Final

Place the steps of the scientific method in their correct order with number 1 being the first step of the process. 1. Formulate a question or hypothesis. 2. Evaluate results of the study. 3. Collect data. 4. Identify the problem. 5. Test the question or hypothesis.

4, 3, 1, 5, 2

The focus of quality health care should be on which of the following items? (Select all that apply.) a. Excellent services b. Comprehensive communication c. Private hospital rooms d. Health team collaboration e. Culturally competent care

ANS: A, B, D, E Excellent services, communication, collaboration, and culturally competent care brings quality to the health care delivered to the patient. Private hospital rooms may be a preference by some patients, but they do not add to the quality of care.

What are the major attributes of health care quality? (Select all that apply.) a. Conforms to standards b. Sound decision making c. High acuity patients d. Low health care costs e. Identifies adverse events

ANS: A, B, E Major attributes of health care quality include conformation to standards set by regulatory agencies, sound decision making regarding care, and identifying potential adverse events. High acuity of patients does not contribute to quality health care, because the care demand is increased, and low health care costs mean fewer services may be available.

A nurse manager has recently overheard several negative comments made by nurses on the unit about other nurses on the unit. The manager recognizes that the nurses are exhibiting what type of behavior that is detrimental to collaboration? a. Vertical violence b. Lateral violence c. Descending violence d. Personal violence

ANS: B Lateral violence undermines collaboration and occurs nurse-to-nurse. Vertical or descending violence implies one participant has a higher status than another. Personal violence falls in a legal category, and while it will hinder collaboration, it is not specific to coworkers.

The qualities of leadership, clinical expertise and judgment, mentorship, and lifelong learning would describe a nurse who is a(n) a. administrator. b. certified nurse specialist. c. practitioner. d. professional.

ANS: D The qualities listed are those of a professional nurse. The other options are all nurses who may have these qualities, but the focus of their title includes qualities not essential for the professional nurse. The administrator would have management qualities; the clinical nurse specialist would have specialty area knowledge; and the practitioner would meet legal requirements as a health care provider.

Two patient deaths have occurred on a medical unit in the last month. The staff notices that everyone feels pressured and team members are getting into more arguments. As a nurse on the unit, what will best help you manage this stress? Keep a journal Participate in a unit meeting to discuss feelings about the patient deaths Ask the nurse manager to assign you to less difficult patients Review the policy and procedure manual on proper care of patients after death

Participate in a unit meeting to discuss feelings about the patient deaths

4. The new director of case management assessed the need to improve the organization's patient satisfaction with the discharge process. Which statement below illustrates the vision that would lead the team to this goal? a. "The department will deliver reliable, collaborative, and compassionate discharge planning services to all patients." b. "The department will hold weekly meetings every Tuesday at 11:00 AM." c. "There will be implementation of a new uniform policy so staff can be readily identified." d. "Staff are encouraged to complain about difficult patients, families, and physicians."

ANS: A A vision is a statement about the long-term desired state for the department. The other choices describe specific actions, not a long-term vision statement.

7. The main features of complex adaptive systems that are relevant to nursing leadership are a. focused on creating organizational change and looking at the whole versus individual parts. b. defined by efforts of leadership to mandate organizational change. c. autocratic in nature with a top-down structure for change. d. dependent on employees knowing what change is necessary and acting independently.

ANS: A Complexity science posits that interactions of the parts within a system are more important than the individual parts. The autocratic top-down decision-making and mandates do not create a sustainable change. Being dependent on employees knowing what change is necessary and acting independently lacks interaction of leadership to stimulate change and adaptation among employees.

6. According to situational and contingency theory, which of the following is true? a. The theory challenges the concept that one leadership style is always best. b. The theory supports employee feelings, morale, and feedback during the change process. c. Motivation through inspiration and recognition is the focus for transforming employee behavior. d. A leader is someone who possesses great intelligence and decision-making authority.

ANS: A Situational and contingency theory challenges the assumption that there is "one best way" to lead. "The theory supports employee feelings, morale, and feedback during the change process" describes behavioral leadership. "Motivation through inspiration and recognition is the focus for transforming employee behavior" describes transformational leadership. "A leader is someone who possesses great intelligence and decision-making authority" describes Great Man or Trait theory.

When discussing the purposes of health care informatics with a nurse during orientation, the nurse educator would be concerned if the nurse orientee said that one purpose would be to a. develop a cognitive science. b. improve disease tracking. c. improve the health provider's work flow. d. increase administrative efficiencies.

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

Critical Thinking: The nurse and the patient are conversing face to face. What communication technique is this? a. linguistic b. paralinguistic c. explicit d. metacommunication

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

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

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

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

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

Exemplars of the health informatics concept include a. clinical research informatics. b. hardware and software. c. privacy and security. d. standard terminology.

