Unit 2 Exam= Fundamentals

The nurse is assessing a patient's functional performance. What assessment parameters will be most important in this assessment? a. Continence assessment, gait assessment, feeding assessment, dressing assessment, transfer assessment b. Height, weight, body mass index (BMI), vital signs assessment c. Sleep assessment, energy assessment, memory assessment, concentration assessment d. Health and well-being, amount of community volunteer time, working outside the home, and ability to care for family and house

A Functional impairment, disability, or handicap refers to varying degrees of an individual's inability to perform the tasks required to complete normal life activities without assistance. Height, weight, BMI, and vital signs are part of a physical assessment. Sleep, energy, memory, and concentration are part of a depression screening. Healthy, volunteering, working, and caring for family and house are functional abilities, not performance.

The nurse administrator is doing a study that entails gathering data about new employees over a 10-year period. Which research method would be the best one to use for this type of study? a. Quantitative longitudinal cohort b. Qualitative longitudinal c. Qualitative interview d. Qualitative case study

A Quantitative research has been defined as being "focused on the testing of a hypothesis through objective observation and validation." The types of studies that make up this category include randomized controlled studies, cohort studies, longitudinal studies, case-controlled studies, and case reports. The other options are examples of quantitative, not qualitative, studies.

The nurse is assessing a patient's functional abilities and asks the patient, "How would you rate your ability to prepare a balanced meal?" "How would you rate your ability to balance a checkbook?" "How would you rate your ability to keep track of your appointments?" Which tool would be indicated for the best results of this patient's perception of their abilities? a. Functional Activities Questionnaire (FAQ)TM b. Mini Mental Status Exam (MMSE) c. 24hFAQ d. Performance-based functional measurement

A The FAQ is an example of a self-report tool which provides information about the patient's perception of functional ability. The MMSE assesses cognitive impairment. The 24hFAQ is used to assess functional ability in postoperative patients. Performance-based tools involve actual observation of a standardized task, completion of which is judged by objective criteria.

The nurse is assessing a patient's ability to perform basic activities of daily living (BADLs). Which activities are considered in the BADLs assessment? (Select all that apply.) A. Brushing teeth or dentures B. Dressing oneself in the mornings C. Washing, drying, and folding laundry D. Counting own pulse and taking heart pill E. Taking the bus to the park F. Calling family members

A, B BADLs include actions related to self-care and mobility and also include eating, personal hygiene, and grooming activities. Instrumental activities of daily living (IADLs) include shopping, meal preparation, housekeeping, doing laundry, managing finances, using the telephone, taking medications, and using transportation.

A student in the RN-BSN program is taking a research course. The instructor asks "What are the components of evidence-based practice (EBP)"? How should the student reply? (Select all that apply.) A. EBP relies on practice and research. B. Research utilization occurs after evaluation of all available evidence. C. EBP assists the nurse in the decision-making process. D. Research utilization and EBP are the same concept. E. EPB is more like performing a meta-analysis than is EBP.

A, B, C Evidence-based practice relies on practice and research. Before the research can be utilized it is important to see what the evidence supports prior to implementation. When a nurse is uncertain of a practice question, the evidence can be used for best practices. Research utilization is using the evidence found in the research EPB occurs after the evaluation of all available evidence.

How does the Iowa model transcend mere nursing care? (Select all that apply.) a. It includes formalized internal feedback loops. b. Its triggers can have their origins practically anywhere. c. It generates change in practice solely through research. d. It implies a layer of policy development. e. It addresses multiple disciplines' impacts on quality.

A, B, D, E, The triggers addressed within the Iowa model process can be problem focused and evolve from risk management data, process improvement data, benchmarking data, financial data, and clinical problems. The triggers can also be knowledge focused, such as new research findings, change in a national agency's or an organization's standards and guidelines, expanded philosophy of care, or questions from the institutional standards committee. Because the Iowa model is often implemented at a fairly high level of nursing or hospital administration, it scrutinizes the input of nursing and other disciplines in its process. Its output is applied as widely as possible throughout the organization, and it can affect policy within a multihospital system and even across systems. The success of EBP is determined by all involved, including healthcare agencies, administrators, nurses, physicians, and other healthcare professionals.

Which interventions are priorities in a plan of care for a patient who had a stroke 30 days ago and is now in home care rehabilitation? (Select all that apply.) A. Promoting rest and sleep B. Promoting a diet rich in protein C. Promoting exercise and ambulation D. Assisting the patient with ADLs E. Limiting visitors and social contacts

A, C It is important to promote independence in ADLs early in the plan of care to increase independence in general. Promoting rest and sleep will promote well-being. Ambulation and exercise promote well-being and increase healing by circulating oxygen to the brain. Protein promotes healing in postsurgical patients but is not a main focus in stroke patients. Assisting the patient does not promote independence. Limiting visitors will isolate the patient, which can lead to depression.

The nurse is conducting a review of the literature for pain management techniques. Which of the following should the nurse consider when conducting research that yields solid EBP? (Select all that apply.) a. Search the literature to uncover evidence to answer the question. b. Evaluate the outcome. c. Use the nursing process to evaluate evidence. d. Evaluate the evidence found. e. Develop an answerable question. f. Develop a question that has not been answered. g. Apply the evidence to the practice situation.

A,B,D,E,G To facilitate the use of evidence, steps have been developed to systematically approach a question of patient care. The steps are outlined as follows: • Develop an answerable question. • Search the literature to uncover evidence to answer the question. • Evaluate the evidence found. • Apply the evidence to the practice situation. • Evaluate the outcome. • The nursing process is a method of problem solving and can be used to develop a plan of care. Formulating a question that has not been answered in the research would be considered primary research. Therefore, there is no evidence in which to draw from.

Which are exemplars of negative/dysfunctional family dynamics? A. Codependency B. Divorce/remarriage C. Marital infidelity D. Sibling rivalry E. Traumatic injury of a family member

A,C,D Codependency, marital infidelity, and sibling rivalry are exemplars of negative/dysfunctional family dynamics. Divorce/remarriage and traumatic injury of a family member are exemplars of changes to family dynamics.

The nurse is assessing a patient with a mobility dysfunction and wants to gain insight into the patient's functional ability. What question would be the most appropriate? a. "Are you able to shop for yourself?" b. "Do you use a cane, walker, or wheelchair to ambulate?" c. "Do you know what today's date is?" d. "Were you sad or depressed more than once in the last 3 days?"

B "Do you use a cane, walker, or wheelchair to ambulate?" will assist the nurse in determining the patient's ability to perform self-care activities. A nutritional health risk assessment is not the functional assessment. Knowing the date is part of a mental status exam. Assessing sadness is a question to ask in the depression screening.

An array of assessment tools has been developed to assess activities of daily living (ADLs) as an indication of a person's functional ability. Some of these tools including the 24-Hour Functional Ability Questionnaire (24hFAQ) for outpatient postoperative patients, the Long Term Care Minimum Data Set (MDS) for nursing home patients, the Functional Status Scale (FSS) for hospitalized children, and the Edmonton Functional Assessment Tool for cancer patients are used to assess activities of daily living (ADLs). What is a disadvantage to these specific tools? A. The measurement of efficacy and reliability of the instruments are used to assess activities of daily living (ADLs). B. The variations in assessments and responses may be subjective because of self-reporting of functional activities. C. The instruments do not show a true measure of ability because of a lack of interactivity during the assessments. D. The information contained in the instruments is insufficient to make a determination about functional status in these populations.

B A disadvantage of many of the ADLs and instrumental activities of daily living (IADLs) instruments is the self-reporting of functional activities. Efficacy and reliability are not measured when assessing ADLs and IADLs. Interaction with the patient is necessary to complete the ADL and IADL assessments. The FAQ and FSS are comprehensive tools that can help the nurse determine functional status.

The daughter of an 84-year-old client is concerned about her mother's ability to live at home alone. Which assessment or tool should the nurse complete? A. Developmental assessment B. Functional assessment C. Life experiences survey D. Recent life changes questionnaire

B The nurse would complete a functional assessment of an individual's ability to carry out activities of daily living (ADLs) such as basic activities of daily living (BADLs) or instrumental activities of daily living (IADLs). The focus of the assessment to address the daughter's concern should be function, not overall development. The life experiences survey is aimed at identifying those in need of guidance relative to stress and coping, as is the recent life changes questionnaire.

The nurse in the outpatient setting would like to conduct a research study that compares patients who take tramadol (Ultracet) to patients who take oxycodone hydrochloride and acetaminophen (Percocet) for managing back pain. Which quantitative research method should yield the best results? a. Longitude study b. Randomized controlled study c. Systematic reviews/meta-analysis d. Survey study

B A randomized controlled study is a type of quantitative research that seeks to control and examine the variables to determine effectiveness. In this case, the variables would be those that were administered tramadol (Ultracet) and those that were administered hydrochloride and acetaminophen (Percocet) for managing back pain. Correlational research methods help determine association between or among variables. A longitudinal study examines variables over a designated course of time. A systematic review/meta-analysis is a type of literature review and not a research method. A survey study is a type of qualitative research method.

The nurse is assessing a patient's ability to perform instrumental activities of daily living (IADLs). Which activities are considered in the IADLs assessment? (Select all that apply.) A. Feeding oneself B. Preparing a meal C. Balancing a checkbook D. Walking E. Toileting F. Grocery shopping

B, C, F IADLs include shopping, meal preparation, housekeeping, doing laundry, managing finances, taking medications, and using transportation. The other activities listed are activities of daily living (ADLs) related to self-care. IADLs are more complex skills that are essential to living in a community.

Which statements are true about the Iowa model of EBP? (Select all that apply.) a. It addresses utilization of research findings at an individual level. b. It addresses the relevance of the question to the organization. c. Individual nurses enact an Iowa decision tree when they examine risk management data. d. It identifies triggers capable of posing hazard or benefit. e. It reiterates that innovators embrace change far earlier than laggards.

