. A diet that includes a large number of beets or blackberries c. An enlarged prostate or kidney stones d. High concentrations of bilirubin secondary to liver disease e. Increased carbohydrate intake
a,b,c,d
Commonly reported drugs that are abused include which of the following? (Select all that apply.) a. Marijuana b. Oxycodone c. Fentanyl d. Hashish e. Codeine
a,b,c,d,e
When an injury to a child is suspicious for abuse, which is/are important to document? (Select all that apply.) a. Size and location of bruising b. Distinguishing characteristics of injuries c. Height and weight of the child d. Time of last meal e. General state of health of the child
a,b,c,e
The nurse is caring for a surgical patient who speaks only Mandarin Chinese. The nurse will: (Select all that apply.) a. consider the body structure of the patient for rehabilitation needs. b. use the translation services of the institution for communication of the care plan. c. explore the cultural practices for foods, eye contact, and body space for care provision. d. ask a family member to translate so the patient doesn't get charged for an interpreter. e. determine the patient's role and functions within the family.
a,b,c,e Patients are not charged for translation services.
Which items are supported by point-of-care use of information technology? (Select all that apply.) a. More accurate documentation b. Direct access to diagnostic results c. Confidentiality d. Direct access to records by patients e. Access to medication profiles
a,b,c,e Patients do not have direct access to their medical records because these records are secured by log-ins and passwords accessible only to health care providers caring for each patient.
The nurse is caring for a group of older adults. Which patient(s) in this group is/are exhibiting normal signs of aging? (Select all that apply.) a. The patient with knee pain and wrinkles around the eyes b. The patient who needs reading glasses and states that the food tastes bland c. The patient who is confused and does not know the current year d. The patient who states that constipation is an increasing problem e. The patient who is showing signs of depression and hopelessness
a,b,d
Which of the following questions are appropriate to ask during a transcultural assessment? (Select all that apply.) a. How do you act when you are angry? b. What is your role in your extended family? c. Why do you continue to speak German at home? d. When communicating with friends, how close do you stand? e.What is the purpose of not preparing beef with milk products?
a,b,d
The registered nurse (RN) on an inpatient medical unit delegates vital signs and morning care to the unlicensed assistive personnel (UAP) for five stable patients. The nurse asks the UAP to document the vital signs and report any abnormal results immediately. Which rights of delegation is the nurse demonstrating? (Select all that apply.) a. Right person b. Right circumstance c. Right time d. Right supervision e. Right patient
a,b,d (c and e are part of the five rights to drug administration)
A nurse is studying ethics as they related to informatics. What actions does the nurse learn to be unethical? (Select all that apply.) a. Using proprietary software for which you have not paid b. Assuming a false identity online c. Accessing patient's records d. Claiming another person's intellectual output e. Interfering with another's computer work
a,b,d,e
Which are major areas to be addressed when evaluating a website? (Select all that apply.) a. Authority b. Purpose c. Popularity d. Verification e. Currency
a,b,d,e
1. Which interventions are considered helpful to assist nurses coping with the unexpected death of a patient for whom they cared for many weeks? (Select all that apply). a. Attending a Code Lavender with unit colleagues b. Journaling personal reflections surrounding the death of the patient c. Scheduling to work to a different shift than the one regularly worked d. Arranging a consultation with the unit manager to discuss a possible unit transfer e. Setting aside time for relaxation activities such as painting, gardening, or exercising
a,b,e
A student has prepared an educational presentation for classmates on the human papilloma virus. What information shows a need to study the material further? (Select all that apply.) a. Only girls need to be vaccinated. b. HPV is linked to oral cancer. c. HPV infections are low risk infections. d. There is no cure for HPV. e. HPV infections are rare nowadays.
a,c
Which behaviors are expected of the nurse at the experienced informatics competency level? (Select all that apply.) a. Collect accurate assessment data. b. Conduct informatics research. c. Group assessment data. d. Document data appropriately on the electronic health record (EHR). e. Integrate information science, computer science, and nursing science.
a,c,d there are four competency levels: beginner, experienced, specialist, and innovator, table 15.1 page 205
To prevent constipation in an inactive patient, which early interventions should the nurse implement? (Select all that apply.) a. Stool softener administration b. Enema administration c. Increasing the fiber in the diet d. Increasing physical activity e. Increasing fluid intake
a,c,d,e
Which of the following questions would be included in the health assessment of the young adult? (Select all that apply.) a. Have you ever tried harm yourself? b. Is your salary range sufficient for your needs? c. Do you store any guns in your house safely? d. How often do you wear your seat belt? e. Tell me about your typical daily diet.
a,c,d,e Some potential health concerns for the young adult include suicide, gun safety, motor vehicle crashes, and poor nutrition.
What legal consequences may a nurse experience if the nurse is convicted of a crime? (Select all that apply.) a. Loss of nursing licensure b. Employment affirmation c. Monetary penalty d. Unit transfer e. Imprisonment
a,c,e
When administering a cleansing enema, which techniques should the nurse use? (Select all that apply.) a. Assist the patient to a left side-lying (Sims) position. b. Add room-temperature solution to enema bag. c. Lubricate 2 to 4 cm (1 to 2 inches) of tip of rectal tube with lubricating jelly. d. Raise container, release clamps, and allow solution to fill tubing before administration. e. Clamp tubing after solution is instilled
a,d,e
A 15-year-old female gymnast is hospitalized with the diagnosis of bulimia nervosa. Which data would the nurse anticipate finding in the patient's admission history and physical assessment? a. Excessive intake of food, self-induced vomiting, and use of laxatives b. Refusal to eat, body image disturbance, constipation, and amenorrhea c. Excessive exercise, refusal to eat, poor muscle tone, and social isolation d. Hair loss, BMI of 27, occasional use of diuretics, calorie intake 2200/day
a.
A famous rock star has just been admitted to Unit 12A after an automobile accident. A nurse on Unit 12B who is a fan of the musician uses the electronic health record (EHR) to find out how the patient is doing. Which is true regarding the use of a patient's EHR? a. Only staff caring for the patient should access this record. b. Permission from a supervisor is needed to read this record. c. The patient's record can be discussed with the nurse's co-worker. d. The nurse can call a friend who works at the local newspaper.
a.
A nurse delegates a bed bath to unlicensed assistive personnel (UAP). After lunch, the patient rings for the nurse and complains that he has not yet been cleaned up. He is very upset and angry. What should the nurse's next action be? a. Assist the patient in getting cleaned up. b. Write up the UAP for not carrying out the assignment. c. Report the UAP to the unit manager. d. Go find the UAP, and tell her to complete the bath immediately.
a.
A nurse is caring for an American Indian who lives on a reservation. What spiritual practices would the nurse incorporate in care for this patient? a. Storytelling b. Native American foods c. Organic-based medications d. Native American dance and music
a.
A nursing is caring for a Chinese patient. What question is best to determine religious practices? a. Are there any religious practices I need to know about to help care for you? b. What is your religion? c. Would you like to talk to a chaplain? d. Tell me about your family.
a.
A patient has suspected iron-deficiency anemia. The nurse monitors the patient and reports which of the following findings supporting this diagnosis? a. Elevated transferrin level b. Elevated oxygenation saturation c. Urine tests positive for protein d. Increased hemoglobin level
a.
A patient prefers to seek acupuncture for pain relief before taking prescribed medication. What response by the nurse is most appropriate? a. Recognize that alternative forms of treatment can be effective. b. Require that the patient take the ordered pain medication. c. Refer the patient for professional pain relief counseling. d. Have the patient's family get the patient to take the medication.
a.
A patient with a history of diarrhea is seen in the clinic. Which nursing intervention is most essential to include in this patient's plan of care? a. Weighing the patient daily b. Encouraging a diet high in fiber c. Decreasing the patient's fluid intake d. Instructing the patient to increase protein in the diet
a.
A patient with an indwelling catheter reports a need to void. What is the priority intervention for the nurse to perform? a. Check to see if the catheter is patent. b. Reassure the patient that it is not possible to void while catheterized. c. Catheterize the patient again with a larger gauge catheter. d. Notify the primary care provider.
a.
A teenage girl faces a long hospitalization after surgery. How can the girl's continued development be fostered? a. Encourage her to write her feelings in a journal. b. Divert her attention by playing video games. c. Encourage her to work on craft projects. d. Make sure her parents are constantly by her side.
a.
Culturally competent care would encourage which action by a patient's family? a. Asking the family's spiritual advisor to visit the patient b. Speaking English to everyone involved in patient care c. Adhering to highly publicized restrictive unit visiting hours d. Limiting food consumption to items provided by the cafeteria
a.
From the nurse's knowledge about the emerging adult according to Arnett's theory, which behavior by a 21-year-old hospitalized male patient is most appropriate for his age group? a. Talking about college courses that he is taking while working part-time at a restaurant b. Requesting that his mom be present when his IV line is started c. Stating that he cares for his disabled father and his 2-year-old daughter d. Becoming upset that he is not giving back to his community
a.
If a nurse threatens to strike a patient while rushing toward the patient in an angry manner, which intentional tort has been committed? a. Assault b. Battery c. Negligence d. Invasion of privacy
a.
Nursing interventions for the patient who suffers from stress incontinence include: a. Kegel exercises. b. surgical interventions. c. bowel retraining. d. intermittent catheterization.
a.
On which ethical theory do nurses implement their care when they act on the basis of the needs of one specific patient rather than the potential consequences to other patients? a. Deontology b. Autonomy c. Utilitarianism d. Nonmaleficence
a.
The hallmark of the older adult populations is: a. increasingly diverse. b. majority male. c. universal confusion. d. cessation of sexual function.
a.
