Exam 1- learning objectives (2700)

Attitudes, attributes and characteristics of critical thinkers

-non bias/neutral -honest -open-minded -not easily swayed by opinion -considers opposing views -aware of limits -challenges self -seeks knowledge

Verbal Communication

-pace and intonation -simplicity -clarity and brevity (congruence) -timing and relevance -adaptability -credibility -humor (when appropriate)

Potential nursing diagnoses:

-powerlessness -spiritual distress -risk for impaired religiosity -disturbed thought processes -fear -decisional conflict -noncompliance -ineffective health maintenance -ineffective coping -impaired social interaction

Moslow's Hierarchy of Needs

5. self actualization 4. esteem and achievement 3. love and belonging 2. safety 1. needs (food, sleep, sex)` ***Important for prioritization of "who do I see first, or what should I do first" type of questions

Building trust (aspects that affect therapeutic relationships)

The act of establishing a open relationship with a patient that views the nurse as competent professional capable of helping

Caring attitude

The act of showing concern for others (aspects that affect therapeutic relationships)

Personal space

The area around an individual that promotes comfort or can be uncomfortable if it is violated (components of nonverbal communication)

*External locus of control

The belief that an individual's health is controlled by forces outside of his or her control such as chance or fate

***Cultural competence

the ability to apply knowledge, skills to provide high-quality care to clients of diverse backgrounds

clarity and brevity

the shortest, simplest communication is usually most effective

*Drug tolerance

the tendency for larger doses of a drug to be required over time to achieve the same effect

Posture

the way in which individuals walk and carry themselves. (components of nonverbal communication)

*problem focused assessment

to determine the status of a specific problem identified in an earlier assessment

The nurse is discussing leadership styles that will help eliminate the lateral violence that is occurring in the workplace. Which leadership style should the nurse associate with the most positive​ change? Transformational ​Laissez-faire Autocratic Facilitative

transformational (rationale:recommended as the leadership style for facilitating progress and innovation in nursing)

pitfalls

unforeseen situations that harbor consequences for nurses and can result in client harm

*Inspection examination

using sight; Visual examination Deliberate, purposeful, systematic Naked eye, lighted instruments

define clinical judgment for nursing practices

using subjective and objective data to form a clinical judgment and come to a nursing diagnosis

caring behavior/process reflect of Compassion

validating the​ client's experience through attentive​ listening, holding hands with the​ client, and eye contact

Pharmacokinetics

what the body does to the drug

Pharmacodynamics

what the drug does to the body

*Drug interaction

when a drug reacts with another drug, food, or dietary supplement such that the effect of one of the substances is greater or smaller

ANA

American Nursing Association

*Enculturation definition

cultural transmission from adults to children

How to use the Nursing Process in Clinical Judgement

5 Steps: Assessment Diagnose Planning Implementation Evaluation

*Assimilation definition

process of adapting to and integrating characteristics of dominant culture

assertive communication techniques

"I" without placing blame ("I have a patient that is..") fogging negative assertion repetition confidence managing nonverbal comm thinking before speaking avoiding apologizing whenever possible

Open- ended questions

(Therapeutic communication techniques) Asking broad questions that can lead or invite the client to explore thoughts or feelings.

Pace and Intonation

(mode of communication) The rhythm of speech. Pitch that expresses joy, sadness, anger or amusement. The speed of the speech that may indicate interest, anxiety, boredom, or fear.

adaptability

(mode of communication) spoken messages altered in response to behavior cues from the client

SBAR

*Concise way to communicate completely to new personal Situation Background Assessment (personal) Recommendation

Sleep: Infants

-at first, infants wake every 3-4 hours -by 6 mo, most infants sleep through night -by end of first year, usually takes 2 naps/day

characteristics that create an environment to support therapeutic communication

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Generic name

- the common name used throughout the drug's lifetime -not capitalized

Sleep: Toddlers, preschoolers, school-aged

-1-2 years: 9-16 hrs -3-5 years: 8-14 hrs -6-13 years: 7-12 hrs -Naps continue to reduce

Sleep: Newborns

-1-3 hours awake -irregular schedule -enter REM immediately -50/50 REM vs NREM -cycle = 50 min

Sleep: Adolescents

-14-17 years: 8-10 hrs

Sleep: Young Adults

-18-25 years: 7-9 hrs

REM

-70-90 mins after sleep begins. -dreams -healthy: 2+ hrs each night dreaming -brain/body highly active and stimulated -increased HR, BP

NREM sleep

-80% of nights sleep -4 stages: --N1: light. only few min --N2: light. body processes slow (50% or total sleep) --N3: Deep. extremely slow brain waves. --N4: Deep. Delta waves. difficult to arouse. (children may wet bed, night terrors, sleepwalk)

Nursing diagnosis types:

-Actual diagnosis: "impaired skin integrity" -risk diagnosis: "risk fall" -wellness diagnosis: describes a human response to levels of wellness the patient hopes to achieve. "readiness for enhanced spiritual wellbeing" -health promotion diagnosis: motivation and desire to enhance health behavior -syndrome diagnosis: cluster of nursing diagnosis which will have a better result if addressed simultaneously "risk for disuse syndrome"

The​ foreign-trained nurse is recruited from that country to work for a medical hospital. Which factor related to the nursing shortage may have contributed to this​ solution? (Select all that​ apply.) a.Insufficient nursing faculty to educate students ​b.Nurses' boredom c.Increased demand for foreign nurses d.Aging nurse workforce e.New nurses entering the workforce at an older age

-Aging nurse workforce -New nurses entering the workforce at an older age -Insufficient nursing faculty to educate students

Nurses in a nursing program are collaborating with hospital leaders to reduce the impact of the nursing shortage. Which action should be​ included? (Select all that​ apply.) 1.Recommending increasing the​ nurse-to-client staffing ratio 2.Analyzing staffing options to increase flexibility 3.Determining ways to increase the number of nursing scholarships 4.increasing recruitment of students into nursing as a second career 5.Discussing increasing nursing salaries to be comparable with those of similar organizations