B, D The Iowa model of EBP provides direction for the development of EBP in a clinical agency and as such focuses on the relevance of the question to the organization. In a healthcare agency, there are triggers that initiate the need for change, and the focus should always be to make changes based on best evidence. The Iowa model of EBP was revised in 2015 to provide additional feedback loops, detailed instructions, and inclusion of patient preferences.

A 65-year-old female patient has been admitted to the medical/surgical unit. The nurse is assessing the patient's risk for falls so that falls prevention can be implemented if necessary. Select all the risk factors that apply from this patient's history and physical. (Select all that apply.) a. Being a woman b. Taking more than six medications c. Having hypertension d. Having cataracts e. Muscle strength 3/5 bilaterally f. Incontinence

B,D,E,F Adverse effects of medications can contribute to falls. Cataracts impair vision, which is a risk factor for falls. Poor muscle strength is a risk factor for falls. Incontinence of urine or stool increases risk for falls. Men have a higher risk for falls. Hypertension itself does not contribute to falls. Taking medications to treat hypertension that may lead to hypotension and dizziness is a fall risk. Dizziness does contribute to falls.

The home care nurse is trying to determine the necessary services for a 65-year-old patient who was admitted to the home care service after left knee replacement. Which tool is the best for the nurse to utilize? a. Minimum Data Set (MDS) b. Functional Status Scale (FSS) c. 24-Hour Functional Ability Questionnaire (24hFAQ) d. The Edmonton Functional Assessment Tool

C The 24hFAQ assesses the postoperative patient in the home setting. The MDS is for nursing home patients. The FSS is for children. The Edmonton is for cancer patients.

The nurse is caring for an 85-year-old woman 6 weeks following a hysterectomy secondary to ovarian cancer. The patient will need chemotherapy and irradiation on an outpatient basis. The nurse should identify and address which barriers to healing? (Select all that apply.) A. Can feed herself and prepare meals but cannot drive to the store B. Lives on a fixed income and can balance her checkbook C. Experiences stress incontinence D. Cannot participate in activities at the senior center E. Lives alone and has no nearby relatives F. Has no transportation to the oncology clinic

C, E, F The patient will not be able to get treatment if she has no transportation or no relatives who live nearby who can help her with recovery. Stress incontinence increases the risk of falls because of urgency and rushing to get to the bathroom. Income and social abilities are lower priorities during this phase of recovery.

Which relationships and differences would one find when comparing evidence-based practice (EBP) and research utilization? (Select all that apply.) A. EBP relies totally on research evidence, as does research utilization. B. Research utilization occurs after evaluation of all available evidence. C. EBP implies internal decision making on the nurse's part. D. Research utilization cannot be imposed from above. E. EBP was a later historical development than was research utilization. F. EBP considers values before it mandates utilization. G. Research utilization is more like performing a meta-analysis than is EBP.

C,E,F,G Research utilization is seen as an organizational process rather than as a process to be implemented by an individual practitioner. Activities of research utilization include (1) identification and synthesis of multiple studies in a common conceptual area (research base), (2) transformation of the knowledge derived from a research base into a solution or clinical protocol, (3) transformation of the clinical protocol into specific nursing actions (innovations) that are administered to patients, and (4) clinical evaluation of the new practice to ascertain whether it produced the predicted result. Evidence-based practice requires synthesizing research evidence from randomized controlled trials, and these types of studies are limited in nursing. Extensive evidence has been generated through nursing research, but there is a need for more. A criticism of the EBP movement is that the development of evidence-based guidelines has led to a "cookbook" approach to health care. The benefits of EBP are improved outcomes for patients, providers, and healthcare agencies. The best research evidence has been synthesized in many areas by teams of expert researchers and clinicians and then used to develop strong evidence-based guidelines for practice.

A sentinel event refers to which situation? a. An event that could have harmed a patient, but serious harm didn't occur because of chance b. An event that harms a patient as a result of underlying disease or condition c. An event that harms a patient by omission or commission, not an underlying disease or condition d. An event that signals the need for immediate investigation and response

D A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof called sentinel, because it signals the need for immediate investigation and response. A near-miss refers to an error or commission or omission that could have harmed the patient, but serious harm did not occur as a result of chance. Harm that relates to an underlying disease or condition provides the rationale for the close monitoring and supervision provided in a healthcare setting. An adverse event is one that results in unintended harm because of the commission or omission of an act.

Which best describes terms related to research that attempt to determine an association between or among variables? A. Qualitative research B. Outcomes research C. Intervention research D. Correlational

D Correlational research attempts to determine an association between or among variables. Qualitative research studies the whole human's response, within an individual or a group framework. Outcomes research examines the results of care and measures the changes in the health status of patients. Intervention research investigates the effectiveness of an intervention.

The nurse in the psychiatric unit is involved in a research study for a depression medication. In the study, patients are randomly assigned to one depression medication and the other group is receiving no medication to treat the depression. What method of research are the patients involved with? a. Descriptive b. Correlational c. Quasi-experimental d. Experimental

D Experimental tests an intervention and includes both a control group and random assignment. This research study tests an intervention and includes both a control group and random assignment. Descriptive defines the magnitude of a concept and its characteristics. Correlational determines association between or among variables. Quasi-experimental tests an intervention and lacks either a control group or random assignment.

One of the first nurse researchers to document evidence-based practice for nursing was Florence Nightingale. What did Nightingale incorporate into her practice that made her practice different from her colleagues? a. Nightingale gathered scientific data. b. Nightingale calculated statistics to report her findings. c. Nightingale communicated her findings to powerful others. d. Nightingale based her nursing practice on her findings.

D Florence Nightingale had tried to develop the role of researcher by using evidence from her practice and implementing these findings. Evidence-based practice (EBP) includes conducting quality studies, synthesizing the study findings into the best research evidence available, and using that research evidence effectively in practice. Although gathering scientific data, calculating statistics to report findings, and communicating findings to powerful others are all important components of conducting research, Nightingale's action that most appropriately reflects the current nursing research priority is that she based her nursing practice on her findings.

The nurse is assessing a patient's functional ability. Which patient best demonstrates the definition of functional ability? a. Considers self as a healthy individual; uses cane for stability b. College educated; travels frequently; can balance a checkbook c. Works out daily, reads well, cooks, and cleans house on the weekends d. Healthy individual, volunteers at church, works part time, takes care of family and house

D Functional ability refers to the individual's ability to perform the normal daily activities required to meet basic needs; fulfill usual roles in the family, workplace, and community; and maintain health and well-being. The other options are good; however, healthy individual, church volunteer, part time worker, and the patient who takes care of the family and house fully meets the criteria for functional ability.

The nurse educator would identify a need for additional teaching when the student lists which example as a type of learning? a. Affective b. Cognitive c. Psychomotor d. Self-directed

D Self-directed is one approach to learning but is not considered a type or domain of learning. Self-directed would be a cognitive way of learning. Affective (feelings/attitude), cognitive (knowledge), and psychomotor (skills/performance) are the main domains of learning.

The nurse identifies the family with a child graduating from college as having which effect on the family life cycle? a. Minimal impact b. Considered to be a negative impact on the family unit c. Leads to role confusion d. Expectation of role change

D The family life cycle developmental theory focuses on the growth and development of changes in role relationships during transitional periods. A child graduating from college is an example of a transition which requires a role change. As this is a transition, one would expect to see a change so minimal impact would not be expected. Graduation does not imply that it will be a negative change on the family life cycle or lead to role confusion.

A nurse manager is reviewing interrelated concepts to the professional nursing role. Which factor should the nurse manager consider when addressing concerns about the quality of patient education? a. Adherence b. Developmental level c. Motivation d. Technology

D The interrelated concepts to the professional role of a nurse include health promotion, leadership, technology/informatics, quality, collaboration, and communication. Adherence, culture, developmental level, family dynamics, and motivation are considered interrelated concepts to patient attributes and preference.

The nurse is developing an interdisciplinary plan of care using the Roper-Logan-Tierney Model of Nursing for a patient who is currently unconscious. Which interventions would be most critical to developing a plan of care for this patient? a. Eating and drinking, personal cleansing and dressing, working and playing b. Toileting, transferring, dressing, and bathing activities c. Sleeping, expressing sexuality, socializing with peers d. Maintaining a safe environment, breathing, maintaining temperature

D The most critical aspects of care for an unconscious patient are safe environment, breathing, and temperature. Eating and drinking are contraindicated in unconscious patients. Toileting, transferring, dressing, and bathing activities are BADLs. Sleeping, expressing sexuality, and socializing with peers are a part of the Roper-Logan-Tierney Model of Nursing; however, these are not the most critical for developing the plan of care in an unconscious patient.

A nurse has designed an individualized nursing care plan for a patient, but the patient is not meeting goals. Further assessment reveals that the patient is not following through on many items. Which action by the nurse would be best for determining the cause of the problem? a. Assess whether the actions were too hard for the patient. b. Determine whether the patient agrees with the care plan. c. Question the patient's reasons for not following through. d. Reevaluate data to ensure the diagnoses are sound.

b. Determine whether the patient agrees with the care plan. Having patient and/or family provide input to the care plan is vital in order to gain support for the plan of action. The actions may have been too difficult for the patient, but this is a very narrow item to focus on. The nurse might want to find out the rationale for the patient not following through, but instead of directly questioning the patient, which can sound accusatory, it would be best to offer some possible motives. Reevaluation should be an ongoing process, but the more likely cause of the patient's failure to follow through is that the patient did not participate in making the plan of care.

An interpretivist nurse is caring for a patient in the hospital setting. Which factors will the interpretivist consider when caring for this patient? (Select all that apply.) 1. Context of care 2. The information from the chart 3. What the nurse personally brings to the caring encounter 4. Information from significant others and friends 5. The nurse's previous experiences, values, and emotions

1, 3, and 5 Interpretivist approaches situate the nurse squarely in the context of care and account for what the nurse personally brings to the caring encounter, including previous experiences, values, and emotions. The information from the chart and from others is gathered in the steps of the nursing process.