The nurse has been caring for a patient who just died. The patient's daughter is crying uncontrollably, saying, "She was my best friend. I thought she would make it! I don't know what I am going to do." What is the nurse's best response? a. Express sympathy and ask if she would like to talk with a chaplain. b. Give the daughter time to cry in her mother's room alone. c. Ask the daughter if her father is still living. d. Inquire if the daughter would like to pray.
a.
The nurse is in a patient room ready to administer a new medication to the patient. Which action best demonstrates awareness of safe, proficient nursing practice? a. Identify the patient by comparing her name and birth date to the medication administration record (MAR). b. Determine whether the medication and dose are appropriate for the patient. c. Make sure the medication is in the medication cart. d. Check the accuracy of the dose with another nurse.
a.
The nurse is preparing a plan of care for a patient. What is the most appropriate goal for a patient related to medications? a. The patient will administer all medications correctly by discharge. b. The patient will be taught common side effects of prescribed medications. c. The patient will have a good understanding of prescribed medications. d. The patient will have all medications administered by staff as prescribed.
a.
The nurse is speaking to UAP about an immigrant for whom they are caring. Neither the nurse nor the UAP are familiar with the patient's culture. The UAP states, "I don't trust him. He never looks you in the eye. He must be lying about something." What must the nurse recognize in order to effectively manage the situation? a. The UAP is unaware of the cultural traditions of the patient and beliefs about eye contact. b. The UAP most likely has some good insight into this patient's behavior. c. The UAP comfort with closer social space is making the patient uncomfortable. d. The patient most likely does not feel well and just wants to rest.
a.
The teaching plan for a patient with diarrhea should include which intervention? a. Drinking at least eight glasses of fluid each day b. Eating foods low in sodium and potassium c. Limiting the amount of soluble fiber in the diet d. Eliminating whole-wheat and whole-grain breads and cereal
a.
What action by a nurse would indicate an understanding that foreign-speaking patients experience a clash of more than one culture when admitted to a health care facility? a. Explaining medical terms and verifying that the patient understands b. Sharing written patient information pamphlets for the patient to read c. Orienting the patient's family to the hospital lounge and visiting hours d. Contacting the pharmacy for generic and brand name medications
a.
Which of the following questions may help the nurse determine the mental health status of a patient? a. "How do you feel about any recent changes in your life? b. "Do you think you have depression? c. "Has the number of your activities declined? d. "How many alcoholic drinks do you have in a week?"
a.
Which organism is responsible for the majority of urinary tract infections in female patients? a. Escherichia coli b. Neisseria gonorrhoeae c. Candida albicans d. Haemophilus influenza
a.
Which statement below is not true about fluid intelligence? a. Increases throughout middle adulthood. b. Supports reasoning, abstraction, and problem solving. c. Represents basic information-processing skills. d. Peaks in adolescence and progressively declines beginning around age 30.
a.
Which statement is true regarding codes of ethics and laws? a. Ethical codes hold professionals to a higher standard than the law. b. Laws limit the scope of codes of ethics in most professions. c. Breaking the law is not always an ethical code violation. d. Codes of ethics delineate punishments for breaking laws.
a.
You are caring for a 28-year-old married man diagnosed with leukemia. He is hospitalized on reverse isolation. It is his anniversary and his wife is planning to visit. What would be appropriate nursing care to promote spiritual health? a. Assist him in planning a celebration of his anniversary. b. Ensure he has adequate pain medication to endure the visit. c. Maintain strict reverse isolation to prevent infection. d. Congratulate the couple on their anniversary.
a.
What aspect of culture is a full-time employed granddaughter of an elderly female exhibiting if she asks the social worker to place her grandmother in an extended-care facility against the wishes of her parents? a. System change b. Gender role c. Cultural norms d. Shared attributes
a. As one aspect of a society changes, the systems within that society change. The granddaughter in this case is employed full time and unable to adequately care for her grandmother at home. Therefore her request to have the grandmother placed in an extended-care facility reflects societal changes that affect traditional culture expectations of one generation's providing care in the home.
The most important aspect of providing culturally competent care is exhibited through what action by the nurse? a. Seeking to understand individual patient customs, beliefs, and values b. Planning collaborative care with a variety of health care professionals c. Providing similar care for all patients regardless of their background d. Transferring patients to more culturally conducive areas more quickly
a. Assessing and listening to each patient's customs and beliefs is the most important way to provide culturally congruent and patient-centered care. Collaboration with other professionals is secondary to needs assessment. Treating everyone identically or transferring patients with diverse cultural backgrounds off of the unit does not meet individualized, culturally sensitive standards of care.
Which action by a healthcare facility would demonstrate a commitment to providing culturally competent care? a. Providing continuing education events focused on delivery of linguistic services b. Referral of cultural diverse patients for counseling to help them communicate more clearly c. Providing hospital signage in several languages to help patients and families navigate d. Delegation of all patient and family care to health care professionals that are of the same ethnicity
a. Counseling is unnecessary to overcome most communication challenges. Signage needs to be provided in multiple languages commonly spoken in the health care facility in order to better inform and direct patients who do not speak English. However, that is a small part of being culturally competent. It is impossible and unnecessary to delegate all care to persons of like ethnicity
A female nurse is caring for a male patient who is a follower of Islam. How would this affect the nurse's care? a. Integrate prayer times around care. b. Have the wife present during bathing. c. Provide for a kosher diet. d. Maintain the headdress covering.
a. Muslims pray five times a day facing Mecca with cleansing preparation (providing a washcloth is appropriate).
Which activity by a unit nurse demonstrates information literacy? a. Researching a patient's diagnosis online b. Entering patient data into the electronic health record (EHR) c. Organizing patient data to study trends d. Learning a new electronic health record system
a. The nurse is demonstrating information literacy (the ability to recognize when information is needed and to locate and use that information) when researching a patient's diagnosis online. Entering patient data into the EHR or learning a new EHR system demonstrates beginner nursing informatics competency. Organizing patient data to study trends demonstrates an experienced level of nursing informatics competency.
A father is upset because his preschool son has told him he wishes he were gone and pushes him and his wife apart whenever they are together. What information does the nurse give the father? a. This is normal at this age and should resolve on its own. b. The child may need counseling to resolve his conflict. c. Tell the child this is inappropriate and will not be tolerated. d. The child needs to go to preschool to separate from his mother.
a. In the preschool years, feelings of resentment toward the parent of the same sex often occur as the child develops a strong bond with the parent of the opposite sex. As the child matures, these feelings usually resolve on their own. This is not something that requires counseling. (EW)
Which action by a 3-month-old infant would the nurse interpret as an example of Piaget's sensorimotor stage of primary circular reaction? a. Deliberately placing the thumb into the mouth b. Accidentally kicking a ball c. Searching for an object under a blanket d. Shaking a rattle
a. The deliberate action of placing the thumb in the mouth elicits a pleasurable effect. Accidentally kicking a ball is not a deliberate action. Searching for objects and shaking a rattle occur at later stages.
What is the best way to provide spiritual care to a 2-year-old patient? a. Read a childhood story about good versus evil. b. Play hide and go seek and let the child find you every time. c. Let the toddler play with pretend medical supplies. d. Talk to the mother about special religious diets.
a. Toddlers need concrete examples of good versus evil to better understand meaning. (???)
A nurse is teaching a patient about the difference between mild anxiety to moderate anxiety. Which statement by the patient indicates a need for further education? a. moderate anxiety will increase my perception b. mild anxiety can help me remember things c. moderate anxiety will narrow my focus d. mild anxiety will help me be creative
a. moderate anxiety DULLS perception
The nursing instructor is teaching information about constipation in the elderly. Which statement from the student indicates a need for further instruction on this topic? a. Patients receiving tube feedings often experience constipation. b. Poor fluid intake and inability to eat a high-fiber diet often cause constipation. c. Patients with impaired mobility may experience constipation. d. Medications commonly taken by elders often contribute to constipation.
a. (pts often experience diarrhea not constipation, so this is wrong)
A nurse is making assignments for the day. One of the nurses just returned from medical leave due to a back injury. Which patient would be most appropriate to assign to this nurse? a. Confused, ambulatory, and requires assistance with feeding b. Recent postoperative total knee replacement patient who has not gotten out of bed yet c. Elderly, requires one-person assistance for bed-to-chair transfers d. Cerebral palsy patient with pneumonia, uses a wheelchair
a. (since he is ambulatory he needs the least amount of assistance)
1. Which statement is an example of the use of situational leadership? a. The emergency room manager takes a vote on holiday coverage and then responds to a Code Blue by directing orders at the nursing staff. b. The manager in surgery uses the vacation policy to grant time off and then performs a surgical count in an operating room using a checklist. c. A vice president of nursing allows the department directors to make a decision about a hospital policy on holiday time and then sides with a nurse who does not want to work the required time. d. The Chief Executive Officer (CEO) of the hospital instructs the nursing senate to develop a dress code and then changes the dress code after determining he does not like it.
a. (the manager moved from a democratic to an authoritarian leadership style to fit the change in situation)
tertiary prevention
actions taken to contain damage once a disease or disability has progressed beyond its early stages
what are the four schemas of piaget's developmental theories?
adaption assimilation accomodation equilibrium
total parenteral nutrition
administered to patients who cannot, or should not, get their nutrition through eating,
inanition
adult failure to thrive
what are some diversity consideration in regards to culture and religion for development?
affects diet, infant care, birth practice, some may prohibit abortion
pc
after meals
factors affecting health literacy
age and developmental stage, role, environment, timing, availability of resources, EBP
what factors affect the process of grief and bereavement
age of bereaved & of deceased, health status of the survivor (if the person was a long-term caregiver they often neglect their own needs), cognitive status of the survivor, relationship to the deceased, coping styles and concurrent stressors, available support systems, socioeconomic status, religion and spirituality, type of loss
what are some factors that influence health and the impact of illness?
age, gender, genetics and inherited traits, lifestyle, environment, attitudes and emotions, self concept, developmental level, influence of peers or family, traditions beliefs & values, health care access and availibility
trade drug name
also known as brand or proprietary name. This is the name under which a manufacturer markets the medication (advil or motrin --> both of these are ibuprofen)
enteral nutrition
alternate form of feeding that involves passing a tube into the gastrointestinal tract to allow installation of the appropriate formula, NG, PEG, USES GI TRACT or INTESTINES
what is home healthcare nursing?
alternative to hospital or nursing home, component of comprehensive health services, is provided on continuum to individuals and families at their place of residence *establishing a trusting relationship with patients is important*
safe practice alert for newborns
always use good handwashing technique when handling and caring for newborns!!!!
