Health and Wellness Week 3 & 4

During a visit to a family clinic, a nurse teaches a mother about immunizations, the use of car seats, and home safety for an infant and toddler. Which type of nursing interventions are these? 1. Restorative 2. Health promotion 3. Acute care 4. Growth and development

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The nurse uses silence as a therapeutic communication technique. What are the purposes of the nurse's silence? (Select all that apply.) 1. Allows the nurse time to focus and avoid saying the wrong thing 2. Prompts the patient to talk when he or she is ready 3. Allows the patient time to think and gain insight 4. Allows time for the patient to drift off to sleep 5. Determines whether the patient would prefer to talk with another staff member

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A nurse is caring for a young patient who has been told he has multiple sclerosis. The nurse has planned time to conduct a teaching session that will focus on the disease and principles of management. The nurse chooses to use the EDUCATE model to proceed with instruction. Which of the following are components of the model? (Select all that apply.) 1. State goals of the session for the patient. 2. Repeat the most important information. 3. Practice empathetic skills. 4. Be aware of nonverbal messages. 5. Use a standard question list for the chosen topic.

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Nurses must communicate effectively with the health care team for which of the following reasons? (Select all that apply.) 1. To improve the nurse's status with the health team members 2. To reduce the risk of errors to the patient 3. To provide an optimum level of patient care 4. To improve patient outcomes 5. To prevent issues that need to be reported to outside agencies

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The nurse therapeutically responds to an adult patient who is anxious by: (Select all that apply.) 1. Matching the rate of speech to be the same as that of the patient 2. Providing good eye contact 3. Demonstrating a calm presence 4. Spending time attentively with the patient 5. Assuring the patient that all will be well

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Which of the following is an example of a patient with a health disparity? (Select all that apply.) 1. A patient who has a homosexual sexual preference 2. A patient unable to access primary care services 3. A patient living with a chronic disease 4. A family who relies on public transportation 5. A patient who has had a history of smoking for 10 years

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Poor Health, Disease Risk Factors, Poor Health Outcomes, and Limited Access to Health Care

Types of preventable health care disparities often interrelated and influenced by the conditions and social context in which people live.

The Ideal Environment for Learning

Well lit and has good ventilation, appropriate furniture, and a comfortable temperature.

As you provide family-centered care

You continually assess, analyze, and reflect on the changing needs and health care goals of patients and their families.

Caring for a Patient

You direct your nursing interventions to increase abilities of family members to function and perform, remove barriers to health care, and do things that the family cannot do for itself. Whether with the family as context, patient, or a system.

On the situation and the family's needs

Your decision to view a family as an important context for an individual family member or to view a family unit as the patient or as a system depends:

A patient who is newly diagnosed with breast cancer states, "Although I am really scared about what is going to happen to me, I know my family will learn from this experience, and we will be stronger in the end." What term does the nurse use in the patient's 133medical record to describe the characteristic displayed in this statement? 1. Resiliency 2. End-of-life care 3. Family functioning 4. Family's culture

1

During a nursing assessment a patient displayed several behaviors. Which behavior suggests the patient may have a health literacy problem? 1. Patient has difficulty completing a registration form at a medical office 2. Patient asks for written information about a health topic 3. Patient speaks Spanish as primary language 4. Patient states unfamiliarity with a newly ordered medicine

1

Which explanation provided by the nurse is the most accurate meaning for "providing culturally congruent care"? 1. It fits the patient's valued life patterns and set of meanings. 2. It is the same set of values as those of the health care team member providing daily care. 3. It holds one's own way of life as superior to those of others. 4. It redirects the patient to a more socially expected set of values.

1

Which statement made by a new graduate nurse about the teach-back technique requires intervention and further instruction by the nurse's preceptor? 1. "After teaching a patient how to use an inhaler, I need to use the teach-back technique to test my patient's technique." 2. "The teach-back technique is an ongoing process of asking patients for feedback." 3. "Using teach-back will help me identify explanations and communication strategies that my patients will most commonly understand." 4. "Using pictures, drawings, and models can enhance the effectiveness of the teach-back technique."

1

A family consisting of a grandparent, two adults, and three school-age children just immigrated to the United States. They come to a community wellness center to establish health care. Which of the following questions does the nurse ask to assess the family's function? (Select all that apply.) 1. "What does your family do to keep members healthy?" 2. "How does your family usually make decisions?" 3. "What health services are available in your neighborhood?" 4. "Which rituals or celebrations are important for your family?" 5. "Is there a lot of crime in your neighborhood?" 6. "How many parks are there in your community?"