When planning to evaluate a patient's satisfaction with a teaching activity, what is the most appropriate strategy? a. Include a survey instrument. b. Observe for level of skill mastery. c. Present information more than one time. d. Provide for a return demonstration.

A A survey or questionnaires can be used to measure affective behavior change as well as patient satisfaction with the teaching experience. Observing for level of skill mastery would evaluate achievement of a psychomotor goal rather than satisfaction with the experience. Repeating information more than one time or in more than one way may be appropriate strategies to include in the teaching plan but would provide no evaluation data. Providing for a return demonstration would help in evaluating achievement of a psychomotor goal, not satisfaction with the activity.

The nurse and the patient are conversing face to face. What communication technique is being demonstrated? a. Linguistic b. Paralinguistic c. Explicit d. Metacommunication

A Conversing face to face, reading newspapers and books, and even texting are all common forms of linguistic communication. Paralinguistics include less recognizable but important means of transmitting messages such as the use of gestures, eye contact, and facial expressions. Explicit communication is not a therapeutic communication technique. Metacommunication factors that affect how messages are received and interpreted would include internal personal states (such as disturbances in mood), environmental stimuli related to the setting of the communication, and contextual variables (such as the relationship between the people in the communication episode).

The nurse manager of a pediatric clinic could confirm that the new nurse recognized the purpose of the HEADSS Adolescent Risk Profile when the new nurse responds that it is used to assess for needs related to a. anticipatory guidance. b. low-risk adolescents. c. physical development. d. sexual development.

A The HEADSS Adolescent Risk Profile is a psychosocial assessment screening tool which assesses home, education, activities, drugs, sex, and suicide for the purpose of identifying high-risk adolescents and the need for anticipatory guidance. It is used to identify high-risk, not low-risk, adolescents. Physical development is assessed with anthropometric data. Sexual development is assessed using physical examination.

A nurse is conducting a therapeutic session with a patient in the inpatient psychiatric facility. Which remark by the nurse would be an appropriate way to begin an interview session? a. "How shall we start today?" b. "Shall we talk about losing your privileges yesterday?" c. "Let's get started discussing your marital relationship." d. "What happened when your family visited yesterday?"

A The interview is patient centered; thus, the patient chooses issues. The nurse assists the patient by using communication skills and actively listening to provide opportunities for the patient to reach goals. In the distracters, the nurse selects the topic.

Which interrelated concept regarding patient attributes and preferences should the nurse take into consideration when providing patient education? A. Adherence B. Health promotion C. Quality D. Technology

A Adherence, culture, developmental level, family dynamics, and motivation are considered interrelated concepts regarding patient attributes and preferences. Interrelated concepts regarding the professional role of a nurse include health promotion, leadership, technology and informatics, quality, collaboration, and communication.

Aspects of safety culture that contribute to a culture of safety in a healthcare organization include which component? a. Communication b. Fear of punishment c. Malpractice implications d. Team nursing

A Aspects that contribute to a culture of safety include leadership, teamwork, an evidence base, communication, learning, a just culture, and patient-centered care. Fear of professional or personal punishment and concern about malpractice implications are considered barriers to a culture of safety. No model of nursing care has been related to a culture of safety.

When discussing the purposes of healthcare informatics with a nurse during orientation, the nurse educator would be concerned if the nurse orientee stated that which is one purpose of informatics? a. Develop a cognitive science. b. Improve disease tracking. c. Improve the health provider's work flow. d. Increase administrative efficiencies.

A Cognitive science is one of the theories that play a role in the implementation of informatics. Its development is not a purpose, and the nurse educator would use this incorrect response of the orientee to plan additional teaching about the purposes of healthcare informatics. Purposes of information health technology include to improve health provider work flow, improve healthcare quality, prevent medical errors, reduce healthcare costs, increase administrative efficiencies, decrease paperwork, and improve disease tracking.

When a nurse manager plans to address concerns about the quality of health promotion provided, what interrelated concepts regarding patient attributes should be considered? A. Culture B. Evidence C. Health policy D. Nutrition

A Culture, development, adherence, and motivation are patient attribute concepts. Interrelated concepts regarding professional nursing include evidence, healthcare economics, health policy, and patient education. Nutrition is a health and illness concept.

When discussing the purposes of nursing healthcare informatics with a staff nurse during orientation, a nurse educator should be concerned if the nurse orientee stated that which is a primary purpose of informatics? A. Develop a data management system. B. Improve disease tracking. C. Improve a health provider's work flow. D. Increase administrative efficiencies.

A Data management is an exemplar of health informatics, but it would not be a primary purpose for a bedside nurse. The nurse educator would use this incorrect response to plan additional teaching about the primary purposes of healthcare informatics for the staff nurse. Purposes of information health technology include improving health provider work flow, improving healthcare quality, preventing medical errors, reducing healthcare costs, increasing administrative efficiencies, decreasing paper work, and improving disease tracking.

Which are exemplars of the health informatics concept? a. Clinical research informatics b. Hardware and software c. Privacy and security d. Standard terminology

A Exemplars of the health informatics concept include clinical healthcare informatics, clinical research informatics, public/population health informatics, and translational bioinformatics. Hardware and software, privacy and security, and standardized information systems and terminology are considered attributes related to the concept, not exemplars.

A patient does not make eye contact with the nurse and is folding his arms at his chest. Which aspect of communication has the nurse assessed? A. Nonverbal communication B. A message filter C. A cultural barrier D. Social skills

A Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patient's social skills or whether a cultural barrier exists.

In which situation would formal patient education courses or classes be the most appropriate strategy? A. Address needs common to a group. B. Explain self-directed learning. C. Describe nursing interventions. D. Respond to questions of a patient's family.

A Group needs are often the focus of formal patient education courses or classes. Self-directed learning refers to an educational activity completed independently from the nurse or other healthcare providers. Describing nursing interventions with formal patient education courses or classes is not the most appropriate strategy, because most patient education is done by nurses during the explanation of an intervention, and that is a spontaneous, one-to-one activity. Formal courses or classes are not the most appropriate strategy to address a patient's or a family's questions; from a time perspective, it is not appropriate to have the patient or family wait for a class.

A staff nurse reports a medication error due to failure to administer a medication at the scheduled time. What is the charge nurse's best response? a. "We'll conduct a root cause analysis." b. "That means you'll have to do continuing education." c. "Why did you let that happen?" d. "You'll need to tell the patient and family."

A In a just culture the nurse is accountable for their actions and practice, but people are not punished for flawed systems. Through a strategy such as root cause analysis the reasons for errors in medication administration can be identified and strategies developed to minimize future occurrences. Requiring continued education may be an appropriate recommendation but not until data is collected about the event. Telling the patient is part of transparency and the sharing and disclosure among stakeholders, but it is generally the role of risk management staff, not the staff nurse.

The school nurse that incorporates seatbelt and helmet use in a high school class on health promotion is an as example of which strategies? A. Primary prevention B. Rehabilitation C. Secondary prevention D. Tertiary prevention

A Seatbelt and helmet use are considered primary prevention measures, or strategies aimed at optimizing health and disease prevention in general. Rehabilitation strategies are tertiary prevention measures, which minimize the effects of disease and disability. Secondary prevention strategies are measures designed to identify individuals in an early stage of a disease process so that prompt treatment can be started.

When there is evidence that supports a screening for an individual patient but not for the general population, the nurse would expect the United States Preventive Services Task Force Grading (USPSTF) to be what? a. No recommendation for or against b. Recommends c. Recommends against d. Strongly recommends

A The USPSTF Grading is an example of how evidence is used to make guidelines and determine priority. When there is evidence that supports a screening for an individual patient but not for the general population, there is no recommendation for or against screening the general population. Recommends is the grading when there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Recommends against is the grading when there is moderate or high certainty that the intervention has no net benefit or that the harms outweigh the benefits. Strongly recommends is the grading when there is high certainty that the net benefit is substantial.

Which are consequences for a staff nurse related to the use of health informatics? A. Clinical decision support tools B. Confidentiality of health data C. Decreased cost of health care D. Personal health record

A The availability of clinical decision support tools at the point of care would be a consequence for a staff nurse. Confidentiality of health data affects patients; a nurse might be involved in ensuring the security and privacy of health information and exchange. A decreased cost of health care would affect a patient; a nurse's ability to reduce duplication of services will influence costs. Adopting a personal health record would be a consequence for a patient.

The nurse has provided patient education on diabetes. What opportunity should be provided for the patient in order for the nurse to evaluate the goal of awareness of long-term effects of diabetes? A. Ask questions. B. Inject insulin. C. Meet exercise goals. D. Prepare a menu.

A The evaluation should match the goal. In this scenario, the goal is related to long-term effects, so providing an opportunity for the patient and family to ask questions gives the nurse information about their understanding of the content and allows the nurse to evaluate the cognitive and affective impacts of the teaching. Opportunities to inject insulin, meet exercise goals, and prepare a menu would be strategies to assess psychomotor domain learning, and this is not the goal of the teaching activity.

To promote safety, the nurse manager sensitive to point-of-care (sharp-end) and systems-level (blunt-end) exemplars works closely with administrators to address which organizational system exemplar? A. Care coordination B. Communication C. Diagnostic workup D. Fall prevention

A The most common safety issues at the blunt end include documentation/electronic records, team systems, environmental systems, error reporting/analysis systems, and regulatory systems. Each of the other options is classified as a point-of-care, sharp-end exemplar.

A nurse is planning to assess the structure of a family. Which question should the nurse ask? a. "Who lives with you in this home?" b. "Who does the grocery shopping?" c. "Who provides support in your family?" d. "How old are the members of your family?"

A The structure of the family includes who is in the family and what their relationship is. "Who does the shopping?" would provide information about family functioning. "Who provides support?" would provide information about family functioning. "How old are the members?" would provide information about family development.