Stress
an autonomic physiologic response to an internal or external environmental challenge, which is automatic and typically beyond a person's resources or ability to respond
Stressor
an event or stimulus that disrupts a person's equilibrium
Stressor
an event or stimulus that disrupts a person's sense of equilibrium
severe anxiety
an increased level of anxiety when more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly; person with severe anxiety has trouble thinking and reasoning
healthcare definition
any care, treatment, service, or procedure to maintain, diagnose, or treat physical or mental conditions
Disenfrachised grief
any loss that is not validated or recognized ex. unborn baby, ex husband
disenfranchised grief
any loss that is not validated or recognized, occurs with ex-spouses, ex-partners, friends, lovers, mistresses, coworkers, or moms of unborn babies
medication error
any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer
Information Literacy is best defined as the ability to do which of the following? (Select all that apply.) a. Access an electronic library. a. Understand data processing. b. Recognize when information is needed. c. Locate, evaluate, and effectively use needed information. d. Knowledge of computers and the ability to use them efficiently.
b,c
Which descriptions are advantages of health care information technology (IT)? (Select all that apply.) a. Increases health care delivery costs b. Improves communication among providers c. Improves administration functions d. Increases the potential for errors e. Decreases the safety of providing care
b,c
Nursing students are held to which standards by the Code of Ethics for Nurses? (Select all that apply.) a. Clinical skills performance equal to that of an experienced nurse b. Demonstration of respect for all individuals with whom the student interacts c. Avoidance of behavior that shows disregard for the effect of those actions on others d. Accepting responsibility for resolving conflicts in a professional manner e. Incorporating families in patient care regardless of patient preference
b,c,d
Which components must exist for nursing malpractice to be established? (Select all that apply.) a. Intent of harm to the patient b. Omitted or substandard care c. Injury resulting from care provided d. Responsibility to provide nursing care e. Emotional distress
b,c,d
Which of the following are examples of the planning function of management? (Select all that apply.) a. Taking action b. Goal setting c. Assessing the present situation d. Setting the plan e. Being creative
b,c,d
Which step(s) can nurses and health care providers take to remove barriers to identifying and treating victims of domestic violence? (Select all that apply.) a. Call the police. b. Ask about abuse. c. Ask for proof of domestic violence. d. Screen for domestic violence with all patients. e. Disregard reported abuse in spouses.
b,d
A 40-year-old patient complains of 4 days of frequent loose stools with abdominal cramping. What is the priority nursing diagnosis for this patient? a. Impaired Skin Integrity b. Fluid Imbalance c. Acute Pain d. Self-Care Deficit (i.e., toileting)
b.
A Jewish patient who adheres to a kosher diet is diagnosed with type 1 diabetes. What would be the best response of the nurse when the patient refuses to take insulin, stating, "Insulin contains pork and I do not eat pork"? a. "There is only a tiny amount of pork by-product in insulin." b. "All of the insulin used today is made synthetically." c. "I will notify your physician to change the insulin order." d. "You really do not have the option of not taking insulin."
b.
A nurse is caring for a patient with malnutrition who reports night blindness, a poor appetite, and frequent infections. The nurse performs a dietary assessment for which nutrient? a. Magnesium b. Vitamin A c. Protein d. Beta Carotene
b.
A patient is admitted to the hospital with pernicious anemia and a surgical history of having had a gastrectomy 6 months ago. On assessment, the nurse questions the patient about compliance with taking which of the following medications? a. Vitamin K b. Vitamin B12 c. Calcium supplement d. Magnesium supplement
b.
A patient is being discharged from the hospital with a new ileostomy. The patient expresses concern about caring for the ostomy. Before hospital discharge, it is most important for the nurse to coordinate with which member of the health care team? a. Home care nurse b. Wound ostomy continence nurse c. Registered dietitian d. Primary care provider
b.
A patient is scheduled for an intravenous pyelogram (IVP). Which piece of data would be most important to know before the procedure is carried out? a. Urinalysis negative for sugar and acetone b. History of allergies c. History of a recent thyroid scan d. Frequency of urination
b.
A patient recovering from major abdominal surgery is to be progressed from a clear liquid diet to the next diet level. Which statement by the nurse would be most appropriate in this circumstance? a. "You will progress from a clear liquid diet to a mechanical soft diet." b. "If you can tolerate the clear liquid diet, your next meal will be a full liquid." c. "You will receive a regular diet tray with anything you want at the next meal." d. "It is important that you eat a pureed diet after you are able to tolerate the clear liquids."
b.
A toddler's parents express frustration over trying to get a toddler to bed at night. They state they have "tried everything." What question or statement will provide the nurse with the most pertinent information? a. "Are there other children in the house?" b. "I'd like to hear more about your bedtime routine." c. "Do you have a quiet place for the child to sleep?" d. "Have you tried time outs for resisting behavior?"
b.
An indwelling catheter is ordered for a postoperative patient who is unable to void. What is the primary concern of the nurse performing the procedure? a. Teaching deep-breathing techniques b. Maintaining strict aseptic technique c. Medicating the patient for pain before the procedure d. Positioning the patient for comfort during the procedure
b.
Data are best described as: a. organized information. b. facts, observations, and measurements. c. knowledge used to make decisions. d. the appropriate application of knowledge.
b.
How best can a nurse evaluate goal attainment for a patient with a culturally diverse background? a. Assume that gender roles will be a challenge to overcome regardless of the patient's ethnicity. b. Base decisions on feedback from the patient and the nurse's professional judgment. c. Collaborate with future community care providers to determine patient strengths. d. Seek input from members of the patient's support system to avoid biased patient responses.
b.
In examining a 3-month-old infant, you would expect to see all of the following except: a. raising chest and head when prone. b. responding to own name. c. social smile. d. bringing hand to mouth.
b.
Standardized nursing terminologies include: a. the ABC coding system. b. NANDA, NIC, and NOC. c. SNOMED-CT. d. ICD9 codes.
b.
The hospital has implemented a new electronic medication administration record (eMAR). What is true about the use of this new tool? a. Verifies medication dosages b. Reduces medication administration errors c. Eliminates the need to count narcotics d. Requires a hard copy of the MAR to be printed
b.
The nurse instructs a patient with a vitamin A deficiency on good food sources of this vitamin. What foods would the nurse include in this list? a. Corn and potatoes b. Carrots and spinach c. Iron-fortified bread d. Raisins and papaya
b.
The nurse is assessing a patient with an indwelling catheter and finds that the catheter is not draining and the patient's bladder is distended. What action should the nurse take next? a. Notify the primary care provider. b. Assess the tubing for kinks and ensure downward flow. c. Change the catheter as soon as possible. d. Aspirate the stagnant urine in the catheter for culture.
b.
The nurse is placing an indwelling catheter in a female patient. The nurse accidentally inserts the catheter into the vagina. What is the next action for the nurse to implement? a. Collect a urine specimen and notify the primary care provider (PCP). b. Leave the catheter in place and insert a new catheter into the urethra. c. Remove the catheter from the vagina and place it into the urethra. d. Ask another nurse to attempt the catheterization of the patient.
b.
What is spirituality? a. Practicing religion b. Expressing meaningful and purpose in life c. Yoga or other meditative practices d. Spending time with family
b.
What is the best way for a nurse to avoid crossing professional practice boundaries with patients? a. Spend extensive time with a patient without visitors b. Focus on the needs of patients and their families c. Intervene in problematic patient relationships d. Relay personal stories when unsolicited
b.
What nursing intervention best demonstrates a commitment to patient autonomy? a. Encouraging a patient to ambulate independently following surgery b. Collaborating with a patient while developing the patient's care plan c. Establishing patient-centered goals for decreased chronic pain d. Assessing a patient for potential postprocedural complications
b.
What should the nurse do first when preparing to administer medications to a patient? a. Check the medication expiration date. b. Check the medication administration record (MAR). c. Call the pharmacy for administration instructions. d. Check the patient's name band.
b.
Which action taken by a nurse would reflect application of an appropriate generalization in a patient care setting? a. Assigning same-gender nurses to all patients admitted to the unit b. Asking the dietary intern to verify with Middle Eastern patients whether or not they eat pork c. Telling the radiology technician that every non-Hispanic family is late for appointments d. Assuming that extended families share financial responsibility for medical bills
b.
Which behavior by the young adult patient indicates an understanding of patient education aimed at reducing the health risks for that age group? a. Smoking only one pack of cigarettes per day b. Limiting alcohol use to an occasional drink c. Using drugs found in a roommate's drawer for anxiety d. Having a relationship with a partner who was threatening in the past
b.
Which nursing instruction is correct when a urine specimen is collected for culture and sensitivity testing from a patient without a urinary catheter? a. Tell the patient to void and pour the urine into a labeled specimen container. b. Ask the patient to void first into the toilet, stop midstream, and finish voiding into the sterile specimen container. c. Instruct the patient to discard the first void and collect the next void for the specimen. d. Have the patient keep all voided urine for 24 hours in a chilled, opaque collection container.
b.
