Med Surg Final 4/30

The staff nurse is teaching a group of student nurses the situations that necessitate hand-off communication. Which student responses indicate the need for further education related to this procedure? Select all that apply.

"A hand-off is required during change of shift." "A hand-off is required for a patient is transferred to the surgical suite." "A hand-off is required whenever the nurse receives a new patient assignment."

Which statement from the nurse to family members is appropriate to encourage the participation of providing physical care to the patient during the dying process? Select all that apply.

"Apply lip balm to your loves one's mouth if you feel the lips are dry." "You can massage your loved one's arms and legs to provide comfort."

The nurse is providing care to a patient who is approaching death. Which family member statement regarding the physical and psychological changes associated with death is reflective of the middle stage?

"Confusion or disorientation may begin to occur during this stage."

The nurse is assessing the patient for palliative care. When assessing the cultural domain, which question should the nurse include?

"Do you have any specific dietary preferences that affect your care?"

Which response by the nurse indicates the use of reflective reasoning when communicating with the family of a patient who is in the process of dying?

"I can see this is difficult for you."

A patient is being prepared for a transvenous pacemaker. What should the nurse include when explaining this pacemaker to the family?

"It is inserted using an internal jugular vein."

A patient asks why cardiac leads are being placed on the chest. What should the nurse respond to this patient?

"It provides a graphic picture of the heart's electrical activity."

The nurse is caring for a terminally ill patient and family members. The family has been tearful and sad since the terminal diagnosis was given. Which should be the nurse's focus when planning care?

Anticipatory grieving

The nurse is discussing follow-up care with a patient who is being discharged. The patient and family cross their arms and state angrily that the team's suggestions are not acceptable. Which response by the nurse is appropriate?

"Let's discuss other options that might work well for you and your family."

The nurse is providing care to a patient who is approaching death. Which family member statement regarding the physical and psychological changes associated with death is reflective of the late stage?

"Respirations may sound loud and wet during this stage."

A patient with a cardiac dysrhythmia asks why it is important to recognize the signs of a stroke. What should the nurse respond to this patient? "So you can respond quickly and prevent adverse effects."

"So you can respond quickly and prevent adverse effects."

A patient who is recovering from coronary bypass surgery is placed on a critical pathway for extended care. Which patient statement indicates appropriate understanding of the plan of care?

"The chosen critical pathway can be altered to meet my needs."

Which statement regarding the use of the nursing process in clinical practice is accurate?

"The nursing process is closely related to clinical decision-making."

The staff nurse is communicating with the change nurse about the change of status of the patient. The nurse would begin her communication with which statement if correctly using the SBAR format?

"The patient is complaining of chest pain."

Which statement should the nurse make when communicating the "S" in the SBAR approach for effective communication?

"The patient presented to the emergency department at 0200 with lower left abdominal pain."

The nurse is preparing to defibrillate a patient. Which setting should the nurse use for this treatment?

200 J

A patient's heart rate is 48 beats per minute. Which structure is most likely generating this heart rate?

AV node

An older client is being evaluated for a new onset of a cardiac dysrhythmia. What should the nurse consider as being the cause for this abnormal heart rhythm? Select all that apply.

Advanced age Fat deposits around the SA node Fewer pacemaker cells in the SA node Calcification around the SA node and valves

When the nurse receives a telephone order from the health-care provider's office, which guidelines are used to ensure the order is correct? Select all that apply.

Ask the prescriber to speak slowly. Read the order back to the prescriber. Know agency policy for telephone orders. Ask the prescriber to repeat or spell out medication.

The nurse is caring for a dying child who is being treated with comfort measures only. Which nursing action supports the primary goal for this patient?

Assess and medicate, as ordered, for any signs and symptoms of distress.

The medical-surgical nurse assumes care for a patient who is receiving continuous cardiopulmonary monitoring. Which actions by the nurse enhance safety for this patient? Select all that apply.