The nurse is assessing a family composed of a married couple with three children, one from the wife's previous marriage and two from the union of this couple. This couple would be considered what type of family? A. Married-blended family B. Nuclear family C. Same-sex family D. Single-parent family

A This family is a married-blended family with one child from the wife's previous marriage and two children from the union of this couple. A nuclear family refers to the traditional male and female core family with one or more children. A same-sex family is one where two individuals of the same sex have an established relationship and commitment; this may be referred to as a homosexual couple or family, but the preferred term is same-sex family. A single-parent family refers to a family with one adult and one or more children.

Which concepts should a nurse consider to have the strongest links to technology and informatics? (Select all that apply.) A. Clinical judgment B. Ethics C. Leadership D. Professionalism E. Safety

A, B, C, E Professionalism refers to the attributes and behaviors of a nurse as a representative of the nursing profession and as a healthcare professional. There are many interrelated concepts that bear some relationship to health information technology and health informatics, including data, information, knowledge, wisdom, trust, health, health care, meaningful use, bandwidth, and interoperability. Others found in this book include clinical judgment, leadership, communication, collaboration, safety, evidence, care coordination, healthcare quality, ethics, health policy, and healthcare law.

A nurse is caring for a patient in a long-term care facility who has not been sleeping well. She notes that the patient is new to the facility, has been refusing therapy, and is also not eating well. The nurse interprets this to mean that the patient has been having trouble adjusting. The nurse decides to meet with the patient's care team. The team decides to assess the patient's willingness to participate in group recreational activities. The patient agrees to participate. After 1 week, the nurse reevaluates the plan of care and notes that the patient has been sleeping much better. Which of the following terms best describe processes used in the nurse's plan? (Select all that apply.) a. Clinical judgment b. Evidence-based practice c. The nursing process d. Collaborative care planning e. Positive reward process

A, C, D Clinical judgment is a reflective process by which the nurse notices, interprets, responds, and reflects in action. The nursing process is a process by which the nurse assesses, diagnoses, implements, and evaluates the nursing care plan. Consulting and gaining input from the healthcare team is collaborative care planning. Evidence-based practice refers to using interventions found in research studies. The positive reward process is not a term used in care planning.

The nurse is having a therapeutic conversation with a patient newly diagnosed with hypertension. Which communication techniques will most likely prove effective for this patient? (Select all that apply.) A. The nurse presents a laminated poster to the patient that depicts pictures of foods that would be on the low sodium diet. B. The nurse and patient engage in a humorous conversation about the top ten "what not to eat when you are being treated for hypertension." C. The nurse gives the patient a sheet full of information and asks the patient to read the information and let the nurse know if they have any questions. D. The nurse states the risk factors and statistics of patients who do not take their medications as prescribed. E. The nurse helps the patient identify weight loss goals that are reasonable. F. The nurse waits until the patient has been awake for a few hours before beginning the teaching plan.

A,B,E,F Effective communication has clarity and is goal-directed. Engaging techniques such as humor, visual props, and waiting for the patient to be more alert will increase the therapeutic interaction. Providing the patient with written materials is important; however, there is no way to gauge the effectiveness of the teaching and does not guarantee that the patient has read the information. It would be useful to implement the teaching plan and supplement the teaching with a handout at the end of the session to reinforce the teaching. Stating the consequences of not taking the medications is a scare tactic and may result in defensiveness or closed communication.

Which statement best describes clinical reasoning? 1. The mathematical calculation process by which a nurse verifies a medication dosage. 2. An iterative process of noticing, interpreting, and responding to the patient and how the patient responds to the nurse's actions 3. The process of a nurse using experiential knowledge to put everything together to make sense of it. 4. An inherently complex process influenced by many factors related to the particular patient and caregiving situation.

An iterative process of noticing, interpreting, and responding to the patient and how the patient responds to the nurse's actions Clinical reasoning is an iterative process of noticing, interpreting, and responding—reasoning in transition with a fine attunement to the patient and how the patient responds to the nurse's actions. Process orientation utilizes experimental knowledge. The holistic view is influenced by complex factors surrounding the patient and caregiving situation. A dosage calculation is a knowledge-based skill.

A mother complains to the nurse at the pediatric clinic that her 4-year-old child always talks to her toys and makes up stories. The mother wants her child to have a psychological evaluation. The nurse's best initial response is to a. refer the child to a psychologist immediately. b. explain that playing make believe is normal at this age. c. complete a developmental screening using a validated tool. d. separate the child from the mother to get more information.

B By the end of the fourth year, it is expected that a child will engage in fantasy, so this is normal at this age. A referral to a psychologist would be premature based only on the complaint of the mother. Completing a developmental screening would be very appropriate but not the initial response. The nurse would certainly want to get more information, but separating the child from the mother is not necessary at this time.

The staff nurse who uses informatics in promoting quality patient care is most likely to access data in which domain? a. Certified clinical information systems (CIS) b. Clinical healthcare informatics c. Public health/population informatics d. Translational bioinformatics

B Clinical healthcare informatics and the subset, nursing informatics, provides for the development of direct approaches to patients and their families which can be used by the staff nurse to promote quality patient care. Certified CIS refers to the tools for achieving quality outcomes, including electronic health records, clinical data repositories, decision support programs, and handheld devices—not the data. Public health/population informatics is the domain which relates information, computer science, and technology to public health science to improve the health of populations; this domain would provide data for the nurse working with communities. Translational bioinformatics refers to the research science domain where biomedical and genomic data are combined; it is a new term that describes the domain of where bioinformatics meets clinical medicine, generally for healthcare research rather than direct patient care.

Which tertiary prevention measure should be included in the health promotion plan of care for a patient newly diagnosed with diabetes? a. Avoiding carcinogens b. Foot screening techniques c. Glaucoma screening d. Seat belt use

B Foot screening is considered a tertiary prevention measure, one that minimizes the problems with foot ulcers, an effect of diabetic disease and disability. Avoiding carcinogens is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Glaucoma screening is considered secondary screening—measures designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Seat belt use is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity.

What is the process of enabling people to increase control over and improve their health? A. Community care B. Health promotion C. High-level wellness D. Primary prevention

B Health promotion is the process of enabling people to increase control over, and improve, their health, according to the World Health Organization. Community care refers to interventions directed at a community rather than a process. High-level wellness refers to a positive state of health for an individual, a family, or a community; it is not a process. Primary prevention refers to strategies aimed at optimizing health and disease prevention rather than a process.

The three elements of nursing competency described in the Quality and Safety for Nurses (QSEN) initiative are knowledge, skill, and which other element? A. Accountability B. Attitude C. Education D. Value

B The Robert Wood Johnson Foundation funded the national initiative called Quality and Safety for Nurses (QSEN), which builds on the work of the Institute of Medicine (IOM), defines safety, and outlines the necessary elements of knowledge, skill, and attitude to demonstrate safety in one's practice. Accountability is a critical aspect of a culture of safety; recognizing and acknowledging one's actions is a trademark of professional behavior, but accountability is not considered one of the three major elements of QSEN.

The mother of a 2 year old asks the nurse about her child's cognitive development. Which response by the nurse best describes the normal cognitive development of a 2-year-old child? A. At this age children begin thinking intuitively. B. Two year olds use magical thinking. C. At this age children can solve concrete problems. D. Two year olds use abstract thinking.

B The expected stage of development for a 2 year old is one with magical thinking, where a child begins to engage in make-believe play. Intuitive reasoning occurs by the end of the preoperational period (at 2-7 years of age). The ability to solve concrete problems occurs with the period of concrete operations (at 7-11 years of age). The formal operational period (at 11+ years of age) is when individuals use thinking that is logical and can consider abstract ideas.

What question should the nurse ask to assess the function of a family? A. Who lives with you? B. Who does the grocery shopping? C. Who are the members of your family? D. How old are the members of your family?

B The question "Who does the grocery shopping?" would provide information about family functioning and how individuals actually behave in relation to one another. The question "Who lives with you?" would provide information about the structure of the family. The question "Who are the members of your family?" provides information about the structure of the family. The question "How old are the members of your family?" would provide information about family development.

A nurse has prepared a discharge teaching plan for an adult patient who is not being compliant. Which strategy should the nurse include to help increase compliance with following discharge instructions? a. Individualized handout b. Instructional videos c. Internet resources d. Self-help books

B An instructional video would provide a visual/auditory approach for discharge instructions. Repeatedly not following written instructions is a clue that the patient may not be able to read or understand the information. While assessing the literacy level of an adult patient can be challenging, the information that they have not been able to follow previous written instructions would suggest that the nurse use an alternate strategy that does not require a high degree of literacy. An individualized handout would be written, very similar to previous instructions, and would not address a concern about literacy. Internet resources generally require an individual to be able to read, and although videos are available through the Internet, this is not the best response. Self-help books would be appropriate for an individual who reads. There is a question about whether this patient is literate, so these would not be the best choice.

To design and implement a decubitus ulcer risk management protocol in the electronic health record, the informatics nurse would first perform which action? a. Build the screens in the electronic health record. b. Determine evidence supporting decubitus ulcer risk management. c. Develop the training program for staff. d. Select the appropriate standardized language.

B Collecting the evidence related to the issue is the first step in addressing a problem (remember the nursing process, the foundation of nursing practice). Based on the evidence, an assessment tool or tools and data needed from a patient perspective would be identified. The screens in the electronic record would be based on the workflow surrounding the patient assessment. A training program could not be developed until the protocol is adopted. The appropriate standardized language is selected based on what needs to be documented and what has been approved for use by the agency (e.g., ANA recognized terminologies).

Which tertiary prevention measure is included in the plan of care for a patient newly diagnosed with asthma? A. Cholesterol screening B. Eliminating allergens C. Glaucoma screening D. Safe sex practices

B Eliminating allergens is considered a tertiary prevention measure, or one that minimizes the problems with asthma and potential responses to environmental triggers, effects of asthma disease, and disability. Cholesterol screening is considered a form of secondary screening, which involves measures designed to identify individuals in an early stage of a disease process so that prompt treatment can be started. Glaucoma screening is also considered a form of secondary screening. Safe sex practices are considered a form of primary prevention, or strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity.