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A family is facing job loss of the father, who is the major wage earner, and relocation to a new city where there is a new job. The children will have to switch schools, and his wife will have to resign from the job she enjoys. Which of the following contribute to this family's hardiness? (Select all that apply.) 1. Family meetings 2. Established family roles 3. New neighborhood 4. Willingness to change in time of stress 5. Passive orientation to life

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A nurse is teaching an older adult patient about ways to detect a melanoma. Which of the following are age-appropriate teaching techniques for this patient? (Select all that apply.) 1. Speak in a low tone. 2. Begin and end the session with the most important information regarding melanoma. 3. Provide a pamphlet about melanoma with large font in blues and greens. 4. Provide specific information in frequent, small amounts for older adult patients. 5. Speak quickly so that you do not take up much of the patient's time.

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Health care organizations must provide which of the following based on federal civil rights laws? (Select all that apply.) 1. Provide language assistance services at all points of contact free of charge. 2. Provide auxiliary aids and services, such as interpreters, note takers, and computer-aided transcription services. 3. Use patients' family members to interpret difficult topics. 4. Ensure that interpreters are competent in medical terminology. 5. Provide language assistance to all patients who speak limited English or are deaf.

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The patient states, "I don't have confidence in my doctor. She looks so young." The nurse therapeutically responds: (Select all that apply.) 1. Tell me more about your concern. 2. You have nothing to worry about. Your doctor is perfectly competent. 3. You are worried about your care? 4. You can go online and see how others have rated your doctor. I do that. 5. You should ask your doctor to tell you her background.

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Which strategies should a nurse use to facilitate a safe transition of care during a patient's transfer from the hospital to a skilled nursing facility? (Select all that apply.) 1. Collaboration between staff members from sending and receiving departments 2. Requiring that the patient visit the facility before a transfer is arranged 3. Using a standardized transfer policy and transfer tool 4. Arranging all patient transfers during the same time each day 5. Relying on family members to share information with the new facility

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1. When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.) Check for needed adaptive equipment. 2. Exaggerate lip movements to help the patient lip-read. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point. 5. Communicate only through written information.

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A nurse is caring for a 66-year-old patient who lives alone and is receiving chemotherapy and radiation for a new cancer diagnosis. He is unable to care for himself because of severe pain and fatigue. He moves into his 68-year-old brother's home so his brother can help care for him. Which assessment findings indicate that this family caregiving situation will be successful? (Select all that apply.) 1. Both the patient and his brother attend church together regularly. 2. The brothers are living together and enjoy eating the same foods. 3. Other siblings live in the same city and are willing to help. 4. The patient and his brother have a close network of friends. 5. The patient has obsessive-compulsive disorder and has difficulty throwing away possessions.

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Motivational interviewing (MI) is a technique that applies understanding a patient's values and goals in helping the patient make behavioral changes. When using motivational interviewing, what outcomes does the nurse expect? (Select all that apply.) 1. Gaining an understanding of the patient's motivations 2. Directing the patient to avoid poor health choices 3. Recognizing the patient's strengths and supporting his or her efforts 4. Providing assessment data that can be shared with families to promote change 5. Identifying differences in patient's health goals and current behaviors

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A 35-year-old woman has Medicaid coverage for herself and two young children. She missed an appointment at the local health clinic to get an annual mammogram because she has no transportation. She gets the annual screening because her mother had breast cancer. Which of the following are social determinants of this woman's health? (Select all that apply.) 1. Medicaid insurance 2. Annual screening 3. Mother's history of breast cancer 4. Lack of transportation 5. Woman's age

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A patient's cultural background affects the motivation for learning. Using the ACCESS model, match the nursing approach with the correct model component. ACCESS model component Nursing approach 1. Assessment 2. Communication 3. Cultural 4. Establishment 5. Sensitivity 6. Safety A. Help patients feel culturally secure and able to maintain their cultural identity. B. Remain aware of verbal and nonverbal responses. C. Be aware of how patients from diverse backgrounds perceive their care needs. D. Become aware of your patient's culture and your own cultural biases. E. Learn about the patient's health beliefs and practices. F. Show respect by creating a caring rapport.