Assessing the alarm parameters at the start of the shift Responding to the alarm in a timely fashion Adjusting alarm parameters based on specified practitioner prescription

Which nursing action exemplifies the Quality and Safety Education for Nursing (QSEN) competency of safety?

Assessing the right drug prior to administering a prescribed patient medication

A patient is being cardioverted for symptomatic atrial fibrillation. At which point of the cardiac cycle will the electric impulse occur?

At the peak of the R wave

A patient is admitted for treatment for a low junctional rhythm. Where should the nurse expect to assess the P wave on this patient's electrocardiogram?

At the tail end of the QRS wave

A patient with shortness of breath has a heart rhythm of 46 beats per minute. Which medication should the nurse anticipate being prescribed for this patient?

Atropine sulfate

A patient's cardiac rhythm has no identifiable P or QRS waves. What action should the nurse take first?

Begin chest compressions

The nurse is providing care for a Catholic patient who has suffered a massive cerebral hemorrhage and is not expected to survive. Which intervention by the nurse is most appropriate?

Contact a priest to deliver the Sacrament of the Sick.

An older school-age child is brought to the emergency department (ED) after a car accident. The parents witness and stare at the resuscitation scene unfolding before them. The child is not responding to the resuscitative efforts after 30 minutes. Which is the best communication strategy for the nurse to use in this situation?

Inform the parents that resuscitative efforts have not been effective and are not beneficial to the child.

The nurse is planning an interprofessional care conference for a patient who is approaching discharge from the hospital. Which members of the interprofessional team should the nurse invite to attend? Select all that apply.

Physician Pharmacist Social worker

A competent older adult patient has a living will that expresses the patient's desire to avoid resuscitation and heroic life support measures. The patient's family, however, is not supportive of this directive and plans to contest the living will. Which nursing action is appropriate based on the current situation?

Place the document on the patient's medical record.

A patient is in normal sinus rhythm with prolonged PR intervals. What treatment should the nurse expect to be prescribed for this patient?

Continue to monitor

Which interprofessional role does the nurse often assume when providing patient care in an acute care setting?

Care coordinator

The nurse is concerned that a patient is at risk for pulseless electrical activity. What information from the assessment did the nurse use to make this clinical decision?

Blood pH 7.30

A patient with a cardiac dysrhythmia is experiencing nausea and vomiting. What is the reason for this to occur?

Blood shunted away from nonessential organ systems

The home care nurse is planning care for a diabetic patient requiring an extensive dressing change twice a day, assistance with activities of daily living (ADLs), and comprehensive education. Which role is the nurse assuming by coordinating the care this patient requires?

Case manager

The nurse is preparing a patient for discharge who will be requiring physical therapy (PT) to rehabilitate after a total knee replacement. After reading the health-care provider's order for PT, which would be the nurse's initial action?

Discuss the various types of settings for therapy and have the patient choose the venue.

Which did the Nursing Executive Center of The Advisory Board identify as an academic-practice gap for new graduate nurses?

Disease pathophysiology

Which should be the focus of an educational session for nurses and other members of the interdisciplinary team when addressing high rates of patient readmission to the health system?

Coordination of care

A nurse is working as the designated leader of a group of health-care providers in a community clinic setting. The team members are working to decrease the number of adolescent pregnancies in the community. They have defined the problem and are now focusing on objectives and considering various viewpoints presented by the group. The nurse is tasked with helping the team to stay focused in order to address the defined problem. Which competency of collaboration does this describe?

Decision making

Which is a basic principle of the Patient Protection and Affordable Care Act of 2010 that the nurse should include in a teaching session for members of the health-care team?

Decreased cost of care

The nurse is assessing the patient for palliative care. When assessing the psychosocial and psychiatric domain, which should the nurse include?

Depression

Which action should the nurse implement when providing patient care in order to support The Joint Commission's (TJC) National Patient Safety Goals (NPSG)?

Determining patient safety issues upon admission

The medical-surgical nurse wants to determine if a policy change is needed for an identified clinical problem. Which is the first action the nurse should implement?