At the well-child clinic, how does the nurse correctly teach a mother about health promotion activities and describe immunizations? a. Unique for children b. Primary prevention c. Secondary prevention d. Tertiary prevention

B Immunizations/vaccinations are considered primary prevention measures, those strategies aimed at optimizing health and disease prevention in general. Immunizations/vaccinations are primary prevention measures for individuals across the lifespan, not just children. Secondary prevention measures are those designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Tertiary prevention measures are those that minimize the effects of disease and disability.

Which communication term can be applied to this statement: How messages are received and interpreted would include personal states such as mood disturbance, environmental stimuli related to the setting of the communication, and contextual variables? A. Therapeutic communication B. Metacommunication C. Vigor communication D. Internal noise

B Metacommunication is a term which means how messages are received and interpreted would include personal states such as mood disturbance, environment stimuli related to the setting of the communication, and contextual variable. Therapeutic communication is consciously influencing communication to help patient understand plan of care. Vigor communication is used by advertisers for products such as soaps and foods are colorful, humorous and often quite memorable. Internal noise inhibits the ability to accurately receive and interpret messages.

Prior to drug administration the nurse reviews the seven rights, which include right patient, right medication, right time, right dose, right education, right documentation, and what other right? a. Room b. Route c. Physician d. Manufacturer

B The right route (e.g., oral or intramuscular) is an essential component to verify prior to the administration of any drug. The patient does not need to be in a specific location. There may be a number of physicians caring for a patient who prescribe medications for any given patient. A similar drug may be made by a number of different companies, and checking the manufacturer is not considered one of the seven rights. However, the nurse will want to be aware of a difference, because different companies prepare the same medication in different ways with different inactive ingredients, which can affect patient response.

The nurse is working with a patient diagnosed with posttraumatic stress disorder related to childhood sexual abuse. The patient is crying and states, "I should be over this by now; this happened years ago." Which response(s) by the nurse will facilitate communication? (Select all that apply.) a. "Why do you think you are so upset?" b. "I can see that this situation really bothers you." c. "The abuse you endured is very painful for you." d. "Crying is a way of expressing the hurt you're experiencing." e. "Let's talk about something else, since this subject is upsetting you."

B,C,D Reflecting and giving information are therapeutic techniques. "Why" questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.

A nursing instructor is explaining how clinical judgment is different than clinical reasoning and critical thinking. Which statements should the instructor include in the explanation? (Select all that apply.) A. Clinical judgment is an iterative process of noticing, interpreting, and responding. B. Clinical reasoning is the thinking process by which a nurse reaches a clinical judgment. C. Clinical judgment is the interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision whether or not to take action. D. Critical thinking is a cognitive process that is knowledge based and used for analysis of an issue or problem but is not situated or specific to a given patient. E. Clinical judgment requires the nurse to apply knowledge to the unique patient situation to make sense of it and respond appropriately in the specific context.

B,C,D,E Clinical judgment is the interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision whether or not to take action. It requires the nurse to apply knowledge to the unique patient situation to make sense of it and respond appropriately in the specific context. Critical thinking is a cognitive process that is knowledge based and used for analysis of an issue or problem but is not situated or specific to a given patient and clinical reasoning is the thinking process by which a nurse reaches a clinical judgment.

Which concepts should a nurse recognize have the strongest link to safety? (Select all that apply.) A. Cognition B. Communication C. Quality D. Regulation E. Teamwork

B,C,D,E Communication, quality, regulation, and teamwork are the concepts with the strongest links to safety and include processes that are essential for the nurse to consider related to safety. Safety refers to the prevention of injuries or freedom from accidents. Quality and safety are interrelated, overlapping concepts, and it is difficult to achieve outcomes in one without working on the other. Regulation refers to the mandates that have been credited with many of the improvements in health care systems, such as those from the Joint Commission, and to the oversight for the safety of the public provided by state boards of nursing. Teamwork and the ability of healthcare professionals to work together account for as much as 70% of healthcare errors. Cognition dependent on an optimally functioning brain could affect vigilance but would not be considered a concept that has one of the strongest links to safety.

A new graduate nurse is working with a nurse who has been out of school for 10 years. The experienced nurse states, "I don't see the difference between this clinical reasoning and the nursing process." Which statements by the graduate nurse are appropriate? (Select all that apply.) A. Clinical reasoning is limited to assessing, evaluating, and treating the nursing diagnosis. B. Clinical reasoning involves reflecting on interventions and reevaluating the plan of care based on the results of reflection. C. Clinical reasoning involves assessing, diagnosing, and planning and using interventions based on assessments. D. Clinical reasoning is the thinking process by which a nurse reaches a clinical judgment. E. Clinical reasoning is an iterative process of noticing, interpreting, and responding—reasoning in transition with a fine attunement to the patient and how the patient responds to the nurse's actions.

B,D, and E Clinical reasoning is an iterative process of noticing, interpreting, and responding—reasoning in transition with a fine attunement to the patient and how the patient responds to the nurse's actions. The nursing process is limited to assessment, diagnosis, planning, and developing interventions based on assessments.

Which statement made by a mother should raise concerns about a developmental delay? A. "My 3 month old raises her head and chest when lying down." B. "My 7 month old transfers blocks from one hand to the other." C. "My 7 month old never seems to smile." D. "My 1 year old seems shy or anxious with strangers."

C A 7 month old who never seems to smile should be a concern. The lack of smiling could be related to a number of developmental issues, including vision and hearing. By the end of 3 months, a child begins to develop a social smile, and by the end of 7 months, a child enjoys social play. A 3 month old is expected to raise her head and chest when lying down. A 7 month old is expected to be able to transfer blocks from one hand to the other. By the end of 1 year, a child is often shy or anxious and may experience what is referred to as separation anxiety.

A child uses two- to four-word sentences. The nurse should interpret this data as expected development for a child of what age? A. Two months B. One year C. Two years D. Three years

C A child of 2 years is expected to say several single words and use simple phrases and two- to four-word sentences. A child of 2 months may begin to babble and imitate some sounds. A child of 1 year is paying increasing attention to speech, babbles with inflection, and usually says "dada" and "mama." A child of 3 years is expected to understand most sentences and use four- to five-word sentences.

The nurse is seeking clarification of a statement that was made by a patient. What is the best way for the nurse to seek clarification? a. "What are the common elements here?" b. "Tell me again about your experiences." c. "Am I correct in understanding that ..." d. "Tell me everything from the beginning."

C Clarification ensures that both the nurse and the patient share mutual understanding of the communication. The distracters encourage comparison rather than clarification and present implied questions that suggest the nurse was not listening.

To plan early intervention and care for a child with a developmental delay, the nurse would consider knowledge of the concepts most significantly impacted by development, including a. culture. b. environment. c. functional status. d. nutrition.

C Function is one of the concepts most significantly impacted by development. Others include sensory-perceptual, cognition, mobility, reproduction, and sexuality. Knowledge of these concepts can help the nurse anticipate areas that need to be addressed. Culture is a concept that is considered to significantly affect development; the difference is the concepts that affect development are those that represent major influencing factors (causes); hence determination of development would be the focus of preventive interventions. Environment is considered to significantly affect development. Nutrition is considered to significantly affect development.

The nurse caring for a patient would identify a need for additional interventions related to family dynamics when? a. extended family offers to help. b. family members express concern. c. the ill member demands attention. d. memories are shared.

C It is not uncommon for the ill family member to become demanding and indicate that they deserve special treatment and care, and the supportive family may need assistance in understanding the dynamics of the illness in order to continue to be supportive. Offers from extended family to help can be indicative of positive dynamics. Concern expressed by family members can be indicative of positive dynamics. Sharing of family memories can be indicative of positive dynamics.

To address a goal of improving the health of populations, a nurse is most likely to use which domain of informatics? A. Certified clinical information systems B. Clinical healthcare informatics C. Public health/population informatics D. Translocational bioinformatics

C Public health/population informatics is the domain that relates information, computer science, and technology to public health science to improve the health of populations; this domain would provide data for a nurse working with communities. Certified clinical information systems (CISs) refers to the tools used for achieving quality outcomes, including electronic health records, clinical data repositories, decision support programs, and handheld devices, not to the data. Clinical healthcare informatics and the subset nursing informatics provide for the development of direct approaches to patients and their families that can be used by a staff nurse to promote quality patient care. Translational bioinformatics refers to the research science domain where biomedical and genomic data are combined; it is a new term that describes the domain where bioinformatics meets clinical medicine and generally applies to healthcare research rather than direct patient care.

A 17-year-old girl is hospitalized for appendicitis, and her mother asks the nurse why she is so needy and acting like a child. The best response of the nurse is that in the hospital, adolescents a. have separation anxiety. b. rebel against rules. c. regress because of stress. d. want to know everything.

C Regression to an earlier stage of development is a common response to stress. Separation anxiety is most common in infants and toddlers. Rebellion against hospital rules is usually not an issue if the adolescent understands the rules and would not create childlike behaviors. An adolescent may want to "know everything" with their logical thinking and deductive reasoning, but that would not explain why they would act like a child.

The nurse preparing a teaching plan for a preschooler knows that, according to Piaget, the expected stage of development for a preschooler is a. concrete operational. b. formal operational. c. preoperational. d. sensorimotor.

C The expected stage of development for a preschooler (3-4 years old) is pre-operational. Concrete operational describes the thinking of a school-age child (7-11 years old). Formal operational describes the thinking of an individual after about 11 years of age. Sensorimotor describes the earliest pattern of thinking from birth to 2 years old.

A primary healthcare provider has recommended a mammogram and a Papanicolaou (pap) smear for a 50-year-old female patient. In response to questions, the nurse teaches the patient about health promotion activities, describing the mammogram and pap smear as which forms of prevention? A. Illness prevention B. Primary prevention C. Secondary prevention D. Tertiary prevention

C A mammogram and a pap smear are cancer screening measures. They are considered secondary prevention measures, which are designed to identify individuals in an early stage of a disease process so that prompt treatment can be started. Illness prevention is considered a primary prevention measure, or strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Tertiary prevention measures are strategies that minimize the effects of disease and disability.

