Module 11

It is important for nurses to remember that patients learn in three domains: __________, cognitive, and psychomotor.

Affective

A home health care nurse is autonomous and not held accountable to the primary health care provider for delivery of care T or F

False

Care in the home environment is designed primarily for patients with terminal illnesses. T or F

False

A facility must be certified by Medicare to receive reimbursement for services from Medicare. T or F

True

Nurses providing care in community-based settings must assume responsibility for independent decision making. T or F

True

Planning for discharge actually begins on admission when information about the patient is collected and documented. T or F

True

The "Teach Back Method" assesses health literacy, seeking to confirm that the learner understands the health information received from the healthcare professional and has been proven to be effective in a wide variety of patient care settings.

True

Contracts between nurses and patients are common in many health care settings. A contractual agreement is a pact that includes agreed upon goals, in informal and not legally binding.

True Rationale: When teaching a patient, such an agreement can serve to motivate both the patient and the teacher to do what is necessary to meet the patient's learning outcomes.

The cognitive processes of adolescents are similar to those of adults, thus the content and strategies of patient teaching should resemble those used for teaching adults.

True Rationale: Peer group acceptance is critical for most adolescents; teaching strategies should recognize the need for independence and the need to establish a trusting relationship that demonstrates respect for the adolescent's opinions.

Learning readiness, the patient's willingness to engage in the teaching- learning process, is distinguished from the patient's actual ability to learn.

True Rationale: These are two separate concepts.

A nurse incorporates use of the patient portal in the discharge teaching for a patient who received a kidney transplant. What services does the nurse explain are available with this technology? Select all that apply. a. Reviewing diagnostic and lab test results b. Making follow-up appointments c. Using health and fitness apps d. Entering clinical data, such as blood pressure e. Providing digital medication reminders f. Requesting prescription refills

a, b, c, d, f. Rationale: The patient portal can streamline services by allowing access to medical history and other health information; facilitating completion of online forms and questionnaires; offering secure and convenient communication with providers; and having the ability to place request prescription refills, pay bills, review lab results, schedule appointments, receive reminders for screenings and immunizations, enter clinical data such as blood pressure, glucose levels, weight, and other activity tracking data, review progress notes, and access educational materials based on diagnosis or procedure.

The nurse coach at a cardiac rehabilitation office is meeting with a patient who has learned they have heart failure. Which nursing actions might the nurse coach include in coaching sessions for this patient? (Select all that apply.) a. Provide education based on the patient's personal goals. b. Explore the patient's readiness for change. c. Assist the patient to determine progress toward goals. d. Direct the patient to exercise daily. e. Identify goals for the patient.

a, b, c. Rationale: The nurse coach facilitates change or development that assists the individual to cope with health challenges. The nurse coach establishes a partnership with the patient to support the patient to identify and work toward the patient's personal agenda and goals; nurse coaches do not use teaching and other strategies directed by the nurse as an expert. A, b, and c are patient-driven, person-centered interventions to educate and empower the patient. D and e are interventions identified and directed by the nurse, not by the patient, which is not part of the coaching process.

A discharge nurse is evaluating patients and their families to determine the need referrals to other facilities after hospitalization. Which patients will the nurse recommend for these services? Select all that apply. a. Older adult diagnosed with dementia in the hospital b. Adult diagnosed with Parkinson disease c. Adult woman receiving chemotherapy for breast cancer d. Adolescent being discharged with a cast on his leg e. New mother who delivered a healthy infant via a cesarean birth f. Adult man diagnosed with end-stage cancer

a, b, f. Rationale: The patients who are most likely to need a formal discharge plan or referral to another facility are those who are emotionally or mentally unstable (e.g., those with dementia), those who have recently diagnosed chronic disease (e.g., Parkinson disease), and those who have a terminal illness (e.g., end-stage cancer). Other candidates include patients who do not understand the treatment plan, are socially isolated, have had major surgery or illness, need a complex home care regimen, or lack financial services or referral sources.

After instituting a new system for recording patient data, a nurse evaluates the "usability" of the system. Which actions will the nurse include in this step? Select all that apply. a.Checking that the screens are formatted to allow for ease of data entry b. Reordering the screen sequencing to maximize effective use of the system c. Ensuring that the computers can be used by specified users effectively d. Checking that the system is intuitive and supportive of nurses e. Improving end-user skills and satisfaction with the new system f. Ensuring patient data is shareable across health care systems

a, c, d. Rationale: Usability refers to the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use. Checking that screens are formatted to allow ease of data entry, ensuring that computers can be used by specified users effectively, and checking that the system is intuitive and supportive of nurses are all tasks related to the "usability" of the system. Maximizing screen sequencing and improving end-user skills and satisfaction with the new system refer to optimization. The ability to share patient data across health care systems is termed interoperability.

