NCLEX - basics

The nurse is planning the client assignments for the day and has an RN, LPN, and UAP. Which clients can be safely assigned to the LPN? 1. client scheduled for ultrasound of heart 2. client w/ open abdominal wound who requires irrigations q3 hours 3. client w/ spinal cord injury who requires intermittent urinary catheterization q4 hours 4. client newly dx w/ DM who requires teaching about insulin administration 5. client w/ PE who was admitted to hospital 2 hours ago and requires frequent respiratory assessments 6. client w/ central IV line whoo is receiving parenteral nutrition and lipids and has primary HCP's prescription to receive 2 units of packed RBC

- 1, 2, 3

African Americans & Blacks (care of special populations)

- 50% chronic health conditions (obesity, DM, HTN, HD, asthma, cancer) - leading causes of death HD, cancer, stroke

Licensed Practical Nurse (LPN) / licensed vocational nurse (LVN)

- A nurse who has completed a 1-year nursing program and has passed a licensing test - can assume some responsibilities that are invasive - Ex suctioning for tracheostomy, blood administration, medication administration

Nontherapeutic Communication Techniques

- Any method of communication that detracts from the therapeutic relationship. 1) APPROVAL - imply the client is thinking or doing what is right/wrong 2) EXCESS Qs - demand information w/o considering client's readiness 3) CHANGE Subject - not validating client's feelings 4) CLOSED-ended Qs - y/n q's 5) DISAGREE - implies client is wrong 6) DISAPPROVE - indicates negative value judgment about client 7) FALSE reassurance - don't worry be happy attitude belittles client's feelings 8) ADVICE - fosters client dependence and assumes client can't think for self 9) PARROTING - repeat what client says before determining what client has said 10) PLACE Client's Feelings on HOLD - makes them feel undervalued 11) VALUE judgments - addressing client morals can make them feel unsupported 12) POR QUE - asking all the why questions makes them feel defensive as if they have to justify how they feel

Advanced directives

- Communicates a client's wishes regarding and end-of-life care should the client become unable to do so. PSDA requires that all health care facilities ask if a patient has advanced directives upon admission. - 2 types = instructional directives & durable power of attorney for health care - instructional directives: lists medical treatment that a client chooses to omit or refuse if the client becomes unable to make decisions and is terminally ill - durable power of attorney for health care: appoints a person (health care proxy) chosen by the client to make health care decisions on the client's behalf when the client can no longer make decisions

Battered individuals and victims of abuse or neglect (care of special populations)

- HCP are often first point of contact for victims of abuse or neglect - at risk include older adults, children, females - abuse sequelae (physical, somatic, psychological, behavioral, sexual, pregnancy related effects) - sx include bruises, sprains, broken bones, chronic fatigue, SOB, muscle tension, involuntary shaking, changes in eating and sleeping patterns, sexual dysfunction, fertility issues *NURSES are MANDATED reporters of domestic violence and abuse incidents*

Contact precautions are used for what 4 types of diseases?

- Indicated for MRSA, VRE, diarrheal illnesses, open wounds, RSV, TB (used when caring for clients who have an infection that can be spread by direct or indirect contact such as draining wounds or splashes) - Type of transmission based precaution that requires use of a special particulate filter mask - used to prevent infection when infectious organisms can remain in the air for prolonged periods and can be transmitted in the air for distances greater than 3 feet

Droplet precautions are for what 2 diseases?

- Indicated for all meningitis and all influenza Pertusis, Diptheria, Mumps, All Meningitis - Type of transmission based precaution that requires use of a mask and are used when organisms can be spread by respiratory droplets but are unable to remain in the air farther than 3 feet.

Hispanics/Latinos (care of special populations)

- Language barriers and lack of access to preventative care influence health - 35% chronic health conditions (obesity, DM, end-stage renal disease secondary to diabetes, cervical cancer) - leading causes of death HD, cancer, accidents - important health topics diet, meal planning, exercise, safe sex practices

Medicare

- a federal health insurance program for persons aged 65+, certain younger people with disabilities and people with end stage renal disease requiring dialysis or renal transplant - Part A = covers hospital stays, skilled nursing facility stays, hospice care, some home health care - Part B = helps pay for some services not covered by part A. usually covers 80% and the remaining 20% is for customers and supplemental coverage - Part C = health plan offered by a private insurance agency that contracts with Medicare to supplement coverage - Part D = covers prescription medication needs

Medicaid

- a joint federal and state program that provides health benefits to eligible low income adults, children, pregnant women, elderly, disabled - major concern for fraud and abuse