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

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

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

A hospital is experiencing a drop in patient admissions, resulting in the implementation of a hiring freeze. What is a potential critical consequence of this internal organizational decision? a. A decrease in the availability of future nurses to hire b. A savings of salaries and benefits c. Increased scholarships to nursing students from the local high school d. Increased cross-training of current staff

ANS: A In an economic climate where hospitals are not hiring, nursing schools may limit enrollment which will limit the availability of future nurses available to be hired when the current nurses retire or reduce their hours. Salary savings is minimal as the number of patients, staffing, and revenue are closely aligned. Scholarships will decrease as hiring commitments to scholarship holders will no longer be in effect. Cross-training may occur, but it is not a critical consequence of a hiring freeze.

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

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

A new registered nurse asks the registered nurse (RN) preceptor what could be done to become more professional. The best response of the preceptor is a. "Attend nursing educational meetings." b. "Listen to other nurses." c. "Read the agency newsletter." d. "Pass the licensing exam."

ANS: A Knowledge and commitment are essential components of professionalism. Attending nursing educational meetings can promote collaborative learning with peers and maintenance of competence in an ever-changing health care environment. Listening can promote professionalism, and communication is certainly a component of professionalism; however, there is also a social sense to listening, and without the educational/learning component, this is not the best answer. An agency newsletter could include information about professional opportunities, but it is not the best answer. The new nurse would have already passed the licensing exam, the legal requirement to be considered a nurse.

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

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

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

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

Recommendations published in the IOM's report The future of nursing: Leading change, advancing health include that nurses a. teach, advocate, assess, and nurture. b. should have a graduate degree to practice. c. diagnose and recommend treatments. d. must have continuing education.

ANS: A Professional nurses teach, advocate, assess, and nurture. The IOM recommends that 80% of nurses have a minimum baccalaureate degree (not graduate degree) by 2020. Physicians diagnose and recommend treatments, and nurses provide the majority of these treatments. Lifelong learning is recommended, and some, not all, states require continuing education.

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

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

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

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

A nurse manager recognizes that systems theory identifies that there is a social component within an organization that affects the overall functioning of the system. What indicator would demonstrate to the nurse manager that the social needs of an organization are being met? a. Most employees from the organization attend an annual holiday celebration. b. Separate eating areas for each discipline are set up in the cafeteria. c. Nurse managers are planning to move to a centralized area away from the care units. d. The summer softball teams are canceled due to lack of interest.

ANS: A Systems theory focuses on the needs and desires of people who work in the organization. Good attendance at a work-sponsored function indicates that staff enjoy interacting and are meeting social and relationship roles. Separating disciplines does not foster a sense of team. Moving administration away from staff limits interaction and informal conversations that build trust. Lack of participation in sponsored events such as a softball team indicates that staff relationships are not strong, and a social component is not being achieved within the work environment.

The nurse is presenting an in-service on the importance of collaborative communication. The nurse includes which critical event identified by the Joint Commission as an outcome of poor communication among health care team members? a. The occurrence of a patient event resulting in death or serious injury b. Decreased ability to document expenses of care provided c. Longer time to begin surgical cases d. Increased time to discharge patients to outpatient care

ANS: A The Joint Commission has identified that poor communication is the primary factor in the occurrence of sentinel events, or events resulting in unintended death or serious injury to patients. Lack of documentation, longer time to begin surgery, and increased delays in discharge all contribute to the management of health care, but do not result in critical patient outcomes.

Which of the following statements is true about health care in the US? a. The US spends more money on health care than any other nation. b. The US provides health care to every citizen. c. The US relies on government funding to treat most citizens. d. The US spends less money on pediatric care than other nations.

ANS: A The US spends more money on health care than any other country. The US does not provide health care to every citizen, nor does it rely entirely on government funding. The US does not spend less money on pediatric care but usually more than other countries.

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

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

Components of a professional identity in nursing include which of the following? (Select all that apply.) a. Accountability b. Advocacy c. Autonomy d. Competence e. Culture

ANS: A, B, C, D The scope of professional identity in nursing includes: autonomy, knowledge, competence, professionalism, accountability, advocacy, collaborative practice, and commitment. Cultural sensitivity is important to professional nursing; however, culture is an inherent quality of nurses and patients, not a component of the professional identity.

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

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

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

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

8. To be an effective nursing leader today requires effective collaboration, which is modeled by which answer below? a. The nursing manager of the observation unit was certain the psychology department would assist the unit with a motivational plan, so she did not request their assistance. b. The nursing manager of the observation unit worked with the psychology department and physical therapy to develop a motivational plan for patients on the unit. c. The nursing director of behavioral health services followed the administrative directive to reduce services and refused to provide services for patients on other units. d. Frustrated by the trend of patients unwilling to work with therapy, the unit manager recommended that these patients be placed on another unit.

ANS: B The nursing manager works collaboratively with other departments to solve the patient care issue. In the other choices, the unit manager does not involve collaboration to resolve the patient concern.

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

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

The staff nurse who uses informatics in promoting quality patient care is most likely to access data in the domain of a. certified clinical information systems (CIS). b. clinical health care informatics. c. public health/population informatics. d. translational bioinformatics.

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

To design and implement a decubitus ulcer risk management protocol in the electronic health record, the informatics nurse would first a. build the screens in the electronic health record. b. determine evidence supporting decubitus ulcer risk management. c. develop the training program for staff. d. select the appropriate standardized language.

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

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

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

Two nurses are discussing health care in the past and the present. The two nurses know which of the following to be true about health care in the present? a. Health care in the present is mostly provided by nurses. b. Health care in the present is controlled by third party payers. c. Health care in the present is controlled by physicians. d. Health care in the present is dictated by the patient.

ANS: B Health care in the past was controlled by physicians, because they provided the care. Health care in the present is controlled by third party payers, because they finance the care. Health care is provided by nurses, but patient care requires a team of health care workers to assist the patient. The patient is part of the team, but they do not dictate the health care. The patient works with the physician to bring about a good outcome.

A hospital organization is working to improve a feeling of being valued and respected among all staff members. Which action by administration would reinforce the feeling of being valued? a. Create professional pathways that require advanced education for any advancement of staff. b. Seek staff input when planning a remodeling project of patient rooms. c. Form committees that consist of upper management to plan organizational goals. d. Consistently schedule required staff meetings at the same time each month.

ANS: B Including staff at all levels of an organization in planning and projects demonstrates respect for the intelligence and creativity of the individual. Requiring advanced education for any advancement limits those with barriers to attending additional schooling; advancement should be available in a variety of ways to show the value of the individual. Committees that only consist of upper management cause a feeling of disconnect between staff and administration. Scheduling meetings at the same time does not consider those who work shifts and either have to come in on their day off or must disrupt sleep to attend.

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

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

A nurse is interviewing at an agency owned by a national religious organization that serves homeless and uninsured patients. A large poster display shows a proposed addition that would add 16 beds to the facility that will be funded from profits of the previous 3 years of operation. The nurse recognizes that the agency is most likely what type of agency? a. For-profit b. Not-for-profit c. Publicly-owned d. Investor-owned

ANS: B Many religious organizations are privately owned and administer not-for-profit health facilities, where profits are returned into the facility for improvements or equipment. For-profit agencies distribute profits to shareholders. Publicly-owned facilities are government supported and not linked to religious organizations. Investor-owned agencies would be for-profit agencies with profits distributed to investors.

A patient states that everything has been going great; however, the nurse observe the patient biting his nails and fidgeting. What assessment can the nurse make? The patient's communication type is a. linguistic. b. paralinguistic. c. explicit. d. inadequate.

ANS: B Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient's verbal message that all is well in the relationship is modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

A student nurse is talking with his instructor. The student asks how quality of care is evaluated. The best response by the instructor is "Quality of care is evaluated a. by the patient getting well." b. on the basis of process and outcomes." c. by the physician's assessment." d. by the patient's satisfaction."

ANS: B Quality of care is evaluated by process and outcomes. If the outcomes are achieved, then the care has achieved what is was designed to do. The patient getting well may be an action of the body doing what it is supposed to do and not quality of care; the same can be said of the physician's assessment. The patient's satisfaction is subjective according to his or her perceptions and not the quality of care.

The management of a community hospital is trying to encourage a more collaborative environment among staff members. Which concept is most important for management to develop first? a. Post educational posters about how well collaboration is being performed b. Highlight that no single profession can meet the needs of all patients c. Provide meetings for each department on how their role affects patients d. Begin implementing evaluations of collaborative skills on annual performance reviews

ANS: B Recognizing that collaboration needs all professions to provide patient-centered care is an important first step to implementing a different philosophy in the hospital. Posting an evaluation of performance before education will not encourage participation. Collaboration requires an understanding of more than your own discipline. It is unfair to evaluate staff on a requirement that they have not been introduced to.

The focus for The Joint Commission (TJC) is _____ and _____ in the delivery of health care. a. cost containment; safety b. safety; quality c. quality; assessment d. assessment; evaluation

ANS: B The focus of TJC is quality and safety for patient care. TJC does not address cost containment, assessment of care, or evaluation of care.

The patient's perception of his or her care is not as important as the outcome of the care. a. True b. False

ANS: B The patient's perception of his or her care is just as important as the outcome of the care. If the patient perceives the care as meeting the aspects of quality, then patient satisfaction increases.

An accountable care organization (ACO) seeks to deliver which of the following aspects of health care? (Select all that apply.) a. Lessen Medicare payments b. Integrate care c. Enhance evidence-based practices d. Manage acute conditions e. Support hospice charges

ANS: B, C ACOs work to integrate care, manage chronic conditions, and enhance the use of evidence-based practices. They do not have any involvement with Medicare payments, the management of acute conditions, or hospice care.

A student nurse is discussing Medicare coverage with the clinical instructor. The instructor knows the student understands Medicare when the student makes this which statement(s)? (Select all that apply.) a. Medicare covers all patients while they are in the hospital. b. Medicare is funded by the federal government. c. Medicare is for persons 65 years old and older. d. Medicare is partially funded by private third-party payers. e. Medicare is for patients who are disabled and/or have end-stage renal disease.

ANS: B, C, E Medicare is funded by the federal government. It covers people who are 65 years old and older, disabled people, and patients who have end-stage renal disease. It does not cover all patients in the hospital, because some patients do not qualify for Medicare. It is not funded by third-party payers.

Which activities are appropriate for the nurse to collaborate with a patient? (Select all that apply.) a. Prescribing a new medication dose b. Health promotion activities c. End-of-life comfort decisions d. Interpreting laboratory results e. Lifestyle changes to improve health

ANS: B, C, E Nurses should include patients and their families when exploring health promotion activities, end-of-life decisions, lifestyle changes, and treatment options. Prescribed medication doses are initiated by educated professionals, although the patient gives feedback on the effectiveness of medications. Patients are not trained to interpret lab results, but patients rely on health professionals to explain results to them.

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

ANS: B, D The Iowa model of EBP provides direction for the development of EBP in a clinical agency. This EBP model was initially developed in 1994 and revised in 2001. In a health care agency, there are triggers that initiate the need for change, and the focus should always be to make changes based on best evidence. These triggers can be problem focused and evolve from risk management data, process improvement data, benchmarking data, financial data, and clinical problems. The triggers can also be knowledge focused, such as new research findings, change in a national agency's or an organization's standards and guidelines, expanded philosophy of care, or questions from an institutional standards committee.

1. The nursing unit director exhibits the definition of leadership in which of the following responses? a. The nurse manager refers the concern to the director of the department. b. The nurse manager corrects the concern with the patient directly and does not communicate her actions to the staff. c. The nurse manager meets with the staff to discuss the concern and identify solutions. d. The nurse manager tells the staff that they need to correct the situation by tomorrow and leaves the meeting.

ANS: C Leadership is defined as an interactive process that provides needed guidance and direction which is present in the correct answer. The other choices do not involve an interactive process with staff to resolve the concern.

3. The hospital must reduce the number of readmissions from 11% to 8% in the next year. Which of the following best represents the transformational leadership style in accomplishing this goal? a. The director communicates the goal of reducing readmissions to the hospital operations team and tells them to submit their action plan by the end of the week. b. The organization charters three work teams to identify solutions for the top three causes for readmissions. These teams are given full authority to implement their solution. c. The director of quality develops a vision statement and action plan to achieve the goal. The director works directly with the involved departments to implement the action plan. d. The CEO communicates the goal to the organizational directors and managers and states that they are entrusted to solve the problem.

ANS: C Transformational leaders communicate a vision and motivate employees to accomplish the goal. The director who communicates the goal of reducing readmissions to the hospital operations team and tells them to submit their action plan by the end of the week leaves the solution to achieve the goal to the followers to develop without motivating them. The solution that is left to the work teams to resolve is not an example of transformational leadership. The CEO entrusts the managers and directors to solve the problem without giving them a vision or engaging in the solution with them.

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

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

The annual report for a hospital shows that external environment factors are affecting the amount of new staff hired. What is a likely factor contributing to this outcome? a. The recent implementation of becoming a not-for-profit institution b. The implementation of a hospital electronic medical record system c. A national recession that has been occurring for 3 years d. The closure of a hospital-based school of nursing due to lack of funding

ANS: C External environmental factors that affect organizations are conditions or events that occur outside the control of the agency, such as new health laws, governmental regulations, or economic trends. Internal environmental factors occur within the organizational structure and include such factors as technology issues, changes in personnel roles, or the implementation of new policies.

Two nurses are discussing health care quality. They agree on the statement that health care quality requires a. magnet status hospitals. b. fewer adverse events. c. collaboration of multiple health care agencies. d. increased patient education.

ANS: C Multiple health care agencies are able to collaborate and provide better outcomes for health care personnel and patients. Magnet status hospitals may be good, but the status does not always mean a quality outcome. Fewer adverse events and increased patient education are good, but they may be the result of other variables and not just quality of care rendered.

The US health care system is different from that of other countries in which way? a. The US charges money from the private sector only. b. US health care is funded from private organizations. c. The US health care system is not entirely government funded. d. The US health care treats the older person first.

ANS: C Other countries fund the health care system so that every citizen may have health care. In addition they provide the option that citizens may purchase private health care too. The US has a combination of private companies and government agencies funding health care, so money is not coming from just the private sector. The older person in the population receives care according to the insurance coverage they have, but the care is not before anyone else.

The scope of professional nursing practice is determined by the rules promulgated by which organization? a. American Nurses' Association (ANA) b. Institute of Medicine (IOM) c. State's Board of Nursing d. State's Nursing Association

ANS: C Professional nursing practice is regulated by each state's Board of Nursing. The ANA is the professional organization of registered nursing in the United States and may influence, but it does not regulate. The IOM collaborated with the Robert Wood Johnson Foundation to improve the fractured health care system in the United States, and it makes recommendations, not rules. The state nursing associations are state organizations of the ANA and may collaborate with the public and boards of nursing to promote nursing rules which improve health care.

A student nurse and clinical instructor are discussing quality in health care. The instructor knows the student understands when the student says, "Quality is a. apparent in all health care." b. an outcome of health care." c. seen and unseen in health care." d. achieved by collaboration in health care."

ANS: C Quality in health care is tangible and intangible. Quality in health care is not apparent in all health care, as many areas of health care are lacking. Quality of care does not always affect the outcome of care; the patient may recover no matter what care is given. Quality is not always achieved by collaboration.

A quality improvement committee is reviewing discharge surveys. Results show that patients and their families have difficulty finding departments and areas of the hospital. What action by the committee would best address this concern for the organization? a. Continue to review future surveys to monitor the situation. b. Give additional training to the receptionists and switchboard personnel to give better directions. c. Form a multidisciplinary committee to identify options to help travel through the hospital. d. Send a work order to the maintenance department requesting that brighter lights be installed.

ANS: C Successful organizations respect the input of all disciplines when searching for solutions for problems. Continuing to gather data delays solving a problem. There is no indication that verbal directions will solve the problem; additional measures may be required. Merely providing additional light may not solve the problem—multi-language signs or even remodeling may be identified by the committee as being needed.

The economics of health care include a. Medicare and Medicaid dollars. b. patients' rights. c. equal distribution of health care. d. nurse salaries.

ANS: C The economics of health care include the equal distribution of health care services so everyone may be served when services are needed. Medicare and Medicaid, patients' rights, and nurse salaries do not factor into the economics of health care; they are only parts of the health care system.

The application of information processing that deals with the storage, retrieval sharing, and use of health care data, information, and knowledge for communication and decision making is the definition of a. computer science. b. health informatics. c. health information technology. d. nursing informatics.

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

Nursing demonstrates dedication to improving public health through a. changing health care standards. b. legal regulations. c. scope of practice. d. technology.

ANS: C Through the scope of practice, specialized knowledge, and code of ethics, the discipline of nursing has demonstrated its dedication to improving public health. The changing health care environment is one of the challenges to nursing, not an indicator of dedication. Legal regulations are generally promulgated by legislators rather than nurses to protect the public. A highly technological environment is considered a challenge to nursing rather than an indicator of dedication.

The nurse is caring for a patient with a progressive, degenerative muscle illness. The patient states that she would like to remain in her home with her daughter as long as possible. What action should the nurse take? a. Teach the patient muscle strengthening and stretching exercises. b. Tell the patient to make plans to move to an assisted-living facility. c. Discuss resources to help the patient and make appropriate referrals. d. Ask the patient to come in for daily physical therapy.

ANS: C To honor the patient's request to stay at home the nurse should make appropriate referrals for needed evaluation and assistance. Most nurses will not have the expertise to teach appropriate exercises for degenerative illness. Asking the patient to move to an assisted-living facility does not account for the patient's request. The patient has not been assessed for the need of daily therapy, and it is not likely that a patient with a degenerative illness will be able to make daily appointments for treatment as the illness progresses.

A hospital organization is applying for Magnet© status to show excellence in nursing practice. What components would indicate that the hospital is meeting Magnet© principles? (Select all that apply.) a. The education budget for nursing has been cut to provide for new laboratory equipment. b. On average, 40% of new nurses are leaving within 1 year of hire. c. Nurses are active participants on all major hospital committees. d. Quality improvement projects are planned and evaluated by nurses. e. Patient care outcome data are reported in the annual executive board meeting.

ANS: C, D To gain Magnet© status, an organization must show that nurses are active participants in the organization administrative structure, fully involved in quality improvement projects, and are recognized as a valuable resource.

5. The clinical nurse leader needs to identify the staff who must go home due to low census. Which answer below describes a democratic style of decision making? a. The clinical nurse leader identifies the staff person with the most vacation and asks them to go home. b. The clinical nurse leader tells the last person to show up for their shift to go home. c. The clinical nurse leader decides not to send anyone home because it is too difficult to decide who should lose hours. d. The clinical nurse leader asks the group if any of them would like the opportunity to go home and selects staff who volunteer.

ANS: D Democratic leaders use a participatory style of decision making. In the other choices, the clinical nurse leader makes the decision independent of the staff.

2. The nurse who is certified as a Critical Care Registered Nurse (CCRN™) represents the unit on the organizational performance improvement team. This is an example of _____ leadership. a. formal b. unit c. organizational d. informal

ANS: D Informal leaders are recognized as leaders because of their capabilities and actions. Formal leaders are recognized because of the position they hold such as director or manager. Unit leadership refers to the leader of the particular unit. Organizational leadership refers to any leader within the organization.

Florence Nightingale, the first nurse informatician, sought hospital data for comparison purposes to a. allow faster and accurate diagnosis. b. better coordinate care. c. improve the efficiency of care. d. show people how their money was spent.

ANS: D "They would show the subscribers how their money was being spent, what amount of good was really being done with it, or whether the money was not doing mischief rather than good" (Florence Nightingale, 1863). Although health information and informatics could fulfill the other purposes, none of these were the focus of Florence Nightingale's published purposes of her requests for hospital information.

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

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

A nurse is reported for taking prescribed patient medications for their personal use. Who has direct authority over deciding if the nurse may keep their professional license to continue practicing as a nurse? a. The hospital where the nurse is currently employed b. The American Nurses Association c. The National League for Nursing d. The State Board of Nursing who issued the license

ANS: D Decisions related to practice are the responsibility of the licensing body, or State Board of Nursing, who is charged with protecting the public. The hospital does not determine who is eligible for a professional license. The National League for Nursing is active in nursing education standards. The American Nurses Association helps develop standards of care and is politically active, but it does not enforce standards for individuals.

A student asks the instructor about health care economics. The instructor knows the student understands when the student states which of the following? a. "The elderly population uses most of the health care services." b. "Everyone should have health insurance to obtain services." c. "Health care dollars should be partitioned by the government." d. "Resources will be needed to serve health care issues."

ANS: D Every health care issue needs resources to bring it to fruition. Without the resources, the health care issue would not be served. The elderly are a large part of the population, but that does not change the economics of health care. Everyone does not have health insurance, so that statement would not enter into health care economics. Last, all health care dollars are not partitioned by the government; third party payers exist.

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

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

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

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

A newly licensed nurse is assigned to an experienced nurse for training on a medical unit of a hospital. What type of nurse-to-nurse collaboration does this assignment demonstrate? a. Interprofessional collaboration b. Shared governance collaboration c. Interorganizational collaboration d. Mentoring collaboration

ANS: D Mentoring is a collaborative partnership between a novice nurse and an expert nurse to help transition a nurse through career development, personal growth, and socialization into the profession. Interprofessional collaboration is working with several disciplines. Shared governance is a type of management for nursing. Interorganizational collaboration often includes teams from inside and outside an organization to meet a common goal.

Which statement correctly describes the nurses' role in collaboration? a. State boards of nursing mandate that collaboration can only occur in hospitals. b. Collaboration should occur only with physicians. c. Collaboration occurs only between nurses with the same level of education. d. Collaboration may occur in health-related research.

ANS: D Nurses collaborate with many different persons, including patients, managers, educators, and researchers. Collaboration does not occur only with physicians or nurses of equivalent educational background, but with anyone who is working towards meeting patient goals. Collaboration occurs in any health care setting as well as community and home settings.

Which patient scenario describes the best example of professional collaboration? a. The nurse, physician, and physical therapist have all visited separately with the patient. b. The nurse, physical therapist, and physician have all developed separate care plans for the patient. c. The nurse mentions to the physical therapist that the patient may benefit from a muscle strengthening evaluation. d. The nurse and physician discuss the patient's muscle weakness and initiate a referral for physical therapy.

ANS: D Professional collaboration includes team management and referral to needed providers to meet patient needs. Each discipline retains responsibility for their own scope of practice but recognizes the expertise of other providers. Working separately does not develop a comprehensive plan of care. Casual mentioning of patient needs does not follow professional communication channels and frequently delays needed interventions.

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

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

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

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

A nurse manager finds an unsigned note reporting that patient care standards are not consistently being followed. Within the organizational structure, what is the best action for the manager? a. Schedule a staff meeting to ask staff who left the note. b. Send an email reminder that all staff need to review the policy and procedure book. c. Wait for a staff member to come forward who is willing to be identified. d. Form a small group to explore why staff are not comfortable reporting errors.

ANS: D There are significant problems in an organization where staff are not willing to openly discuss problems, especially problems that affect patient care. A focus group can help identify what is preventing a sense of comfort to reveal problems. Scheduling a meeting is unlikely to have the person admit to complaining about care provided by coworkers in front of coworkers. A request to review policies and procedures is so broad the staff will not be able to identify a specific problem that needs to be corrected. Unless organizational changes are made, it is unlikely that staff will decide to come forward when they would not do so in the first place.

A patient has been admitted to an acute care hospital unit. The nurse explains the hospital philosophy that the patient be an active part of planning their care. The patient verbalizes understanding of this request when they make which statement? a. "I will have to do whatever the physician says I need to do." b. "Once a plan is developed, it cannot be changed." c. "My insurance will not pay if I don't do what you want me to do." d. "We can work together to adjust my plan as we need to."

ANS: D Treatment plans need to be developed, evaluated, and adapted as needed based on the patient status and willingness to complete the prescribed care. Stating that the patient has to do whatever the care provider prescribes does not include the principle of collaboration. Care plans can be altered based on patient status. Insurance providers do not determine a patient's ability to complete prescribed care, although they do reimburse for standard care given.

The nurse manager of a medical/surgical unit wants to increase the use of health care technology on the unit and is working with an ANA-certified informatics nurse to reduce barriers to health information exchange, including a. basic informatics knowledge and skills. b. offering the best set of tools. c. privacy and security policies. d. unit-specific terminology.

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

A nurse has seen many cancer patients struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of: Creativity. Fairness. Clinical reasoning. Applying ethical criteria.

Applying ethical criteria. The use of ethical criteria for nursing judgment allows a nurse to focus on a patient's values and beliefs. Clinical decisions are then just, faithful to the patient's choices, and beneficial to the patient's well-being.

A nurse prepares to insert a Foley catheter. The procedure manual calls for the patient to lie in the dorsal recumbent position. The patient complains of having back pain when lying on her back. Despite this, the nurse positions the patient supine with knees flexed as the manual recommends and begins to insert the catheter. This is an example of: Accuracy. Reflection. Risk taking. Basic critical thinking.

Basic critical thinking Basic critical thinking is concrete and based on a set of rules or principles such as the guidelines in a hospital procedure manual. The nurse's approach is not accurate because accuracy requires use of all of the facts (e.g., the patient's discomfort). A critical thinker is willing to take risks to try different ways to solve problems; following one basic approach is not risk taking. This is also not an example of reflection.

A nurse changed a patient's surgical wound dressing the day before and now prepares for another dressing change. The nurse had difficulty removing the gauze from the wound bed yesterday, causing the patient discomfort. Today he gives the patient an analgesic 30 minutes before the dressing change. Then he adds some sterile saline to loosen the gauze for a few minutes before removing it. The patient reports that the procedure was much more comfortable. Which of the following describes the nurse's approach to the dressing change? (Select all that apply.) Clinical inference Basic critical thinking Complex critical thinking Experience Reflection

Complex critical thinking Experience The nurse relies on experience and the ability to adapt a procedure such as a dressing change (complex critical thinking) to make it successful.

A nurse on a busy medicine unit is assigned to four patients. It is 10 am. Two patients have medications due and one of those has a specimen of urine to be collected. One patient is having complications from surgery and is being prepared to return to the operating room. The fourth patient requires instructions about activity restrictions before going home this afternoon. Which of the following should the nurse use in making clinical decisions appropriate for the patient group? (Select all that apply.) Consider availability of assistive personnel to obtain the specimen Combine activities to resolve more than one patient problem Analyze the diagnoses/problems and decide which are most urgent based on patients' needs Plan a family conference for tomorrow to make decisions about resources the patient will need to go home Identify the nursing diagnoses for the patient going home

Consider availability of assistive personnel to obtain the specimen Combine activities to resolve more than one patient problem Analyze the diagnoses/problems and decide which are most urgent based on patients' need Analyzing urgency of problems helps to prioritize as does considering the resources that are available (such as assistive personnel) to complete patient care activities. Deciding how to combine activities is good time management. Holding a family conference is a good idea but in this case would be too late to be beneficial to the patient. To determine priorities the nurse must identify nursing diagnoses for all patients.

A nurse enters a 72-year-old patient's home and begins to observe her behaviors and examine her physical condition. The nurse learns that the patient lives alone and notices bruising on the patient's leg. When watching the patient walk, the nurse notes that she has an unsteady gait and leans to one side. The patient admits to having fallen in the past. The nurse identifies the patient as having the nursing diagnosis of Risk for Falls. This scenario is an example of: Inference. Basic critical thinking. Evaluation. Diagnostic reasoning.

Diagnostic reasoning. Diagnostic reasoning begins when you interact with a patient or make physical or behavioral observations. An expert nurse sees the context of a patient situation (e.g., patient lives alone, has fallen in past), observes patterns and themes, and makes a diagnostic decision.

By using known criteria in conducting an assessment such as reviewing with a patient the typical characteristics of pain, a nurse is demonstrating which critical thinking attitude? Curiosity Adequacy Discipline Thinking independently

Discipline Discipline is being thorough in whatever you do. Using known criteria for assessment and evaluation, as in the case of pain, is an example of discipline.

A nurse just started working at a well-baby clinic. One of her recent experiences was to help a mother learn the steps of breastfeeding. During the first clinic visit the mother had difficulty positioning the baby during feeding. After the visit the nurse considers what affected the inability of the mother to breastfeed, including the mother's obesity and inexperience. The nurse's review of the situation is called: Reflection. Perseverance. Intuition. Problem solving

Reflection. The mother had difficulty breastfeeding first time. The nurse relied on reflection to consider her previous actions and review what was successful and the opportunities for improvement. The nurse has not yet problem solved but might do so after reflection in anticipation of the patient's next clinic visit.

A nurse is preparing medications for a patient. The nurse checks the name of the medication on the label with the name of the medication on the doctor's order. At the bedside the nurse checks the patient's name against the medication order as well. The nurse is following which critical thinking attitude: Responsible Complete Accurate Broad

Responsible The nurse is demonstrating responsibility for correct medication and patient identification. The other three choices are critical thinking intellectual standards.

An aspect of clinical decision making is knowing the patient. Which of the following is the most critical aspect of developing the ability to know the patient? Working in multiple health care settings Learning good communication skills Spending time establishing relationships with patients Relying on evidence in practice

Spending time establishing relationships with patients Knowing the patient relates to a nurse's experience with caring for patients, time spent in a specific clinical area, and having a sense of closeness with them. However, a critical aspect to knowing the patient and thus being able to make timely and appropriate decisions is spending time establishing relationships with them.

The ANA outlines expectations of the nursing profession in the a. Gallup poll. b. Goldman report. c. Social Policy Statement. d. social identity theory.

The ANA's Nursing's Social Policy Statement outlines expectations of nurses. The national Gallup poll has found nursing to be one of the most trusted professions for their honesty and ethical standards almost every year, but it does not outline expectations. Emma Goldman was a radical anarchist nurse who advocated and cared for indigent women in New York. She demonstrated the expectations of a professional nurse. Social identity theory posits that social identity is derived from group membership and that most people work to attain a positive social identity, and it not specific to nursing.

In which of the following examples is a nurse applying critical thinking skills in practice? (Select all that apply.) The nurse thinks back about a personal experience before administering a medication subcutaneously. The nurse uses a pain-rating scale to measure a patient's pain. The nurse explains a procedure step by step for giving an enema to a patient care technician. The nurse gathers data on a patient with a mobility limitation to identify a nursing diagnosis. A nurse offers support to a colleague who has witnessed a stressful event.

The nurse thinks back about a personal experience before administering a medication subcutaneously. The nurse uses a pain-rating scale to measure a patient's pain. The nurse gathers data on a patient with a mobility limitation to identify a nursing diagnosis. Reflection, using a pain-rating scale to be precise and specific, and nursing assessment (the first step of the nursing process) are examples of critical thinking skills. Explaining a procedure based on policy is not critical thinking. However, performing a procedure following policy is basic critical thinking. Offering support to a colleague is an important way to help another manage stress but is not a critical thinking skill.

The nurse and physician are explaining the home care that will be needed by a patient after discharge. The patient's spouse states angrily that it will not be possible to provide the care recommended. What is the best response by the nurse? a. "Let me review what is needed again." b. "It is important that you do what the physician has prescribed." c. "What concerns do you have about the prescribed care?" d. "I can come back after you talk with your spouse about the care."

The patient needs to be the focus of developing care plans, and communication is an important part of collaboration with the patient to discover barriers for the patient to follow recommendations. It is important to either provide solutions to the barriers or present other options. Reviewing the care again does not demonstrate willingness to have the patient be part of the team. Insisting that the patient do what is prescribed is autocratic and does not recognize the role the patient has in their care. Leaving the patient and spouse with the situation unresolved fosters distrust and more anger.

Which of the following describes a nurse's application of a specific knowledge base during critical thinking? (Select all that apply.) Initiative in reading current evidence from the literature Application of nursing theory Reviewing policy and procedure manual Considering holistic view of patient needs Previous time caring for a specific group of patients

nitiative in reading current evidence from the literature Application of nursing theory Considering holistic view of patient needs A nurse's specific knowledge base will vary but includes basic nursing education, continuing education courses, and additional college degrees. In addition, it includes the knowledge gained from a nurse reading the nursing literature and acquiring information and theory from the basic sciences, humanities, behavioral sciences, and nursing. Nurse's knowledge base also involves a different way of thinking holistically about patient problems.