A nurse is considering moving from the hospital setting to home health care. In speaking with other professionals, what qualities does the nurse find they should possess to be successful? Select all that apply. a. Making accurate assessments b. Researching new treatments for chronic diseases c. Communicating effectively d. Delegating tasks appropriately e. Performing clinical skills effectively f. Making independent decisions

a, c, e, f. Rationale: Nurses working in the community must have the knowledge and skills to make accurate assessments, work independently, communicate effectively, and perform clinical skills accurately. Community-based nurses may be researchers and occasionally delegate care, but these are not key qualities for this type of nursing.

A nurse is using the steps in informatics evaluation to assess a patient portal. Which activities might occur in the "determining the question" step? Select all that apply. a. Developing a clear, focused question to determine the data to be collected b. Determining what to evaluate c. Determining how the data ultimately should be reported d. Deciding what specific data elements need to be collected e. Clarifying exactly how the data will be collected f. Performing comprehensive documentation of the data collected

a, c. Rationale: The nurse develops a clear, focused question to determine the data to be collected and the nurse determines how the data ultimately should be reported during the "determine the question" step. The nurse determines what to evaluate during the step "determine what will be evaluated." The nurse decides what specific data elements need to be collected during the "determine the needed data" step. The nurse clarifies exactly how the data will be collected during the "determine the data collection method and sample size" step. The nurse performs comprehensive documentation of the data collected during the "document your outcome evaluation" step.

A client was admitted to the hospital for treatment of pneumonia and was also diagnosed with mild dementia while in the hospital. In preparing for discharge, what should the nurse discuss with the family? a. The possible need for home care b. Legal responsibility for the future c. The risks and benefits of long-term residential care d. The importance of adhering closely to the prescribed medication regimen

a.

A nurse has a two-way video communication with the specialist involved in the care of a client in a long-term care facility. This is an example of what nursing informatics technology? a. Client engagement technology b. Data aggregation technology c. Telemedicine and mobile technology d. Population health management technology

a.

A nurse is developing a contractual agreement with a client. Which statement is true of a contractual agreement? a. The contract serves to meet the client's learning outcomes. b. The contract is a formal agreement. c. The contract is legally binding. d. The contract serves to meet nursing goals.

a.

A nurse is educating a 4-year-old client about cast care following a tibia-fibula fracture. Which action is not developmentally appropriate to include in the nurse's teaching? a. Blocking 30 minutes of time for skill teaching b. Using dolls to demonstrate psychomotor skills c. Ensuring the client's parents are present d. Giving stickers as a reward for task completion

a.

A nurse is preparing a teaching plan for a patient with asthma on the use of an inhaler. What teaching method is most appropriate for this patient? a. Demonstration b. Lecture c. Discovery d. Panel session

a.

A nurse on a medical-surgical unit is teaching a patient's family about hospice care. How does the nurse best explain the focus of this care? a. Hospice care focuses on symptom and pain relief. b. Nutrition is provided orally or by tube to maintain intake. c. Surgical procedures are performed when medically necessary. d. Services are provided until the patient's death.

a.

A patient is being transferred from the intensive care unit (ICU) to a medical-surgical unit. What is the responsibility of the ICU nurse during the transfer of care? a. Providing a verbal report to the nurse on the new unit b. Giving a detailed written report to the unit secretary c. Delegating the responsibility for providing information d. Making a copy of the patient's medical record

a.

The nurse has provided education to a client about home care for an open surgical wound on the lower left extremity. When evaluating learning through the cognitive domain, what statement by the nurse would be appropriate? a. "Tell me about what signs of infection you will report to the health care provider." b. "I would like you to demonstrate how to change the dressing on your leg." c. "Let's see how you irrigate the wound with saline." d. "I notice that you do not have the dressing secured. Place a piece of tape on the wrap."

a.

Which is the largest single source of reimbursement for home health care services? a. Medicare b. Client's self-pay c. Private insurance d. Medicaid

a.

A registered nurse acts as nurse coach to provide teaching to patients who are recovering from a stroke. Which statement directs the nurse in performing this role? a. The nurse uses discovery to identify the patients' personal goals and create a plan that will result in change. b. The nurse is the expert in providing teaching and education strategies to provide dietary and activity modifications. c. The nurse becomes a mentor to the patients and encourages them to create their own fitness programs. d. The nurse assumes an authoritative role to design the structure of the coaching session and support the achievement of patient goals.

a. Rationale: A nurse coach establishes a partnership with a patient and, using discovery, facilitates the identification of the patient's personal goals and agenda to lead to change rather than using teaching and education strategies with the nurse as the expert. A nurse coach explores the patient's readiness for coaching, designs the structure of a coaching session, supports the achievement of the patient's desired goals, and with the patient determines how to evaluate the attainment of patient goals.