Developing a question

The nurse is providing care to a patient who is diagnosed with terminal lung cancer. Which clinical manifestations indicate imminent death? Select all that apply.

Diaphoresis Decreased blood pressure Tachycardia followed by bradycardia

The nurse manager wants to designate a member of the nursing team as the care coordinator for a patient who will require significant care during the hospitalization. Which skills should this nurse possess in order to assume this role? Select all that apply.

Effective clinical reasoning Effective communication Effective documentation

The nurse is assessing the patient for palliative care. When assessing the social domain, which should the nurse include?

Financial concerns

The nurse is educating the family of a patient who is receiving hospice care due to a terminal illness. Which medication should the nurse tell the family to administer for this patient if delirium occurs?

Haloperidol

Which factors can create moral distress for nurses? Select all that apply.

High technology patient care situations Cultural differences with the patient population Resource pressures when providing patient care

A patient is experiencing supraventricular tachycardia. What should be done before determining this patient's treatment?

Identify the underlying rhythm

Which actions by the nurse enhance patient safety during medication administration? Select all that apply.

Identifying the patient using two sources prior to administering the medication Holding a medication if the patient's diagnosis does not support its use Having another nurse verify the prescribed dose of insulin the patient is to receive

The nurse manager is preparing a medical-surgical unit for The Joint Commission (TJC) visit With the nurse manager presenting staff education focusing on TJC benchmarks, which of the following topics would be most appropriate?

Implementation of patient-centered care

The hospital's nurse case manager has been extensively involved with a shooting victim and members of the patient's family in coordinating care of providers from many disciplines as the patient progressed from the emergency department (ED) to the intensive care unit (ICU), and then onto the medical-surgical unit. After three weeks of hospitalization, the case manager is helping to prepare the patient for discharge to a rehabilitation center where treatment will continue. Which outcomes have been documented in the literature as benefits of such collaboration? Select all that apply.

Improved patient outcomes Decreased duplication of health-care services Decreased patient morbidity and mortality

When discussing the importance of interprofessional collaboration, which advantages should the nurse include? Select all that apply.

Improved team member satisfaction Increased division among team members Enhanced communication among team members

The nurse notes that a patient with a cardiac dysrhythmia is developing shortness of breath. What is the pathophysiological reason for this manifestation?

Increase in oxygenation because of a drop in cardiac output

The wife of a patient with end-stage chronic obstructive pulmonary disease (COPD) tells the nurse that she wishes her husband were eligible for hospice care but she thinks that hospice is only available for cancer patients and would require a change in health-care providers. Which responses by the nurse are appropriate? Select all that apply.

Inform her that a diagnosis of cancer is not required for hospice care. Inform her that her husband can retain his provider when transitioning to hospice care.

The Chief Nursing Officer and Chief Medical Officer in an urban teaching hospital are leading a series of meetings with nurses, physicians, hospital lawyers, and risk managers to review and update hospital privileging procedures and requirements for advanced practice RNs and physicians new to the hospital. This is an example of which type of collaborative team?

Interdisciplinary

The case manager assembles a team of health-care professionals, including the patient's primary health-care provider, physical therapist, and social worker, for the purpose of collaborative discharge planning and decision making. Which type of team did the case manager assemble? Select all that apply.

Interdisciplinary Interprofessional

The patient's case manager, diabetes educator, and dietician meet to discuss the patient's needs in preparation for discharge to home. The patient's primary health-care provider arrives and states, "I will be making all decisions regarding the patient's discharge care." With the primary health-care provider's decision to lead the team, the dynamic has shifted between which two types of teams?

Interdisciplinary to multidisciplinary team.

The nurse is providing care to a terminal patient who is experiencing delirium. Which should the nurse assess prior to administering haloperidol to this patient? Select all that apply.

Last stool Bladder distention Medication regimen

When analyzing a patient's electrocardiogram, the nurse notes that the P wave is normal. What criteria did the nurse use to make this decision?