While assessing a patient for domestic violence, the nurse knows that which statement is true regarding domestic violence? a. It is a health risk factor only during young adulthood. b. It occurs across socioeconomic levels and cultural boundaries. c. Young women aged 20 to 24 have the lowest incidence of rape and sexual assaults. d. Women are the only victims of domestic violence whom nurses should be concerned about.
b.
An adult patient is mentally incompetent to make personal health care decisions. Which advance directive should the nurse refer first prior to contacting a person to provide consent for the patient? a. Living will b. Health care proxy c. Do not resuscitate orders d. Durable power of attorney
b. A patient's health care proxy specifies who is to make health care decisions for individuals who are unable to comprehend information. It limits the scope of power of the designated individual to health care and treatment decisions. If a patient has not established a health care proxy, then the nurse would default to contacting a patient's durable power of attorney, who may be charged with the responsibility of making all legal decisions on behalf of the patient. A living will specifies treatment desired by patients if they are no longer capable of making decisions. Do not resuscitate orders are written by a patient's primary health care provider in consultation with patients, their immediate family members, and/or their health care proxy or durable power of attorney, if a health care proxy is not designated.
A 1-year-old child grabs an Easter egg and attempts to throw it across the room. The nurse knows that the child is exhibiting which scheme according to Piaget? a. Adaptation b. Assimilation c. Accommodation d. Equilibration
b. Assimilation occurs when the child attempts to use a new object in the same fashion as for a more familiar object. ( child thinks easter egg is a ball )
If a patient's primary language differs from that of the health care professionals providing care, which action is most appropriate for the nurse to take? a. Use colorful pictures, whiteboards, and gestures to communicate all important information. b. Verify patient understanding of questions asked when the patient responds with continuous affirmative answers. c. Arrange for a professional language translator to be present 24 hours each day. d. Decrease interaction with the patient and family to avoid making them uncomfortable for not understanding.
b. Consistent affirmative answers from a patient in the form of verbal responses of nods may indicate that a patient does not really understand what is being asked and is just trying to be cooperative. It is important for the nurse to double check to make sure a patient understands instructions and questions to ensure safety and proper care. Not all information can be conveyed via pictures or gestures, and a professional interpreter need not be present 24 hours a day. Ignoring or avoiding patients or families with culturally diverse backgrounds serves to isolate them and is never appropriate.
A nurse is caring for a Hindu patient. What religious practice might affect nursing care? a. Patient will refuse pain medication because pain is due to bad karma. b. Family may bring in hot or cold food and drink from home to help remove toxins. c. Patient may have special head coverings that cannot be removed. d. Religious leaders are usually involved in health care decision making.
b. Hindus integrate both Western and Eastern medicine. They believe that disease is caused by toxins in the body and medicine or hot/cold food helps remove toxins. Headdress and gurus are associated with Sikhism.
A 14-year-old male is upset because he is shorter in stature and smaller in build than the other boys in his class. He is concerned about never growing. How would the nurse address his concern? a. Reassure him that everyone grows at his own rate. b. Reassure him that males often do not stop growing until they are 18 to 20 years old. c. Tell him that most males start their growth spurt around 9 to 14 years of age. d. Tell him to take in more protein in order to get his growth spurt started.
b. In males, the adolescent growth spurt usually begins sometime between the ages of 10 to 16 years of age and often does not end until 18 to 20 years. Although everyone grows at his/her own rate, it does not specifically address this boy's concern. The remaining options provide inaccurate information.
Information can be best defined as: a. organized and processed data that can be applied to problem solving and decision making. b. organized and processed data that can be communicated and are meaningful and useful to the recipient. c. the transformation of patient data to clinical information easily retrieved by others. d. the appropriate application of knowledge to improve patient care.
b. Knowledge is organized and processed information that can be applied to problem solving and decision making. The transformation of patient data to clinical information becomes nursing knowledge. Wisdom addresses the use of knowledge and experience to manage and solve problems. Wisdom is the appropriate application of knowledge.
A nurse is working with an adult child struggling to care for an aging parent. Which idea would be least likely for the nurse to suggest? a. Seek social support. b. Place him or her in a nursing home. c. Use community resources. d. Utilize respite care services.
b. Nursing home placement should be used as a last resort. The idea of placing an aging parent in a nursing home can bring on provider guilt, which is a stressor itself. Also, nursing placement can be taxing on the finances of the family. All the other options may be available for stress relief for the caregiver of aging parents.
A 2-year-old child insists on having a drink of water and having a story read to him and says, "Good night, sleep tight" at bedtime every night. The nurse knows the child is exhibiting which type of behavior? a. Controlling b. Ritualism c. Obsession d. Compulsion
b. Ritualism offers the toddler a sense of security and comfort. The child is not trying to control his behavior with the ritual. Obsession and compulsion are terms commonly used in patients in older age groups and describe maladaptive behaviors.
The mother of a 5-month-old infant is concerned because her child is not yet sitting on his own. What is the nurse's best response to her concerns? a. Informing the mother that this is not normal and recommending further evaluation b. Telling the mother that this is normal development for a 5-month-old c. Encouraging the mother to do sit-ups with the child to encourage muscle development d. Asking the mother if the child had any trauma at birth
b. ( this occurs at 7 months )
A student is reviewing class material with the faculty member. What statement by the student regarding older adults indicates a need for further review? a. Common causes of death include heart disease, stroke, and influenza. b. Chronic illnesses include arthritis, COPD, and STDs. c. Declines in the immune system make older adults susceptible to infections. d. Acute injuries are often the result of falls and pneumonia.
b. STDS are not chronic
A 16-year-old patient has been involved in a motor vehicle crash. Every time the nurse enters the room, there are at least 4 to 5 friends laughing and talking with the patient. The nurse is frustrated in trying to get things done. What is the nurse's best action? a. Call security to escort the visitors from the room. b. Work with the teen to coordinate activities. c. Ask the teen's parents to tell the friends to limit visits. d. Post a "Do not disturb" sign on the door.
b. Teenagers have strong bonds with peer groups, and this continues even with hospitalization. The best approach is to plan activities so as to minimize interruptions.
The standard of how security and confidentiality of health care information must be maintained is determined by: a. NANDA-I. b. HIPAA. c. each health care facility. d. the Computer Ethics Institute.
b. !!
A nurse is volunteering in the community to educate parents to increase the number of children in the school district who are immunized. The nurse oversees the activities of a group of volunteers. Which role best describes the nurse's activity in this situation? a. Management b. Leadership c. Volunteerism d. Activism
b. (because she is acting in an informal role, this is leadership not management)
A nurse manager is trying to improve patient satisfaction ratings for her area of responsibility. The manager meets with the staff and forms an ad hoc committee to address the issues around the problem. This is an example of what style of leadership? a. Bureaucratic b. Democratic c. Laissez-faire d. Autocratic
b. (because staff members have input on the problem)
A staff nurse in the critical care unit routinely assists with calling staff to find coverage for the next shift and volunteers to coordinate policy and procedure revision and development on the unit. Which type of leadership is this nurse demonstrating? a. Formal b. Informal c. Laissez-faire d. Democratic
b. (she is performing outside the expectations of her position)
Average urine pH is: a. 4. b. 6. c. 7. d. 9.
b. (slightly acidic)
Buddhism and illness
be clear and concise in terminologies, health is a balance of body, mind, emotion, and spirit, avoid intoxicants and psychotics as they mess with mind
you should perform oral care when?
before and after eating
ac
before meals
Utilitarianism
behaviors are determined right or wrong solely based on consequences - the ends justify the means - do what is good for the whole not the individual
Fidelity
being dependable and reliable, keeping promises and agreements made with patients, ex. if a patient states they are in pain, the nurse acknowledges this and returns promptly with pain medication
Jewish Death & Loss diversity considerations
burial as quickly as possible
how is the crisis resolved in the trust vs. mistrust phase?
by developing a sense of trust in others due to having needs met
The nurse is teaching a patient about how to take a sublingual nitroglycerin tablet. Which statement by the patient best demonstrates understanding of the teaching? a. "I will take the tablet with plenty of water." b. "I will place the tablet inside my cheek." c. "I will put the tablet under my tongue." d. "I will take the tablet while I am eating."
c
A female Muslim patient is admitted to the hospital and informs the nurse that it is the month of Ramadan. Which action should be taken by the nurse to address possible dietary concerns while caring for this patient? a. Provide a vegetarian diet for the patient on Friday throughout her hospitalization. b. Ask the dietitian to visit the patient to ensure that fruit and cheese are not combined. c. Check on the potential effect fasting until sundown will have on the patient's condition. d. Document that milk and milk products cannot be prepared with meat or meat products.
c.
A kindergartner's mother is concerned because the child has had two bouts of respiratory infections in the past 3 months since school started. What is the nurse's best response? a. "His immune system should be stronger by now; I think we will need to do some further screening." b. "His immune system is compromised because his schedule has changed. Be sure he gets to bed on time." c. "He is exposed to more germs now that he is in school. Let's go over good handwashing." d. "You should talk to the school about disinfecting the classroom."
c.
A nurse has considered relevant patient factors such as isolation requirements, acuity, mobility, and other care needs when determining who can care for each patient. This is a demonstration of what right of delegation? a. Right task b. Right person c. Right circumstance d. Right supervision
c.
A nurse manager receives two vacation requests from staff for the same days off. Unit policy states that only one person may be off at a time. The manager decides to allow the staff the time off anyway. What type of leadership is the manager demonstrating? a. Democratic b. Bureaucratic c. Laissez-faire d. Autocratic
c.
A nurse states she believes in the dignity of each patient. At break, she is overheard talking about a patient in a persistent vegetative state as a "lump." This represents an inconsistency in which quality of an effective leader? a. Dedication b. Magnanimity c. Integrity d. Humility
c.