Nursing students enrolled in an informatics course question the purpose of "big data." Which statement do the students find best describes use of big data? a. Gathering data from multiple sources to help organizations answer questions and make predictions in multiple settings b. Predicting patients likely to be readmitted, allowing early intervention c. Promoting the most efficient staffing model for the organization d. Developing charts or graphs to visualize large amounts of complex data

a. Rationale: As organizations transition from traditional fee-for-service models to value-based payment models, information about populations rather than individuals is needed. Big data comprises the accumulation of health care-related data from multiple sources, combined with new technologies that allow for the transformation of data to information for patient care regardless of setting. Sources of available data can include the EHR; medical devices such as monitors, ventilators, and smart pumps; radiology, laboratory, and pathology systems; wearable devices and home monitoring systems; financial databases; genomics; open sources; patient portals; and real-time location systems. Predictive analytics uses statistical techniques to make predictions about future or unknown events, such as patients who are at risk for readmission. Data visualization presents data in a pictorial or graphical format for analysis. The growing population of older adults with complex health needs and a potential understaffing are important but are not the driving force for the development of this technology.

When signing in to the electronic medical record, a nurse is prompted to change their password. Which best-practice guideline does the nurse use to formulate the new password? a. Password should be at least 8 characters long and unique. b. Passwords should be memorable and used in other applications. c. Date of birth makes an ideal password. d. Nurses should share their passwords with their nurse managers.

a. Rationale: Passwords should contain 8 to 15 characters, never be shared or re-used, and be easy to remember but hard to guess. Using multifactor authentication and a password manager can help organize and protect information. The password should not be shared with the nurse manager or others.

A nurse is caring for a 17-year-old pregnant client who is unable to afford health care. Which action will the nurse perform to obtain assistance for this client? a. Create a referral to the social work department b. Assess the reasons why the client is experiencing financial challenges c. Offer to work with the client to explore money management strategies d. Offer to mediate between the client and her family to obtain financial assistance

a. Rationale: social workers provide financial assistance

An informatics nurse specialist is conducting an orientation for the staff of a primary care provider's office about a new web-based tool that they will be implementing. The goal of the tool is to promote client engagement. The informatics nurse specialist is most likely orienting the staff to which system? a. Patient portal b. Telehealth c. Telemedicine d. Telecare

a. Rationale: web-based tool can be securely accessed and provides functions to increase engagement

An informatics nurse specialist is involved in developing a clinical information system for a facility. Place the phases of development that the nurse will be involved with in the proper order from first to last. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. a. analyze and plan b. design and build c. test d. train e. implement f. maintain g. evaluate

a. b. c. d. f. e. g.

An informatics nurse is working as part of a team considering an update to a clinical information system already in place. Which questions would be important for the team to ask first? Select all that apply. a. "What is the purpose of the change?" b. "Will it improve overall usability?" c. "How will its use be incorporated into the nurse's current workflow?" d. "How should the screen be laid out so it's consistent with other screens?" e. "Can the design support the nurse's workflow?"

a., b., c.

An informatics nurse specialist is working with a team that is involved in activating an update to the clinical information system. The team employs nurse superusers to assist when help is needed. Prior to activating the update, which phases would the team have already completed? Select all that apply. a. Analysis and planning b. Design c. Training d. Testing e. Maintaining

a., b., c., d.

Which are components of the nursing case management process? Select all that apply. a. Coordinating b. Making referrals c. Monitoring medical progress d. Prescribing medications e. Driving a client to appointments f. Filing and completing paperwork

a., b., c., f.

A facility is considering the addition of an alert system to the current electronic documentation system. The goal is to identify clients at risk for post-operative complications based on client data. A team consisting of an informatics nurse specialist, information technology experts, and nurses work on this. The team is currently in the "analyze and plan" phase of the system development lifecycle. Which activity would the team be involved with at this time? Select all that apply. a. Identifying the specific purpose for this system b. Collecting data to determine the seriousness of postoperative complications c. Identifying the need for a entirely separate system for this task d. Evaluating how the system might affect the current electronic documentation system e. Assessing how the system can be incorporated into the nurses' current workflow patterns

a., b., d, e.

Which actions constitute a violation of client privacy, confidentiality, and professionalism? Select all that apply. a. The nurse asks a family member for assistance in completing an admission assessment form for a client who does not speak the dominant language. b. The nurse posts a picture of an anonymous comatose client's pressure injury on a social media site. c. The nurse provides information to a family member over the telephone after verifying this person is allowed to receive client information. d. The nurse looks up information for a client on another hospital unit who is a personal friend. e. The nurse working on an inpatient unit uses the computer to access the nurse's own diagnostic data from when the nurse was an outpatient.

a., b., d., e.

The community-based nurse is a coordinator of services, a patient and family educator, and a patient ____________ who protects and supports the patient's rights.

advocate

Pedagogy, the science of teaching, generally refers to the teaching of children and adolescents, whereas ___________ refers to the study of teaching adults.

andragogy

When transferring a patient from the operating room to the medical-surgical unit, a nurse uses the SBAR format for handoff communication. Place the components of the SBAR communication (Situation, Background, Assessment, and Recommendations) in their proper order. a.. This 20-year-old patient presented to the ER with right lower quadrant pain, fever, and an elevated WBC count. b. The patient is postlaparoscopic appendectomy. c. The patient may need pain medication in 30 minutes. d. The patient is sleepy, but responsive; five small bandages on the abdomen are clean and dry.

b, a, c, d. Rationale: The SBAR communication for this patient should be: The patient is post laparoscopic appendectomy. This 20-year-old patient presented to the ER with right lower quadrant pain, fever, and an elevated WBC count. The patient may need pain medication in 30 minutes. The patient is sleepy, but responsive; there are five small bandages on the abdomen that are clean and dry.