-Analyzing staffing options to increase flexibility -Determining ways to increase the number of nursing scholarships -Discussing increasing nursing salaries to be comparable with those of similar organizations

Which should be the​ nurse's next action following the collection of assessment​ data? (Select all that​ apply.) -Analyzing the data for gaps and inconsistencies -Identifying strengths and resources -Comparing the data with suspected medical problems -Measuring the data against standards to identify significant cues -Clustering cues to generate tentative hypotheses

-Analyzing the data for gaps and inconsistencies -Measuring the data against standards to identify significant cues -Clustering cues to generate tentative hypotheses

Recommended Health Promotions: School-age

-Annual physical -Immunizations: (ex HPV (early as 9 yrs), MMR, tetanus-diptheria [Tdap], annual influenza vac) -Screening for blood cholesterol level between 9 and 11 yrs to reduce risks of obesity -Periodic vision, speech, and hearing screenings -Education about nutrition and obesity prevention, rest and exercise, safety promotion, and injury control -prediabetes screening, if high-risk -Regular dental screenings (fluoride)

*Factors affecting delivery of health care

-Changing Demographics -Advances in Technology -Health Literacy

Interprofessional team skills

-Communication -Teamwork -Value roles, responsibilities of other team members -Mutual respect -Trust -Decision making -Conflict management

Therapeutic Communication

-better able to collect assessment data -develop care plans in collaboration with patients -initiate interventions -evaluated outcomes of interventions -initiate changes that promote health -prevent legal problems associate with nursing practice

Recommended Health Promotions: Older Adults

-Dental -Tonometry for signs of glaucoma and other eye diseases every 2-3 yrs -Total cholesterol and HDL test every 3-5 yrs until age 75 -Aspirin, 81 mg, daily, if high-risk -Diabetes screen every 3yrs, if high-risk - Smoking: history and counseling, if needed. Until age 74, low-dose CT chest scan with contrast annually if 30 pay-yr, current, or quit w/i past 15 yrs -Breast exam annually, mammogram every 2 yrs -Pap, only if previous abnormal smears, serious cervical precancer, or hysterectomy for malignancy -Annual digital rectal exam -Testicular exam annually, PSA test by choice -Vision and hearing -Depression and family violence screening -height and weight measurements annually -STD, if high risk -Flu vacc -Two pneumococcal vaccs at age 65 -Sigle dose of shingles vacc starting at 60 yrs -Tetanus every 10 yrs -Education about restful sleep, adequate nutrition, maximization of strengths, medication compliance, and accident prevention

Recommended Health Promotions: Adolescent

-Health exam as recomd. by PCP -Immunizations: (ex: HPV and HepB vac) -HIV screenings between ages 16 and 18 yrs -Visioni and hearing screenings -Assess for depression -Use of CRAFFT (car, relax, forget, friends, trouble) screening questionnaire for drug and alcohol use -Education about hormonal changes and body image, sexuality, safety promotion, and accident prevention -prediabetes screening, if high risk

Recommended Health Promotions: Toddler

-Health exam at 15 and 18 mo and then as recommended by pediatrician -Dental visits starting at tooth formation, with fluoride varnish application from 6 mo through 5 yrs -Immunizations -Risk assessment at age 15 mo and 30 mo to detect iron deficiency -Fluoride supplements if there is inadequate water fluoridation -Education about nutrition, rest and exercise, safety promotion, and injury control

Recommended Health Promotions: Preschool

-Health exam every 1-2 yrs -Immunizations -Vision and hearing screening -Dental visits regularly with fluoride varnish application through age 5 yrs -Education about nutrition, rest and exercise, safety promotion, and injury control

benefits of assertive communication

-Improves communication -Reduces stress -De-escalates conflict -Improves outcomes -Reduces likelihood of angry encounters

*Frameworks for providing care

-Managed care: seen in office; cost effective, high quality care -Case management: seen in hospital; enables continuity of client care -client focused care: seen in hospice/home care; based on expressed physical, emotional needs, involves family of client

*benner's skill acquisition model

-Novice, advanced beginner, competent, proficient, expert -Moving from no experience, Following sequentially ordered steps, moving from noticing cues to identifying significant cues & how they form patterns., progressing from bystander to active participant.

The nurse is teaching a new nurse about developing an appropriate nursing diagnosis for a client. Which information should the nurse use to accurately describe nursing​ diagnosis? (Select all that​ apply.) -Nursing diagnosis is uniform between clients. -Nursing diagnosis is flexible and changes based on client responses. -Nursing diagnosis describes responses to a health problem. -A nursing diagnosis is a judgment statement. -A nursing diagnosis is a condition that nurses are licensed to treat.

-Nursing diagnosis is flexible and changes based on client responses -Nursing diagnosis describes responses to a health problem -A nursing diagnosis is a judgment statement -A nursing diagnosis is a condition that nurses are licensed to treat

Recommended Health Promotions: Middle-aged adults

-Physical (3-5 yrs until age 40, then annually) Immunizations -Regular dental (6 mo) -Tonometry for signs of glaucoma and other eye diseases every 2-3 yrs or annually if indicated -Breast exam annually by PCP. Age 40-44 choice of getting mammogram; age 45-54, annual mammogram; age 55+, hcoice of mammogram annually or every 2 yrs -Screen for women for cervical dysplasia with Pap every 3 yrs and HPV every 5 yrs -Testicular exam annually by PCP. Prostate-specific antigen (PSA) testing starting age 50, age 45 for African Americans with positive history -Cardiovascular disease -Diabetes -Colorectal cancer: age 50 (every 10 years) -Smoking: history and counseling -Education about sleep, weight control, medication compliance, and accident prevention