A patient is scheduled for a colonoscopy. After preprocedure teaching by the nurse, the patient demonstrates understanding when he makes which statement? a. "I can have coffee the morning of the procedure." b. "I should drink a red sports drink the day before to stay hydrated." c. "I should drink clear liquids for 2 days before the procedure." d. "I will be able to drive home immediately after the procedure."
c.
A patient tells the nurse that he needs to increase his intake of potassium because he has been taking large doses of diuretics. To minimize complications from hypokalemia, the nurse should instruct the patient to include which of the following foods as a part of his diet? a. Cheese and crackers b. Peanut butter and jelly sandwich c. Tomatoes and spinach d. Apples and grapes
c.
A young adult female is considering becoming pregnant and is not taking any multivitamins. Which nursing action would best help reduce the potential for development of neural tube defects in the fetus? a. Discuss taking selenium supplements with meals. b. Stress the importance of prenatal exercise. c. Recommend folic acid dietary supplements. d. Inquire about the patient's diet and birth control method.
c.
After 6 hours of parenteral nutrition (PN) infusion, the nurse checks a patient's capillary blood glucose level and finds it to be 120 mg/dL. The most appropriate action by the nurse is to a. obtain a venous blood glucose specimen. b. slow the infusion rate of the PN infusion. c. recheck the capillary blood glucose in 4 hours. d. notify the health care provider of the glucose level.
c.
How do people who participate in organized religion differ from nonreligious people? a. Religious people are healthier than spiritual people. b. Religious people are more spiritual than nonreligious people. c. Religious people express their spirituality through faith traditions. d. Religious people have spiritual practices, whereas nonreligious people do not have spiritual practices.
c.
If a student nurse is asked by a staff nurse to complete a patient care procedure that the student has previously performed only in lab, what response by the student best exemplifies an ethical commitment to both safe practice and learning? a. Asking the staff nurse to perform the care procedure while the student observes b. Locating the clinical instructor to provide the patient care procedure with student oversight c. Reviewing the procedure prior to initiating the patient care with supervision of a registered nurse d. Requesting the help of another student who has previously performed the patient care procedure
c.
Making prejudicial, untrue statements about another person during conversation may expose a nurse to being charged with what offense? a. Libel b. Assault c. Slander d. Malpractice
c.
Processes used in management parallel the nursing process. Which sentence describes a nurse using a management principle paralleled with the nursing process? a. Planning is demonstrated when the nurse motivates others. b. Directing is demonstrated when the nurse plans care for the patient. c. Organizing is demonstrated when the nurse coordinates care for patients. d. Controlling is demonstrated when the nurse tells other staff members what to do.
c.
The health care provider prescribes a transdermal medication. The nurse understands what feature of the transdermal route? a. It is inhaled into the respiratory tract. b. It is dissolved inside the cheek. c. It is absorbed through the skin. d. It is inserted into the vaginal cavity.
c.
The nurse is caring for a middle-aged patient with severe heart disease who is awaiting a heart transplant. The patient must stay in the hospital until the surgery or death occurs. The patient breaks down crying saying, "I don't want this and I just want to go home." What response by the nurse is best? a. "If you go home, you know you will die." b. "What can I do to make your hospital stay better?" c. "You don't have to do this. What do you want to do?" d. "Can I call the chaplain to come talk to you?"
c.
The nurse is caring for a patient who is unable to hold a cup or spoon. How should the nurse administer oral medications to the patient? a. Crush the pills and mix them in pudding before administering. b. Ask the pharmacist to change all of the medications to a liquid form. c. Use a small paper cup to place the pills into the patient's mouth. d. Place the pills on the table and have the patient take the pills by hand.
c.
The nurse is caring for a religious patient who is going to surgery the next day. The patient states that she is afraid and asks the nurse to pray with her, although the nurse is not religious. What is the most appropriate response by the nurse? a. "I am not confident praying, but I will think about you tomorrow." b. "I need to take care of other patients right now, but I will be back." c. "I am uncomfortable praying. May I call the chaplain for you?" d. "I don't do that. Nurses are not allowed to do that at our hospital."
c.
The nurse is caring for an 11-year-old girl in a hospital. The nurse finds a bunch of gum wrappers in her bedside stand. Which is the most appropriate action by the nurse? a. Tell the girl this might attract bugs. b. Quietly clean up the mess and throw them away. c. Leave the wrappers as you found them. d. Tell the girl to clean up the mess.
c.
The nurse reviews a primary care provider's order and finds that the medication amount is greater than the standard dose. What should the nurse do? a. Give the standard dose rather than the one that is ordered. b. Consult with the nursing supervisor to get a second opinion. c. Call the primary care provider to discuss the order in question. d. Administer the medication as ordered by the primary care provider.
c.
The term "ageism" refers to: a. the act of getting older. b. the hallmark of older adult populations. c. prejudices and stereotypes based on age. d. octogenarians.
c.
To best determine the patient's competency in changing an ostomy appliance, what does the nurse ask the patient to do? a. Verbalize the procedure. b. Identify the supplies needed. c. Perform the procedure. d. List the steps in the procedure.
c.
What is the most important aspect of providing spiritual care in nursing practice? a. Call a chaplain. b. Complete the FICA spiritual assessment and refer as needed. c. Recognize situations and patient behaviors indicating a spiritual need. d. Spend some time in self-reflection.
c.
What nursing intervention is best when a patient is struggling with the decision to abort an abnormally developing fetus discovered during genetic testing in the first trimester of pregnancy? a. Recommend additional testing b. Refer the patient to an abortion clinic c. Listen to the patient's concerns d. Discuss regional adoption agencies
c.
What nursing intervention would be most beneficial to implement in an effort to prevent aspiration by a patient receiving tube feedings? a. Check the pH of residual before starting each feeding. b. Hold prescribed medications until after each feeding. c. Elevate the head of the patient's bed at least 45 degrees. d. Slow the delivery of the tube feeding to 15 mL/hour.
c.
What self-care measure is most important for the nurse to include in the teaching plan for a patient who will be discharged with a urostomy? a. Change the appliance before going to bed. b. Cut the wafer 1 inch larger than the stoma. c. Cleanse the peristomal skin with mild soap and water. d. Use firm pressure to attach the wafer to the skin.
c.
What would be included in teaching for a patient who will be discharged with a prescription for a laxative? a. Calling the health care provider if nausea, vomiting, or abdominal pain occurs b. Continuing use of laxatives to encourage bowel evacuation c. Adding regular exercise, sufficient fluids, and regular defecation habits to his/her routine d. Knowing the difference between laxatives and cathartics
c.
Which action by the nurse best illustrates the ethical concept of fidelity? a. Caring for an incarcerated patient without expressing disdain b. Weighing the benefits versus the risks of medical treatment c. Ensuring that patients receive care that is promised d. Endorsing equal access to health care for everyone
c.
Which action by the nurse is essential to providing culturally congruent care? a. Follow established patient interview guidelines without variation. b. Understand that environmental context need not be documented. c. Recognize one's own personal cultural heritage, patterns, and biases. d. Assume that cultural values are identical for all members of one family.
c.
Which group is referred to as the sandwich generation? a. Older adults who are caretakers for their elderly parents b. Younger adults who are reexamining their life choices c. Middle adults who are caretakers for multiple generations of their family d. Younger adults who are changing employment constantly
c.
Which nursing intervention is included for a patient experiencing diarrhea? a. Limiting fluid intake to 1000 mL/day b. Administering a cathartic suppository c. Increasing fiber in the diet d. Limiting exercise
c.
Which nursing intervention is the best example of patient advocacy? a. Collecting blood samples according to the physician's order each morning b. Assessing the vital signs of a patient who is receiving a blood transfusion c. Seeking an additional analgesic medication order for a patient who is experiencing severe pain d. Accompanying an ambulating patient who is walking for the first time after undergoing surgery
c.
Which statement best serves as a guide for nurses seeking to learn more about ethnicity? a. Ethnicity, like culture, generally is based on genetics. b. A patient's ethnic background is determined by skin color. c. Ethnicity is based on cultural similarities and differences in a society. d. Culture and socialization are unrelated to the concept of ethnic origin.
c.
Which statement is correct concerning the implementation of computerized provider order entry (CPOE)? a. The unit secretary transcribes the physician's orders into the computer. b. The nurse must ensure that orders go to the appropriate departments. c. Physician orders go directly to the appropriate department. d. Handwriting legibility is a major problem.
c.
Which statement most closely reflects the differences between nurse leaders and managers? a. Nurse leaders are always in formal positions of authority. b. Nurse managers use transactional principles to accomplish goals. c. Nurse leaders rely primarily on interpersonal skills to accomplish goals. d. Nurse managers rely on supervisors for accountability and responsibility.
c.
Which strategy would most help an English-speaking nurse to communicate with a patient for whom English is a second language? a. Use acronyms when referring to community organizations. b. Abbreviate medical terminology as much as possible. c. Slow down when speaking to articulate more clearly. d. Speak more loudly when the patient misunderstands
c.
Which term indicates a mental health disorder that is frequently seen in older adults? a. Schizophrenia b. Bipolar disorder c. Depression d. Posttraumatic stress disorder (PTSD)
c.
For which person seen at a physician's office appointment would patient and family education be most critical? a. A 24-year-old male patient with a cold virus and on no medications b. A 45-year-old male patient on metformin for type 2 diabetes for the past 3 years c. A 75-year-old female patient just prescribed the anticoagulant warfarin d. A 40-year-old male asthmatic patient diagnosed 10 years ago and on albuterol
c. A middle adult who has had diabetes and has been maintained on this medication for 3 years would have had education when he was first started on the medication.