A nurse is planning teaching strategies in the affective domain of learning for patients with alcohol use disorders. Which teaching-learning activities will the nurse use? Select all that apply. a. Preparing a lecture on the harmful long-term effects of alcohol on the body b. Asking the patient to discuss reasons people with alcohol use disorders drink and exploring other methods of coping with problems c. Requesting that patients perform a return demonstration for using relaxation exercises to relieve stress d. Helping patients to reaffirm their feelings of self-worth and relate this to their alcohol use disorder e. Using a pamphlet to discuss the tenets of the Alcoholics Anonymous program with patients f. Reinforcing the mental benefits of gaining self-control over a substance use disorder

b, d, f. Rationale: Affective learning includes changes in attitudes, values, and feelings (e.g., the patient expresses renewed self-confidence to be able to give up drinking). Cognitive learning involves the storing and recalling of new knowledge in the brain, such as the learning that occurs during a lecture or by using a pamphlet for teaching. Learning a physical skill involving the integration of mental and muscular activity is called psychomotor learning, which may involve a return demonstration of a skill.

A discharge nurse manager is preparing the plan for a patient returning home after receiving a kidney transplant. What actions will the nurse perform to ensure continuity of care? Select all that apply. a. Conduct an admission health assessment b. Evaluate the effectiveness of the current nursing care plan c. Participate in transferring the patient to the postoperative care unit d. Make referrals to appropriate facilities e. Maintain records of patient satisfaction with services received f. Assess the strengths and limitations of the patient and family

b, d, f. Rationale: The primary roles of the discharge planner as patients move from acute to home care are evaluating the nursing plan for effectiveness of care, making referrals for patients, and assessing the strengths of patients and their families. The staff typically performs an admission health assessment and assists with patient transfers from the OR. In most facilities, maintaining records of patient satisfaction is the role of the public relations manager or office manager.

A nurse develops a contractual agreement with a morbidly obese patient to achieve optimal weight goals. Which statement best describes the nature of this agreement? a. "This agreement forms a legal bond between the two of us to achieve your weight goals." b. "This agreement will motivate the two of us to do what is necessary to meet your weight goals." c. "This agreement will help us determine what learning outcomes are necessary to achieve your weight goals." d. "This agreement will limit the scope of the teaching session and make stated weight goals more attainable."

b.

A nurse is caring for an older adult client with arthritis. Which action is the priority for the nurse when conducting the health education for the client? a. Divide information into manageable amounts. b. Find out what the client wants to know. c. Provide an environment that promotes learning. d. Identify how long the education session will last.

b.

A nurse is reviewing the discharge plan with a patient who had major abdominal surgery. Which statement by the nurse is most appropriate? a. "I'll bet you will be so glad to be home and sleep in your own bed." b. "Tell me about your understanding of your recovery needs after discharge." c. "Be sure to take your pain medications and change your dressing." d. "You will just be fine! Please stop worrying."

b.

A nurse is working with the Red Cross to assist a family whose home was destroyed by fire. Which statement is most appropriate to assist with this situational crisis? a. "Over time this will all just be a memory. You will adjust to the changes." b. "You have had a tremendous loss. What are your plans for shelter tonight?" c. "You have lost everything. I guess family will be taking you in for a while." d. "I cannot believe the destruction. I would not know where to begin to rebuild."

b.

An active, otherwise healthy, older adult client presents to the clinic with severe osteoarthritis in both knees. The nurse knows this client does not want to be a burden on the family, and the client remains stoic despite reporting the pain as severe. The client avoids the topic of surgery and attends church weekly. The client's family is supportive of any decisions the client makes regarding health. Which of the assessment data is most important to forming an individualized education plan for this client concerning treatment for osteoarthritis? a. Orthopedic surgical history b. Personal perception of health and aging c. Floor plan of the client's dwelling d. Formal religious beliefs

b.

An informatics nurse specialist is attempting to identify a connection between a client's health history and the client's current health status. The nurse specialist interprets and analyzes the various items documented to determine the relationship. The nurse is integrating which component of the nursing informatics framework? a. Data b. Knowledge c. Information d. Wisdom

b.

The nurse has taught a patient with diabetes how to administer subcutaneous insulin injections. Which is the best strategy to evaluate if the teaching goal has been met? a. Ask the patient the insulin dose and times of day they will administer insulin. b. Observe the patient's technique in drawing up and administering insulin. c. Have the patient explain the skill they have just learned. d. Document the teaching session in the patient's electronic health record.

b.