A nurse is preparing to implement a teaching plan. Which factor might be considered to be a barrier to patient education? a. Family resources b. High school education c. Hunger and pain d. Need perceived by patient

C A patient who is hungry or in pain has limited ability to concentrate or learn. Family resources would be considered in developing a plan of care and could be an asset or a barrier to patient education. The patient's educational level would be considered in planning teaching strategies but would not be a barrier to education. A need perceived by a patient would provide motivation for learning and would not be a barrier.

What is the most appropriate resource to include when planning to provide patient education related to a goal in the psychomotor domain? a. Diagnosis-related support groups b. Internet resources c. Manikin practice sessions d. Self-directed learning modules

C A teaching goal in the psychomotor domain should be matched with teaching strategies in the psychomotor domain, such as demonstration, practice sessions with a manikin, and return demonstrations. Diagnosis-related support groups would be most effective with goals in the affective domain. Internet resources would be most effective for goals in the cognitive domain. Self-directed learning modules would be most effective for goals in the cognitive domain.

Two female adults have an established long-term relationship and are attending parenting classes in anticipation of finalizing the adoption of their first baby. This couple demonstrates understanding of potential effects on family dynamics when making which statement? A. "Our relationship with one another will not be affected." B. "Any stress will finally be over once the baby arrives." C. "Communication may be a challenge since we'll be busier." D. "Codependency is important to support each other."

C Addition of children, whether by birth, adoption, or blending families, increases the complexity of interactions in a family, introduces stress, and provides the potential for growth and maturation. Communication and interactions between family members are affected with the addition of new family members. Addition of any new family may place added stress on the relationship of the couple. Codependency refers to the dependence on another individual, usually family member, who actually contributes to negative behaviors, such as substance abuse.

When reviewing the purposes of a family assessment, the nurse educator would identify a need for further teaching if the student responded that family assessment is used to gain an understanding of which aspect of the family? a. Development b. Function c. Political views d. Structure

C An understanding of the political views of family members is not a primary purpose of a family assessment. A family assessment provides the nurse with information and an understanding of family dynamics. This is important to nurses for the provision of quality health care. A family assessment provides an understanding of family development, function, and structure.

When teaching a patient with a family history of hypertension about health promotion, the nurse describes blood pressure screening as which type of prevention? a. Illness b. Primary c. Secondary d. Tertiary

C Blood pressure screening is considered secondary prevention. It is a measure designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Illness prevention is considered primary prevention. Primary prevention measures are those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Tertiary prevention measures are those that minimize the effects of disease and disability.

When an error or patient safety issue is identified in an agency with a culture of safety, what does the individual who reports the problem know? A. Established protocols for discipline will be followed. B. The problem must be communicated to the patient. C. Near misses in health care are used to improve care. D. Details need to be shared in order to locate the individual at fault.

C In an agency with a culture of safety, a nurse knows that near misses are used to improve care. Individual people are not punished for flawed systems, and there are no protocols for discipline. Consequences are individualized to improve the system and minimize the opportunity for future problems. Telling the patient is part of the transparency and the sharing and disclosure among stakeholders but is generally the responsibility of the risk management staff, not the staff nurse. Through a strategy such as root cause analysis, the reasons for errors in medication administration can be identified and strategies developed to minimize future occurrences, not to point a finger at a certain person.

The most appropriate response of the nurse when a mother asks what the Denver II does is that it a. can diagnose developmental disabilities. b. identifies a need for physical therapy. c. is a developmental screening tool. d. provides a framework for health teaching.

C The Denver II is the most commonly used measure of developmental status used by healthcare professionals; it is a screening tool. Screening tools do not provide a diagnosis. Diagnosis requires a thorough neurodevelopment history and physical examination. Developmental delay, which is suggested by screening, is a symptom, not a diagnosis. The need for any therapy would be identified with a comprehensive evaluation, not a screening tool. Some providers use the Denver II as a framework for teaching about expected development, but this is not the primary purpose of the tool.

Two women have an established long-term relationship and are attending parenting classes in anticipation of finalizing adoption of a baby. The nurse identifies them as which type of family? a. Cohabiting b. Nuclear c. Same-sex d. Single parent

C This family would be considered a same-sex family. Cohabiting refers to a couple who live together with no legal bond. Nuclear refers to the traditional male and female core family with one or more children. Single parent refers to a family with one adult and one or more children.

The application of information processing that deals with the storage, retrieval sharing, and use of healthcare data, information, and knowledge for communication and decision making is the definition of which area? a. Computer science b. Health informatics c. Health information technology d. Nursing informatics

C This is the definition of health information technology. Computer science is a branch of engineering that studies computation and computer technology, hardware, software, and the theoretical foundations of information and computation techniques. Health informatics is a discipline in which health data are stored, analyzed, and disseminated through the application of information and communication technology. Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.

Which nursing action indicates that a nurse is more likely to incur a medication error during medication administration? a. Checks the original medication order on the patient's chart b. Asks the patient to state his/her name and date of birth c. Does not scan the barcode of the patient prior to administering the medication d. Does not provide the patient with a glass of water

C Use of barcode scanning of both the medication and the patient's hospital band is critical to maintaining safe practice during medication administration. The nurse by not scanning the barcode is not maintaining the required elements and as a result is more likely to incur a medication error. Checking the original order and asking the patient to provide identification are required elements. Not providing a glass of water to the patient is not related to a medication error but does not represent best practice unless the patient is NPO except meds which would require sips of water.

A nurse manager is reviewing interrelated concepts to professional nursing. Which concepts should the nurse manager consider when addressing concerns about the quality of health promotion? (Select all that apply.) a. Culture b. Development c. Evidence d. Nutrition e. Health policy

C and E The interrelated concepts to professional nursing include evidence, healthcare economics, health policy, and patient education. Culture is a patient attribute concept. Development is a patient attribute concept. Nutrition is a health and illness concept.

The nurse is admitting a new patient to the psychiatric unit. Which factors will most likely contribute to a positive outcome of the interaction? (Select all that apply.) A. The patient is in a bad mood. B. The patient states that he or she is in pain. C. The unit is quiet. D. The patient has been admitted to the facility in the past. E. The patient is awake, alert, and oriented to person, place, and time. F. There are various interactive sessions going on in the unit today.

C,D,E Positive outcomes for interactions include factors such as the relationship between participants, internal mood states, mental and physical condition, experience and education, and external noise emanating from the environment. Noisy environments increase stress, as does pain. If the patient is in a bad mood, it may be best to address this issue prior to completing the admission because the patient will be more receptive.

To plan early intervention and care for an infant with Down syndrome, the nurse considers knowledge of other physical development exemplars such as a. cerebral palsy. b. autism. c. attention-deficit/hyperactivity disorder (ADHD). d. failure to thrive.

D Failure to thrive is also a physical development exemplar. Cerebral palsy is an exemplar of motor/developmental delay. Autism is an exemplar of social/emotional developmental delay. ADHD is an exemplar of a cognitive disorder.

The school nurse talking with a high school class about the difference between growth and development would best describe growth as a. processes by which early cells specialize. b. psychosocial and cognitive changes. c. qualitative changes associated with aging. d. quantitative changes in size or weight.

D Growth is a quantitative change in which an increase in cell number and size results in an increase in overall size or weight of the body or any of its parts. The processes by which early cells specialize are referred to as differentiation. Psychosocial and cognitive changes are referred to as development. Qualitative changes associated with aging are referred to as maturation.

A student nurse receives an order for diazepam to be given intravenously. Diazepam tablets are available. The student nurse crushes a tablet and mixes it with sterile water for injection. The instructor notes that the solution is cloudy and asks to see the medication vial. When the student produces the vial of sterile water for injection and the instructor stops the medication from being given, what type of error is prevented? A. Communication error B. Diagnostic error C. Preventive error D. Treatment error

D The nurse avoided a treatment error; she was prevented from giving the wrong type of medication. Diazepam (Valium) for intravenous administration is clear and comes prepared in a vial labeled for intravenous administration. According to Leape, treatment errors occur in the performance of an operation, procedure, or test; in administering a treatment; in the dose or method of administering a drug; or in an avoidable delay in treatment or in responding to an abnormal test. A communication error results from a failure to communicate. Diagnostic errors are the result of a delay in diagnosis, a failure to employ indicated tests, the use of outmoded tests, or a failure to act on results of monitoring or testing. Preventive errors occur when there is a failure to provide prophylactic treatment when monitoring is inadequate, or when follow-up of treatment is inadequate.

The nurse is admitting a patient to the medical/surgical unit. Which communication technique would be considered appropriate for this interaction? a. "I've also had traumatic life experiences. Maybe it would help if I told you about them." b. "Why do you think you had so much difficulty adjusting to this change in your life?" c. "You will feel better after getting accustomed to how this unit operates." d. "I'd like to sit with you for a while to help you get comfortable talking to me."

D Because the patient is newly admitted to the unit, allowing the patient to become comfortable with the setting is a technique that can assist in establishing the nurse-patient relationship. It helps build trust and conveys that the nurse cares about the patient. The nurse should not reveal their life experiences as this is not therapeutic. Asking why the patient is having difficulty may provide insight; however, this would be best saved for an established relationship with the patient. Assuring the patient that they will feel better may not be true depending on the reason for the admission.

A patient tells the nurse about plans to do research about the patient's diagnosis and potential treatment on the Internet. What is the nurse's most appropriate initial response? A. Discount the reliability of the Internet. B. Evaluate the patient's computer competency. C. Provide a list of recommended sources. D. Teach about evaluation of Internet resources

D Evaluation of resources is an essential component of gathering information from the Internet, and the nurse would want to be sure the patient finds valid and reliable information. A majority of adults in the United States use the Internet to find information on many aspects of life, and this use of technology expands the role of the nurse in patient education to include teaching on how to evaluate Internet sources. Discounting the reliability of the Internet would not support the positive behavior and motivation of the patient to learn. The nurse would want to evaluate what the patient learns from the Internet rather than the patient's computer competency. Providing a list of recommended sources would be appropriate and support the patient's motivation, but it would not be the first thing the nurse would do.