The nurse is assigned to administer medications to a patient on a unit that has just implemented bar-code medication administration (BCMA). Which step is proper for the nurse to follow? a. Open the medication packages at the nurses' station. b. Ask the patient to verify his or her address. c. Scan the nurse's ID, the patient's ID, and the code on the medication package. d. Ask the patient to name two patient identifiers.
c. Asking the patient's address or two random identifiers that the patient may not be aware of would be inappropriate.
Which description is true about the Nursing Minimum Data Set (NMDS)? a. An admission assessment tool b. A discharge summary c. The core nursing data for collection across all sites d. An organization of nursing diagnoses
c. The NMDS is a standardized collection of essential nursing data used by nurses to promote consistent, understandable documentation
What is the best activity for a hospitalized school-age child to encourage continued appropriate development? a. Watching favorite television shows for 2 hours per day b. Keeping a journal of feelings while in the hospital c. Working on a paint-by-number project that can be completed in an afternoon d. Playing a favorite video game each afternoon
c. The school-age child is in Erikson's stage of industry. He needs to work on projects that build a sense of accomplishment
Veracity mandates which action by the nurse if a cancer patient inquires about diagnostic test results that show further metastasis of the patient's cancer? a. Telling the patient that the diagnostic test results are not available yet from the laboratory b. Avoiding contact with the patient to prevent accidental disclosure of the information c. Encouraging the patient to discuss the results with the provider who ordered the tests d. Sharing that the test results do not appear to indicate any significant changes at this time
c. Veracity requires that a person tell the truth. Since the provider who ordered the diagnostic tests has the most extensive knowledge of the patient's case, it would be best for the patient to discuss the results with that person.
How is the toddler's need for autonomy best met? a. The parents' consistently meeting the child's needs b. Encouraging imaginative play c. Allowing the child limited choices d. Promoting experimentation to determine cause and effect
c. ex. "do you want carrots or peas" instead of "would you like carrots yes or no?"
Which developmental task or stage is correctly connected to age? a. Wants to avoid punishment: preschool. b. Questions the status quo: school-aged. c. No sense of good or bad behavior: toddler. d. Judges actions by intentions: adolescent.
c. punishment. Questioning the status quo happens in the adolescent stage. Not having a sense of what constitutes good versus bad behavior describes the infant. A school-aged child can judge actions based on intentions, not just consequences.
Decisions regarding the legality of licensed practical nurses administering intravenous therapy established in the Nurse Practice Act are determined by which type of law? a. Constitutional b. Statutory c. Regulatory d. Case
c. (probably won't be on exam)
Which discharge instruction does the nurse provide to the patient following a colonoscopy? a. Some discomfort and bleeding are normal postprocedure. b. Return to the emergency room if you experience abdominal cramping. c. Do not drive or operate heavy machinery for 12 hours postprocedure. d. Return to your normal bowel pattern immediately postprocedure.
c. (pt is given sedation before so it is unsafe)
Which statement by a patient best illustrates reflection on a spiritual need? a. "My husband told me what to do about this situation, and I'm sure he's right." b. "There is little I can do now to change my circumstances. I just need to adapt." c. "I need to think a little more about how I feel about undergoing this treatment." d. "Whatever the physician wants to do is fine. I don't have much of an option."
c. Reflection requires intentional thought about a situation to determine how it affects or is affected by the person's beliefs and values.
what is futile care?
care that is useless and prolongs the time until death rather than restoring life EX: the continuation of ICU care for a pt in a persistent vegetative state who would, on discharge from the hospital, return to a nursing home incapable of interacting with the environment.
acute illness
characterized by abrupt onset and short duration, 6 months or less, clinical manifestations appear quickly and can be severe or lethal, residual effects may last beyond the course of disease itself
Object Permeance (Piaget)
children do not understand that an object exists when it is out of sight
Asian core beliefs
collectivism and the collective good, unlike western beliefs which focus on autonomy and individualism
the controlling principle involves
comparing expected results of the planned work with actual results
Cognitive Domain of Learning
comprises knowledge and material that is remembered, memorization and recall of information is needed for the learner to remember, understand, apply, analyze, evaluate, and create new material
responsibility
concept of being dependable and reliable, adhering to standards & following policies and orders
what are some social determinants of health?
conditions in which people are born, grow, work, live and age and the wider ss
what should you do to determine if a patient is at risk for aspiration?
consult nutritional therapist, consult the speech therapist, conduct a swallow study
how do you determine risk of aspiration?
consult the nutritional therapist, speech pathologist, have a swallow study done
A listserv is best described as a/an: a. website that compiles health information. b. online library source for clinical research. c. blog concerning health care issues. d. program that sends messages to multiple e-mail addresses.
d.
A newborn's mother is concerned about Sudden Infant Death Syndrome (SIDS). What would the nurse advise her is the best way to prevent SIDS? a. To breastfeed exclusively b. To allow the infant to sleep in mom's bed c. To place the infant prone to sleep d. To place the infant supine to sleep
d.
A nursing job applicant is asked about his/her level of computer Literacy. What answer by the applicant shows the most computer literacy? a. "I can access an electronic library with ease." b. "I understand how the data gets processed. c. "I am able to locate, evaluate, and use information found electronically." d. "I have a working knowledge of computers and the ability to use them efficiently."
d.
A parent of a preschool child is concerned because his teachers have complained about his aggressive behavior toward other children. Which of the following pieces of information is most important in helping the parent determine possible sources of this behavior? a. The types of playmates the child has. b. The kinds of toys the child plays with. c. If the child is allowed to roughhouse with siblings. d. The types of television programs the child watches.
d.
A patient is preparing for discharge. In discussing one of the discharge medications ordered, the patient mentions that the medication is too expensive to purchase. What action by the nurse best displays advocacy? a. Explain to the patient that the medication must be taken as ordered to work. b. Get the names of local pharmacies that offer discounted prescriptions. c. Contact the provider to schedule a follow-up appointment to check adherence. d. Contact the social worker to investigate programs to help the patient.
d.
A patient with a history of kidney stones is experiencing difficulty urinating and laboratory findings indicate the patient is in acute renal failure. What is the probable cause of this condition? a. Hypovolemia b. Cardiogenic shock c. Nephrotoxic substances d. Urethral obstruction
d.
According to Mintzberg's 1994 model, what are the three levels of management? a. Thinking, feeling, and doing b. Planning, directing, and controlling c. Autocratic, democratic, and laissez-faire d. Information, people, and action
d.
An elderly patient is admitted with a diagnosis of osteoporosis and a reduction in bone mass. The nurse encourages the patient to eat foods that are: a. high in iron. b. low in vitamin E. c. low in sodium. d. high in calcium.
d.
If a student nurse overhears a peer speaking disrespectfully about a patient, nurse, faculty member, or classmate, what is the most ethical first action for the student nurse to take? a. Discuss the peer's actions during group clinical conference b. Ignore the initial occurrence and observe if it happens again c. Report the actions of the classmate to the clinical instructor d. Speak to the peer privately to prevent further occurrences
d.
In the United States, practicing nursing without a license is what type of offense? a. Misdemeanor b. Malpractice c. Battery d. Felony
d.
Select the most appropriate goal for a patient experiencing diarrhea related to antibiotic use: a. the patient will return to previous elimination pattern. b. the patient will increase intake of grains, rice, and cereals. c. the patient will discontinue antibiotic use. d. the patient will increase fluid intake.
d.
The nurse is assigned the care of a patient for whom a cleansing enema has been ordered. What information is most important for the nurse to know before administration of the enema? a. The proper way to position the patient b. Signs and symptoms of intolerance to the procedure c. Vital signs before the procedure d. History of surgery of the anus or rectum
d.
The nurse knows that which patient is an example of the Wear-and-Tear Theory of Aging? a. A patient who is dying of cancer at age 35 b. A 55-year-old who runs half-marathons c. A patient with depression and suicidal thoughts who is 65 d. An 88-year-old with heart failure, kidney failure, and osteoarthritis
d.
The nurse manager is monitoring overtime for the unit. She closely monitors staff hours and does not allow staff to come in for extra hours if they are over their allotted time per week. This is an example of which of Mintzberg's decisional roles of the manager? a. Entrepreneur b. Disturbance handler c. Negotiator d. Resource handler
d.
The patient is ordered an ultrasound of the kidneys. The nurse knows that prior to the test the patient will: a. be required to have a bowel cleansing enema. b. be checked for any allergies to shellfish. c. be required to drink a large amount of fluids before the test. d. have no pretest requirements.
d.
To be effective, nurse managers should focus on which area? a. Cost-effective operation of the unit b. Motivation of staff c. Accomplishing organizational goals d. The patients and their needs
d.
What action by the nurse at the site of a motor vehicle accident is critical in order for requirements of the Good Samaritan Act to be met? a. Accepting compensation for professional services b. Transferring rescue efforts to family members c. Providing all needed emergency intervention d. Performing within nursing standards of care
d.
What action should a nurse take if a patient who needs to sign an informed-consent form for nonemergency surgery appears to be under the influence of drugs or alcohol? a. Contact the physician to see what should be done. b. Ask the patient's spouse to sign the informed-consent form. c. Request permission to bypass the need for a signed consent form. d. Wait to have the informed-consent form signed when the patient is alert and oriented.
d.
What action should nurses who demonstrate accountability take if they forget to administer a patient's medication at the ordered time? a. Document the medication as refused by the patient. b. Administer the medication as soon as the error is discovered. c. Record the medication as given after making sure the patient is okay. d. Follow the administration and documentation procedures for medication errors.
d.
What intervention should be initiated first by a nurse assigned to care for a culturally diverse patient admitted with significant body odor? a. Approach the patient with washcloths and towels ready to give a bath. b. Contact family members or friends to learn more about the situation. c. Ask the patient to bathe prior to conducting an admission assessment. d. Seek information to determine the underlying cause of the body odor.
d.