The nurse is assessing the client's readiness to be discharged home after being admitted for 4 days due to falling at home. Which question should the nurse ask the client? a. "What goals do you have for your family?" b. "What medications will you be taking at home?" c. "Do you have available transportation to appointments?" d. "Will you be helping prepare meals for the family?"

b.

The nurse is caring for a client in the intensive care unit who must be administered multiple medications. The client is often unresponsive and cannot offer information during assessment. When administering the medication, which step by the nurse is most important to avoid confusion and ensure safety? a. Identify the client by the wristband at least twice before administering the medication if the client is unresponsive, once upon entering the room and then prior to administration. b. Scan the client's wristband prior to administering medication to verify it is the correct client and correct medication. c. Identify the client by asking the spouse or other family members present if the client is unresponsive, ensuring to obtain the full name and date of birth. d. Compare the client's wristband to the eMAR and EHR information if the client is unresponsive, then verify the medication has the same identifying information.

b.

A nurse is using informatics technology to determine which patients may be at risk for readmission. What term best describes this type of analytic? a. Data visualization b. Predictive analytics c. Big data d. Data recall

b. Rationale: Predictive analytics uses statistical techniques to analyze current and historical facts to make predictions about future or otherwise unknown events. This is used by health care organizations to identify patients who are at risk for readmission, allowing case managers to intervene. Data visualization presents data in a pictorial or graphical format for analysis. Big data comprises the accumulation of health care-related data from various sources, transforming the data to information, to knowledge, and ultimately to wisdom. Data recall is not a technical term for analytics.

A nurse is caring for a patient who is admitted to the hospital with traumatic injuries sustained in a motor vehicle accident. While hospitalized, the patient's spouse tells the patient that their house flooded, damaging their belongings. When the nurse notes that the patient is visibly upset by this news, the nurse suggests which type of counseling? a. Long-term developmental b. Short-term situational c. Short-term motivational d. Long-term motivational

b. Rationale: Short-term counseling might be used during a situational crisis, which occurs when a patient faces an event or situation that causes a disruption in life, such as a flood. Long-term counseling extends over a prolonged period; a patient experiencing a developmental crisis, for example, might need long-term counseling. Motivational interviewing is an evidence-based counseling approach that involves discussing feelings and incentives with the patient. A caring nurse can motivate patients to become interested in promoting their own health.

A nurse is teaching first aid to counselors of a summer camp for children with asthma. This is an example of what aim of health teaching? a. Promoting health b. Preventing illness c. Restoring health d. Facilitating coping

b. Rationale: Teaching first aid is a function of the goal to prevent illness. Promoting health involves helping patients to value health and develop specific health practices that promote and maintain wellness. Restoring health occurs once a patient is ill, and teaching focuses on developing self-care practices that promote recovery. When facilitating coping, nurses help patients come to terms with whatever lifestyle modification is needed for their recovery or to enable them to cope with permanent health alterations.

A nurse informaticist is using the steps of the SDLC to design a new system for home health care documentation. The nurse analyzes the old system and develops plans for the new system. What step of this process will the nurse take next? a. Testing b. Designing c. Implementing d. Evaluating

b. Rationale: The SDLC focuses on the areas of Analyze and Plan, Design and Build, Test, Train, Implement, Maintain, and Evaluate. After analyzing and planning the new system, the nurse would move on to the design step in which the basic design of the new system is developed. The nurse would then test the system, train employees, and implement, maintain, and evaluate the new system in that order.

A visiting nurse is performing the initial assessment and plan for a patient who receives Medicare and was recently discharged from the acute care hospital. Before implementing the plan of care, what follow-up is required by the nurse? a. Validating the patient's consent for care b. Obtaining the health care provider's signature and approval c. Determining how the patient will pay for services d. Ensuring that a family member or friend can assist with implementation

b. Rationale: The nurse assesses the patient eligible for home services and presents the plan to the health care provider for approval. This approval allows for provision of care and reimbursement of services.

The nurse is caring for a client who would benefit from home health care services. In preparing for discharge, the nurse is aware that home health care can only be initiated if the: a. appropriate transfer forms are completed. b. health care provider writes an order for home care. c. social worker assesses the need and Medicare agrees to pay for home health care services. d. home health care agency evaluates the client and determines the need for services.

b. Rationale: The physician or nurse practitioner must write an order for all home care services, and the patient must meet eligibility criteria for reimbursement for home health care visits

During a feedback session on the updates to the electronic health record, nurses complain that they must use standard terminology rather than enter "free text" data in their own words. How will the nurses developing the system explain the purpose of standardization? a. It leads to fewer spelling errors and less misrepresentation of data. b. It provides for easier retrieval of data for use. c. The program was designed this way, and we cannot change it. d. Standardization uses preselected terminology, reducing lawsuits.

b. Rationale: Using standard terminology in the electronic health record allows data to be easily retrieved and better captures nursing's contribution to care delivery and patient outcomes. For example, to capture all patients using canes, quad canes, and walkers, a common phrase such as "uses assistive device" allow data for all these mobility issues to be captured.

A home care nurse has completed a home assessment. Of the following findings, which should be reported to service providers immediately? a. Infestation with roaches b. The smell of natural gas c. Unclean environment d. Diminished food sources

b. Rationale: think what will kill them first

What is a violation(s) of the nurse's responsibility when using electronic communication? Select all that apply. a. The nurse wrote on a social media site, "Had a bad day at work. Need some support. Call me." b. The nurse posted on a social media site, "Psychotic mean client in Room 502 hit me," and, within 5 minutes, deleted the post. c. The nurse sent an email message to a client informing the client how to access a secured website to view the lab report. d. When a visitor inquired about a hospitalized client, the nurse, prior to answering, closed the computer monitor screen that was open to client data and could be seen by the visitor. e. The nurse accidentally texted a message about a new prescription for HIV medication to the wrong phone number.

b., e.

A home health nurse is scheduled to visit a patient recently discharged from the hospital with a new colostomy. During the entry phase of the home visit, what actions will the nurse perform? Select all that apply. a. Collect information about the patient's diagnosis, surgery, and treatments b. Call the patient to make initial contact and schedule a visit c. Develop rapport with the patient and their family d. Assess the patient to identify their needs e. Assess the physical environment of the home f. Evaluate safety issues including the neighborhood in which the patient lives

c, d, e. Rationale: In the entry phase of the home visit, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes, plans and implements prescribed care, and provides teaching. In the pre-entry phase of the home visit, the nurse collects information about the patient's diagnoses, surgical experience, socioeconomic status, and treatment orders. In the pre-entry phase, the nurse also gathers supplies needed, makes an initial phone contact with the patient to arrange for a visit, and assesses the patient's neighborhood for safety issues.

A nurse is teaching patients of all ages in a hospital setting. Which teaching examples are appropriate for the patient's developmental level? Select all that apply. a. The nurse plans long teaching sessions to discuss diet modifications for an older adult diagnosed with type 2 diabetes. b. The nurse recognizes that a female adolescent diagnosed with anorexia is still dependent on her parents and includes them in all teaching sessions. c. The nurse designs an exercise program for a sedentary older adult male patient based on the activities he prefers. d. The nurse includes an 8-year-old patient in the teaching plan for managing cystic fibrosis. e. The nurse demonstrates how to use an inhaler to an 11-year-old male patient and includes his mother in the session to reinforce the teaching. f. The nurse continues a teaching session on STIs for a sexually active male adolescent despite his protest that "I've heard enough already!"

c, d, e. Rationale: Successful teaching plans for older adults incorporate extra time, short teaching sessions, accommodation for sensory deficits, and reduction of environmental distractions. Older adults also benefit from instruction that relates new information to familiar activities or information. School-aged children are capable of logical reasoning and should be included in the teaching-learning process whenever possible; they are also open to new learning experiences but need learning to be reinforced by either a parent or health care provider as they become more involved with their friends and school activities. Teaching strategies designed for an adolescent patient should recognize the adolescent's need for independence, as well as the need to establish a trusting relationship that demonstrates respect for the adolescent's opinions.

A nurse designing a new EHR system for a pediatric office follows usability concepts in system design. Which concepts are recommended in system design? Select all that apply. a. Users should not explore with forgiveness for unintended consequences. b. Shortcuts for frequent users should not be incorporated into the system. c. Content emphasis should be on information needed for decision making. d. The less times users need to apply prior experience to a new system the better. e. All the information needed should be presented to reduce cognitive load. f. The number of steps it takes to complete tasks should be minimized.

c, e, f. Rationale: When designing a system, content emphasis should be on information needed for decision making. All the information needed should be presented to reduce cognitive load. The number of steps it takes to complete tasks should be minimized. The more users can apply prior experience to a new system, the lower the learning curve, the more effective their usage, and the fewer their errors. Forgiveness means that a design allows the user to discover it through exploration without fear of disastrous results or unintended consequences. Minimizing the number of steps needed to complete tasks and to provide shortcuts for use by frequent and/or experienced users facilitates efficient user interactions.

A 56-year-old client meets with the nurse for education about a recently diagnosed atrial fibrillation. The client verbalizes concerns about being away from work too long and doubts about the necessity of having blood tests every week, as the client has no symptoms. Which is the best motivational statement by the nurse for this client? a. "Your doctor wants you to take your warfarin every day, go to the clinic every week to have blood drawn, and then wait for any dosage change. Do you understand?" b. "You have to take your warfarin and go to the clinic every week for a blood draw. It's not the most convenient way to live, but you have to do it." c. "The medicine and blood work can help prevent blood clots, which can lead to strokes. What do you know about warfarin therapy?" d. "Atrial fibrillation is when your upper heart beats ineffectively and blood clots can go to your brain. Would you like some printed information about this?"

c.

A home care nurse is observing the patient's family member perform a wound irrigation and dressing change for a postoperative wound dehiscence containing purulent drainage. In which situation will the nurse provide additional education? a. The family member places the old dressing in a separate bag at the bedside. b. The patient takes an analgesic a half-hour prior to the dressing change. c. The family member states they washed their hands an hour ago. d. The patient returns to bed during the dressing change.

c.

A nurse in the diabetes clinic initiates education for a patient with a new diagnosis of diabetes. The nurse notes the patient has completed 2 years of college. What action does the nurse select for the initial teaching session? a. Providing the patient with handouts related to blood-glucose management b. Demonstrating the use of the blood-glucose monitor and tool to record blood-glucose readings c. Assessing the patient's knowledge of diabetes and their ability to interpret the health information d. Explaining the dietary restrictions including foods that are prohibited

c.

A nurse is teaching an adult patient how to care for their new ostomy appliance. Which evaluation method is most appropriate to confirm that the patient has learned the information? a. Ask Me 3 b. Newest Vital Sign (NVS) c. Teach-Back Method d. TEACH acronym

c.

Lately there have been many significant changes in the healthcare delivery system; earlier hospital discharges is one of them. What is one result of earlier hospital discharges? a. Patients are in the hospital for a longer period of time. b. Patients are locked into pre-negotiated payment rates that have remained unchanged. c. Patients with high home care needs are being discharged into the community. d. Patient use of ambulatory care has decreased.

c.

One significant change in the health care delivery system in recent years is earlier hospital discharges. What is one result of earlier hospital discharges? a. Clients are in the hospital for a longer period of time. b. Clients are locked into prenegotiated payment rates that have remained unchanged. c. Clients with high home care needs are being discharged into the community. d. Client use of ambulatory care has decreased.

c.

The nurse is conducting discharge education on dressing change to a postoperative client and the spouse. The client's spouse appears anxious about changing the dressing correctly. Which is the best indicator that the spouse is competent to perform the dressing change? a. The spouse listens attentively as the nurse describes the procedure. b. The spouse is able to list all of the supplies needed for the dressing change. c. The spouse is able to correctly demonstrate performing the procedure. d. The spouse is able to list the steps to changing the dressing.

c.

The nurse is discussing the use of the client-controlled analgesia pump with the postoperative client. Which statement by the client indicates a need for additional education? a. "I am able to push the button when I am in pain." b. "The dose is set so I cannot overdose myself." c. "I should not press the button more often than every 3 to 4 hours." d. "The medicine will help me control my pain."

c.

The nurse is preparing to provide health education to a client with a new diagnosis of diabetes. Which action should the nurse perform to create an effective learning environment? a. Adopt a position of empathy while still communicating that the nurse is the expert in the teaching-learning environment. b. Be prepared to handle criticism during the teaching-learning process. c. Adopt a position in which the client and the nurse are equal participants. d. Prioritize the assimilation and application of psychomotor concepts

c.

The nurse is visiting a client who was released from inpatient rehabilitation 6 weeks ago after a 5-month recovery from a motor vehicle accident that left the client immobile. As the nurse enters the home, the client braces hands on the arms of a chair to rise and uses crutches to walk across the room. What is the best response by the nurse? a. "Let me document that you can walk." b. "Those physical therapists work wonders. c. "You have made an amazing recovery." d. "Are you supposed to be out of the wheelchair?"

c.

When caring for a diabetic client, the nurse notes that the client learns better when practicing the self-administration of the insulin injection alone. In which learning domain does this client's learning style fall? a. Cognitive b. Affective c. Psychomotor d. Interpersonal

c.

Which statement describes the person who is likely the most motivated to learn? a. A 29-year-old male whose significant other is insisting on the client receiving the education b. A 52-year-old male who has been hired to drive the client home from the clinic c. A 70-year-old female who is the client's spouse and is learning the care so the client can come home d. A 25-year-old female who just completed a course of physical therapy

c.

While applying dressings to a client's wound, the nurse teaches the client about his wound care. To promote the most effective teaching-learning relationship with this client, which of the following would be most important for the nurse to keep in mind? a. Nurses are experts who generously bestow knowledge upon clients b. Nurses barter knowledge of medication with the client for compliance c. The nurse and client relationship is based on mutual sharing and negotiation d. Nurses have control over the client because of their knowledge and expertise

c.

Nurses test new technology in phases. When will the nurses plan to "test drive" the new system? a. Unit b. Function c. User acceptance d. Integration

c. Rationale: During the phase "user acceptance," the nurse would "test drive" the new system to ensure it's working as designed. Unit testing is basic testing that occurs initially. Function testing uses test scripts to validate that a system is working as designed for one particular function. Integration testing uses test script to validate that a system is working as designed for an entire workflow that integrates multiple components of the system.

A nurse wants to be an ethical practitioner. When using informatics, which action best represents ethical practice? a. Selecting appropriate standardized care plans to meet the patient's needs b. Gathering data for research studies using the electronic health record of multiple patients c. Maintaining confidentiality of patient records within legal and regulatory parameters d. Carrying out all electronic orders entered by the health care provider

c. Rationale: The ANA asserts ethical use of informatics principles, standards, and methodologies to establish and maintain health care consumer confidentiality be used within legal and regulatory parameters.

Three critical developmental areas to consider when developing a teaching plan are: the patient's physical maturation and abilities, psychosocial development, and ______________ capacity.

cognitive

The deliberate organization of patient care activities between two or more participants involved in a patient's care to facilitate the appropriate delivery of health care services is known as care_______________.

coordination

A nurse and AP are planning to receive a patient who sustained a traumatic head injury in a motor vehicle accident. Which activity can the nurse safely delegate to the AP? a. Collecting information for a health history b. Performing a physical assessment c. Contacting the health care provider for medical orders d. Preparing the bed and collecting needed supplies

d.

A nurse asks the AP to prepare the hospital room for a new ambulatory patient. Which aspect of the room will the nurse ask the AP to correct? a. The bed linens are folded back. b. A hospital gown is on the bed. c. Equipment for taking vital signs is in the room. d. The bed is in the highest position.

d.

A nurse is caring for a patient who has been hospitalized for dehydration secondary to a urinary tract infection. The patient states, "I'm leaving. There are too many germs here, and I'll probably get sicker than when I came in." As this patient has capacity for decision making, which response is most consistent with the nurse's legal accountability? a. "Only the primary health care provider can authorize your discharge from a hospital." b. "Let me gather your belongings and prepare the discharge paperwork." c. "I will inform the health care provider that you want to leave and request a psychiatric consult." d. "Your choice carries risks for complications, so I must ask you to sign a release form."

d.

A nurse is testing a new computer program designed to store patient data. During which phase of testing does the nurse determine whether the system can handle high volumes of end users and care providers using the system at the same time? a. Unit b. Function c. Integration d. Performance

d. Rationale: Performance testing is technical and ensures proper functioning of the system and its ability to handle high volumes of care providers using the system at the same time. Unit testing is basic testing that occurs initially. Function testing uses test scripts to validate that a system is working as designed for one particular function. Integration testing uses test script to validate that a system is working as designed for a workflow that integrates multiple components of the system.

A nursing student who is planning their career trajectory tells the nurse preceptor how much they enjoy working with the electronic health record and informatics. What type of graduate program could the preceptor suggest? a. Clinical nurse specialist b. Nurse leader c. Superuser d. Informatics nurse specialist (INS)

d. Rationale: The INS is a registered nurse with formal graduate-level education in informatics. This nurse participates in strategy development, implementation, and maintenance and evaluation of clinical systems, in collaboration with multiple disciplines. The information nurse (IN) is a registered nurse with an interest or experience in informatics, who can assist with the implementation of the EHR or other types of informatics. "Superusers," often trained on the job, assist others to navigate the EHR. The clinical nurse specialist and nurse leader are patient care focused leadership roles.

A nurse on the rehabilitation unit is counseling a young adult athlete who sustained a traumatic below-the-knee amputation following a motorcycle accident. The patient refuses to eat or ambulate, stating, "What's the point? My life is over. I'll never be the football player I dreamed of becoming." What is the nurse counselor's best response? a. "You're young and have your whole life ahead of you. You should focus on your rehabilitation and make something of your life." b. "I understand how you must feel. I wanted to be a famous singer, but I wasn't born with the talent to be successful at it." c. "You should concentrate on other sports that you could play even with prosthesis." d. "I understand this is difficult for you. Would you like to talk about it now or would you prefer me to make a referral to someone else?"

d. Rationale: This answer communicates respect and sensitivity to the patient's needs and offers an opportunity to discuss their feelings with the nurse or another health care professional. The other answers do not allow the patient to express their feelings and receive the counseling they need.

Patient ________ is the process of influencing the patient's behavior to effect changes in knowledge, attitudes, and skills needed to maintain and improve health.

education

A comprehensive and coordinated care for patients with limited life expectancy, known as _____________, is provided in the patient's home and in institutional settings.

hospice

The ANA defines nursing ______________ as "the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice.

informatics

The process of ______ occurs when a person acquires or increases knowledge, or changes behavior in a measurable way, as the result of a teaching experience.

learning

Most private, ______________ home health care facilities are for-profit organizations governed by individual owners or national corporations whose services are paid for through health care insurance or individual self-pay.

proprietary

A __________ source is a person who recommends home health care services and supplies the home health care facility with details about the patient's needs.

referral

The informatics nurse may be a nurse who has assisted with the implementation of an EHR and is considered a "__________," with training being primarily on the job..

superuser

_______________is the use of telecommunications technologies to support the delivery of all types of medical, diagnostic, and treatment-related services, usually by physicians or nurse practitioners.

telemedicine

System ________ is "the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use"

usability

Data ________ is the presentation of data in a pictorial or graphical format.

visualization