Length 0.10 seconds and height 2.5 mm

The nurse is reviewing evidence from a quasi-experimental research study. Which level of evidence should the nurse identify for this research study?

Level III

Which level of evidence should the nurse identify when reviewing evidence from a single descriptive research study?

Level VI

The nurse is evaluating the level of evidence found during a recent review of the literature. Which evidence carries the lowest level of support for a practice change?

Level VII

The nurse is educating the family of a patient who is receiving hospice care due to a terminal illness. Which benzodiazepine medication should the nurse tell the family to administer to treat the patient if hyperactive delirium occurs?

Lorazepam

Which type of nursing is the root of all other nursing practice areas?

Medical-surgical nursing

The nurse notes that PR intervals are getting progressively longer before a QRS complex is dropped on a patient's cardiac rhythm strip. Which health problem should the nurse realize this patient is experiencing?

Mobitz I

The nurse is educating the family of a patient who is receiving hospice care due to a terminal illness. Which medication should the nurse tell the family to administer to treat the patient's pain?

Morphine

Which patient population should the nurse focus on to increase access to care that is coordinated, safe, and focused on the patient's unique needs across all care settings?

Older adult patients

The nurse is assessing the patient for palliative care. When assessing the physical domain, which should the nurse include?

Pain

The nurse is providing care for a patient receiving curative care who is experiencing chronic pain due to cancer. Which type of care should the nurse plan for upon discharge for this patient?

Palliative care

A patient with atrial fibrillation has a heart rate of 90 beats per minute. Which manifestation should the nurse expect to assess in this patient?

Palpitations

A local hospital formed a neurotrauma (NT) team with the following members: acute care nurses, physicians, other care partners (e.g., physical therapists, social workers, case managers, dieticians), and representatives from the NT outpatient clinic. This team is led by a physician who makes treatment decisions based on the treatment plans developed by individual team members who each communicate with the patients, asking the same or similar questions to obtain data needed for their treatment plan. Which type of communication and action is represented in the scenario described?

Parallel communication

Which concept exemplifies a well-managed death experience for a terminal patient and family members?

Preparing the patient and the family for the process of dying

The medical-surgical nurse is providing patient care. Which circumstance would necessitate the nurse verifying the patient's identification using at least two sources?

Prior to medication administration

The medical-surgical unit recently implemented a patient-centered care model. Which action implemented by the nurse supports this model?

Providing compassion

A patient is being evaluated for a blockage in the cardiac ventricles. On which part of the electrocardiogram should the nurse focus as evidence of this blockage?

QRS interval

The medical-surgical nurse identifies a clinical practice issue and wants to determine if there is sufficient evidence to support a change in practice. Which type of study provides the strongest evidence to support a practice change?

Randomized control study

The nurse is caring for a patient with rheumatoid arthritis who expresses the desire to remain active as long as possible. In order for the patient to meet this goal, what should the nurse prepare to do?

Refer the patient to the appropriate professionals.

The nurse is observed marching out the rhythm on a patient's cardiac monitor tracing. What is this nurse assessing?

Regularity

The nurse is caring for a patient who is reporting pain of 8/10 on a 1 to 10 numeric pain scale. The nurse administers the prescribed pain medication. When the nurse re-evaluates the patient one hour later, the patient is still reporting pain of 8/10. Which action by the nurse is appropriate at this time?

Report to the health-care provider by telephone.

An adolescent patient with terminal cancer tells the nurse that she does not want to continue treatment, even though her parents are planning for her to participate in a study trial that involves aggressive chemotherapy. Which action by the nurse is the most appropriate?

Request that the parents and daughter meet together with the health-care team to discuss options and the implications of various choices.

Which is the basis of nursing care practices and protocols?

Research

Which is a team action that nurses can employ as a stress-reducing strategy?

Sending a bereavement card to the family of a patient who recently passed

The parents of a child with terminal cancer ask the nurse that the child not be told that he will not recover. The child asks the nurse if he is dying. What should the nurse do at this time?