To promote a culture of safety, the nurse manager preparing the staff schedule considers the anticipated census in planning the number and experience of staff on any given shift. Which is the human factor primarily addressed with this consideration? a. Available supplies b. Interdisciplinary communication c. Interruptions in work d. Workload fluctuations

D Including an adequate number of staff members with experience caring for anticipated patients is a strategy to manage the workload and potential fluctuations. A safety culture requires organizational leadership (e.g., the nurse manager) that gives attention to human factors such as managing workload fluctuations. This strategy also applies principles of crew resource management in that it addresses workload distribution. Lack of supplies can create a challenge for safe care but could not be addressed with the schedule. Concerns with communication and coordination across disciplines, including power gradients, and excessive professional courtesy can create hazards but would not be the best answer. Strategies to minimize interruptions in work are essential but would not be the best answer in this situation.

When describing patient education approaches, the nurse educator would explain that informal teaching is an approach that involves which quality? a. Addresses group needs b. Follows formalized plans c. Has standardized content d. Often occurs one-to-one

D Informal teaching is individualized one-on-one teaching which represents the majority of patient education done by nurses that occurs when an intervention is explained or a question is answered. Group needs are often the focus of formal patient education courses or classes. Informal teaching does not necessarily follow a specific formalized plan. It may be planned with specific content, but it is individualized responses to patient needs. Formal teaching involves the use of a curriculum/course plan with standardized content.

Which factors which would alert the nurse to negative/dysfunctional family dynamics? a. Aging of family members b. Chronic illness of a family member c. Disability of a family member d. Intimate partner violence

D Intimate partner violence is an exemplar of negative/dysfunctional family dynamics. Aging of family members is an exemplar of changes to family dynamics. Chronic illness of a family member is an exemplar of changes to family dynamics. Disability of a family member is an exemplar of changes to family dynamics.

The most appropriate initial nursing intervention when the nurse notes dysfunctional interactions and lack of family support for a patient would be to? a. enforce hospital visiting policies. b. monitor the dysfunctional interactions. c. notify the primary care provider. d. role model appropriate support.

D Nurses can, at times, role model more appropriate interactions or provide suggestions for improving communication and interactions among family members. If the nurse determines that the number of visitors has a negative impact on the patient, hospital policy may be to limit visitors, but that would not be the initial action. Monitoring the dysfunctional interactions would not be an adequate response. The primary care provider should certainly be notified, but that would not be the initial response.

The nurse working with a family to prepare them for discharge of the father after a stroke would help them to address the things they can control. Which factor should the nurse include in the education? A. Economic state of society B. Genetic inheritance C. Maturity of individuals D. Psychological defenses

D Nursing intervention can help the family with psychological defense strategies, which are the ways a family reacts to the stress of a member whose health status has changed. This nurse would use knowledge of family stress theory in differentiating things the family can control and things the family cannot control. The family has no control over the economic state of society. The family would have no control over genetic inheritance in this situation. The family would have no control over the maturity of the individuals involved. Psychological defense strategies could promote adaptation of the family unit.

The primary healthcare nurse would recommend screening based on known risk factors, because of which action? a. Eliminate the possibility of developing a condition. b. Identify appropriate treatment guidelines. c. Initiate treatment of a condition or disease. d. Make a substantial difference in morbidity and mortality.

D Screenings are typically indicated and recommended if the effort makes a substantial difference in morbidity and/or mortality of conditions, and they are safe, cost-effective, and accurate. Ideally a screening measure will accurately differentiate individuals who have a condition from those who do not have a condition 100% of the time; however, there may be a false-negative result, or the patient may develop a condition after the screening was conducted. A screening does not specify treatment guidelines; the screen provides results, and the healthcare provider identifies the treatment. The goal of screening is to identify individuals in an early state of a disease so that prompt treatment can be initiated. The screening results are used for this purpose.

Which is an exemplar of a social/emotional developmental delay? A. Developmental dyspraxia B. Fragile X syndrome Incorrect C. Cognitive impairment D. Separation anxiety disorder

D Separation anxiety disorder is an exemplar of a social/emotional developmental delay. Developmental dyspraxia is an exemplar of an adaptive developmental delay. Fragile X syndrome is an exemplar of a physical developmental delay. Cognitive Impairment is an exemplar of a cognitive developmental delay

A nurse is reviewing concepts related to documentation in the electronic health record. Which statement best represents the concept of "meaningful use"? a. Allows for privacy of information b. Uses individualized log on for access c. Completes charting in a timely manner d. Meets established criteria related to technological use

D The concept of "meaningful use" refers to the establishment of criteria related to technological use of the electronic health record as determined by federal guidelines. HIPAA policy mandates privacy of personal information and patient medical records. Use of an individualized log on to access relates to security concerns. Completing charting in a timely manner is an expectation of prudent practice.

A facility's administration has concerns about the effectiveness of staff nurses related to patient education. What should be the nurse manager's first action in addressing this concern? A. Assign one nurse to teach patients. B. Organize patient teaching resources. C. ost a teaching outline in the lounge. D. Survey nurses about patient teaching

D The first step in addressing any concern is assessment, or determining what the issues are, so conducting a verbal or written survey would be the most appropriate first step. Education of patients is integral to professional nursing practice; it would not be appropriate, or even possible, to assign one nurse to teach patients, because much patient education is informal, spontaneous, and takes place during treatments or when a nurse is responding to patient questions. There is no information to support a problem with the organization of patient teaching resources. Posting a teaching outline in the lounge could be an appropriate strategy if a need related to a specific area was identified; however, a needs assessment must first be completed

To promote safety, the nurse manager sensitive to point of care (sharp end) and systems level (blunt end) exemplars works closely with staff to address which point of care exemplar? a. Care coordination b. Documentation c. Electronic records d. Fall prevention

D The most common safety issues at the sharp end include prevention of decubitus ulcers, medication administration, fall prevention, invasive procedures, diagnostic workup, recognition of/action on adverse events, and communication. These are the most common issues the staff nurse providing direct patient care encounters. Each of the other options is classified as systems level exemplars.

The nurse is caring for a patient experiencing an allergic reaction to a bee sting who has an order for diphenhydramine (BenaDRYL). The only medication in the patient's medication bin is labeled BenaZEPRIL. The nurse contacts the pharmacy for the correct medication to avoid what type of error? a. Communication b. Diagnostic c. Preventive d. Treatment

D The nurse avoided a treatment error, giving the wrong medication. Benazepril is an ace inhibitor used to treat blood pressure. The Institute of Medicine (IOM) report referred to Leape's identification of four types of errors. Treatment errors occur in the performance of an operation, procedure, or test; in administering a treatment; in the dose or method of administering a drug; or in avoidable delay in treatment or in responding to an abnormal test. Communication errors refer to those that occur from a failure to communicate. Diagnostic errors are the result of a delay in diagnosis, failure to employ indicated tests, use of outmoded tests, or failure to act on results of monitoring or testing. Preventive errors occur when there is inadequate monitoring or failure to provide prophylactic treatment or follow-up of treatment.

A nurse administers an incorrect medication to a patient. In reviewing this medication error, the nurse finds out that incorrect medication was placed in the Pyxis system. What type of error has the nurse committed? a. Latent error b. Blunt end c. Did not follow nursing process d. Latent error resulting in active error

D The situation described is a latent error which resulted in an active error as incorrect medication was placed in the Pyxis system. Latent errors are also referred to as blunt end whereas active errors are applied as occurring at the sharp end. There is no provided information to suggest that the nurse did not follow nursing process.

The specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice is known as which specialty? A. Computer science B. Health informatics C. Health information technology D. Nursing informatics

D The specialty is nursing informatics. Computer science is a branch of engineering that studies computation and computer technology, hardware, software, and the theoretical foundations of information and computation techniques. Health informatics is a discipline in which health data are stored, analyzed, and disseminated through the application of information and communication technology. Health information technology is an application of information processing that deals with the storage, retrieval sharing, and use of healthcare data, information, and knowledge for communication and decision making.

A patient states, "I had a bad nightmare. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which response by the nurse would be an example of interpersonal therapeutic communication? a. "It sounds as though you were uncomfortable with the content of your dream." b. "I understand what you're saying. Bad dreams leave me feeling tired, too." c. "So, all in all, you feel as though you had a rather poor night's sleep?" d. "Can you give me an example of what you mean by a 'bad nightmare'?"

D The technique of clarification is therapeutic and helps the nurse examine meaning. The distracters focus on patient feelings but fail to clarify the meaning of the patient's comment.

The nurse manager of a medical/surgical unit wants to increase the use of healthcare technology on the unit and is working with an ANA-certified informatics nurse to reduce which barriers to health information exchange? a. Basic informatics knowledge and skills b. Offering the best set of tools c. Privacy and security policies d. Unit-specific terminology

D Unit-specific terminology would be a barrier to sharing health information because there could be confusion about terms. Standardized terminology within the electronic health record is critical for communicating care to the interprofessional team and exchanging health information. Competency in informatics including basic informatics knowledge and skills could facilitate the use of informatics; lack of competency could be a barrier. Offering the best set of tools could promote the ease of data entry and access. Privacy and security policies reduce legal and ethical concerns about sharing data, thus reducing barriers to health information exchange.

The nurse in a newly opened community health clinic is developing a program for the individuals considered at greatest risk for poor health outcomes. How should the nurse consider this group? a. Global community b. Sedentary society c. Unmotivated population d. Vulnerable population

D Vulnerable populations refer to groups of individuals who are at greatest risk for poor health outcomes. The entire world is the global community. Sedentary refers to the lifestyles of people worldwide who have epidemic rates of obesity and many other related chronic diseases. Unmotivated population refers to the individuals who have not demonstrated interest in changing.