What is the best method for the nurse to ensure that a Croatian patient's nutritional needs are met during hospitalization? a. Preorder a diet that is consistent with the typical Croatian patient's dietary preferences. b. Ask a Croatian co-worker for ideas on what would be best to order for the patient's meals. c. Request that a variety of dietary entrees be provided to the patient to provide options. d. Check with the patient on admission to determine dietary limitations and preferences.
d.
When caring for patients who are Jewish, how best can the nurse address their religious needs? a. Order a kosher diet. b. Allow time for prayer before each meal. c. Ask about religious holidays, particularly religious practices around the Sabbath. d. Ask about religious practices affecting care.
d.
Which action should the nurse take first when caring for a patient receiving a continuous enteral feeding through a percutaneous endoscopic gastrostomy (PEG) tube if the feeding tube becomes occluded? a. Use 15 mL of cranberry juice in a 20-mL syringe to clear the tubing. b. Ask to have the PEG tube replaced to prevent rupture of the gastrostomy. c. Flush the PEG tube with 60 mL of cold tap water, using gravity. d. Try using enzyme solution if a 30-mL warm-water flush is ineffective.
d.
Which nursing intervention would be the highest priority when caring for a patient complaining of voiding small amounts of urine in relation to his fluid intake? a. Placing a disposable waterproof pad on the patient's bed before he goes to sleep. b. Documenting in the patient's electronic health record that he is complaining of anuria. c. Notifying the patient's primary care provider (PCP) of the need for intermittent catherization. d. Palpating the patient's bladder for distention before scanning for possible retention.
d.
While performing an abdominal assessment on an unconscious patient, the nurse notes presence of an ostomy. The fecal output is liquid in consistency, with a pungent odor, from the stoma that is located in the upper right quadrant of the abdomen. What type of ostomy does the patient have? a. Descending colostomy b. Ureterostomy c. Ileostomy d. Ascending colostomy
d.
You are the nurse in charge of a care team consisting of a new graduate, a male UAP, and an LPN. You are caring for a patient with renal failure and congestive heart failure. The patient is bedridden and weighs 227 kilograms (500.1 lb) and must be turned every 2 hours. In making out assignments, what is your best approach? a. Assign the patient to the new nurse so she can get experience with a large patient. b. Assign the patient to the UAP because he is a male and is stronger. c. Assign the patient to the LPN and the new RN so the new RN can perform assessments. d. Take this patient as your own assignment and assign the other staff to assist with turns every 2 hours.
d.
Immigrants who begin to use technology while continuing to adhere to their traditional mode of dress are exhibiting what aspect of cultural identity? a. Socialization b. Ethnocentrism c. Assimilation d. Acculturation
d. Acculturation occurs when individuals accept some aspects of a new culture without losing their distinct cultural identity. Assimilation involves a total blending of cultures when individuals actually reject or lose much of their original cultural identity. Ethnocentrism is the belief that one's culture is superior to another. Socialization takes place throughout a person's life and involves nurture and a gradual acquisition of cultural characteristics.
A nurse has presented education to a community group on the consequences of domestic violence. In reviewing, what consequence mentioned by a participant indicates the need for further review? a. Unwanted/unplanned pregnancies b. STDs c. Drug abuse d. Type 1 diabetes and hyperglycemia
d. All other options are possible consequences of being a victim of domestic violence.
Which action by an individual best demonstrates enculturation? a. Using elaborate symbols to represent words b. Confronting parents with their traditional family values c. Providing for the necessities of life such as food and shelter d. Sharing cultural expectations with younger family members
d. Enculturation is the process of passing culture from one generation to the next
The nurse is caring for a 45-year-old woman who is a breast cancer survivor. What activity associated with her cancer experience will promote this patient's spiritual well-being? a. Attending church every week b. Ensuring she follows her medication regimen c. Genetic testing on family members d. Speaking about her cancer experience to increase breast cancer awareness
d. Speaking about her experience helps promote meaning and purpose in life. Church attendance does not guarantee time of spiritual reflection related to her breast cancer experience.
What is transcendence? a. Out of body experience b. A meditative state c. A higher power d. Spiritual growth over time
d. Transcendence is moving beyond who you are toward who you will become. By definition, it is spiritual growth over space and time or moving beyond one's current self.
A global perspective on nursing practice might best be obtained from: a. NANDA, NIC, and NOC. b. ICD9 Codes. c. SNOMED-CT. d. ICNP.
d. The International Classification for Nursing Practice (ICNP), developed under the auspices of the International Council of Nurses (ICN), provides a standard that facilitates the description and comparison of nursing practice locally, regionally, nationally, and internationally.
A preschooler's mother is concerned because her child behaves in a mean fashion toward her younger brother. The mother states, "She acts like she has no sympathy for him!" What is the nurse's best response? a. "She is very young to exhibit sibling rivalry." b. "What does her brother do to her to make her act this way?" c. "Do you fight at home? She is probably imitating you." d. "Preschoolers are not capable of putting themselves in another's place."
d. egocentrism
The nurse manager of a nursing unit monitors the actual number of missed medications on the unit each month and compares this number with the expected results. This is an example of which function of management? a. Planning b. Organizing c. Directing d. Controlling
d. (controlling involves COMPARISON)
A patient is scheduled for an upper GI series. Which information is most important for the nurse to obtain before the procedure? a. Allergy to shellfish b. Last bowel movement c. Time the enema was administered d. Any difficulty swallowing
d. (pt has to drink barium before procedure)
The nurse knows that the teaching for a patient who was recently diagnosed with constipation has been effective if the patient's meal request specifies which food choice? a. Hot dog on a bun b. Grilled chicken c. Tuna sandwich on white bread d. Spinach salad with dressing
d. (these foods are high in fiber)
affective domain of learning
deals with expression of feelings and acceptance of attitudes, opinions, or values
what are some interventions for stress management?
decrease stressors, improve coping strategies (involves - time management - anger management - nutrition - support groups - alternative therapies)
parenteral vs enteral nutrition
enteral: any method of getting nutrition that using the GI tract to deliver nutrients and meet caloric requirements *feeding tube* parenteral: delivery of calories and nutrients into a vein *TPN*
what medications cannot be administered through a tube?
enteric coated timed-release sublingual buccal meds with special coatings
ex. of how limited resources affects patient teaching
ex. patient with limited health care might not be able to afford medications, this involves taking social services into account
Health Belief Model
explores how patients' attitudes and beliefs predict health behavior, their SUSCEPTIBILITY, confidence to take action, costs to taking action etc.
Buddhism & death
family stays with body for two hours after death and then it can be transferred off unit, bodies are cremated, there is a belief of figurative and literal reincarnation depending on denomination, organ donation is allowed, white thread
african american core beliefs
family!!! close bond between family members/those referred to as family - family friends are called "uncles" or "aunts" - belief in standing up for oneself or ones family
latino and death
fatalism: belief that illness is god's will or divine punishment -autopsies and organ donation is uncommon - public expression of grief is expected - dia de los muertos
Compensation
focusing on strengths rather than perceived weaknesses in response to stress
examples of times when someone under the age of 18 does not need parent's consent for a procedure/treatment?
for blood donation: patient can be 17 years of age without parent consent or 16 WITH parent consent if pregnant and over 16: you do not need consent from parent to receive pregnancy treatment if an emancipated minor
* tertiary prevention
for those who are ALREADY DIAGNOSED, ex. support groups, pain management counseling, and rehab!
the planning principle involves
goal setting, assessment, and setting the plan and acting on it
african american food
greens (wealth), rice (prosperity), grits, potatoes, fish (promote motivation), hearty meals with meat
chronic grief
grief reactions that do not diminish over time and continue for an indefinite period or very long period of time
Perceived benefits (HBM)
individual's conclusion as to whether the new behavior is better than what her or she is already doing
what stage of erikson's theory is age 6-12 years?
industry vs inferiority
what are some pros of TPN
it can be individualized to meet the patients needs, and it can be changed daily until patients needs are met
Informal patient education
learner or patient directed, may occur when patient asks question about medication or procedure
Confidentiality
limits sharing patient information, the cornerstone of nurse-patient relationship in which trusting, unguarded communication takes place, HIPAA
what organ does albumin measure the function of?
liver
local adaptation syndrome (LAS)
localized response of the body to stress, precipitated by trauma or pathology, can involve inflammation, reflexive response to pain, or hypoxia
what behaviors are demonstrated in the concrete operational stage?
logical reasoning gradually replaces intuitive thought, child develops seriation
low health literacy vs low literacy
low health literacy is CONTENT specific, meaning that the patient may not struggle reading and writing outside of the healthcare arena
Buccal Route of Drug Administration
meds are placed against the mucous membrane of the cheek
judaism spiritual symbols
menorah, star of david, dradyl
conventional level
middle stage of moral development; at this level, strict adherence to societal rules and the approval of others determine what is moral, good/bad orientation, law and order orientation
can IVP be performed on pregnant women?
no, because it uses contrast media
accommodation schema
occurs when the child discovers that an object cannot be used in the same way as a familiar object, occurs via discovery by changing the pattern of behavior on subsequent encounters
exaggerated grief
occurs when the survivor is overwhelmed by grief and cannot function in daily life
complicated loss
occurs with a sudden death, a violent or traumatic death, multiple losses, loss that is related to a social stigma, and with the loss of a young person
african american family practices
often nuclear, extended, and matriarchal - largest ethnic minority in the united states - rich in poetry, gospel music, blues & rap, all which influence family practices
what should be taken in account when it comes to the role of technology in patient education?
older adults are much more likely to not have access to internet or not have knowledge on how to use technology, ensure that medical information patients are reading on the internet is accurate, use reliable websites to develop patient education
when can nurses use physical restraints?