1E 2B 3D 4F 5C 6A

Match the cultural concepts on the left with the correct definitions on the right. 1. Etic world view __________ 2. World view __________ 3. Cultural desire __________ 4. Intersectionality __________ 5. Emic world view __________ a. Factor that shapes how people perceive others and how they relate to reality b. Insider's perspective in an intercultural encounter c. A policy model that describes factors and power structures that shape and influence life d. An outsider's perspective in an intercultural encounter d. An outsider's perspective in an intercultural encounter e. The motivation of a health care professional to "want to" engage in cultural competency

1d 2a 3e 4c 5b

A nurse desires to communicate with a young woman who is Serbian and who has limited experience with being in a hospital. The nurse has 10 years of experience caring for Serbian women. The patient was admitted for a serious pregnancy complication. Apply the LEARN model and match the nurse's behaviors with each step of the model. 1. L ___________a. The nurse notes that she has learned that fathers can visit mothers at any time in both Serbia and the United States. 2. E ___________b. The nurse shares her perception of the woman's experiences as a patient. 3. A ___________c. The nurse asks the patient how she can maintain bed rest when she returns home. 4. R ___________d. The nurse attends to the patient and listens to her story about hospitals in Serbia. 5. N ___________e. The nurse involves the patient in a discussion of the treatment options for her condition.

1d 2b 3a 4e 5c

A patient suddenly experiences a severe headache with numbness and decreased movement in the left arm. The emergency room physician suspects a stroke and is going to have the patient undergo an emergent angiogram to remove the clot. Which teaching approach is most appropriate? 1. Selling approach 2. Telling approach 3. Entrusting approach 4. Participating approach

2

Which of the following scenarios demonstrate that learning has taken place? (Select all that apply.) 1. A patient listens to a nurse's review of the warning signs of a stroke. 2. A patient describes how to set up a pill organizer for newly ordered medicines. 3. A patient attends a spinal cord injury support group. 4. A patient demonstrates how to take his blood pressure at home. 5. A patient reviews written information about resources for cancer survivors.

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A nurse works with a patient using therapeutic communication and the phases of the therapeutic relationship. Place the nurse's statements in order according to these phases. 1. The nurse states, "Let's work on learning injection techniques." 2. The nurse is mindful of his/her own biases and knowledge in working with the patient with B12 deficiency. 3. The nurse summarizes progress made during the nursing relationship. 4. After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship.

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A mother and her two children are homeless and enter a free health care clinic. Which statements most likely describe the effects of homelessness on this family? (Select all that apply.) 1. The children have stability in their education. 2. The family members may have symptoms of malnutrition, such as anemia. 3. The family is at a low risk for experiencing violence. 4. The children are at higher risk for developing ear infections. 5. All family members may have mental health issues.

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A 63-year-old woman is a family caregiver for her 88-year-old mother who has dementia. The caregiver asked the home health nurse how to manage her mother when she becomes confused and violent. The best instructional method a nurse can use for this situation is: 1. Demonstration 2. Preparatory instruction 3. Role-playing 4. Group instruction with other family caregivers

3

A family includes a mother, a stepfather, two teenage biological daughters of the mother, and a biological daughter of the father. The father's daughter just moved home following the loss of her job in another city. The family is converting a study into a bedroom and is in the process of distributing household chores. Nursing assessment reveals all members of the family think that their family can adjust to lifestyle changes. This is an example of family: 1. Diversity. 2. Durability. 3. Resiliency. 4. Configuration.

3

A nurse is preparing to teach a patient who has sleep apnea how to use a CPAP machine at night. Which action is most appropriate for the nurse to perform first? 1. Allow patient to manipulate machine and look at parts. 2. Provide a teach-back session. 3. Set mutual goals for the education session. 4. Discuss the purpose of the machine and how it works.

3

A nurse working in a large occupational health clinic knows that many of the workers at her company are marginalized and at risk for poor health outcomes. Which of the following individuals are most likely to be marginalized? 1. Wives of the employees 2. The head supervisors of the company 3. Workers who have a high school education 4. Workers employed for less than a year at the company

3

A patient recovering from open heart surgery is taught how to cough and deep breathe using a pillow to support or splint the chest incision. Following the teaching session, which of the following is the best way for the nurse to evaluate whether learning has taken place? 1. Verbalization of steps to use in splinting 2. Selecting from a series of flash cards the images showing the correct technique 3. Return demonstration 4. Cloze test

3

A married couple has three children. The youngest child just graduated from college and is moving to a different city to take a job. The other two children left the home several years ago. Both of their parents are older and are beginning to need help to maintain their home. What assessment questions will help the nurse determine the family's functioning? (Select all that apply). 1. Which transitions or changes in your family are you currently experiencing? 2. Are your children having any problems that are affecting your family right now? 3. Describe a recent family conflict and how your family resolved it. 4. What coping strategies do you typically use as a family? 5. Who is involved in helping care for your parents?