A nurse wishes to obtain data about a patient's self-esteem. What is the best assessment technique for the nurse to use to obtain this data? 1. Completing an entire head-to-toe assessment first 2. Conducting a structured interview with direct questions 3. Interviewing the patient in an unstructured format 4. Disregard any nonverbal clues from the patient

Interviewing the patient in an unstructured format An unstructured interview format allows the nurse to establish rapport and get insight into the patient's perspective. Combined with observation, this would yield the best information. Observation often results in gathering a depth of data that is difficult to gain by other methods. Combined with an unstructured interview to gain the patient's trust, this technique would be very valuable. A head-to-toe assessment would not yield information about self-esteem. A structured interview is often used to gather specific information, but since this nurse has not yet had time to develop rapport, focusing questions on a sensitive issue such as self-esteem would probably not elicit accurate information. Also, structured interviews are most often used in emergency situations, and this does not qualify as an emergency.

A nursing instructor assigns the clinical group the task of writing a journal depicting the student's clinical day. What is the most likely rationale for this assignment? 1. Journaling allows reflection, an important critical thinking skill. 2. Journaling gives you time to review what happened in your clinical. 3. Journaling is a way to organize your thoughts about your experiences. 4. Journaling teaches open-mindedness, a critical thinking disposition.

Journaling allows reflection, an important critical thinking skill. Critical thinking requires reflection on what occurred, how data were processed, and how decisions were made. Journaling is one method of developing critical thinking skills. Journaling does give nurses time to review what happened in their clinical, but this statement does not go far enough in explaining the importance of the journal-writing process. Journaling may be a way to organize thoughts about one's experiences, but this statement is too narrow an explanation and does not account for the critical aspect of reflection. Open-mindedness is a critical thinking disposition that allows one to be tolerant of divergent views. Journaling can assist with developing this disposition, but only if what is written reflects that specific topic.

The nurse is implementing a plan of care for a patient newly diagnosed with type 2 diabetes mellitus. The plan includes educating the patient about diet choices. The patient states that they enjoy exercising and understand the need to diet; however, they can't see living without chocolate on a daily basis. Using the principles of responding in the Model of Clinical Judgment, how would the nurse proceed with the teaching? a. The nurse explains to the patient that chocolate has a high glycemic index. The nurse then focuses on foods that have low glycemic indexes and provides a list for the patient to choose from. b. The nurse explains that the patient may eat whatever they would like as long as the patient's glucose reading and A1c remain stable. c. The nurse derives a new nursing diagnosis of Knowledge Deficit and readjusts the plan of care to include additional sessions with the registered dietician. d. The nurse examines the patient's daily glucose log and incorporates the snack into the time of day that has the lowest readings. The nurse then follows up and evaluates the response in 1 week.

The nurse examines the patient's daily glucose log and incorporates the snack into the time of day that has the lowest readings. The nurse then follows up and evaluates the response in 1 week. Responding entails adjusting the plan of care to the particular patient issue through one or more nursing interventions. In this case, the nurse is working with the patient's wishes, knowing that the patient will most likely cheat. The patient will be allowed to "cheat." The plan will be evaluated to be sure the snack does not elevate the glucose excessively and be readjusted if warranted. While it is true that most chocolate has a high glycemic index, providing a list of foods that do not include the one thing the patient enjoys will most likely lead to nonadherence to the diet. Advising the patient that they can have whatever they want to eat may lead to further dietary indiscretions and cause side effects such as obesity or high glucose readings. Knowledge Deficit is an inaccurate diagnosis for this patient as evidenced by the patient stating they understand the need to exercise and the need to diet.

A student nurse is studying clinical judgment theories and is working with Tanner's Model of Clinical Judgment. How can the student nurse best generalize this model? a. A reflective process where the nurse notices, interprets, responds, and reflects in action b. One conceptual mechanism for critiquing ideas and establishing goal-oriented care c. Researching best practice literature to create care pathways for certain populations d. Assessing, diagnosing, implementing, and evaluating the nursing care plans

a. A reflective process where the nurse notices, interprets, responds, and reflects in action Looking across theories and definitions of clinical judgment, they all have in common the ability to reflect on data and choose actions. Reflection also considers evaluating the result of the actions to determine whether they were effective. Although critiquing ideas and establishing goal-oriented care could be considered part of a generalized statement of critical thinking, this is not broad enough without the reflection and evaluation. Clinical judgment would most likely be used to create care paths derived from the evidence; however, this is not the cornerstone of the Tanner Model. Clinical judgment is used when engaging in the nursing process, but this is too narrow in focus to capture the essence of critical thinking definitions and theories. Critical thinking is not synonymous with the nursing process.

A home care nurse receives a physician order for a medication that the patient does not want to take because the patient has a history of side effects from this medication. The nurse carefully listens to the patient, considers it in light of the patient's condition, questions its appropriateness, and examines alternative treatments. What is the nurse's best action? a. Call the physician, explain rationale, and suggest a different medication. b. Consult an experienced nurse on whether there are other similar treatments. c. Hold the drug until the physician returns to the unit and can be questioned. d. Question other staff as to the physician's acceptance of nursing input.

a. Call the physician, explain rationale, and suggest a different medication. Determining how best to proceed on behalf of a patient's best health outcomes care may require clinical judgment. At the committed level of critical thinking, the nurse chooses an action after all possibilities have been examined. A home care nurse who is using good clinical judgment techniques should have confidence in their decision and may not have another nurse available as this is an autonomous setting. Holding the drug might jeopardize the patient's health, so this is not the best solution. The nurse working at this level of critical thinking makes choices based on careful examination of situations and alternatives; whether or not the physician is open to nursing input is not relevant.

A new graduate nurse is working with an experienced nurse to chart assessment findings. The new nurse notes that the physical therapist wrote on the chart that the patient is lazy and did not want to participate in assigned therapies this AM. The experienced nurse asks the new nurse what may be going on here. What is the best explanation for this statement? a. Data on the chart can sometimes be documented in a biased manner. b. Data on the chart changes as the patient's condition changes. c. Data on the chart is usually accurate and can be verified from the patient. d. Reading the chart is not a wise use of time as this can be time consuming and tedious.

a. Data on the chart can sometimes be documented in a biased manner. It is important that the nurse records only what is assessed, without adding judgments or interpretations to the record. Data do indeed change (and need to be charted) as the patient's condition changes, but this would not be the best answer to this question. Assessment data may at times be difficult to obtain, but that would not occur often enough to warrant a warning about the difficulty in charting it. Also, obtaining data is clearly a different activity from charting it. Charting can be time consuming and tedious, but this is not the most complete answer to this question.

A new nurse appears to be second-guessing herself and is constantly calling on the other nurses to double-check their plan of care or rehearse what they will say to the doctor before she call on the patient's behalf. This seems to be annoying some of the nurse's coworkers. What is the nurse manager's best response? a. Explain to coworkers that this is a characteristic of critical thinking and is important for the new nurse to improve reasoning skills. b. Agree with the staff and have someone follow and work more closely with a preceptor. c. Have a talk with the nurse and suggest asking fewer questions. d. Tell the staff that all new nurses go through this phase, and ignore their behavior.

a. Explain to coworkers that this is a characteristic of critical thinking and is important for the new nurse to improve reasoning skills. Reflection-on-action is critical for development of knowledge and improvement in reasoning. It is where learning from practice is incorporated into experience. Inquisitiveness is a characteristic of critical thinking and reflects a desire to learn even when the knowledge may not appear readily useful. The manager should promote this. Suggesting the nurse work more closely with a preceptor implies that the manager thinks the nurse needs to learn more and increase confidence. In reality, this nurse is demonstrating a characteristic of critical thinking. Suggesting that the nurse ask fewer questions would hamper the development of the nurse as a critical thinker. All new nurses do go through a phase of asking more questions at one time, but dismissing the nurse's behavior with this explanation is simplistic and will discourage critical thinking.

A nurse has committed a serious medication error and has reported the error to the hospital's adverse medication error hotline as well as to the unit manager. The manager is a firm believer in developing critical thinking skills. From this standpoint, what action by the manager would best nurture this ability in the nurse who made the error? a. Have the nurse present an in-service related to the cause of the error. b. Instruct the nurse to write a paper on how to avoid this type of error. c. Let the nurse work with more experienced nurses when giving medications. d. Send the nurse to refresher courses on medication administration.

a. Have the nurse present an in-service related to the cause of the error. Nurturing critical thinking skills is done in part by turning errors into learning opportunities. If the nurse presents an in-service on the cause and prevention of the type of error committed, not only will the nurse learn something but many others nurses on the unit will learn from it to. This is the best example of developing critical thinking skills. This option would allow the nurse to learn from the mistake, which is a method of developing critical thinking skills, but the paper would benefit only the nurse, so this option is not the best choice. Letting the nurse work with more experienced nurses might be a good option in a very limited setting, for example, if the nurse is relatively new and the manager discovers a deficiency in the nurse's orientation or training on giving medications in that system. Otherwise, this option would not really be beneficial. Sending the nurse to refresher courses might be a solution, but it is directed at the nurse's learning, not critical thinking. The nurse might feel resentful at having to attend such classes, but even if they were helpful, only this one nurse is learning. Going to generic classes also does not address the specific reason this error occurred, and thus might be irrelevant. Critical thinking and learning can be enhanced by a presentation to the staff on the causes of the error.

A patient has been admitted for a skin graft following third degree burns to the bilateral calves. The plan of care involves 3 days inpatient and 6 months outpatient treatment, to include home care and dressing changes. When should the nurse initiate the educational plan? a. After the operation and the patient is awake b. On admission, along with the initial assessment c. The day before the patient is to be discharged d. When narcotics are no longer needed routinely

b. On admission, along with the initial assessment Initial discharge planning begins upon admission. After the operation has been completed is too late to begin the discharge planning process. The day before discharge is too late for the nurse to gather all pertinent information and begin teaching and coordinating resources. After a complicated operation, the patient may well be discharged on narcotic analgesics. Waiting for the patient to not need them anymore might mean the patient gets discharged without teaching being done.