Physician assistant (PA) role

- acts to limited extent in the role of physician during the physician's absence - conducts physical exams, dx procedures, assists in OR and ED, performs treatment - some have prescriptive powers

RN scope of practice

- administer IV medications by continuous IV, piggyback, and IV push - initiate client teaching - nursing process (assess, analyze, plan, implement, evaluate)

Types of consent

- admission agreement (obtained at time of admission and ID health care agency's responsibility to the client) - immunization consent (may be required before administration of certain immunizations where client was informed of benefits and risks of immunization) - blood transfusion consent (client informed benefits and risks of transfusion) - surgical consent (used for all surgical and invasive procedures or dx tests that are invasive. primary HCP, anesthesiologist, surgeon responsible for explaining risks and benefits, and alternative options) - research consent (permission for client participation in research study of risks, consequences, benefits of research) - special consent (required for restraints, photographing client, disposal of body parts during surgery, organ donation post humous, performing autopsy) *clients can waive the informed consent and right to refuse information and still undergo treatment, however this must be documented in medical record*

Homeless (care of special populations)

- affects everyone - risk for early death r/t chronic illness, substance abuse, environmental exposures, communicable diseases, cardiovascular / respiratory disorders, skin disorders, mental illness - mental health, coexisting substance abuse disorders, disability from illness (barrier for further employment), - infants of homelessness LBW, increased risk die w/in first 12 months of life - children sick, asthma, iron deficient, lead poisoning, ear infections, GI illness, mental health/behavioral problems, when basic needs are unmet can act out or become less attentive - youth risk taking behaviors (ETOH, drug abuse, depression, suicide, unintended PG, STI, HIV/AIDS) - Avoid certain medications d/t increased risk of interactions, unintended SE (albuterol, benzodiazepines, beta blockers, bupropion, Ca2+ channel blockers, clonidine, NSAIDs, quetiapine, sulfonylureas diabetic meds, statins)

Transgender

- an umbrella term describing people whose gender identity or expression differs from that associated with their birth sex - includes MTF (male to female); FTM (female to male)

In a telephone call from emergency medical services, the nurse in the ED is told that several victims who survived a plane crash and are suffering from cold exposure will be transported to the hospital. What is the initial nursing action by the emergency department nurse? - call the nursing supervisor to activate the agency disaster plan - supply the trauma rooms w/ bottles of sterile water and normal saline - call intensive care unit to request nurses be sent to ED - call laundry department to request as many warm blankets as possible for ED

- call the nursing supervisor to activate agency disaster plan *Choose the umbrella term. This option includes all the other options below*

LPN/LVN scope of practice

- can perform certain invasive tasks and client care activities in addition to all UAP roles. - administer oral medication, IM injections, SQ injections, intradermal injections - administer rectal, vaginal, eye, ear, nose, topical medication - administer meds via GI tube - administer some IV piggyback medications - changing dressings - irrigating wounds - monitor IV flow rate - suctioning - teach basic hygiene and nutritional measures - urinary catheter - use nursing process (data collection, plan, implement, evaluate)

Cultural considerations for therapeutic communication

- communication style - use of eye contact - meaning of touch

components of telephone order prescription guidelines

- date and time of entry - repeat prescription to primary HCP and record prescription - begin with t.o. (telephone order), write primary HCP's name, sign the prescription - if another nurse witnessed prescription that nurse's signature follows - Primary HCP needs to countersign prescription w/in time frame according to agency policy

components of medication prescription

- date and time prescription written - medication name - medication dosage - route of administration - frequency of administration - primary HCP's signature

when are clients deemed mentally or emotionally incompetent?

- declared incompetent - unconscious - under influence of chemical agents such as alcohol or drugs - chronic dementia or other mental deficiency that impairs thought processes and ability to make decisions

occupational therapist roole

- develops adaptive devices that help chronically ill clients or clients with a disability perform ADL

Asian American (care of special populations)

- different types of cancer, TB, hepatitis - leading causes of death cancer, HD, stroke - some older women increased risk suicide

The nurse prepares to perform a sterile dressing change on an abdominal incision. The nurse explains the procedure to the client, washes her hands, and sets up the sterile field. The nurse should take which action next? - don sterile gloves - assess integrity of abdominal incision - don clean gloves and remove the old dressing - clean the wound with povidone-iodine solution as prescribed

- don clean gloves and remove the old dressing *visualize*

Nurse practitioner / Advanced practice registered nurse (APRN) role

- educated to diagnose and treat acute illness and chronic conditions - health promotion and maintenance - can work in family practice, internal medicine, acute gerontology, women's health or obstetrics, acute care, pediatrics,

ED triage system

- emergent priority 1 (highest) = life-threatening injuries and need immediate attention and continuous evaluation; high probability for survival when stabilized. *trauma victims, chest pain, severe respiratory distress or cardiac arrest, limb amputation, acute neurological deficits, chemical splashes with eyes - urgent priority 2 = require treatment and whose injuries have complications that are not life-threatening with treatment within 30 min to 2 hours; require continuous evaluation q 30-60 min after *oopen fractures with a distal pulse and large wounds* - non-urgent priority 3 = local injuries who do not have immediate complications and who can wait at least 2 hours for medical treatment, require evaluation q 1-2 hrs after

Sexual orientation terms

- encompassing terms used to describe a person's behavior, identity, or desire - ex MSM (men who have sex with men); WSW (women who have sex with women); gay; lesbian; asexual; bisexual; pansexual; queer; same-gender loving

Nursing delegation tasks

- ensure client safety - be aware of individual variations in work abilities - determine which tasks can be delegated and to whom - match the task to the delegatee based on the nurse practice act and appropriate position descriptions - provide directions that are clear, concise, accurate and complete - validate delegatee's understanding of the directions - communicate feelings of confidence to delegatee and provide feedback promptly after task is performed - maintain continuity of care as much as possible *not within the scope to worry about staff requests, convenience of clustering client rooms, or anticipated changes in unit (discharges)*

UAP scope of practice

- generally noninvasive tasks and basic client care activities - ambulation - basic skin care - bathing - client transport - grooming - hygiene measures - positioning - ROM exercises - Urine or stool collections

Special population groups

- groups of people that require sensitivity regarding their healthcare needs - includes racial/ethnic minorities; LGBTQ community; homeless; SEC disadvantaged individuals/families; intellectually disabled; abuse/neglect victims; single parents; foster children; mental illness; older adults; military veterans; prisoners; immigrants/refugees; individuals with chronic illness

Case management

- health care delivery strategy that supports managed care; it is an interdisciplinary health care delivery approach that provides comprehensive client care using available resources to promote quality and cost-effective care. - components = assessment, development of care plan, service coordination, referral, f/u, consultation, collaboration - core function = assessment, treatment planning, linking, advocacy, monitoring

Intellectually disabled (care of special populations)

- high risk for health disorders and undertreated d/t atypical sx presentation - communication barriers, poor historians (ask multiple times in a variety of ways) - risk for motor deficit, epilepsy, allergies, otitis media, GERD, dysmenorrhea, sleep problems, mental illness, vision and hearing impairment, constipation, oral health problems

Native Hawaiian or Other Pacific Islander (care of special populations)

- higher rates of smoking, alcohol consumption, obesity, DM - higher incidence of SIDS and infant mortality - prevalent diseases are Hep B, HIV, AIDS, TB

Unlicensed Assistive Personnel (UAP)

- individual who is trained to function in an assistive role to the licensed registered nurse in the provision of patient activities as delegated by and under the supervision of the RN - can only assume responsibilities that are noninvasive - Ex ambulation, repositioning patient, ROM exercises, collecting urine

Informed consent for the treatment of minors

- parents normally must give informed consent (anesthesia, surgery, blood administration) for treatment of a minor - some exceptions to this include the need for emergency treatment; when the consent of the minor is sufficient (STI treatment); or when a court order or other legal authorization has been made

The nurse is caring for a client with a diagnosis of heart failure who suddenly experiences severe dyspnea and suspects that pulmonary edema has developed. What is the immediate nursing action? - insert a foley catheter - place the client in high-fowler's position - obtain a vial of furosemide and a syringe - obtain a dose of morphine sulfate from the opioid medication drawer

- place the client in high-fowler's position *remember this asks for immediate and nursing action so remember nursing scope*

What is the goal for critical pathways

- provide interprofessional collaboration to anticipate and recognize negative variance (client problems) early so that appropriate action can be taken and positive client outcomes can result

The nurse is providing dietary instructions to a client about a low-fat diet. The nurse should make which statement to the client - never use butter for cooking - drink fluids only if they are fat free - eat foods that have less than 1% fat content only - read the labels on food items to determine the fat content

- read the labels on food items to determine the fat content *eliminate close-ended words*

Important tool when working with clients of various backgrounds to ensure safety and mutual understanding

- return explanation and demonstration (teach-back)

The nurse is admitting an infant to the pediatric unit with a dx of respiratory synctial virus (RSV). The nurse anticipates that the primary health care provider will prescribe which measure? - ribavirin - a private room - contact precautions - strict handwashing procedures

- ribavirin *this question specifically asks for the HCP scope of practice and they can prescribe medications, all other options a nurse has the ability to do*

LGBTQIA+ (care of special populations)

- special population d/t discrimination - important to use preferred pronoun when addressing clients - transgender may have less access to screenings - high concern for STI, HIV, AIDS, syphilis, gonorrhea, HPV, anal cancers *HIGH risk depression, suicide, stressors (rejection from friends, family members, and social support systems), physical abuse from family members d/t sexual orientation* * TEENS increased risk for threats, bullying, injuries, rape, victimization - health promotion (depression screening, assessing for suicide, education safer sex practices, counseling for alcohol and drug abuse

The nurse receives a telephone call from the hospital admission office and is told that a client with HIV will be admitted to the nursing unit. In planning infection control measures for the client, which is the best type of isolation precaution that the nurse should prepare for? - droplet precautions - contact precautions - standard precautions - airborne precautions

- standard precautions *this includes blood and body fluid precautions and will prevent contact with infectious matter and protect a HCP from contracting the virus when providing care

In which cases are consent of minor sufficient?

- substance abuse treatment - treatment of STI, HIV testing, AID treatment - birth control, pregnancy, psychiatric services - minor is an emancipated minor (via marriage, PG, service in armed forces, court order) or court order or other legal authorization has been obtained

When delegating care for patients what is important to know?

- the RN is educationally prepared to assume the highest level of responsibility - HCP delegated to must be competent and skilled to perform assigned task or client activity

American Indians and Alaska Natives (care of special populations)

- tribal and community attachment - cultural barriers, geographic isolation, low income prevent population from receiving quality health care - 1/3 population smokes (18 y/o +) - higher incidence DM, stroke - leading causes of death HD, cancer, malignant neoplasm, CVD, accidents *HIGH risk altered mental health, suicide, SIDS, teenage pregnancy, liver disease, hepatitis*

Lewin's Change Model

- unfreezing (ID problem and individuals involved gather facts and evidence supporting a basis for change) - changing (change is planned and implemented) - refreezing (change becomes stabilized)

communication questions

- use therapeutic communication techniques to answer communication questions (client focused, caring, answers question) - focus on feelings, concerns, anxieties, or fears of client - consider cultural and spiritual differences - select client-focused option

A client scheduled for CT scan of abdomen asks the nurse when the results of the test will be available. The nurse should make which most appropriate response to the client? - your doctor may have the results in about 3 days - the results will not be available for at least a week - you must ask the CT tech for that information - every scan is read by a radiologist and this process always takes 1 week

- your doctor may have the results in about 3 days *avoid closed-ended words*

therapeutic communication techniques

1) ACTIVE LISTENING - Shows clients that they have your undivided attention 2) OPEN-ENDED QUESTIONS - Used initially to encourage clients to tell their story in their own way. Ask questions in a language that a client can understand 3) FOCUSING - direct conversation to topic 4) CLARIFYING - Questioning clients about specific details in greater depth or directing them toward relevant parts of the history. 5) SUMMARIZING - Validates the accuracy of the story. 6) Offering self to help - includes staying w/ client, talk to client, offer help to client 7) BROAD OFFERINGS - ensures patient centered care by allowing client to select topics of discussion 8) RESTATE 9) REFLECT - say what you understood that the patient has said 10) SILENCE - allow time to formulate thoughts 11) VALIDATE - verify information being talked about

The nurse is caring for a client who is diagnosed with a terminal disease. The nurse should plan which appropriate interventions in the care of the client? SATA - offer to contact the clergy to support the client's spiritual needs - make referrals to other disciplines based on the client's stated needs - plan to balance client's need for assistance with that for independence - provide extremely thorough answers to each question asked by client or family - ask client about goals for treatment plan and how she or he can best be assisted in achieving these goals

1, 2, 3, 5 - extremely thorough answers can be overwhelming to the family at this time. Also avoid closed-ended words.

Ampule medication preparation

ampule is a small container usually made of glass that contains a single dose of medication - tap the top chamber until the medication lies in the lower area - place alcohol wipe around the neck of the ampule - snap the top so that it opens away from the nurse - withdraw medication without injecting air into the ampule

Why shouldn't family members be used as interpreters for clients?

confidentiality HIPAA policy, conflict of interest potential, risk associated w/ relaying inaccurate information