Suggest a meeting with the health-care team and the parents.

During a home visit the nurse learns that a patient has been skipping doses of antiarrhythmic medication. What should the nurse include when counseling this patient?

Taking the medication as prescribed reduces the occurrence of side effects

A patient with Type 1 diabetes mellitus has developed an open sore on the shin and is having trouble meeting daily goals for exercising. The patient is scheduled for discharge in a couple of days. When planning for this patient's continued care, who will the nurse notify regarding the patient's needs after discharge?

The case manager

The nurse is preparing to document care provided to the patient during the day shift. The nurse documents that the patient experienced an increased pain level while ambulating which required an extra dose of pain medication; took a shower; visited with family; and ate a small lunch. Which information is important to include during the oral end-of-shift reporting? Select all that apply.

The extra dose of pain medication The patient's response to ambulation

The nurse is providing care to a patient diagnosed with end-stage renal disease. When planning a care plan conference for this patient, who does the nurse invite to participate?

The family members

Which statement is a primary and historical barrier to effective nurse-physician collaboration that has persisted over time?

The nurses' and physicians' perceptions of inequity in their roles, with nurses assuming a subservient role and physicians assuming leadership and superior role in health-care settings

A terminal patient has opted to stop treatment. The family, however, believes the patient is no longer competent to make this decision. Which data supports that the patient is capable of making this treatment decision? Select all that apply.

The patient communicates the decision with the health-care team. The patient understands the nature and consequences of treatment. The patient states the benefits and risks associated with the treatment.

The nurse managers in a community hospital have been charged with reviewing job descriptions of unlicensed assistive personnel (UAPs) and have questions about the delegation of certain patient care activities to UAPs by nurses. To which group, organization, or individual would committee members direct their questions to obtain definitive answers about the parameters of nurse delegation to UAPs?

The state board of nursing

Which is a common theme regarding patient dissatisfaction related to care provided in the hospital setting?

Time spent with the health-care team

Handoff communication, the transfer of information during transitions in care such as during change-of-shift report, includes an opportunity to ask questions, clarify, and confirm the information between sender and receiver. Which is the main objective for ensuring effective communication during a patient handoff?

To ensure patient safety

The case manager interviews an older adult patient hospitalized after hip replacement surgery. The patient requires in-patient rehabilitation prior to being discharged home. The case manager works with the hospital nursing staff, the rehabilitation center, the patient's family members, and other care providers to assist with a smooth transition. Which is the primary goal of the care management model described here?

To provide a continuum of clinical services in order to help contain costs and improve patient outcomes

A school-age patient is admitted to the pediatric intensive care unit (PICU), unconscious and with multiple traumatic injuries, after a skateboard accident that included a closed head injury. Many health professionals are involved in the patient's care and the scene is chaotic. The parents are extremely anxious and want to know what is happening. The case manager asks for an interdisciplinary team meeting to speak with the patient's parents. Which is the rationale for this meeting?

To share and evaluate information for care planning and implementation, and prevent priority conflicts, redundancy, and omissions in care

A patient with atrial fibrillation is being considered for cardioversion. Which diagnostic test should the nurse anticipate being prescribed prior to this procedure being completed?

Transesophageal echocardiogram (TEE)

The nurse is providing care to several patients on a medical-surgical unit. Which situation would necessitate the nurse to use SBAR during the hand-off process?

Transfer to radiology

A patient is diagnosed with third-degree AV block. For which type of pacemaker should the nurse prepare this patient?

Transvenous

Which aspect of patient-centered care should the nurse manager evaluate prior to The Joint Commission site visit for accreditation?

Visitation rights

The nurse is providing care to a patient who is diagnosed with terminal lung cancer. The patient is lying in the supine position with noisy wet respirations noted and is not breathing well. The patient has a living will which designates the implementation of comfort measures. Which action by the nurse is appropriate?

Withhold all care until the patient dies.