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A patient asks a nurse to provide instruction on how to perform a breast self-exam. Which domains are required to learn this skill? (Select all that apply.) 1. Affective domain 2. Sensory domain 3. Cognitive domain 4. Attentional domain 5. Psychomotor domain

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A 55-year-old adult male has been in the hospital over a week following surgical complications. The patient has had limited activity but is now finally ordered to begin a mobility program. The patient just returned from several diagnostic tests and tells the nurse he is feeling quite fatigued. The nurse prepares to instruct the patient on the mobility program protocol. Which of the following learning principles will likely be affected by this patient's condition? 1. Motivation to learn 2. Developmental stage 3. Stage of grief 4. Readiness to learn

4

A 7-year-old child was recently diagnosed with asthma. A nurse is providing education to the child and her parents about the treatment and management of asthma and changes they need to make in their home environment to promote her health. Which statement made by the parents requires follow-up by the nurse? 1. "We have made an appointment to talk with the school nurse about the change in our child's health." 2. "We forgot to give our daughter her medications before bedtime, so we made a list of her medications to help us remember." 3. "We have worked out a schedule to check on her before and after school." 4. "We have not been spending time with our parents because we are so busy taking care of our daughter."

4

A mother is concerned about her child's flulike symptoms. You learn from the health assessment that the mother practices use of "hot" and "cold" foods to treat ailments. Which of the following foods do you expect the mother to use to treat her child? 1. Chicken 2. Yogurt 3. Fresh fruits 4. Eggs

4

The nurse applying effective communication skills throughout the nursing process should: (Place the following interventions in the correct order.) 1. Validate health care needs through verbal discussion with the patient. 2. Compare actual and expected patient care outcomes with the patient. 3. Provide support through therapeutic communication techniques. 4. Complete a nursing history using verbal communication techniques.

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Health Care Systems and Providers

Contribute to the problem of health disparities as a result of inadequate resources, poor patient-provider communication, a lack of culturally competent care, system fragmentation, and inadequate access to language services.

A nurse prepares to contact a patient's physician about a change in the patient's condition. Put the following statements in the correct order using SBAR (Situation, Background, Assessment, and Recommendation) communication. 1. "She is a 53-year-old female who was admitted 2 days ago with pneumonia and was started on levofloxacin at 5 PM yesterday. She states she has a poor appetite, her weight has remained stable over the past 2 days." 2. "The patient reported feeling very nauseated after her dose of levofloxacin an hour ago." 3. "Is it possible to make a change in antibiotics, or could we give her a nutritional supplement before her medication?" 4. "The patient started to complain of nausea yesterday evening and has vomited several times during the night."

4S 1B 2A 3R

A hospice nurse is caring for a family that is providing end-of-life care for their grandmother, who has terminal breast cancer. The nurse focuses on symptom management for the grandmother and on helping the family with developing coping skills. This approach is an example of which of the following? 1. Family as context 2. Family as patient 3. Family as a system 4. Family as structure

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Effective Communication

A critical skill in culturally competent care and helps you engage a patient and family in a respectful, patient-centered dialogue. Qualified translators (written words), interpreters (verbal words), and/or the use of a cultural broker (mediator) are options to be utilized to assist with linguistic needs related to effective communication.

A Nurse Bases Educational Priorities

A patient's immediate needs, nursing diagnoses, and the goals and outcomes established for the patient. Depend on what a patient perceives to be most important.

Health, Illness, and Health care

A person's culture and life experiences shapes his or her world view about?

Use of both Professional and Therapeutic Communication Techniques

Contributes to achievement of patient outcomes. Practicing these techniques is essential in your development as a nurse.

An Effective Nurse-patient Relationship

Adapting your communication with older adults to meet their unique needs ensures?

Gaining Cultural Knowledge and Conducting a Self-examination

Allows a health care provider to understand the cultural factors that shape a patient's life experiences, a patient's health care problems, a patient's behavior, and how a patient might perceive those problems while building a positive nurse-patient relationship.

Family Caregiving

An interactive process that occurs within the context of the relationships among its members. Are often spouses who are older adults or adult children trying to work full time and care for aging family members.

Teach-back

An ongoing process of asking patients open-ended questions to gather feedback through explanation or demonstration until the health care provider feels confident in the patient's ability to understand and safely apply the new educational content.

Avoid Forming Inappropriate Biases or Stereotypes

Approach each person individually and ask questions to gain a better understanding of a patient's perspective and needs. When assessing a patient's needs, what should you avoid?

Families and Family Members

Are as diverse as the individuals who compose them. Some have different beliefs and traditions, even within the same generation.

