Fundamentals test 1

The nurse's responsibility for informed consent:

-witness informed consent -document refusals -those with mental disorders or substance abuse need to consent like everyone else -if unconscious, use POA or surrogate -in an emergency for life and limb, okay to skip consent

Patient self determination act

requires health care institutions to provide written information to patients concerning their rights to make decisions about their care, including the right to refuse treatment and to formulate an advance directive. Advanced directives, durable power of attorney for health, will, living will.

Mental health parity and addiction equity act

requires health insurance companies to provide coverage for mental health and substance use disorder (SUD) treatment, just as they do for medical coverage.

Charting by exception

shorthand method for documenting patient data that is based on well-defined standards of practice; only exceptions to these standards are documented in narrative notes. WNL

Omnibus Budget Reconciliation Act

significantly altered the way in which health care is provided to older adults. It focused on patient rights, quality of life, quality of care, and the physical environment in which patients live. One change focused on the use of restraints intended to change older-adult behavior

Advocacy

speaking on someone else's behalf.

Tertiary care

specialized consultative care, usually provided on referral from secondary medical personnel. ICU.

Who issues nursing licesnses?

state boards of nursing

Nurse practice act

state laws intended to protect citizens, make nurses accountable, and ensure care is consistent with best practices within the scope and standards of nursing

SOAP note

subjective, objective, assessment, plan

Accountability

taking ownership for your actions

Confidentiality

the act of holding information in confidence, not to be released to unauthorized individuals

Barriers to caring

time restraints, stressors, sicker patients, interruptions, burnout, nursing shortage

values clarification

two opposing views that are both correct

responsibility

willingness to take on an action and follow through

Epidemiologist role

you apply principles of epidemiology, the science dealing with the incidence, distribution, and possible control of diseases and other health problems.

Clara Barton

Nurse during the Civil War; founder of the American Red Cross

A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request.

Advocacy

Morals

judgement about behavior, based on specific beliefs

Analyticity (critical thinking skill)

Anticipate how a patient might respond to a treatment.

Henderson (nursing theorist)

Based on 14 activities, the belief that the nurse should assist patients with meeting needs until they are able to do so independently

King (nursing theorist)

Based on the belief that nurses should work with patients to develop goals for care

Orem (nursing theorist)

Based on the belief that people who participate in self-care activities are more likely to improve their health outcomes

Neuman (nursing theorist)

Based on the theory that focuses on wellness and prevention of disease

Accountability

You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the provider and your nurse manager and follow agency procedure.

Focus charting (DAR)

data, action, response

Using the Transtheoretical Model of Change, order the steps that a patient goes through to make a lifestyle change related to physical activity.

-The individual becomes angry when the physician tells him that he needs to increase his activity to lose 30 pounds. -The individual recognizes that he is out of shape when his daughter asks him to walk with her after school. -The individual visits the local running store to purchase walking shoes and obtain advice on a walking plan. -The individual walks 2 to 3 miles, 5 nights a week, with his wife. -Eight months after beginning walking, the individual participates with his wife in a local 5K race.

communicating with patients who are unresponsive

-call pt by name during interactions -communicate verbally and by touch -speak to pt like they can hear you -explain all procedures and sensations -provide orientation to person, place, and time -avoid talking abt patient to others in their presence

communicating with Pts who are visually impaired

-check for glasses/contacts -ID yourself when you enter and notify when you exit -do not rely on gestures or nonverbal communication -use indirect lighting avoiding glare -use at least 14 pt print

communicating with pts who have hearing impairment

-check for hearing aids and glasses -reduce environmental noise -face pt with mouth visible -do not chew gum -speak in a normal voice -rephrase rather than repeat if misunderstood -provide sign language interpreter if needed

handling and disposing of PHI

-dont remove any printed info from the facility -de identify all pt data -use a cover page when faxing -verify all numbers that you are faxing to -do not share passwords -encrypt when possible -lock computer when you leave

communicating with Pts who cannot speak clearly

-listen attentively, be patient, do not interrupt -ask simple yes/no questions -allow time for understanding and response -use visual cues -allow one person to speak at once -encourage pt to converse -let pt know if you understand -collaborate w speech therapy if needed -use communication aids

communicating with Patients Who Do Not Speak English

-speak in normal tone of voice -establish method for pt to ask for assistance -provide an interpreter -avoid using family as interpreters -use communication board, pictures, cards -translate words for basic requests -have a dictionary