only in the event that alternative, less restrictive interventions to prevent patient injury have been unsuccessful, and a written order for restraints is in place
Nonmaleficence
only to avoidance of harm, "do no harm", nurses are often required to weigh the benefits of medical treatment with their risks and harm to patients, can be intentional or unintentional
what encompasses the safe practice alert about verbalization of suicidal ideation or a suicide plan?
patient MUST BE TAKEN SERIOUSLY! NEVER leave patient alone and one-on-one observation must be implemented to ensure patient safety as well as a psychiatric consult.
what should you check always before drug administration? (safe practice alert)
patient allergies
Literacy Problem Nursing Diagnosis
patient has a desire to learn but puts pamphlets aside because they are "too hard to read", waits for daughter to read them
**what are the dietary restrictions when it comes to a cystoscopy?
patient must be NPO for 8-12 hours prior
**what are the diet restrictions before a patient has a lower GI performed?
patient must be on a LIQUID DIET for 2 days prior, then clear liquids 24 hours prior
**what are the diet restrictions before a colonoscopy?
patient must be on a clear liquid diet 1-3 days prior
Ready to Learn Nursing Diagnosis
patient sitting in bed reading assigned materials, patient actively asking questions
multimodal learner
patient's learning is facilitated when more than one style of learning is used, ex. see, write, physically learn
Perceived severity (HBM)
patient's opinion on the seriousness of the condition and its health risks
what type of patients require an NG tube?
patients who require short term nutritional therapy & bowel decompression, issues with sucking and swallowing
what patients are nasogastric tubes used for?
patients with a functional GI tract that either cannot swallow, refuse to eat, or need additional nutrients to meet the body's needs, pts that have had GI surgery
after 6 hours of your patient not urinating, what should you do?
perform a bladder scan on your patient, if bladder is above 800 mL and seems distended, there is normally a standing order for a straight catheterization to drain the bladder
warning signs of child abuse?
physical evidence, signs of neglect, vague explanation of injury, failure to explain injury
Maslow's Heirarchy of Human Needs
physiological safety love & belonging self-esteem self actualization
Maslow's Hierarchy of Needs
physiological, safety, love/belonging, esteem, self-actualization
**what is a possible side effect of a cystoscopy?
pink urine
what age group has "magical thinkging"
preschool age!
what are some components necessary on a physician order?
prescriber name, designation, signature, client name, DOB, drug name, dosage, route, frequency
what is the main focus of community based nursing?
prevent illness, maintain or regain health, or die with dignity while living in a community *health literacy assessment is ESSENTIAL to providing effective education*
what is the first step against medication errors?
preventing
coping strategies
problem & emotion-focused techniques aimed at altering or removing a stressor
Allostasis
process by which the body achieves stability through physiological change
Fertilization
process of sperm and ovum uniting
asian health beliefs
restoration of health and healing the cause of illness not fixing the symptoms - body has to have a balance and harmony or illness will happen - use of both western and eastern medicine - traditional practitioners are more thorough in assessment - goal is to *prevent illness and maintain health--> more PREVENTATIVE* -ex. acupuncture, cupping, massage, herbal remedies
are nasogastric tubes used for short-term or long-term nutritional aid?
short-term
what patients qualify for an NG tube?
short-term nutritional therapy & bowel decompression, pts who have issues sucking & swalling
core beliefs of middle class?
stability through all aspects, working hard and achieving professional and financial goals, pulling yourself up by your bootstraps
Sister Callista Roy's Adaptation Model
states that people adapt to stress by meeting their physiologic needs, developing a positive sense of identity, performing social role functions and balancing dependence and independence
arbitration agreement
states you cannot sue in public court, rather a non-public arbitration, you cannot file a law suit, you can escape agreement if court deems agreement seemed to only benefit employer and not others
what are some examples of professional boundary violations?
stealing a patient's property, personally gaining at a patient's expense, intervening in a patient's personal relationships, making seductive or sexually disparaging statements, engaging in sexual conduct with a patient or a patient's family member, keeping secrets with the patient, spending excessive time with one patient, giving out personal information
rigor mortis
stiffness of the body that sets in several hours after death
distress
stress that is beyond the ability of the affected person to cope with or adapt effectively
what can cause low levels of prealbumin?
stress, inflammation, surgery
Deontology
stresses the rightness & wrongness of behaviors - does not take into account consequences!!! - maintaining autonomy, dignity, confidentiality & privacy while meeting needs appropriately
Deontology ethical theory
stresses the rightness and wrongness of individual behaviors, duties, and obligations, without concern for the CONSEQUENCES of specific actions, meeting the needs of the patients while maintaining their right to privacy, confidentiality, autonomy and dignity
Advocacy
supporting and promoting the interests of our patients or a cause greater than ourselves, contacting referral agencies & networking to meet patient's needs
How is a PEG tube placed?
surgically into the upper abdomen
hinduism spiritual symbols
swastika (good luck and fortune) - OM, first word of any prayer
reaction formation
switching unacceptable impulses into their opposites
What is a fecal occult blood test?
tests for presence of blood in stool
what did kohlberg theorize?
that people progress through three levels of moral reasoning, each level is divided into sublevels called stages, he believes that reasoning is the most important part of the moral development process, and believes that a person cannot comprehend & function at higher levels until they work through the lower levels
who is the patient's last line of defense against medication mistakes?
the NURSE!
Whose responsibility is it to witness the client's signing of the consent form, and to verify that he is consenting voluntarily and appears to be competent to do so?
the NURSE, it is NOT their job to explain the procedure, however
the directing principle involves
the ability to motivate others toward a common goal using good communication skills
Centration (Piaget)
the act of focusing on one aspect of something. It is a key factor in the preoperational stage.
Confidentiality
the act of holding information in confidence, not to be released to unauthorized individuals, limits sharing pt information
moral distress
the anguish health care professionals experience when their basic beliefs of what is right and wrong or ethical principles are challenged
Alarm phase of GAS
the body mobilizes its fight or flight defenses; heart-beat and breathing quicken, muscles tense, pupils dilate and hormones are secreted.
what is the behavior of the trust vs. mistrust phase?
the caregiver must meet the needs of the child both affectionately and physically
assimilation schema
the child attempts to use a new object in the same way as that applied with more familiar ex. a child uses a tomato as a ball
what behaviors are demonstrated in the preoperational phase?
the child begins to use images and symbols to represent mentally what he or she can do physically, child develops conservation, centration, and egocentric thinking
what is the behaviors are demonstrated in the sensorimotor stage?
the child explores the environment by using senses, children develop object permeance
what is the behavior in the autonomy vs. shame and doubt phase?
the child strives to make decisions for himself, parents provide flexible but firm guidance
anticipatory grief
the cognitive, affective, cultural, and social reactions to an expected death, felt by the patient as well as family members and friends, experienced before the actual loss occurs and can arise when a person is initially diagnosed with an acute illness, chronic disease, or terminal disease
Perceived susceptibility (HBM)
the degree to which a person feels at risk for a health problem
Colonoscopy
the direct visual examination of the inner surface of the entire colon from the rectum to the cecum
what must be done by a hospital or staff before filing for guardianship?
the effort MUST be made to contact patient's family or friends
grief
the emotional response to loss
urinalysis
the examination of urine to determine the presence of abnormal elements, can be used to detect the presence and amount of bacteria, RBC, WBC, protein, and other substances
inanition
the exhausted condition that results from lack of food and water, failure of an adult to thrive
what is the nurse's role in regards to stress using Sister Callista Roy's Adaptation Model?
the nurse should try to alter stimuli that are stressors to the patient, and help patients adapt to illness or develop positive adaptive behaviors
what part of parenteral syringes can the nurse touch?
the outside of the barrel and the plunger handle
mourning
the outward social expression of loss
mourning
the outward, social expression of loss
a patient is intoxicated & needs nonemergency surgery, his wife is present, who obtains consent?
the patient (after he sobers up)
if the specific gravity of urine is elevated in the urinalysis, what could that indicate?
the patient is dehydrated
**if there is an increase in WBC found in the urinalysis, what is the most-likely cause?
the patient is experiencing a UTI or an infection of some sort
what are the behaviors demonstrated in the formal operational stage?
the person refines his or her ability to think logically, is capable of abstract thought, can start having adult like conversations
stress appraisal
the process by which a person interprets a stressor as a threat or a challenge
adaption schema
the process of adjusting behavior in response to stimuli within the environment
health promotion
the process of enabling people to increase control over, and to improve, their health
Conservation (Piaget)
the realization that properties of objects remain the same even when appearance changes
cystoscopy
the visual examination of the urinary bladder using a cystoscope
illness behavior
the way in which symptoms are perceived, evaluated, and acted upon by a person who recognizes some pain, discomfort, or other signs of organic malfunction ex. a patient stating their disease has made them immobile when they are still ambulatory
a patient is intoxicated & needs emergency surgery, his wife is present, who obtains consent?
the wife
who is responsible for given informed consent for minors?
their legal guardian or parent unless minor is emancipated or married
If BUN and Creatinine are both elevated?
this could indicate dehydration
sublingual route of drug admin
under the tongue
what types of patients need PTN
vented patients patients who have a non-functional GI tract, malnourished patients
what site is the site of choice for IM injections in the adult?
ventrogluteal
you always repeat back _______ orders
verbal
what is the principle rule for restraints?
you have to start with the least restrictive before you go to actual physical restraints, ex. distraction, having a sitter
what is the window when it comes to the right time for administering medication ?
you must administer within HALF HOUR of the time stated on the prescription
what are some important factors of a 24 hour urine collection?
you put the urine on ice with no light, and if you miss a drop of urine you must restart the collection
what are some examples of a targeted populations?
young, elderly, homeless, inmates, area residents, etc