Recommended Health Promotions: Young Adults

-Routine physical (1-3 yrs for women; every 5 yrs for men) -Immunizations: ( DTap booster every 10 yrs, HepB vacc, Meningococcal vacc if not given in early adolescence) -HPV vacc for women up to 26 yrs who have not complete series -Regular dental (every 6 mo) -Risk-based assessment of vision at age 18 -Screening for cervical dysplasia for women starting at 21 yrs. Pap and HPV test every 5 yrs for women age 30-65 -Testicular exam yearly -Screening for cardiovascular disease (eg. cholesterol test every 5 yrs if results normal; blood pressure to detect hypertension; baseline EKG at age 35) -Diabetes screen every 3 yrs, if high risk -Smoking: history and counseling, if needed -Education about career efforts and personal balance, stress management, sexuality, safety promotion, nd accident prevention

identify barriers to therapeutic communication

-Stereotyping -Agreeing and disagreeing (Implies patient is either right or wrong and that nurse is in pos. to judge this) -Defensiveness -Challenging -Probing -Testing -Rejecting -Changing topics/subjects -Unwarranted/false reassurance -Judgemental -Common advice

Clinical decision making and nursing process

-adaptation of problem solving -common language for all nurses -contributes to body of knowledge -helps to develop intuition NCLEX Qs ++++What is the priority? +++++Weed out what's important and what's not. +++++Don't add extra info +++++Read whole question/get whole picture

differentiate lifespan considerations when assessing children (establishing rapport)

-same eye level -show interest in what child is doing -agree when appropriate -compliment -calm tone (developmentally appropriate) -pace so child does not feel rushed -explain so child can understand -include child in discussion of care if developmentally appropriate -listen more than you talk

Recommended Health Promotions: Newborn and Infant

-screenings for congenital heart disease and hearing loss -health examinations at 2 weeks and 2, 4, 6, 9, 12 months -immunizations: (MMR not given before 12 mo) -fluoride supplements for infants over 6 months if inadequate water fluoridation -screening for PKU -Denver Developmental Screening Test (DDST-II) or other developmental screening -eduacation about infant-parent attachment and bonding, playful activities to stimulate development, safety promotion, and injury control

**AACN's five competencies for providing culturally competent care

1. Apply knowledge of social and cultural factors that affect nursing 2. Use relevant data sources and best evidence 4. Promote achievement of safe, quality outcomes 5. Advocate for social justice 6. Participate in continuous development

Process of Administering Medications (steps 1-6)

1. Identify the client 2. Inform the client 3. Administer the drug 4. Provide adjunctive interventions as indicated 5. Record the drug administered 6. Evaluate the client's response to the drug

7 Steps of diagnostic reasoning

1. Identifying abnormal data and strengths 2. Cluster data 2. Draw inferences 4. Propose nursing diagnoses 5. Check for presence of defining characteristics 6. Confirm or rule out the nursing diagnosis 7. Document

*Organization of culture/society includes:

1. Physical element 2. Infrastructure element 3. Behavioral element 4. Cultural element

The four main goals of nursing

1. To promotes health (state of optimal function or well being with physical, social, and mental components) 2. To prevent illness (primary, secondary, and tertiary) 3. To treat human responses to health or illness 4. To advocate for individuals, families, communities, and populations

why should RNs utilize evidence-based practices?

1. Utilize best external evidence. 2. Draw on individual clinical expertise. 3. Consider patient values and expectations Benefits: Improves patient outcomes through superior care. Maximizes providers' time and reduces costs. Adds new contributions to the science of nursing.

1.stat order 2.single order 3. standing order 4. PRN

1. given urgently 2. given just once 3. routine order taken daily 4. as needed for when it's appropriate

*types of assessment

1.Initial (baseline) Assessment 2.Problem-focused Assessment 3. Emergency Reassessment 4.Ongoing Assessment (IPOE)

Sleep: Adults

26-64 years: 7-9

normal albumin level for an adult

3.5-5.0g/dL.

*Managed care

A health care system whose goals are to provide cost effective quality care. Seen in office/community setting. HMO's and PPO's.

How is a nursing diagnosis different than a medical diagnosis?

A nursing diagnosis is a clinical judgment; whereas, a medical diagnosis is the identification of a disease condition based on a specific evaluation of physical signs, symptoms, and the patients medical history

*Illness definition

A state in which an individual has diminished physical, emotional, intellectual, social developmental or spiritual functioning

describe the components of health

A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity

*well-being definition

A subjective perception of feeling well that can be described objectively and measured

Describe motivational interviewing and the role it plays in promoting health

A technique in which you become a helper in the change process and express acceptance of your client.

The nurse is to provide an assessment for a client of Asian descent. Which factor would the nurse need to understand related to the​ client's worldview?​ (Select all that​ apply.) A. Values B. Healthcare practices C. Healthcare beliefs D. Educational level E. Language

A. Values B. Healthcare practices C. Healthcare beliefs E. Language

The nurse is orienting a new nurse and teaching about plans of care. At which time should the nurse instruct the new nurse for evaluating the nursing​ care? (Select all that​ apply.) A. When discharging a client from nursing care B. During a​ time-specified interval C. During the implementation of an intervention D. Upon admission to the hospital E. At the end of a scheduled shift

A. When discharging a client from nursing care B. During a​ time-specified interval C. During the implementation of an intervention

An older client with renal insufficiency is to receive a cardiac medication. Which is the nurse most likely to administer? A. A decreased dosage B. The standard dosage C. An increased dosage D. Divided dosages

A: due to renal insufficiency in order to avoid toxicitiy

*Tertiary prevention

Already established the disease and restoring function i.e. Rehab Delivered in: hospital, rehab, extended care facility

Using Silence (therapeutic)

Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response. (Therapeutic communication techniques)

Which helps to ensure that clients get the right care at the right time while avoiding unnecessary duplication of services and preventing medical​ errors? Centers for Medicare and Medicaid Services Accountable care organization Affordable Care Act Quality and Safety Education for Nurses

Accountable care organization

*Percussion

Act of striking body surface to elicit sounds

The nurse is discussing ethical practices. Which information should the nurse​ include? joining a professional organization Adhering to the nurse practice act Working toward cultural competency Integrating caring interventions

Adhering to the nurse practice act

Adverse reaction vs. side effect

Adverse events are unintended pharmacologic effects that occur when a medication is administered correctly while a side effect is a secondary unwanted effect that occurs due to drug therapy.

While assessing a​ client, the nurse notes that the client has areas of decay on several teeth and her weight is less than​ 85% of normal. The​ client's mother privately tells the nurse her daughter is vomiting after meals and not eating very much during the day. Which alteration of self does the nurse suspect the client to be​ experiencing? Pica Rumination disorder ​Binge-eating disorder Anorexia nervosa

Anorexia nervosa

Accountability of the RN

Answerable for the outcomes of a task or assignment. Accountable for their own actions but may also be accountable for the actions of others (i.e. subordinates or trainees)

Empirical Knowing

Application of​ nursing-related facts to client care

*Use of Interpreter guidelines

Avoid using family member to translate Address questions to client, not interpreter Observe nonverbal communication Speak slowly, distinctly Provide written materials in client's language as available

disorder is characterized by a disturbance in eating patterns in which the client fails to meet nutritional needs

Avoidant/restrictive food intake disorder

continuance commitment

Awareness of costs associated with leaving profession (for money or job security)

Proper administration of an otic medication to a two-year-old client includes which of the following? A. Pull the ear straight back. B. Pull the ear down and back. C. Pull the ear up and back. D. Pull the ear straight upward.

B for children specifically (c is for temp)

*Intraorganizational conflict

Between two organizations within one market

A client tells the nurse, "This pill is a different color than the one that I usually take at home." Which is the best response by the nurse? A. "Go ahead and take your medicine." B. "I will recheck your medication orders." C. "Maybe the doctor ordered a different medication." D. "I'll leave the pill here while I check with the doctor."

B: do not administer if there's any doubt.

The primary care provider prescribed 5 mL of a medication to be given deep intramuscular for a 40-year old female who is 5'7" tall and weighs 135 pounds. Which is the most appropriate method of administration? A. A tuberculin syringe, #25-#27 gauge, ¼ -5/8 inch needle B. Two 3-mL syringes, #20-#23 gauge, 1 ½ inch needle C. Two 2-mL syringes, #25 gauge, 5/8-inch needle D. Two 2-mL syringes, #20-#23 gauge, 1-inch needle

B: sufficient for dosage amount

*Intergroup conflict

Between teams in competition or opposition to one another

*Interpersonal conflicts

Between two or more people Can arise from differences in goals or personalities, competition, concern about territory, control, loss

Nurse listens attentively and responds in ways that indicate the nurse acknowledges the client's concerns and feelings as important

Demonstrating empathy (aspects that affect therapeutic relationships)

Written Communication

Can be considered a form of verbal communication. May include emails, notes, and text messages (modes of communication)

Roles and functions of the RN

Caregiver Teacher Patient advocate Counselor Change agent Leader Manager Case manager Research consumer

The five U.S. races

Caucasian Black or African American American Indian or Native Alaskan Asian Native Hawaiian or Other Pacific Islander Individuals of Hispanic, Latino, or Spanish origin may be of any race

When the nurse starts another topic of conversation in order to stop another

Changing the subject (non therapeutic communication techniques)

*validating assessment data

Client and nurse together review, validate, summarize information, look over existing health problems, key health beliefs, clients perceived degree control over their health status, level of physical fitness and nutritional status

A nursing diagnosis is a ________ about a health concern or life process

Clinical Judgement

A client with heart failure is having difficulty breathing and severe bilateral pitting edema of the ankles and feet. Which tool should the nurse expect to be prescribed to guide this​ client's care from the emergency department through discharge to​ home? A. Standardized care plan B. Clinical pathway algorithm C. Client-specific clinical pathway D. Standards of care guidelines

Clinical pathway algorithm (rationale:can be used to guide multidisciplinary treatment across differing levels of severity of an illness. They include separate assessment and treatment progressive guidelines that can be used as the client transitions from the entry point to discharge)

Characteristics of effective interprofessional collaboration

Common goal Clinical competence Interpersonal competence Humor Trust Value/respect diverse, complementary knowledge

*What are the social differences in our society?

Communication Environmental control (external vs. internal locus of control) Religious variations Space (i.e. personal space) Time(past oriented vs. present oriented) Biological variations susceptibility to disease skin color

Parallel functioning

Communication more coordinated, but each professional has separate interventions, separate plan of care

CUS

Concerned Uncomfortable Safety

what is the nurses role in documentation as an essential component of communication

Confidentiality, communication, planning care, auditing health agencies, research, education, reimbursement, legal documentation, healthcare analysis

The following medications are listed on a client's medication administration record (MAR). Which medication order should the nurse question? a. Lasix 40 mg, po, STAT B. Ampicillin 500 mg, q6 hr, IVPB C. Humulin L (Lente) insulin 36units, subcutaneously, every morning before breakfast D. Codeine q 4-6 hr, po, prn for pain

D- no dose provided

Factors Affecting Medication Action

Developmental Sex Cultural, ethnic, and genetic Diet Environment Psychological Illness and disease Time of administration

Reflection/reflecting (Therapeutic communication techniques)

Directing ideas, feelings, questions, or content back to clients to enable them to explore their own ideas and feelings about a situation

Parallel communication

Each provider communicates with patient independently, similar questions

*Inhibiting effect

Effect of one or both drugs is decreased

*Potentiating effect

Effect of one or both drugs is increased

* EMTALA

Emergency Medical Treatment and Active Labor Act Requires hospitals to treat critical patients even if they do not have health insurance

*Initial (baseline) Assessment

Establish a complete baseline for problem identification, reference, and future comparision

The nurse discusses Erik​ Erikson's theory of psychosocial development with colleagues. Which should the nurse recognize as an overriding theme in​ Erikson's theory?​ (Select all that​ apply.) Establishing trust in others Developing a sense of identity in society Viewing life experiences as isolated events Helping the next generation prepare for the future Identifying relationships that connect actions to self

Establishing trust in​ others, developing a sense of identity in​ society, and helping the next generation prepare for the future

pop-ups

Events such as new admissions that are unexpected and require that nurses take time and attention away from their plan for the day

-Campaign to encourage children to wear seat belts and not smoke -promoting use of sunscreen

Examples of primary prevention

-Screening tests to detect early-stage diseases -Modified physical requirements for return-to-work after back injuries

Examples of secondary prevention

-Chronic disease management programs -Retraining in another career for injured workers

Examples of tertiary prevention

The nurse is reading about means to ensure compliance with the Patient​ Self-Determination Act. Which item should the nurse​ question? Living will Durable power of attorney Explanation of benefits Advance directive

Explanation of benefits (rationale:It is the purpose of this act to ensure that a​ client's right to​ self-determination in healthcare decisions be communicated and protected)

Every Teacher Posts Boring Information (Stages of commitment development)

Exploratory Testing Passionate Bored Integrated

The nurse is discussing the benefits clients receive from the​ nurse's caring interventions. Which benefit will the client​ receive? Keeps the focus on client care Established trust and rapport Demonstration of respect Facilitation of empowerment

Facilitation of empowerment

"dont worry, everything will be alright" (non therapeutic communication techniques)

False reassurance

Facial expressions

Feeling conveyed on face. something the nurse learns to control to ease client communications. (components of nonverbal communication)

*Examples of vulnerable populations

Financial circumstances, place of residence Education, age Functional or developmental status Inability to communicate Chronic or terminal illness, disability Sexual orientation Immigration status, oppression

* Secondary Prevention

Focus on early disease detection, treatment to prevent progression of disease. i.e. performing the screening delivered in: hospital, outpatient surgical center, derm, OB

* Primary Prevention

Focus on health promotion and illness prevention. i.e. Recommending screening Delivered in: Physician's offices Hospital-based clinics

Nurse turns the conversation about self, without using the technique of offering self or presence. (non therapeutic communication techniques)

Focus on self, rather than the client

Multidisciplinary teams

Function as a group (multiple) of professionals who work loosely in the same area or with the same client.

Gestures

Hand and body movements that may emphasize and clarify the spoken word. (components of nonverbal communication)

Which is a core belief about health in​ non-Western cultures?

Health is a state of harmony that encompasses​ mind, body, and spirit

Which is a core belief about health in​ Western cultures?

Health is the absence of disease

The nurse explains the role of family in the development of healthy​ self-esteem to a group of parents. Which action should the nurse explain may contribute to lowered​ self-esteem in​ children? (Select all that​ apply.) Loss of a pet Interfamilial violence Authoritative parenting Overprotective parenting Movement to a new neighborhood

Interfamilial violence Authoritative parenting Overprotective parenting

*When does someone need an interpreter?

If someone does not speak english you need an interpreter, doesnt matter if provider speaks the language.

Significance of Therapeutic Communication

Impels a feeling of comfort in the face of patient. Increases self-worth or decrease psychological distress by collecting information to determine the illness, assessing and modifying the behavior and providing health information

Examples of appropriate nursing interventions

Implementation of educational programs, coordination of community resources, and patient and family teaching

IM DR T

Individual medication dose route time

baseline assessment

Initial observations of the patient and his or her condition

*Methods for examining

Inspection palpation percussion auscultation

The nurse consistently adheres to the professional dress code. Which statement describes the effect on the​ client? Maintains professional boundaries Demonstrates​ self-respect Demonstrates a strong work ethic Instills client confidence and trust

Instills client confidence and trust (rationale:Maintaining a professional appearance instills client confidence and trust)

Critical thinking skills and abilities necessary

Intellect creativity inquiry reasoning reflection intuition

During a hospital​ orientation, the nurse was given copies of hospital​ policies, procedures, and protocols and asked to perform chart reviews. Which goal is this task aiming to​ achieve? Developing resources for quick reference Earning continuing education units Learning precautions Knowing what needs to be communicated to the client

Knowing what needs to be communicated to the client (rationale:These documents provide an overview of a procedure or​ skill, the desired​ outcome, facts,​ step-by-step instructions, red​ flags, and information on what needs to be communicated to the client and the​ client's family. Resources help develop nursing​ competency, critical thinking​ skills, and communication skills.)

Learn and asked model

L-Listen to the patient's perspective E-explain your perception of the problem and of the treatments ordered by the physician A- Acknowledge and discuss the differences and similarities between between these two perspectives R- Recommend the ordered treatments while remembering the patient's cultural parameters N-Negotiate a mutually agreed-on treatment plan (eg. choosing cultural foods that are permitted on an ordered diet)

*chronic illness

Lasts for an extended time (>6 months), slow onset, often periods of remission and exacerbation

The nurse is demonstrating professionalism when following safety guidelines and principles of​ evidence-based practice. Which is reflective of the​ nurse's ability to provide safe​ care? Establishing trust and rapport with the client and team members Using​ evidence-based standards when practicing primary prevention Maintaining a sense of physical limitations and boundaries Assessing the​ client's insurance status and ability to access healthcare

Maintaining a sense of​ one's own physical limitations and boundaries (promotes the safety of the nurse and the healthcare team)

HIPPA is an example of ______

Maintaining confidentiality (aspects that affect therapeutic relationships)

*Pharmacodynamics

Mechanism of drug action and relationships between drug concentration and the body's responses (The process by which a medication works on the body.)

MNA

Minnesota Nursing Association

*Adverse reaction/effect

More severe side effect May justify the discontinuation of a drug

A client presents to the emergency department​ (ED) complaining of pain and burning on urination. The client also tells the triage nurse that she noted blood in the urine the past few times she​ urinated, so she thought she should come to the emergency department. In which category should the nurse classify the​ client's problem to prioritize care in relation to other clients in the​ ED? A.Nonurgent B.Emergent C.Urgent D.Immediate

Nonurgent (rationale: Symptoms indicate that this client may be experiencing a urinary tract​ infection, which would be considered nonurgent since a delay in treatment would not result in a​ life-threatening situation)

The nurse is performing a psychosocial assessment of a client. The nurse should assess for which specific behavioral​ element? (Select all that​ apply.) Nonverbal cues Verbal expression of emotion Current roles and role conflicts Ability to follow a conversation Spiritual affiliations and practices

Nonverbal cues Verbal expression of emotion Ability to follow a conversation

Not All Competent People Excel

Novice Advanced beginner Competent Proficient Expert

The nurse is planning a class about integrity and nursing practice. Which statement should the nurse​ include? "Nurses with integrity provide compassionate​ care." ​"Nurses who engage in ethical behavior demonstrate​ integrity." ​"Nurses who practice cultural competency are demonstrating​ integrity." ​"Nurses who can effectively communicate demonstrate​ integrity."

Nurses who engage in ethical behavior demonstrate​ integrity

*lower health literacy

Older adults, lower socioeconomic status, lower education attainment

problem-focused assessment

Ongoing process integrated with care determines status of a specific problem

*Describe the drug concentration in blood plasma (IV vs. Oral)

Onset of action: the first point of relief peak plasma level: the max/best effect med will give. IV has high effect right away, but gradually decreases. Oral takes longer to get to peak plasma level, but the results of taking oral medication is better long term.

*Culture definition

Patterns of behavior and thinking that people living in social groups learn, develop, and share.

*Strategies to promote behavioral change for each stage of change

Precontemplation: discuss positive and negative aspects of behavior to assist the person to consider changing. Contemplation: assist client to increase awareness of behavior preparation: provide support and guidance for the client to make change a priority action: continue positive reinforcement and encouraging client to modify and substitute maintenance: encourage client to know the danger signs termination: inform the client of criteria for terminators (a new self image, no temptation, solid confidence, healthier lifestyle)

Nursing diagnosis (3 parts)

Problem Etiology Signs/symptoms

3 parts to a nursing diagnosis is:

Problem: impaired physical mobility Etiology: "related to" Manifested by: signs and symptoms

Interprofessional teams

Professional from various disciplines along with support of staff, patient, and family

Ten "Rights" of Accurate Medication Administration

Right medication Right dose Right time Right route Right client Right client education Right documentation Right to refuse Right assessment Right evaluation

Primary sources of conflict

Role boundary issues Accountability

Closed -ended questions

Questions that elicit a yes or no response from the client and don't provide details(non therapeutic communication techniques)

Volume

Quiet or loudness to the voice (components of nonverbal communication)

The nurse is discussing the outcomes of using professional behavior during communication. Which outcome should the nurse​ discuss? Priorities of care can be established to ensure the best outcome. Reliability and accountability for information are conveyed. ​High-quality and​ evidence-based care occurs at all stages. The primary preventative health of the individual can be promoted.

Reliability and accountability for information are conveyed

*State of wellbeing

SELF-RESPONSIBILITY ULTIMATE GOAL DYNAMIC, GROWING PROCESS DAILY DECISION MAKING WHOLE BEING OF INDIVIDUAL

* Case management

Seen in Hospital for short amount of time. essential for collaborative processes with multidisciplinary teams

Keeping the nurse/ client relationship only a professional relationship is _______

Setting boundaries (aspects that affect therapeutic relationships)

*Acute Illness

Severe symptoms with a relatively short duration (i.e. cold, car accident, trauma)

*Pharmacokinetics

Study of absorption, distribution, biotransformation, and excretion of drugs (what the body does to the drug)

The nurse is developing a plan of care for a client with an acute myocardial infraction​ (MI). Which intervention should the nurse include in the plan to address preventive and health maintenance aspects of the​ client's care? A. Encouraging position changes every 2 hours to help keep fluid from pooling in the bases of the lungs B. Reviewing the client history for previous​ angina, anginal​ equivalent, or MI pain C. Teaching about​ heart-healthy living prior to discharge D. Assessing skin temperature and peripheral pulses every 2-4 hours to monitor tissue perfusion

Teaching about​ heart-healthy living prior to discharge

Interdisciplinary teams

Team members from multiple disciplines interact and use each other's suggestions and information in interpreting data. The team collaboratively writes the evaluation report and intervention plan.

The nurse teaches a client to engage in a personal exploration and evaluation of​ thoughts, emotions, and values. Which component of​ self-concept is the nurse​ teaching?

The process of exploring and evaluating​ thoughts, emotions, and values is introspection

*ongoing assessment

To compare the client's current status to baseline data previously obtained

*emergency assessment

To identify life-threatening problems, to identify new or overlooked problems

Providing general leads (Therapeutic communication techniques)

Using statements or questions that 1) encourage the client to verbalize 2) choose a topic of conversation 3) facilitate continued verbalization

*Palpation

Using touch Determine texture, temperature, vibration, position, distention, pulsation, pain

techniques of therapeutic communication

Verbal Nonverbal Electronic Written

An older​ client, who also suffers from who has partial memory loss and anxiety is scheduled for a major surgical procedure in two weeks. Which information should the nurse consider providing to the client about the​ surgery? Provide a detailed description of the upcoming surgery. Present and discuss the surgery in simple terms. Wait until the day of surgery to explain the procedure to the client to decrease anxiety. Provide pamphlets for the client to read and review about the procedure.

Wait until the day of surgery to explain the procedure to the client to decrease anxiety

judgmental response (non therapeutic communication techniques)

When nurse frames messages in terms of the nurses own judgement about whether the client is saying is right or wrong.

*Synergistic effect

When two drugs increase the action of one or another drug

*Intrapersonal conflict

Within an individual Stress, tension resulting from real or perceived pressure generated by incompatible expectations or goals

The nurse has assessed a client and determined the appropriate nursing diagnoses. Which activity should the nurse perform next​? ​(Select all that​ apply.) Reassess the patient to update the database. Write priority nursing interventions. Set priorities and goals in collaboration with the patient. Relate nursing actions to patient outcomes. Write down the desired goals.

Write priority nursing interventions Set priorities and goals in collaboration with the patient Write down the desired goals

percussion assessment

a method in which the body surface is struck to elicit sounds that can be heard or vibrations that can be felt

Humor

a positive and powerful tool that can be helpful in stressful situations when used appropriately. May produce the out come of laughter. (mode of communication)

*Internal locus of control

a belief that an individual can impact their own health and well-being.

Clarity and Brevity

a communication mode that is direct and simple. the most effective type of message

*disease definition

a detectable alteration in body functioning resulting in reduction in capacities and shortening in life span

light (superficial) palpation

nurse extends the dominant​ hand's fingers parallel to the skin surface and presses gently while moving the hand in a circle

Presencing

nurse remains​ receptive, open, and available without judging or labeling the​ client's perceptions,​ feelings, or behaviors

*Acculturation definition

accepting the majority group's culture as one's own. It can have impact on health care decisions

The nurse discusses the status of morning care completed by unlicensed assistive personnel​ (UAPs). Which behavior is the nurse​ demonstrating? Responsibility Accountability Safety ​Client-centered care

accountability (rationale:Accountability is being responsible for the outcome of a completed task or assignment. RNs are accountable for their own actions/behaviors but also accountable for the actions of​ others)

Types of Commitment

affective, continuance, normative

The nurse is caring for a client who is exhibiting extremely low​ self-esteem. Which factor should the nurse assess that could be affecting the​ client's self-esteem?​ (Select all that​ apply.) Age Sex Ethnicity Level of education Socioeconomic status

age, Level of education, Socioeconomic status

Types of communicators

aggressive, passive, assertive

ABCs of who to assist first

airway, breathing, and​ circulation

rapport building

allows the client to control the​ purpose, subject​ matter, and pacing. This approach can be helpful when interviewing a client with a high level of anxiety

affective commitment

an attachment to a profession and desire to become an RN

*Diversity Definition

array of differences among individuals, groups, communities

deep palpation

assesses an organ or mass deeper in a body cavity

*what is the nursing process?

assessment - diagnosis - planning - implementations - evaluations

normative commitment

obligation to continue profession

3 stages of interview

opening, body, and closing

The nurse frequently volunteers to participate in​ hospital-wide committees. Which type of commitment describes the​ nurse's behavior? Collaborative Ethical Organizational Professional

professional

Watsons definition of transpersonal

both nurse and client seek out meaning and connectedness

strategies used to develop professional nursing support networks (professional organizations, mentoring)

provide education, career assistance and networking, create standards of practice and professional performance (ANA,MNA)

Using touch (therapeutic)

providing appropriate tactile contacts. Nurses should keep in mind individuals, families, and cultures are all different (Therapeutic communication techniques)

*Conflict competence

purposeful development of confidence, behavioral skills.

emergency assessment

rapid focused assessment conducted to determine potentially fatal situations

Cultural Humility Approach

realization that a client needs​ care, not judgment

Binge-eating disorder​ (BED) characteristics

recurrent episodes of consuming large amounts of food within a short​ time, with feelings of loss of​ control, guilt, and shame

holistic care

care that provides for the well-being of the whole person and meets not only physical needs, but also social, emotional, and mental needs

*Cultural groups definition

categorized around racial, ethnic, religious, or socially common practice patterns

assertive communicators

clearly and respectfully communicate their own needs and strive for mutually satisfactory solutions

nontherapeutic communication

communication techniques, both verbal and nonverbal, that hinder the nurse-patient relationship

the 6 Cs of roachs theory

compassion, competence,​ confidence, conscience,​ commitment, and comportment

ongoing assessment

continuing assessment activities that proceed from the initial nursing assessment

The nurse instructs​ older, healthy clients on how to adjust their activities of daily​ living, exploring alternative​ options, and developing a sense of control. Which nursing role is this nurse​ reflecting? Client advocate Leader Teacher Counselor

counselor

Negative assertion

can agree with criticism without getting upset

caring behavior/process reflect of Empowerment

reflects the​ client's development of the ability to autonomously identify their own health needs in lieu of being instructed on how to do so

inspection assessment

relies on vision and may also employ smell and hearing

*Discrimination defintion

restriction of justice, rights, privileges when dominant groups reinforce rules that limit opportunities for others

In​ Maslow's hierarchy of​ needs, which category of needs includes financial stability and harmonious family​ relationships?

safety

*Side effect

secondary effect Unintended, usually predictable May be harmless or harmful

The nurse cares for a client who has issues with​ self-concept. Which component of​ self-concept should the nurse assess in the​ client? (Select all that​ apply.): Body image ​Self-awareness Personal identity Role performance Global​ self-esteem

personal​ identity, body​ image, and role performance

Motivational interviewing: change process

precontemplation - contemplation - preparation - action

*Prejudice definition

prejudgments about cultural groups or vulnerable populations that are unfavorable or false

Which cultural characteristic that affects health care should the nurse classify as an environmental​ control? Personal boundaries Emphasis on the past Skin color Preventive medicine

preventive medicine

how to avoid pitfalls

prioritize care​ appropriately, and incorporate client preferences as possible when prioritizing client care

*Multiculturalism definition

many subcultures coexisting within a given society

Prader-Willi Syndrome characteristics

mental​ retardation, poor muscle​ tone, and an incessant desire to eat

organizational governance

mission, policies and​ procedures, and practice implementation should support cultural competence

percussion

striking to elicit sound

The nurse is frequently interrupted by personal calls while working. Which area of professionalism is​ compromised? Ethics Competence Demeanor Communication

demeanor (rationale: The behavior or demeanor of the nurse results in a decreased focus on clients)

Maslach Burnout Inventory (MBI)

depersonalization, emotional​ exhaustion, and personal accomplishment

*Therapeutic effect

desired effect; reason drug is prescribed

aesthetic knowing

empathy, holistic​ thinking, compassion, and sensitivity

*Components of Wellness

environmental occupational intellectual spiritual physical emotional social

When performing an assessment of a client with a suspected alteration of​ self, the nurse should

establish and maintain a safe​ environment, establish a therapeutic​ relationship, interview the​ client,

palpation assessment

examiner's sense of​ touch, specifically the nerve endings in the pads of the fingers

The nurse is reading about means to ensure compliance with the Patient​ Self-Determination Act. Which item should the nurse​ question? advanced directives Living will Durable power of attorney Explanation of benefits

explanation of benefits

fogging techniques (assertive comm)

find common ground (EX: putting in IV, ask what movie, show, book they're into")

*First, second, and third medication checks

first: Verify client identity and compare the med label to the MAR and check expiration date second: While preparing the medication, look at medication label and check against the MAR third: before opening, recheck label on medication against MAR

passive communication

focused only on patient

Trade (brand) name:

given by the drug manufacture and identifies it as property of that company -capitalized

*Vulnerable populations definition

groups of people in our culture at greater risk for diseases and reduced life span. Usually anyone having trouble with ADLs

* Client focused care

hospice/home care Based on expressed physical, emotional needs of client, involves family as part of client

*Worldview definition

how people in a culture perceive ideas and attitudes about the world, other people, life

*Minority definition

individuals or group who are outside of dominant group

*Ethnic group definition

individuals with common characteristics: nationality, language

Nocturnal​ sleep-related eating disorder​ (NSRED) characteristics

insomnia, followed by an episode of sleepwalking or​ semiconsciousness, during which the individual consumes unusual foods or nonfood items

After receiving constructive feedback from the​ supervisor, the nurse registers for a continuing education course. Which behavior is the nurse​ demonstrating? Demeanor Collaboration Integrity Competence

integrity

Which characteristic should the nurse understand is associated with a strong work​ ethic? Collaboration Compassion Integrity Advocacy

integrity

*levels of conflict

intrapersonal, interpersonal, intergroup, interorganizational

Barriers to care that are influenced by cultural differences may include

lack of trust in the healthcare system or​ provider, the belief that illness is not related to​ pathophysiology, the influence of family and​ community, and cultural belief that discussing an illness can influence the disease process

auscultation

listening

*Auscultation

listening to sounds within the body (usually with a stethoscope)

The nurse attended a class about how to maintain civility in the workplace. Which statement by the nurse indicates an​ understanding? "Maintain a positive​ attitude." ​"Abstain from taking personal calls at​ work." ​"Avoid gossiping with​ coworkers." ​"Do not discuss personal problems at​ work."

​"Avoid gossiping with​ coworkers" (rationale:The behavior the nurse will include in the discussion on maintaining civility in the unit is to avoid gossiping with coworkers. Gossiping is a rude and discourteous action that is a form of incivility)

The nurse reviewed the dress code. Which statement by the nurse indicates an understanding of the purpose of the dress​ code? ​"My professional appearance maintains professional​ boundaries." ​"My professional appearance supports my​ credibility." ​"Professional dress will help the client identify my​ role." ​"The dress code prevents client​ confusion."

​"My professional appearance supports my​ credibility." (rationale:How a nurse​ dresses, behaves, and communicates sets the stage for the development of trust or mistrust)

A client scheduled for cesarean birth is anxious and asks about the surgery. Which should the nurse include when providing the client with a​ client-specific pathway? A. "This gives you a visual image of what to expect while you are here. You can easily see how things will be done from now until you go home with your​ baby." B. "Since most of your care will be provided by​ nurses, this will tell you about the common things we see with cesarean deliveries and what kinds of things we will be doing for​ you." C. ​"These are the guidelines we will be using as we care for​ you, it tells you day by day what each healthcare team member will be​ doing." D. ​"This gives you information about​ activities, diet,​ medications, treatments, and tests you can expect from now until you​ deliver."

​"This gives you information about​ activities, diet,​ medications, treatments, and tests you can expect from now until you​ deliver" (rationale: are given to clients to help them understand what to expect related to care and can include information about​ activities, diet,​ medications, and so on)

The nurse attended a class about intimidation in the workplace. Which statement by the nurse indicates​ understanding? "Repeatedly asking another individual for favors is​ intimidation." ​"Intimidation may include unintentional nursing behaviors and statements made to​ clients." ​"Overt forms of intimidation include standing too close to​ someone." ​"Covert forms of intimidation include making verbal​ threats."

​Intimidation may include unintentional nursing behaviors and statements made to​ clients

The nurse conducts a support group for families of clients diagnosed with personality disorders and discusses the components of self that can cause the development of personality disorders. Which component should the nurse​ include? (Select all that​ apply.) Real self Public self ​Self-esteem ​Self-concept ​Self-awareness

​Self-esteem ​Self-concept ​Self-awareness

The nurse prepares to interview a client with suspected alterations of self. Which component should the nurse include in the​ assessment? (Select all that​ apply.) ​Self-esteem ​Self-concept ​Self-awareness Global ideal self Specific​ self-image

​Self-esteem ​Self-concept ​Self-awareness