Steps in how to perform an EBP study

-spirit of inquiry -ask clinical question -search for best evidence in the research -critically look at the evidence from the research -integrate research into practice -evaluate outcomes or changes -communicate the outcomes -sustain knowledge use

communicating with Pts who have cognitive impairment

-use simple sentences and avoid long explanations -ask one question at a time -be an attentive listener -include family and friends in conversations -use pictures and gestures to mimic actions required

Contemporary nursing requires that the nurse have knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples of these roles and responsibilities? (Select all that apply.) 1. Caregiver 2. Autonomy 3. Patient advocate 4. Health promotion 5. Genetic counselor

1. Caregiver 2. Autonomy 3. Patient advocate 4. Health promotion

One element of clinical decision making is knowing the patient. Which of the following activities affect a nurse's ability to know patients better? (Select all that apply.) 1. Caring for similar groups of patients over time 2. Reading the evidence-based practices appropriate to patients 3. Learning how patients typically respond to their clinical situations 4. Observing patients 5. Engaging with patients experiencing illness

1. Caring for similar groups of patients over time 3. Learning how patients typically respond to their clinical situations 4. Observing patients

A hospice nurse sits at the bedside of a male patient in the final stages of cancer. He and his parents made the decision that he would move home and they would help him in the final stages of his disease. The family participates in his care, but lately the nurse has increased the amount of time spent with the family. Whenever the nurse enters the room or approaches the patient to give care, the nurse touches his shoulder and states, "I am your nurse, and I am here for you." This is an example of what type of touch. 1. Caring touch 2. Protective touch 3. Task-oriented touch 4. Interpersonal touch

1. Caring touch

Place the steps of the EBP process in the appropriate order.

-Cultivate a spirit of inquiry. -Ask the clinical question in PICOT format. -Search for the most relevant and best evidence. -Critically appraise the evidence you gather. -Integrate the evidence. -Evaluate the outcomes of the practice decision or change. -Communicate the outcomes of the EBP change.

legal guidelines for documentation

-Just the facts -Legibly in black ink -Date and time everything (military time if institution requires) -Write about calling doctor, PA, NP, team, etc. -Only what you did for yourself, never chart for anyone else (exception → emergency, will have one recorder → every signs at end) -Title with first initial, last name, S.N.

The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution?

-Recognize that the problem requires ethics. -Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem. -Take time to clarify values and identify the ethical elements, such as principles and key relationships involved. -Articulate a statement of the problem or dilemma that you are trying to resolve. -List all the possible actions that could be taken to resolve the problem. -Develop and implement a plan to address the problem.

The REFLECT model can improve learning after providing patient care. Place the steps of this model in the correct order:

-Review the facts of the situation. -Think about your thoughts and actions at the time of a situation. -Recall any feelings you had at the time of the situation. -Review the knowledge you gained from the experience. -Consider options for handling a similar situation in the future. -Create a plan for future situations. -Set a schedule for completing your plan of action.

Which of the following statements indicate that the new nursing graduate understands ways to remain involved professionally? (Select all that apply.) 1. "I am thinking about joining the health committee at my church." 2. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing." 4. "Nurses do not have very much voice in legislation in Washington, DC, because of the nursing shortage." 5. "I will go back to school as soon as I finish orientation."

1. "I am thinking about joining the health committee at my church." 2. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing."

A nurse research investigator is explaining a research study to a patient. The patient is interested in participating in the research study. The nurse investigator reviews the informed consent with the patient. The patient asks the nurse why he must sign the consent to participate in the study. What is the nurse's best response(s) to the patient's question? (Select all that apply.) 1. "The informed consent (IC) provides you with complete information on the research study." 2. "By reviewing the consent with you, I can make sure that you understand the study and what it means for you to participate." 3. "The informed consent provides details on the limitations of the study." 4. "The informed consent provides your voluntary agreement to participate in the research study." 5. "The informed consent explains how the data collected from you will be kept confidential during and after the study."

1. "The informed consent (IC) provides you with complete information on the research study." 2. "By reviewing the consent with you, I can make sure that you understand the study and what it means for you to participate." 4. "The informed consent provides your voluntary agreement to participate in the research study." 5. "The informed consent explains how the data collected from you will be kept confidential during and after the study."

The nurse identifies which of the following as outcomes measurements? (Select all that apply.) 1. A nurse teaches a patient how to administer an injection and then watches the patient do a return demonstration. 2. A nurse implements a new pain-management protocol and checks patients' charts to confirm whether interventions are being provided. 3. A nursing unit adopts a set of strategies for reducing pressure injuries, and the UPC members use direct observation of the skin to measure incidence of pressure injuries. 4. A nursing unit implements a new fall prevention protocol and checks the monthly performance data for incidence of falls on the unit. 5. A nursing unit implements a patient rounding program, and the charge nurse watches the assistive personnel to see whether hourly rounding is being done on patients.

1. A nurse teaches a patient how to administer an injection and then watches the patient do a return demonstration. 3. A nursing unit adopts a set of strategies for reducing pressure injuries, and the UPC members use direct observation of the skin to measure incidence of pressure injuries. 4. A nursing unit implements a new fall prevention protocol and checks the monthly performance data for incidence of falls on the unit.

Which statements properly apply an ethical principle to justify access to health care? (Select all that apply.) 1. Access to health care reflects the commitment of society to principles of beneficence and justice. 2. If low income compromises access to care, respect for autonomy is compromised. 3. Access to health care is a privilege in the United States, not a right. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. 5. If a new drug is discovered that cures a disease but at great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it.

1. Access to health care reflects the commitment of society to principles of beneficence and justice. 2. If low income compromises access to care, respect for autonomy is compromised. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics.

The public health nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2030. Most of the immigrant population do not have a primary care provider, nor do they participate in health promotion activities; the unemployment rate in the community is 25%. How does the nurse determine which goals need to be included or updated? (Select all that apply.) 1. Assess the health care resources within the community. 2. Assess the existing health care programs offered by the county health department. 3. Compare existing resources and programs with Healthy People 2030 goals. 4. Initiate new programs to meet Healthy People 2030 goals. 5. Implement educational sessions in the schools to focus on nutritional needs of the children.

1. Assess the health care resources within the community. 2. Assess the existing health care programs offered by the county health department. 3. Compare existing resources and programs with Healthy People 2030 goals.

When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.) 1. Check for needed adaptive equipment. 2. Exaggerate lip movements to help the patient lip-read. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point. 5. Communicate only through written information.

1. Check for needed adaptive equipment. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point.

Which strategies should a nurse use to facilitate a safe transition of care during a patient's transfer from the hospital to a skilled nursing facility? (Select all that apply.) 1. Collaboration between staff members from sending and receiving departments 2. Requiring that the patient visit the facility before a transfer is arranged 3. Using a standardized transfer policy and transfer tool 4. Arranging all patient transfers during the same time each day 5. Relying on family members to share information with the new facility

1. Collaboration between staff members from sending and receiving departments 3. Using a standardized transfer policy and transfer tool

Which statements reflect the difficulty that can occur for agreement on a common definition of the word quality when it comes to quality of life? (Select all that apply.) 1. Community values influence definitions of quality, and they are subject to change over time. 2. Individual experiences influence perceptions of quality in different ways, making consensus difficult. 3. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 4. Statistical analysis is difficult to apply when the outcome cannot be quantified. 5. Whether a person has a job is an objective measure, but it does not play a role in understanding quality of life.

1. Community values influence definitions of quality, and they are subject to change over time. 2. Individual experiences influence perceptions of quality in different ways, making consensus difficult. 4. Statistical analysis is difficult to apply when the outcome cannot be quantified.

The nurse who works at the local health care agency is transferring a patient to an acute rehabilitation center in another town. To complete the transfer, information from the patient's EHR must be printed and faxed to the acute rehabilitation center. Which of the following actions are appropriate for the nurse to take to maintain privacy and confidentiality of the patient's information when faxing this information? (Select all that apply.) 1. Confirm that the fax number for the acute rehabilitation center is correct before sending the fax. 2. Use the encryption feature on the fax machine to encode the information and make it impossible for staff at the acute rehabilitation center to read the information unless they have the encryption key. 3. Fax the patient's information without a cover sheet so that the person receiving the information at the acute rehabilitation center can identify it more quickly. 4. After sending the fax, place the information that was printed out in a standard trash can after ripping it into several pieces. 5. After sending the fax, place the information that was printed out in a secure canister marked for shredding.

1. Confirm that the fax number for the acute rehabilitation center is correct before sending the fax. 2. Use the encryption feature on the fax machine to encode the information and make it impossible for staff at the acute rehabilitation center to read the information unless they have the encryption key. 5. After sending the fax, place the information that was printed out in a secure canister marked for shredding.

Theory is essential to nursing practice because it: (Select all that apply.) 1. Contributes to nursing knowledge. 2. Predicts patient behaviors in situations. 3. Provides a means of assessing patient vital signs. 4. Guides nursing practice. 5. Formulates health care legislation. 6. Explains relationships between concepts.

1. Contributes to nursing knowledge. 2. Predicts patient behaviors in situations. 4. Guides nursing practice. 6. Explains relationships between concepts.

A community health nurse is working in a clinic with a focus on asthma and allergies. What is the primary focus of the community health nurse in this clinic setting? (Select all that apply.) 1. Decrease the incidence of asthma attacks in the community 2. Increase patients' ability to self-manage their asthma 3. Treat acute asthma in the hospital 4. Provide asthma education programs for the teachers in the local schools 5. Provide scheduled immunizations to people who come to the clinic

1. Decrease the incidence of asthma attacks in the community 2. Increase patients' ability to self-manage their asthma 4. Provide asthma education programs for the teachers in the local schools

A patient has been laid off from his construction job and has many unpaid bills. He is going through a divorce from his marriage of 15 years and has been praying daily to help him through this difficult time. He does not have a primary health care provider because he has never really been sick, and his parents never took him to a physician when he was a child. Which external variables influence the patient's health practices? (Select all that apply.) 1. Difficulty paying his bills 2. Praying daily 3. Age of patient (46 years) 4. Stress from the divorce and the loss of a job 5. Family practice of not routinely seeing a health care provider

1. Difficulty paying his bills 5. Family practice of not routinely seeing a health care provider

You are working on a patient care unit and observe several other nurses who are not following the agency's policy when preparing and administering medications. When you ask them to explain why they are doing this, they state the new medication administration technology installed on the unit takes too much time to use, so they are using workarounds to get their patient medications administered on time. Which is the best action to take first? 1. Discuss the situation with the nursing manager. 2. Call a colleague who works at another institution to talk about the problem. 3. Look for a position on a different nursing unit. 4. Say nothing and begin your work.

1. Discuss the situation with the nursing manager.

The public health nurse is working with the local city/county health department during a pandemic that has created a crisis within the community. What are responsibilities of the public health nurse during the pandemic? (Select all that apply.) 1. Educate the public on disease prevention 2. Serve as liaison between patients and health care services and providers 3. Investigate cases as they arise 4. Monitor trends of the disease outbreak 5. Assist with testing for identification of the disease

1. Educate the public on disease prevention 2. Serve as liaison between patients and health care services and providers 3. Investigate cases as they arise 4. Monitor trends of the disease outbreak 5. Assist with testing for identification of the disease

The nurse spends time with a patient and family reviewing a dressing change procedure for the patient's wound. The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role? 1. Educator 2. Advocate 3. Caregiver 4. Communicator

1. Educator

A nurse in a community health clinic reviews screening results from students in a local high school during the most recent academic year. The nurse discovers a 10% increase in the number of positive tuberculosis (TB) skin tests when comparing these numbers to the previous year. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community nurse is acting in which nursing role(s)? (Select all that apply.) 1. Epidemiologist 2. Counselor 3. Collaborator 4. Case manager 5. Caregiver

1. Epidemiologist 3. Collaborator

A patient is in skeletal traction and has a plaster cast due to a fractured femur. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document and report this to the health care provider because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.) 1. Failure to document a change in assessment data 2. Failure to provide discharge instructions 3. Failure to provide patient education about cast care4. Failure to use proper medical equipment ordered for patient monitoring 5. Failure to notify a health care provider about a change in the patient's condition

1. Failure to document a change in assessment data 5. Failure to notify a health care provider about a change in the patient's condition

A nurse is using motivational interviewing with a patient. What outcomes does the nurse expect? (Select all that apply.) 1. Gain an understanding of the patient's health goals. 2. Direct the patient to avoid poor health choices. 3. Recognize the patient's strengths and support the patient's efforts. 4. Provide assessment data that can be shared with families to promote change. 5. Identify differences in patient's health outcomes and current behaviors.

1. Gain an understanding of the patient's health goals. 3. Recognize the patient's strengths and support the patient's efforts. 5. Identify differences in patient's health outcomes and current behaviors.

A nurse is caring for a patient who has just transferred from an intensive care unit and still has a long hospitalization ahead. Because of the complexity of care and the number of caregivers for this patient, the family members feel disconnected from their loved one and not part of the care team. Which interventions would demonstrate care by helping family members? (Select all that apply.) 1. Helping family become active participants in care 2. Removing family members from assisting with the patient's personal care 3. Allowing the family to offer opinions on health care decisions for the patient 4. Providing the family opportunities to discuss their concerns with the health care team 5. Planning uninterrupted time for the family and patient to be together

1. Helping family become active participants in care 4. Providing the family opportunities to discuss their concerns with the health care team 5. Planning uninterrupted time for the family and patient to be together

When taking care of patients, a nurse routinely asks whether they take any vitamins or herbal medications, encourages family members to bring in music that the patients like to help the patients relax, and frequently prays with her patients if that is important to them. The nurse is practicing which model? 1. Holistic 2. Health belief 3. Transtheoretical 4. Health promotion

1. Holistic

Which of the following are common barriers to effective discharge planning? (Select all that apply.) 1. Ineffective communication among providers 2. Lack of role clarity among health care team members 3. Number of hospital beds to manage patient volume 4. Patients' long-term disabilities 5. The patient's cultural background

1. Ineffective communication among providers 2. Lack of role clarity among health care team members

A nurse is caring for a patient newly diagnosed with testicular cancer. He asked the nurse to help him find the meaning of cancer by supporting beliefs about life. This is an example of: 1. Instilling hope and faith. 2. Forming a human-altruistic value system. 3. Cultural caring. 4. Being with.

1. Instilling hope and faith.

Health care reform will bring changes in the emphasis of care. Which of these models is expected from health care reform? 1. Moving from an acute illness to a health promotion, illness prevention model 2. Moving from an illness prevention to a health promotion model 3. Moving from hospital-based to community-based care 4. Moving from an acute illness to a disease management model

1. Moving from an acute illness to a health promotion, illness prevention model

Which of the following statements related to theory-based nursing practice are correct? (Select all that apply.) 1. Nursing theory differentiates nursing from other disciplines. 2. Nursing theories are standardized and do not change over time. 3. Integrating theory into practice promotes coordinated care delivery. 4. Nursing knowledge is generated by theory. 5. The theory of nursing process is used in planning patient care. 6. Evidence-based practice results from theory-testing research.

1. Nursing theory differentiates nursing from other disciplines. 3. Integrating theory into practice promotes coordinated care delivery. 4. Nursing knowledge is generated by theory. 6. Evidence-based practice results from theory-testing research.

A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is the most appropriate outcome for this patient's restorative care? 1. Patient will be able to walk 200 feet without shortness of breath. 2. Wound will heal without signs of infection. 3. Patient will express concerns related to return to home. 4. Patient will identify strategies to improve sleep habits.

1. Patient will be able to walk 200 feet without shortness of breath.

QSEN competencies

1. Patient-centered care 2. Teamwork and collaboration 3. Evidence-based practice 4. Quality improvement 5. Safety 6. Informatics

A nurse is conducting a home visit with a new mom and her three children. While in the home the nurse weighs each family member and reviews their 3-day food diary. She checks the mom's blood pressure and encourages the mom to take the children for a 30-minute walk every day. The nurse is addressing which level of need, according to Maslow's Hierarchy of Needs? 1. Physiological 2. Safety and security 3. Love and belonging 4. Self-actualization

1. Physiological

Which of the following are examples of a nurse participating in primary care activities? (Select all that apply.) 1. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2. Assessing the nutritional status of older adults who come to the community center for lunch 3. Working with patients in a cardiac rehabilitation program 4. Providing home wound care to a patient 5. Teaching a class to parents at the local elementary school about the importance of immunizations

1. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2. Assessing the nutritional status of older adults who come to the community center for lunch 5. Teaching a class to parents at the local elementary school about the importance of immunizations

The nurse caring for a refugee community identifies that the children are undervaccinated and the community is unaware of resources. The nurse assesses the community and determines that there is a health clinic within a 5-mile radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources. Which of the following practices is the nurse providing? (Select all that apply.) 1. Raising awareness about community resources for the children 2. Teaching the community about health promotion and illness prevention 3. Promoting autonomy in decision making about health practices 4. Improving the health care of the community's children 5. Participating in professional development activities to maintain nursing competency

1. Raising awareness about community resources for the children 2. Teaching the community about health promotion and illness prevention 4. Improving the health care of the community's children

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 health care provider'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? 1. Responsibility 2. Humility 3. Accuracy 4. Fairness

1. Responsibility

Which of the following actions, if performed by an RN, could result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) 1. Reviewing the EHR of a family member who is a patient in the same hospital on a different unit 2. Refusing to provide health care information to an older adult's child 3. Reporting suspected abuse and neglect of children 4. Applying physical restraints without a written order 5. Completing an occurrence report on the unit

1. Reviewing the EHR of a family member who is a patient in the same hospital on a different unit 4. Applying physical restraints without a written order

A nurse is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following theories? 1. Roy 2. Watson 3. Johnson 4. Benner

1. Roy

Which social media uses can be implemented with patients and families without violating confidentiality? (Select all that apply.) 1. Social media can be used to provide supportive information. 2. Results such as x-ray results can easily be sent via social media. 3. Family and friends who cannot be present can connect with the patient. 4. All health information can be shared on social media. 5. Social media should never be used with patients and families.

1. Social media can be used to provide supportive information. 3. Family and friends who cannot be present can connect with the patient.

A nurse needs to use clinical judgment before planning and implementing any touch interventions. What does the nurse need to understand about the use of touch? (Select all that apply.) 1. Some cultures may have specific restrictions about non-skill-based touch. 2. Touch is a form of nonverbal communication. 3. Touch reduces only physical pain. 4. Touch can successfully influence a patient's level of comfort. 5. There is never a problem with using touch at any time.

1. Some cultures may have specific restrictions about non-skill-based touch. 2. Touch is a form of nonverbal communication. 4. Touch can successfully influence a patient's level of comfort.

A patient states, "I don't have confidence in my doctor. She looks so young." What is the nurse's therapeutic response? 1. Tell me more about your concern. 2. You have nothing to worry about. Your doctor is perfectly competent. 3. You can go online and see how others have rated your doctor. I do that.4. You should ask your doctor to tell you her background.

1. Tell me more about your concern.

Which of the following describe characteristics of an integrated health care system? (Select all that apply.) 1. The focus is holistic. 2. Participating hospitals follow the same model of health care delivery. 3. The system coordinates a continuum of services. 4. The focus of health care providers is finding a cure for patients. 5. Members of the health care team link electronically to use the EHR to share the patient's health care record.

1. The focus is holistic. 3. The system coordinates a continuum of services. 5. Members of the health care team link electronically to use the EHR to share the patient's health care record.

The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months, does not have health insurance, and cannot afford the procedure. Which of the following statements speaks to the ethical elements of this case? 1. The health care team should select a plan that considers the principle of justice as it pertains to the distribution of health care resources. 2. The patient should enroll in a clinical trial of a new technology that can do the work of the liver, similar to the way dialysis treats kidney disease. 3. The social worker should look into enrolling the patient in Medicaid, since many states offer expanded coverage. 4. A family meeting should take place in which the details of the patient's poor prognosis are made clear to his family so that they can adopt a palliative approach.

1. The health care team should select a plan that considers the principle of justice as it pertains to the distribution of health care resources.

Resolution of an ethical problem involves discussion with the patient, the patient's family, and participants from appropriate health care disciplines. Which statement best describes the role of the nurse in the resolution of ethical problems? 1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations 2. To study the literature on current research about the possible clinical interventions available for the patient in question 3. To hold a point of view but realize that respect for the authority of administrators and health care providers takes precedence over personal views 4. To allow the patient and the health care provider private time to resolve the dilemma on the basis of ethical principles

1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations

You are a nurse who is working in an agency that has recently implemented an EHR. Which of the following are acceptable practices for maintaining the security and confidentiality of EHR information? (Select all that apply.) 1. Using a strong password and changing your password frequently according to agency policy 2. Allowing a temporary staff member to use your computer username and password to access the electronic record 3. Ensuring that work lists (and any other data that must be printed from the EHR) are protected throughout the shift and disposed of in a locked receptacle designated for documents that are to be shredded when no longer needed 4. Ensuring that the patient information that is displayed on the computer monitor that you are using is not visible to visitors and other health care providers who are not involved in that patient's care 5. Remaining logged into a computer to save time if you only need to step away to administer a medication

1. Using a strong password and changing your password frequently according to agency policy 3. Ensuring that work lists (and any other data that must be printed from the EHR) are protected throughout the shift and disposed of in a locked receptacle designated for documents that are to be shredded when no longer needed 4. Ensuring that the patient information that is displayed on the computer monitor that you are using is not visible to visitors and other health care providers who are not involved in that patient's care

The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other approaches to ethical problems? (Select all that apply.) Ethics of care: 1. pays attention to the context in which caring occurs. 2. is used only by nurses because it is part of the Nursing Code of Ethics. 3. requires understanding the relationships between involved parties. 4. considers the decision maker's relationships with other involved parties. 5. is an approach that suggests a greater commitment to patient care. 6. considers the decision maker to be in a detached position outside the ethical problem.

1. pays attention to the context in which caring occurs. 3. requires understanding the relationships between involved parties. 4. considers the decision maker's relationships with other involved parties.