People who are Marginalized

Are more likely to have poor health outcomes and to die at an early age because of a complex interaction among individual behaviors, public and health policy, cultural factors, and access to and quality of health care.

Ongoing Cultural Competence and Cultural Skill

Are necessary for a nurse to complete a cultural assessment and provide culturally appropriate nursing care for each patient, regardless of the patient's cultural background.

Nurse-patient Caring Relationships

Are the foundation of the nursing process.

Challenges Families Face

Changing structures and roles, especially as the laws, economic status, and demographics of society change.

Nontherapeutic Communication Techniques

Damage professional and caring relationships, therefore pay attention to your own communication to remove these blocking techniques from your responses.

Social Determinants of Health

Defined by conditions in which people are born, grow, live, work, and age.

The Circular Transactional Communication Process

Demonstrates the ever-changing nature of communication, and includes the sender, the receiver, and referents.

The ability to Learn

Depends on physical and cognitive attributes, developmental level, physical wellness, and intellectual thought processes. A person's learning style affects his or her preferences for learning.

Knowledge About Your Patient

Directs your physical assessment, and the health care provider must learn to anticipate physical findings based on the patient's cultural health practices and the physical characteristics of an ethnic or racial group.

Poor Population Health

Disparities in access to quality health care, preventive health care, and health education contribute to

Good Communication

Effective use of critical thinking promotes:

Teaching and Learning

Generally begin when a person identifies a need for knowing or acquiring an ability to do something.

The Joint Commission's Speak Up Initiatives

Help patients understand their rights when receiving medical care.

Verbal Communication

Involves spoken or written words, and the vocabulary, pacing, tone, clarity, and brevity of the message.

Self-efficacy

Is a concept included in many health promotion theories because it often is a strong predictor of healthy behaviors.

Evaluation of Nursing Care of Families

Is centered on the patient and family. Compare actual responses to care with the outcomes you set in the plan of care, and revise the care plan as needed.

Cultural Respect

Is critical to reducing health disparities and improving access to high-quality health care that is respectful and responsive to the needs of a diverse patient.

The Concept of Family

Is highly individual, focus the nursing process and nursing care on a patient's attitude and beliefs about family rather than on a traditional definition of family.

The Goal of Family Nursing

Is to help a family and its individual members reach and maintain maximum health throughout and beyond the illness experience.

Family Forms and a Family's Health

The increased need for family caregivers, poverty, homelessness, and domestic violence affect:

Education to all Patients.

Nurses have a legal responsibility to provide:

Intrapersonal, Interpersonal, Small group, Public, and Electronic

Nurses use the five levels of communication in their interactions:

Nonverbal Communication

Occurs through the five senses and includes everything except the written or spoken word.

An adult's Readiness to Learn

Often associated with his or her developmental stage and other events occurring in his or her life.

Understanding and Communicating

Patients with impaired communication benefit from the use of devices that overcome barriers to:

The nurse to employ specific techniques to facilitate mutual understanding.

Patients with special communication needs such as an inability to speak, cognitive impairment, and hearing or vision loss require:

Effective Nurse-health Care Team Relationships

Promote safe and effective care and contribute to satisfying professional working relationships.

An Effective Educator

Provides a mechanism for evaluating the success of a teaching plan and then provides positive reinforcement.

Both the Nursing and Teaching Processes

Require assessment and evaluation. The nursing and teaching processes differ in that the nursing process requires assessment of all sources of data to determine a patient's total health care needs.

Cultural awareness

Self-examines the dynamics of personal biases, stereotypes, values, and beliefs related to others different from one's own heritage, while cultural encounter is directly interacting with patients of a diverse population other than one's own.

A Family's Structure and Functioning

Significantly influence the family's health, health needs, and ability to respond to health problems.

Linguistic Competence

The ability to communicate effectively and convey information in a manner that is easily understood by diverse audiences.

Preinteraction, Orientation, Working, and Termination

The four phases of a nurse-patient helping relationship are:

At the End of the Session

The nurse uses the teach-back technique to evaluate learning by asking the patient to explain the material that was discussed.

Cultural desire

The pivotal and key construct of cultural competence. It is your desire to engage with patients who have cultural differences that evokes the entire process of cultural competence.

The Family / Family Members

The primary social context in which health promotion and disease prevention take place. Influence one another's health beliefs, practices, and status.

Cognitive, Affective, and Psychomotor.

The three domains of learning including:

Health Promotion and Illness Prevention, Health Restoration, and Coping.

The three purposes of patient education are: