Exam 4 study guide

a. Catheter-related urinary tract infections b. Retained surgical instruments c. Client falls

A nurse manager is working as part of a quality improvement team to address issues that could impact reimbursement by Medicare. Which situation would warrant the team's attention? Select all that apply. a. Catheter-related urinary tract infections b. Retained surgical instruments c. Client falls d. Complex surgical procedures e. Medication reconciliation

Health Maintenance Organization (HMO)

Alternative means of health care in which people or their employers are charged a set amount and the HMO provides health care and covers hospital costs.

-planning care in partnership with patients -providing information so that patients can make informed choices -honoring the right of patients and families to make decisions about health care

Autonomy

b. Unfreezing

Following a myocardial infarction (heart attack), a client begins to recognize the need to increase exercise, eat a low-fat diet, and implement relaxation techniques. According to Lewin, this client is in which stage of the change process? a. Prizing b. Unfreezing c. Moving d. Refreezing

Ethics

Formal, systematic study of moral beliefs

Community and social services

Hospice, personal care services, home-delivered meals, modifications, assistive technology, accessible transportation, education and support for patient self care

a. People b. Practice d. Profession e. Coworkers rationale: The International Code of Ethics is based on the nurse's responsibility to act ethically toward people, practice, profession, and coworkers. Family, although important, is not included among those elements.

The International Council of Nurses (ICN) Code of Ethics for Nurses (2012) has which elements? Select all that apply. a. People b. Practice c. Family d. Profession e. Coworkers

c. Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray.

The nurse is preparing to teach a client from Generation X about hypertension. Which teaching approach should the nurse plan to implement? a. Provide brochures about low-sodium foods. b. Ask a family member to do meal planning to alleviate the burden for the client. c. Demonstrate the MyFoodPyramid phone app, to show the best food choices on a lunch tray. d. Have the client repetitively choose appropriate foods from various menus.

d. Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance.

The parents of a school-age child are meeting with the nurse for health promotional education for their child. The child has the following assessment data: a 7-year-old male with diabetes mellitus type 1 with a hemoglobin A1C level of 8.3%, a body mass index (BMI) of 31.7, and a BMI percentile of 99. What are the most appropriate learning diagnoses for this first session? a. Deficient Knowledge: Readiness for enhanced nutrition, and risk for disturbed body image. b. Deficient Knowledge: Risk for chronic low self esteem, and risk for unstable blood glucose level. c. Deficient Knowledge: Risk for imbalanced nutrition: more than body requirements, and sedentary lifestyle. d. Deficient Knowledge: Imbalanced nutrition: more than body requirements, and ineffective health maintenance.

B. Political and economic considerations RATIONALE: Medicaid cuts by the state government will influence the political, economic, and social realities of the profession.

The state government has decided to decrease funding for the Medicaid program. Which component of care will this most impact? A. The treatment of disease B. Political and economic considerations C. Promotion of health D. Implementation of technology

Values

What is the term for the beliefs held by the individual about what matters ?

Integrity

acting in accordance with an appropriate code of ethics and accepted standards of practice -honesty of the nurse -demonstrating accountability

Preferred Provider Organization (PPO)

group of healthcare providers that provide services to a specific group, often at a reduced rate

d. Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification rationale: Distractions to learning, such as the television being on or the client being at meal time, diminish the effectiveness of any education plan. An authoritarian style of teaching does not honor the client as a partner in the learning process. Age does not necessarily determine developmental stage. Assessing the client's developmental stage and understanding of the health problem, clarifying information that is difficult for the client to understand, and ensuring that the client is physically able to perform the task are all aspects of a well-planned education session for all clients.

The nurse must instruct a 35-year-old client with Down syndrome about the use of an albuterol rescue inhaler. Which documentation demonstrates appropriate individualization of the education plan for this client? a. Taught lesson at a school-age developmental level in an authoritarian style while the client was at meal time b. Taught lesson at an adult developmental level (age 35) using short sentences and assessed motor skills c. Assessed the client's understanding of health and answered questions on an age-appropriate level while the television was on in the room d. Assessed the client's understanding of illness; assessed motor skills and developmental stage; provided clarification

Medicare

The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which system?

d. The nurse practice act or facility's policy and procedures rationale: The RN should consult the nurse practice act or the facility's policy and procedures. The nurse mentor or preceptor and the more experienced nurse are good resources, but may mistakenly give inaccurate information. The medical practice act is designed to govern health care provider practice and may not contain information on the task that is to be delegated.

The registered nurse (RN) wants to delegate a task to an unlicensed assistive personnel (UAP) but is unsure if the task can be delegated. What is the best resource for the RN to use in determining if the task is appropriate? a. The medical practice act website b. A nurse mentor or a nurse preceptor c. A more experienced nurse working on the same unit d. The nurse practice act or facility's policy and procedures

Values

What are the standards for decision-making that endure for a significant time in one's life?

c. The nurse and the client rationale: The nurse and the client should be the individuals who decide who should be included in the learning sessions. The nurse cannot assume that family members are wanted by the client to be included. The client must always be included in the learning session.

When a nurse is planning for learning, who must decide who should be included in the learning sessions? a. The health care team b. The doctor and nurse c. The nurse and the client d. The client and the client's family

autonomy

A client diagnosed with cancer has met with the oncologist and is now weighing whether to undergo chemotherapy or radiation for treatment. This client is demonstrating which ethical principle in making this decision?

b. Creating an atmosphere for discussion of feelings.

A client shares with the nurse how much they appreciates understanding the physiology of human milk productions. The female client states, "I'm feeling much more at ease about breastfeeding than I was this time yesterday." In the domain of affective learning, the nurse has achieved what outcome? a. Creating an educational opportunity for the future. b. Creating an atmosphere for discussion of feelings. c. Creating specific learning sessions for new information. d. Creating an opportunity for rational thought and learning.

a. The nurse writes one or two broad objectives rather than several specific objectives. rationale: The statement that best describes the proper method for writing objectives would be that the nurse writes one long-term objective for each diagnosis, followed by several specific objectives. The nurse would not use general statements that could be accomplished in any amount of time because this action is not addressing the specific needs of the client, and the setting in which the client is in. The nurse would not plan learner objectives with another nurse and would not always obtain input from the family of the client. The objectives need to be specific so the outcomes can be measured in the evaluation phase.

A nurse is writing learner objectives for a client who was recently diagnosed with type 2 diabetes. Which statement best describes the proper method for writing objectives? a. The nurse writes one or two broad objectives rather than several specific objectives. b. The nurse writes general statements for learner objectives that could be accomplished in any amount of time. c. The nurse plans learner objectives with another nurse before obtaining input from the client and family. d. The nurse writes one long-term objective for each diagnosis, followed by several specific objectives.

Integrity

A nurse reports to the charge nurse that a client medication is due at 9am was omitted. Which principle is the nursing demonstrating ?

-Demonstrating understanding of the cultures, beliefs, and perspectives of others -Advocating for patients, particularly the most vulnerable -taking risks on behalf of patients and colleagues -mentoring other professionals

Altruism

Autonomy

Is the right to self-determination it acting independently and making decisions

1. "Tell me about what signs of infection you will report to the health care provider." rationale: Cognitive domain learning may be evaluated through oral questioning. The return demonstration is an excellent way of evaluating psychomotor domain learning. Providing an opportunity for and encouraging clients to change their own dressing, for example, provides concrete evidence of satisfactory or unsatisfactory performance of the procedure.

The nurse has provided education to a client about home care for an open surgical wound on the lower left extremity. When evaluating learning through the cognitive domain, what statement by the nurse would be appropriate? 1. "Tell me about what signs of infection you will report to the health care provider." 2. "I would like you to demonstrate how to change the dressing on your leg." 3. "Let's see how you irrigate the wound with saline." 4. "I notice that you do not have the dressing secured. Place a piece of tape on the wrap."

B. Bathing a combative client

The registered nurse on a busy telemetry floor is delegating tasks to an unlicensed assistive person (UAP). Which task is appropriate for the UAP to complete? A. assessing a client's wound b. bathing a combative client c. inserting an indwelling urinary catheter d. taking an order over the phone from a health care provider

a. Demonstrating the technique for insulin self-injection rationale: The psychomotor domain involves skill performance. In this case, demonstrating the insulin self-injection technique would apply. Describing signs and symptoms, explaining what to do if hypoglycemia occurs, and reviewing appropriate food choices are appropriate for the cognitive domain.

A client diagnosed with type 2 diabetes has been prescribed insulin therapy in conjunction with an oral agent because the client has been experiencing difficulty controlling blood sugar levels with an oral agent alone. The nurse is preparing a teaching plan for this client. Which intervention would the nurse include in the teaching plan to address the psychomotor domain? a. Demonstrating the technique for insulin self-injection b. Describing the signs and symptoms of low blood sugar c. Explaining what to do if hypoglycemia occurs d. Reviewing with the client appropriate foods to eat

values clarification Rationale: values clarification is a process that allows an individual to examine and understand what choices to make.

A nurse is preparing a client for discharge from the cardiac unit and observes cigarettes in the client's belongings. The nurse asks the client to consider the client's health and that of the client's spouse. This is an example of:

a. Available resources b. Learning style preferences c. Literacy level rationale: Availability of resources, learning style preference, and literacy level affect the planning of effective teaching strategies. The size of family and client's job would not be factors which the nurse should prioritize when planning this teaching session. They would only be considered if the nurse determined they could affect the outcome of the teaching session.

A nurse is preparing to teach a client about the importance of contraception and safe-sex practices. Which factors can most affect the nurse's teaching strategies for this client? Select all that apply. a. Available resources b. Learning style preferences c. Literacy level d. Size of family e. The client's job

c. Short-term counseling rationale: Short-term counseling would help a client solve a situational crisis. A client experiencing a developmental crisis, for example, might need long-term counseling. Motivational counseling is an evidence-based counseling approach that involves discussing feelings and incentives with the client. Professional counseling is a general term.

A nurse may attempt to help a client solve a situational crisis during what type of counseling session? a. Long-term counseling b. Motivational counseling c. Short-term counseling d. Professional counseling

c. Nonmaleficence d. Veracity e. Fidelity rationale: Nonmaleficence means "doing no harm" or avoiding an action that deliberately harms a person. By not reporting this incident, the nurse is deliberately harming the client. Veracity means the duty to be honest and avoid deceiving or misleading a client. Fidelity means being faithful to work-related commitments and obligations, such as reporting the incident. Justice and autonomy do not apply in this scenario

A nurse who is infected with human immunodeficiency virus (HIV) accidentally gets a cut while debriding a wound, exposing the client to possible HIV infection. Failure of the nurse to report this incident violates which ethical principles? Select all that apply. a. Justice b. Autonomy c. Nonmaleficence d. Veracity e. Fidelity

Their readiness to learn is often related to a developmental task or social role. Rationale: An adult's readiness to learn is often related to a developmental task or social role. The previous experience of the adult is a rich resource for learning. Most adults' orientation to learning is that material should be useful immediately. Peer group acceptance is a critical issue for the adolescent group and not adults.

A parish nurse is preparing to provide a health promotion class to a group of adults in the parish. In preparing to meet the learning needs of this group, the nurse recognizes which as a characteristic of an adult learner?

safe, effective, patient centered, timely, efficient, equitable

IOM's Six Aims to be Met by Health Care Systems Regarding Quality of Care

Values

Socialization into the nursing profession may have the most significant effect on what?

d. "Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal." rationale: the nurse should document who the teaching was provided to, what was taught, the teaching method, and the evidence of learning. The other answer choices are not as comprehensive and, therefore, are not the best examples of teaching.

Which documentation example best reflects the complexity of client teaching by the nurse? a. "Told client to take antibiotic as ordered." b. "Client return demonstrated how to use glucometer." c. "Taught client about peak flows; client verbalized understanding." d. "Client and spouse taught how to use phone app to count carbohydrates; client return demonstrated carb counting for a hypothetical meal."

d. The client avoids health care screenings and seeks care in the local emergency department.

Which observation during the nursing assessment of a client supports the documentation of low health literacy? a. The client is provides a coherent health history. b. The client's health forms are complete. c. The client complies with the medication regimen despite financial difficulties. d. The client avoids health care screenings and seeks care in the local emergency department.

A. Making referrals to appropriate community resources B. Providing assistance with securing medical devices and supplies C. Assisting with discharge planning E. Assisting clients and families in dealing with the social, emotional, and environmental factors that affect their well-being RATIONALE: Hospital-based social workers generally do not provide direct, in-hospital psychological counseling. All other services indicated are within the scope of practice of a hospital-based social worker.

Which services are within the scope of practice of a hospital-based social worker? Select all that apply. A. Making referrals to appropriate community resources B. Providing assistance with securing medical devices and supplies C. Assisting with discharge planning D. Providing direct, in-hospital psychological counseling E. Assisting clients and families in dealing with the social, emotional, and environmental factors that affect their well-being

a. The client acknowledges the need to lose weight. rationale: In unfreezing, one recognizes the need for change. The client's acknowledgment of the need to lose weight is the only example provided of unfreezing. The nurse providing education on how to count calories in food and the importance of daily exercise is an example of moving, in which change is initiated after a careful process of planning. The client's intentions to begin an exercise program with friends and to begin counting calories with the next meal are examples of refreezing, which involves making a change operational, or a part of one's everyday life.

The nurse is advising a client about health problems related to being overweight. The client acknowledges the need to lose weight. The nurse provides education on how to count calories in food and the importance of daily exercise. The client states an intention to begin counting calories with the next meal. The client also states an intention to begin an exercise program with friends. Which statement associated with this scenario illustrates Lewin's stage of unfreezing? a. The client acknowledges the need to lose weight. b. The client also states an intention to begin an exercise program with friends. c. The client states an intention to begin counting calories with the next meal. d. The nurse provides education on how to count calories in food and the importance of daily exercise.

Justice

The nurse is participating in a workplace group that is charged with making decisions about resource allocation throughout a community. This nurse is enacting what ethical principle?

a. Allow ample time for psychomotor skills. rationale: Older adults generally need more time to learn psychomotor skills. Sessions of 2 to 3 hours are too long and information can be structured or nonstructured, depending on the content. The nurse should not presume that older adults have memory loss.

The nurse is planning to teach an exercise class to a group of older adults. What guideline should the nurse adopt when planning this education? a. Allow ample time for psychomotor skills. b. Keep the session at 2 to 3 hours. c. Allow for long-term memory loss. d. Provide information in a structured format.

d. Monitoring insulin requirements rationale: When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of the condition, and the potential for harm. The nurse should monitor the client's need for insulin. The UAP can monitor blood pressure, offer nourishment, and perform a fingerstick blood glucose test. The UAP should report the result of the fingerstick blood glucose test to the nurse, and the nurse should determine the need for insulin based on health care provider orders.

he nurse and unlicensed assistive personnel (UAP) are working together to admit a client newly diagnosed with diabetes to a nursing unit. Which task would be inappropriate to delegate to the UAP? a. Measuring blood pressure b. Offering sugar-free popsicles c. Performing a fingerstick blood glucose test d. Monitoring insulin requirements

Point of Service (POS)

insurance plan in which a patient may choose an HMO or a non-HMO provider but must pay a deductible for using a non-HMO provider

value clarification

process by which people come to understand their own values and value system

Community Health Centers

regionalized services for vulnerable geographic populations with an emphasis on primary care and education; Most services rely on nurses to provide primary care

care-based approach

Directs attention to the specific situations of individual patients viewed within the context of their life narrative

altruism, autonomy, human dignity, integrity, social justice

what are the professional values that AACN identified that epitomize the caring, professional nurse?

Bundled payments

a model of reimbursement in which single payments are made to multiple providers involved in an episode of care, creating a sense of shared accountability among providers.

medical neighborhood

a patient-centered medical home and the constellation of other clinicians providing health care services to patients within it, along with community and social service organizations and state and local public health agencies

Altruism

concern for the welfare and well-being of others

multispecialty group practice

physicians from different specialties united to share income, expenses, facilities, equipment, and support staff

International Council of Nurses

The nurse beginning practice would like to access the standards for ethical practice. Which organization should the nurse research for these standards?

a. Cognitive

When caring for a client, the nurse observes that the client enjoys reading books and magazines. In which learning domain does the client's learning style fall? a. Cognitive b. Affective c. Psychomotor d. Interpersonal

c. Cognitive

Which learning domain is the focus for instruction when the nurse educates a new parent about the physiology of human milk production? a. Affective b. Psychomotor c. Cognitive d. Behavioral

fee-for-service

a system under which doctors and hospitals receive a payment for each service they provided

ambulatory care

outpatient care; specialty care, subspecialty care, ancillary services (e.g., physical therapy, podiatry, speech therapy), retail clinics.

principle-based approach

combines elements of both utilitarian and deontologic theories and offers specific action guides for practice

Capitation

gives providers a fixed amount per enrollee of health plan which aims to build a payment plan for select diagnoses or procedures that consist of best standards of care at the lowest cost

Managed Care Organization (MCO)

responsible for the health of a group of enrollees; can be a health plan, hospital, physician group, or health system.

Social Justice

upholding moral, legal, and humanistic principles; concept of fair and just relations between the individual and society and us related to wealth and distribution of goods in society

-providing culturally respectful sensitive care -protecting the patient's privacy -preserving the confidentiality of patients and health care providers -designing care in partnership with the patient and with the sensitivity to individual needs

-human dignity

A. "The federal government pays for Part A of Medicare." C. "You don't have to carry Part B of Medicare unless you want to." D. "You may want to pay for a Medicare supplement." RATIONALE: Part A of Medicare is paid for by the federal government and covers most inpatient hospital costs. Part B is voluntary and is paid by monthly premium. Many people carry a Medicare supplement to cover the portion of costs not covered by Medicare. Medicare is the major insurance for older adults; Medicaid is assistance for those with low incomes and some other qualifying situations.

A client is approaching 65 years of age and says, "I will be glad when I am eligible for Medicare so I won't have to worry about insurance anymore." How should the nurse respond to this statement? Select all that apply. A. "The federal government pays for Part A of Medicare." B. "Part A of Medicare pays for your doctor visits, but not hospital charges." C. "You don't have to carry Part B of Medicare unless you want to." D. "You may want to pay for a Medicare supplement." E. "Medicaid is the government insurance for older adults."

b. "What do you see as your biggest hurdle to stopping?" rationale: When counseling a client, the focus should be on assisting the client to make one's own decisions, finding ways to reach goals, and supporting the client. The nurse should never give advice, such as reducing cigarette consumption over time or using nicotine patches or gum. Asking open-ended questions that encourage the client to speak freely about the topic at hand and help define goals is the best option. Asking the client which options have previously been tried is a closed question and limits the response to a list of things the client has tried and would not encourage the client to share other information important to form a smoking cessation plan, such as a spouse that smokes.

A client is meeting with the nurse to discuss options for smoking cessation. Which statement by the nurse is most appropriate for this client? a. "There are many options available. Which options have you previously tried?" b. "What do you see as your biggest hurdle to stopping?" c. "Some people find that reducing cigarette consumption slowly over time is an effective option." d. "Most clients are successful when they use over-the-counter nicotine patches or gum."

B. Sophisticated technology generally allows client care to be managed safely in the home environment.

A client with a recent total knee replacement who is about to be discharged home with home health services states, "I think it is too soon for me to go home." What should the nurse explain to the client is the primary reason for the implementation of this level of care? A. The insurance/payment reimbursement system requires early discharge. B. Sophisticated technology generally allows client care to be managed safely in the home environment. C. Home health agencies are able to provide many different health care-related services. D. Teaching clients is more easily done in the home.

Altruism

A nurse is concerned about how a client will care for self after discharge is an example of what professional value?

A. Triaging walk-in clients C. Teaching clients about wellness and illness D. Assisting with minor surgical procedures E. Performing physical assessments RATIONALE: Prioritizing client care tasks, teaching, assisting in surgery, and performing physical assessments are all within the registered nurse's (RN) scope of practice. Prescribing medications is outside the RN scope of practice.

A nurse is considering accepting a new position in an ambulatory care center. What roles does the nurse understand are likely in this setting? Select all that apply. A. Triaging walk-in clients B. Prescribing medications C. Teaching clients about wellness and illness D. Assisting with minor surgical procedures E. Performing physical assessments

a. Blocking 30 minutes of time for skill teaching rationale: Preschool age children (2 to 5 years) have short attention spans. Five- to ten-minute blocks of time are age appropriate. A 30-minute block is more appropriate for an older client. The other answers are developmentally appropriate for a 4-year-old.

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

a. The client describes signs and symptoms of hypoglycemia rationale: The client's ability to describe the signs and symptoms of hypoglycemia demonstrates cognitive learning (the storing and recalling of new knowledge in the brain). Demonstrating a skill, such as insulin injection, is an example of psychomotor learning. Affective learning includes changes in attitudes, values, and feelings (e.g., desire to lose weight).

A nurse is educating a client with a new diagnosis of diabetes. Which example demonstrates cognitive learning by the client? a. The client describes signs and symptoms of hypoglycemia. b. The client demonstrates proper technique for injecting insulin. c. The client expresses a desire to improve nutritional intake and lose weight. d. The client prepares the skin for the administration of an insulin injection.

Fidelity Rationale: the principle of fidelity involves the nurse being faithful to the client, who has the right to the truth. By not telling the client, the nurse is not being faithful to the client.

A nurse is providing care for a client with cancer. The client's spouse requests that the client not be told that the client is terminal. The nurse complies with this request. The nurse's action is a breach of which principle?

a. 66-year-old male with heart failure c. 45-year-old male with a permanent disability receiving social security benefits rationale:

A nurse is providing care to several clients at the clinic. When reviewing the clients' medical records, which client would the nurse identify as meeting the criteria for Medicare reimbursement? Select all that apply. a. 66-year-old male with heart failure b. 55-year-old female with a temporary disability c. 45-year-old male with a permanent disability receiving social security benefits d. 30-year-old male with blindness from an industrial accident e. 60-year-old female with a low income

a. The nurse fails to accept that clients have the right to change their minds. c. The nurse uses medical jargon frequently when discussing the teaching plan. d. The nurse ignores the restrictions of the client's environment. Rationale: Common teaching mistakes made by health care professionals would include the following: the nurse failing to accept that clients have the right to change their minds; the nurse using medical jargon frequently when discussing the teaching plan; and the nurse ignoring the restrictions of the client's environment. The nurse does negotiate goals with the client. The nurse would evaluate what the client had learned. The nurse would review educational media when planning learner objectives.

A nurse is providing teaching to clients in a short-term rehabilitation facility. Which examples are common teaching mistakes made by health care professionals? Select all that apply a. The nurse fails to accept that clients have the right to change their minds. b. The nurse negotiates goals with the client. c. The nurse uses medical jargon frequently when discussing the teaching plan. d. The nurse ignores the restrictions of the client's environment. e. The nurse evaluates what the client has learned. f. The nurse reviews educational media when planning learner objectives.

Promoting health Preventing illness Restoring health Alleviating suffering rationale: According to the ICN Code of Ethics, nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering. Providing holistic care is not a fundamental responsibility of nurses, according to the ICN Code of Ethics.

A nurse is reviewing The International Council of Nurses (ICN) Code of Ethics for Nurses. Based on this code, the nurse would identify which responsibilities as being fundamental?

a. "What do you know about support groups?" Rationale: By asking the client an open-ended question the nurse can find out what the client knows about support groups. With the client's permission, the nurse can further educate on this topic. The nurse should acknowledge the client's ability to accept or reject the material to empower the client and lead to more healthy decision-making

A nurse is trying to encourage a client with paraplegia who is depressed and not adhering to the treatment program to join a support group. Which statement by the nurse is most appropriate? a. "What do you know about support groups?" b. "Support groups are for people like you who are depressed." c. "I am sure you would feel better if you joined a support group." d. "I am going to sign you up for a support group."

d. Describe how the walker can improve the client's quality of life. rationale: Motivating the older adult client can be done by showing the client how the new knowledge will improve the client's quality of life, regardless of how long that may be. It will also demonstrate how the new knowledge could improve the client's level of independence. Although demonstrating the use of the walker and explaining how the walker assists with ambulation (and the rationale for its use) can be used to educate the client, these actions would not promote motivation for the client to learn

A nurse is working with an older adult client, educating the client on how to ambulate with the aid of a walker. The nurse notes that the client appears to lack the motivation to learn how to use the device. The client states, "I'm just too old to learn." What would be most appropriate for the nurse to do to motivate this client? a. Tell the client how to move the walker as the client ambulates. b. Explain how the walker supports the client's lower extremities. c. Fully discuss the rationale for using the walker. d. Describe how the walker can improve the client's quality of life.

b. giving a bed bath to a client d. taking routine vital signs f. transferring a client to another floor rationale: The nurse should be familiar with guidelines for delegating nursing care. The nurse could delegate the following tasks to UAP: giving a bed bath to a client, taking routine vital signs, and transferring a client to another floor. The nurse could not delegate the administering of medications, planning client education for a client with a colostomy, or the determining a nursing concern for care planning.

A registered nurse is delegating activities to unlicensed assistive personnel (UAP) on a hospital unit. Which activity(ies) could this nurse normally delegate? Select all that apply. a. determining a nursing concern for care planning for a client with breast cancer b. giving a bed bath to a client c. planning education for a client with a colostomy d. taking routine vital signs e. administering medications to a client f. transferring a client to another floor

b. Personal perception of health and aging rationale: Knowing about the client's orthopedic history, religious beliefs, and barriers to mobility in the home are all helpful for an overall plan of care, but DO NOT address individualism. Gaining insight into the client's own perceptions of health and aging, however, will allow the nurse to tailor the plan of care to the client's personal needs.

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

b. Day care center rationale: Day care centers provide these services to senior citizens. Ambulatory care is an overarching category of care centers and clinics that can include psychosocial, physical, and mental health care. Hospital at home care and extended care centers are for clients who require more complex care than can be provided in a day care center.

An ambulatory care center that facilitates socialization and provides health-related services to seniors who are unable to fully care for themselves is best known by what name? a. Ambulatory care center b. Day care center c. Extended care center d. Hospital at Home

c. Have the client rate pain level, and reschedule the teaching session. rationale: The client is not ready or able to learn and is reporting a need that first must be met. Assessing the client's knowledge of self-care or redirecting the client to discuss self-care only delays the care that must be done before the client is able to learn. Although providing written materials is an excellent supplement to a teaching session, it does not replace teaching the client. It is best to address the physical needs before attempting to educate the client.

As the nurse enters the room to teach the client about self-care at home, the client states, "I am glad you are here. I need some pain medicine. I can't stand it anymore." What is the best action of the nurse? a. Redirect the client to learning about self-care and begin education. b. Give written materials to the client and administer pain medication. c. Have the client rate pain level, and reschedule the teaching session. d. Assess the client's understanding of self-care and administer medication.

Acute and post acute caffe

Inpatient hospital care Rehabilitation Skilled nursing care Home health services Emergency department

DRGs

Inpatient hospital services for Medicare patients are grouped into which prospective payment?

-providing honest information to patients and the public -documenting care accurately and honestly -seeking to remedy errors make by self or others -demonstrating accountability for own actions

Integrity

State and public health

Smoking cessation Tobacco use prevention Infectious disease control Chronic disease prevention

-Supporting fairness and nondiscrimination in the delivery of care -promoting universal access to health care -encouraging legislation and policy consistent with the advancement of nursing care and health care

Social justice

a. Assessing a rash on the arm rationale: When delegating, the RN must determine the skill level and education of the UAP, the client's condition and the complexity of the condition, and the potential for harm. Assessment of conditions should be reserved for the nurse. UAPs can be trained to empty indwelling catheter bags, perform EKGs, and place electrodes.

The nurse and unlicensed assistive personnel (UAP) are working together in the emergency room. Which task should the nurse avoid delegating to the UAP? a. Assessing a rash on the arm b. Emptying an indwelling catheter bag c. Obtaining an electrocardiogram (EKG) d. Placing electrodes for cardiac monitoring

c. Begin the session with a reference to the client's actual experience. rationale. Beginning the session with a reference to the client's actual experience will help provide a link to which the new learning can connect. Although it may be appropriate to refer the client to online resources on proper bowel health, to encourage the client to join a support group, and to consult the client's family regarding the client's history, the nurse should first engage with the client to find out the client's experience and specific issues.

The nurse is caring for a 60-year-old client with an improper bowel movement regimen. Which is the most appropriate method for the nurse to use in teaching this client? a. Refer the client to internet resources on proper bowel health. b. Have the client join a small group of other clients with the same problem and facilitate group discussions. c. Begin the session with a reference to the client's actual experience. d. Talk to the client's relatives and get a detailed account of the client's history.

b. Ask the client to recall after approximately 15 minutes. rationale: Asking a client to recall what has been discussed after approximately 15 minutes helps determine what information the client has actually retained. Observing the change in the client's behavior for a month is not feasible or timely. Testing the client on the health education and information imparted would be time-consuming and unnecessarily involved. Asking the client to self-administer the doses of drug (if even appropriate) would help demonstrate the client's understanding of how to actually administer the drug but not any other aspect of teaching related to a fracture.

The nurse is caring for a 70-year-old client with a fractured wrist. Which is the best method to determine whether the client has retained the information taught? a. Observe the change in client's behavior for a month. b. Ask the client to recall after approximately 15 minutes. c. Test the client on the health education and information imparted. d. Ask the client to administer the doses of drug himself.

c. Educate the client about the pathophysiology of the disease process rationale: Cognitive learning theory is the result of people wanting to make sense of the world around them by assimilating and processing information to gain new understandings and insights. Providing concrete information such as pathophysiology is indicative of cognitive learning. Assessing the client's feelings and anticipated effects aligns with affective learning. Demonstrating a technique is a form of psychomotor learning.

The nurse is caring for a client with a new diagnosis of osteoarthritis and degenerative joint disease. Which action should the nurse perform when addressing the client's cognitive learning needs? a. Assess how the diagnosis will affect the client's daily routines b. Assess the client's feelings and emotions surrounding the diagnosis c. Educate the client about the pathophysiology of the disease process d. Demonstrate techniques for minimizing mobility challenges

a. Assess the client with difficulty breathing

The nurse is delegating care to an unlicensed assistive personnel (UAP). Which intervention would be most important for the nurse to perform independently? a. Assess the client with difficulty breathing b. Obtain a postprandial blood sugar reading c. Measure the client's blood pressure d. Assist the client with turning in bed

c. "I should not press the button more often than every 3 to 4 hours." rationale: Specific dosages and time intervals can be programmed into the machine to prevent overdose; medication is delivered when the client pushes a control button. The medicine will help the client control pain. The client need not worry about pressing the button too often, as the machine has been programmed to not allow delivery of too much medication.

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

b. As the client is sitting quietly, reading a book rationale: A client is most ready to learn when the client is comfortable, nourished, pain-free, and has time to learn. It is not an appropriate time to educate the client when the meal tray arrives, at the time of pain medication administration, or immediately before discharge home, as the client may be distracted.

The nurse is planning to provide teaching to a client who is recovering from abdominal surgery. When is the most appropriate time to teach the client? a. When the meal tray arrives b. As the client is sitting quietly, reading a book c. At the time of pain medication administration d. Immediately before discharge to home

b. Lecture/discussion rationale: Lecture/discussion is appropriate for this topic, audience, and group size. A lecture is a formal presentation of information by a teacher to a group of learners. This format is most effective when communicating facts. Role play would not be an appropriate teaching strategy for this topic, as key points cannot be acted out, or for this size of a group, as there are too many students for each one to be able to participate in role play. Demonstration would not be appropriate, either, as the topic does not focus on particular skills that can be demonstrated. Case studies may be used in the lecture but using them as the sole basis of learning would not normally be possible on only one hour

The nurse is responsible for providing a 1-hour presentation on sexual health to a group of 30 college students. What is the most appropriate teaching strategy for the nurse to use? a. Role play b. Lecture/discussion c. Demonstration d. Case studies

c. Ask the client to demonstrate how to self-inject the morning insulin. rationale: By using the teach-back method, the nurse teaches and demonstrates a skill, then the client returns the skill as if teaching the nurse how it is done. This is an effective way to determine the client's ability to independently perform a skill. Asking the client to repeat the steps is good, but self-administering the injection is a better indicator. A brochure could be used as a teaching aid, but it is not the most effective means of determining if the client can perform the skill. Providing a teaching session that includes questions and answers should be done; however, the client should demonstrate the skill.

The nurse is teaching a client with diabetes how to inject daily insulin. Which method is most effective in evaluating the teaching? a. Ask the client to repeat the steps of injection in order. b. The nurse uses a brochure to explain how to give an injection. c. Ask the client to demonstrate how to self-inject the morning insulin. d. Provide a teaching session that includes a question and answer discussion.

d. Delegate bathing and vital signs tasks. rationale: Steps to enhancing time management include: establish goals, evaluate ability to meet goals and identify tasks that can be delegated, establish a timeline, evaluate success of the plan, and use the evaluation to make future plans. Goals were established in the stem of the question and therefore, the next step would be to delegate task.

The nurse is working to enhance time management skills and has to administer pain medications to several clients, obtain vital signs, and assist clients with bathing. What should the nurse do next? a. Bathe clients. b. Obtain vital signs. c. Administer pain medications. d. Delegate bathing and vital signs tasks.

d. The new mother attempts to breastfeed the infant again using the new techniques and is successful. rationale: Refreezing involves making a change operational, or a part of one's everyday life. The mother feeding the infant using new techniques is an example of refreezing. The nurse recognizing that a new mother is having difficulty breastfeeding is an example of unfreezing, in which the need for a change is recognized. The nurse educating the mother on ways to ensure proper latching and demonstrating various positions in which to hold the infant while feeding are examples of moving, in which change is initiated after a careful process of planning.

The nurse recognizes that a new mother is having difficulty breastfeeding. The nurse demonstrates various positions in which to hold the infant while feeding. The nurse also educates the mother on ways to ensure proper latching. The new mother attempts to breastfeed the infant again using the new techniques and is successful. Which statement in this scenario illustrates Lewin's stage of refreezing? a. The nurse also educates the mother on ways to ensure proper latching. b. The nurse recognizes that a new mother is having difficulty breastfeeding. c. The nurse demonstrates various positions in which to hold the infant while feeding. d. The new mother attempts to breastfeed the infant again using the new techniques and is successful.

c. The stability of the client's condition, potential for harm, and complexity of the activity rationale: RNs should consider the following when delegating tasks to UAPs: qualifications and capabilities of the UAP (not the age of the UAP or the RN's skill level), stability of the client's condition (not the autonomy of the client), complexity of the activity to be delegated (not the time required to complete the activity), potential for harm, predictability of the outcome (not the predictability of the UAP or the desired outcome), and overall context of other client needs.

The registered nurse (RN) wants to delegate measuring a client's urinary output to an unlicensed assistive personnel (UAP). Which factors should the nurse consider before delegating the task? a. The complexity of the activity, age of the UAP, and predictability of the outcome b. Predictability of the UAP, the amount of time required for the task, and RN's skill level c. The stability of the client's condition, potential for harm, and complexity of the activity d. The context of the other client needs, the desired outcome, and autonomy of the client

a. Identify and recommend some credible websites appropriate to the spouse's learning needs. rationale: Web-based resources can be a useful tool in client education, but suitability and accuracy need to be carefully considered. Many online databases exist for health professionals, but these are less likely to be accessible to or appropriate for those outside the health professions. The client has requested online resources, so providing print-based materials is not warranted at this time.

The spouse of a client who has recently been diagnosed with early-stage Alzheimer's disease asks the nurse to recommend websites that may supplement the spouse's learning about this diagnosis. How should the nurse respond to the spouse's request? a. Identify and recommend some credible websites appropriate to the spouse's learning needs. b. Encourage the spouse to avoid online resources due to the unregulated nature of the Internet. c. Direct the spouse to online databases such as the Cumulative Index to Nursing and Allied Health Literature. d. Provide the spouse with print-based materials that are clearly referenced and reflect the spouse's learning style.

a. Autocratic b. Laissez-faire c. Democratic d. Authoritarian rationale: Laissez-faire leadership would work best in this situation, as it alone would allow the nurses the autonomy and creative environment they need to complete the project. The autocratic, democratic, and authoritarian leadership styles may stifle the creativity the nurses require to complete the project. Laissez-faire leadership style involves the leader relinquishing power or control to the group. Autocratic, or authoritarian, leadership style involves assuming control over the decisions and activities of the group. Democratic leadership style involves sharing the decision-making process and activities with others who have an interest.

Two nurses have requested that the nurse manager allow them to plan in-service education with creative, new education techniques. Which leadership style would be best for the nurse manager to use to get the new project completed? a. Autocratic b. Laissez-faire c. Democratic d. Authoritarian

altruism

Understanding of cultures, beliefs, and prospective did others; advocating, mentoring other professionals

bathing, grooming, ambulation, collect data (ONLY the nurse can interpret data) feeding, and things like taking vital signs, measuring intake and output, weighing simple dressing changes, transfers, and postmortem care.

What are some of the basis cares that RNs can delegate to APs?

a. making health assessments b. performing technical procedures c. providing health education.

What are the typical roles of a nurse in a primary care center ? a. making health assessments b. performing technical procedures c. providing health education. d. Performing in-service education e. Researching nursing issues

A. Managed care B. Case management E. Primary health care RATIONALE: Methods to ensure continuity of care and cost-effective care would include managed care, case management, and primary health care. Rural health centers are often located in geographically remote areas that have few health care providers. The primary focus of rural health centers is providing primary care. Parish nursing is an expanding area of specialty nursing practice that emphasizes holistic health care, health promotion, and disease-prevention activities. The focus of parish nursing is not continuity of care or cost-effective care. Primary care center services include the diagnosis and treatment of minor illnesses; performing minor surgical procedures; and providing obstetric care, well-child care, counseling, and referrals. The primary care center's main focus is not continuity of care or cost-effective care.

What methods are used to ensure that clients have continuity of care and cost-effective care during movement throughout the health care system? Select all that apply. A. Managed care B. Case management C. Rural health centers D. Parish nursing E. Primary health care F. Primary care centers

filing an incident report after making a medication error

What nursing action demonstrates the principle of fidelity?

Motivational counseling rationale: The most appropriate counseling for the situation at hand would be motivational counseling. With motivational counseling, the nurse would discuss feelings and incentives with the client. Short-term counseling focuses on the immediate problem or concern of the client or family. It can be a relatively minor concern or a major crisis, but in any case, it needs immediate attention. Long-term counseling extends over a prolonged period. A client might need the counsel of the nurse at daily, weekly, or monthly intervals. A client experiencing a developmental crisis, for example, might need long-term counseling. Professional counseling is a general term.

When a client says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate? a. Long-term counseling When a client says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate? Long-term counseling Motivational counseling Short-term counseling Professional counseling c. Short-term counseling d. Professional counseling

a. Assess for cultural differences. rationale: When the client is having difficulty learning, it may be possible that the client does not understand the language that the nurse speaks. In such a case, the nurse should take the necessary steps to break the cultural barrier and then proceed with the education. Written materials can enhance many clients' learning, but will not necessarily overcome many of the common barriers to understanding, including cultural and linguistic factors. The nurse should take action to overcome any barriers to the learning process before delegating to a colleague. The client's morale is not pertinent to the client's difficulty understanding the teaching.

When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health education. Which action is most appropriate? a. Assess for cultural differences. b. Boost the morale of the client. c. Delegate the health education to a colleague. d. Replace one-on-one teaching with written materials.

c. Ask the client, "Do you learn best by observing, valuing, or doing?" rationale: one way to determine the client's preferred learning style is to ask the client about the client's personal learning preference--whether cognitive, affective, or psychomotor. Simply observing the client's behavior or considering the client's age and hearing ability would not provide as much information about the client's preferred learning style as would directly asking the client. Providing teaching using a broad-based approach would not help determine the client's preferred learning style and would not be as effective as providing teaching that is tailored to the client's preferred learning style.

When preparing client teaching materials, how does the nurse best assess a client's preferred learning style? a. Observe the client's behaviors. b. Provide teaching that works for the broadest base of clients. c. Ask the client, "Do you learn best by observing, valuing, or doing?" d. Determine client learning needs based on age and ability to hear effectively.

a. hospitalists. rationale: The hospitalist is a health care provider who provides care to the client in the emergency room and after admission to the hospital. The hospitalist communicates with the client's primary care health care provider but manages the hospital care. An admitting health care provider is one who is responsible for admitting a client to a hospital or inpatient health facility. A referral specialist is a health care office worker who is responsible for making sure that a client's health care insurance will cover expenses related to care from a specialist to whom the client's primary care provider has referred the client. An on-call health care provider is simply one who is scheduled to be available to come to the hospital on a moment's notice to provide emergency care to a client on an as-needed basis

When the client's primary care health care provider does not have hospital privileges, a service is available to provide the client's care and communicate with the client's health care provider. This service is provided by health care providers called: a. hospitalists. b. admitting health care providers. c. referral specialists. d. on-call health care providers.

C. is resourceful D. is supportive E. is an experienced, licensed professional G. Demonstrates leadership abilities

Which attributes should be characteristic of a nurse mentor? Select all that apply. A. embraces disruptive conflict. B. deconstructs health care networks C. is resourceful D. is supportive E. is an experienced, licensed professional F. is driven by financial reward G. Demonstrates leadership abilities

a. Change financial incentives linked to doing more to gain more reimbursement rationale: Prospective payment systems seek to eliminate incentives to doing more to gain more reimbursement. A capitation system pays for select diagnoses cared for via best standards of care, and providers in a capitated system receive a capitated payment for each client enrolled. A bundled system gives providers a fixed sum of money to provide a range of services.

Which description of the primary function of prospective payment systems is most accurate? a. Change financial incentives linked to doing more to gain more reimbursement b. Attempt to build a payment plan for select diagnoses or procedures that consist of best standards of care at the lowest cost c. Allow providers a capitated payment for each client enrolled in the program d. Allow providers a fixed sum of money to provide a range of services

Inpatient hospital services for Medicare patients

Which group of people has a fixed reimbursement amount with adjustments based on case severity, rural/urban/regional costs, and teaching costs?

B. Allowing a child to decide not to have a intravenous line inserted

Which scenario is an example of the laissez-faire approach to value transmission? A. Teaching children right from wrong and telling them the reason behind it B. Allowing a child to decide not to have a intravenous line inserted C. Modeling healthy behaviors for adolescents, such as not smoking electronic cigarettes D. Telling a child an injection will feel like a pinch before the nurse gives the injection

d. Cardiovascular surgery rationale: Same-day surgery, chronic disease management and education, and psychiatric care are typically associated with secondary care centers. Subspecialty care, such as cardiovascular surgery, is generally available in tertiary care centers.

Which service would most likely be provided in a tertiary care center? a. Same-day surgery b. Chronic disease management and education c. Psychiatric care d. Cardiovascular surgery

c. A 70-year-old female who is the client's spouse and is learning the care so the client can come home rationale: Adults learn best when the information given to them is something they need to use immediately, when they are strongly motivated to learn, and when they have an internal motivation to learn the topic. When the adult learner does not see the importance of the topic or has no emotional need to learn (such as the client who appears to be undergoing the education only at the insistence of the client's significant other), motivation is low. Motivation to learn may also be lacking if the adult learner has just reached completion of a major task, such as the client who just completed a course of physical therapy. The adult learner who is seeking knowledge to assist a loved one may be the most motivated. On the other hand, a stranger to the client who has just been hired to bring the client home from the clinic is the least likely to be motivated to learn.

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

a. The nurse maintains standards of personal conduct. c. The nurse is active in developing a core of research-based principles. e. The nurse holds personal information as confidential. rationale: The ANA Code of Ethics states: "The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient." Standards of personal conduct, developing research, and confidentiality are all tenets of the Code of Ethics for Nurses. Fair compensation and participation in the advancement of the profession are related to the Bill of Rights for Registered Nurses, not the Code of Ethics for Nurses.

Which statements indicate a correct understanding of the tenets of the Code of Ethics for Nurses? Select all that apply. a. The nurse maintains standards of personal conduct. b. The nurse has the right to fair compensation for the workload. c. The nurse is active in developing a core of research-based principles. d. The nurse participates in the advancement of the profession. e. The nurse holds personal information as confidential.

B. "Part A pays for inpatient hospital costs; Part B covers most outpatient costs." D. "It's good to have an extra policy to supplement what might not be covered."

While at a clinic visit, a client asks the nurse, "I'm going to be eligible for Medicare soon. Can you help explain what this involves?" Which information would the nurse likely include in the explanation? Select all that apply. A. "You won't have to pay for anything anymore. All your care will be covered." B. "Part A pays for inpatient hospital costs; Part B covers most outpatient costs." C. "If you want coverage for inpatient costs, you'll have to pay a monthly fee." D. "It's good to have an extra policy to supplement what might not be covered." E. "The benefits you receive when you start will stay the same forever."