A patient in the ICU experiences a sentinel event related to central line catheter care that resulted in serious injury. What PI model should the unit use to identify errors that led to the sentinel event? 1. Six Sigma 2. Root cause analysis 3. PDSA 4. Balanced scorecard

2. Root cause analysis

A nurse working on a medical patient care unit states, "I am having trouble sleeping, and I eat nonstop when I get home. All I can think of when I get to work is how I can't wait for my shift to be over. I wish I felt happy again." What are the best responses from the nurse manager? (Select all that apply.) 1. "I'm sure this is just a phase you are going through. Hang in there. You'll feel better soon." 2. "I know several nurses who feel this way every now and then. Tell me about the patients you have cared for recently. Did you find it difficult to care for them?" 3. "You can take diphenhydramine over the counter to help you sleep at night." 4. "Describe for me what you do with your time when you are not working." 5. "The hospital just started a group where nurses get together to talk about their feelings. Would you like for me to e-mail the schedule to you?"

2. "I know several nurses who feel this way every now and then. Tell me about the patients you have cared for recently. Did you find it difficult to care for them?" 4. "Describe for me what you do with your time when you are not working." 5. "The hospital just started a group where nurses get together to talk about their feelings. Would you like for me to e-mail the schedule to you?"

A nurse contacts the health care provider about a change in a patient's condition and receives several new orders for the patient over the phone. When documenting telephone orders in the EHR, what should the nurse do? 1. Print out a copy of all telephone orders entered into the EHR in order to keep them in personal records for legal purposes. 2. "Read back" all telephone orders to the health care provider over the phone to verify all orders were heard, understood, and transcribed correctly before entering the orders in the EHR. 3. Record telephone orders in the EHR but wait to implement the order(s) until they are electronically signed by the health care provider who gave them. 4. Implement telephone order(s) immediately but insist that the health care provider come to the patient care unit to personally enter the order(s) into the EHR within the next 24 hours.

2. "Read back" all telephone orders to the health care provider over the phone to verify all orders were heard, understood, and transcribed correctly before entering the orders in the EHR.

As part of a faith community nursing program in her church, a nurse is developing a health promotion program on breast self-examination for the women's group. Which statement made by one of the participants is related to the individual's accurate perception of susceptibility to an illness? 1. "I have a hanging tag on my bathroom door to remind me to do my breast self-examination monthly." 2. "Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer." 3. "Since I am only 25 years of age, the risk of breast cancer for me is very low." 4. "I participate every year in our local walk/run to raise money for breast cancer research."

2. "Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer."

A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the operation to the family and discusses the patient's wishes with them. The nurse is acting as the patient's: 1. Educator 2. Advocate 3. Caregiver 4. Communicator

2. Advocate

Using Maslow's hierarchy of needs, identify the priority for a patient who is experiencing chest pain and difficulty breathing. 1. Self-actualization 2. Air, water, and nutrition 3. Safety 4. Esteem and self-esteem needs

2. Air, water, and nutrition

When designing a plan for pain management for a patient following surgery, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. If the nurse's actions are driven by respect for autonomy, what aspect of this scenario best demonstrates this action? 1. Assessing the patient's pain on a numeric scale every 2 hours 2. Asking the patient to establish the goal for pain control 3. Using alternative measures such as distraction or repositioning to relieve the pain 4. Monitoring the patient for oversedation as a side effect of his pain medication

2. Asking the patient to establish the goal for pain control

A critical care nurse is using a new research-based intervention to correctly position patients who are on ventilators to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which QSEN competency? 1. Patient-centered care 2. Evidence-based practice 3. Teamwork and collaboration 4. Quality improvement

2. Evidence-based practice

A community health nurse conducts a community assessment focused on adolescent health behaviors. The nurse determines that a large number of adolescents smoke. Designing a smoking-cessation program at the youth community center is an example of which nursing role? 1. Epidemiologist 2. Counselor 3. Collaborator 4. Case manager

2. Counselor

A nurse is assigned to care for a woman who is expecting her first child. The nurse organizes herself and plans to gather data about the patient by applying Pender's health promotion model, including the patient's characteristics and experiences and situational influences. She plans to observe patient behavior and consider the patient's psychosocial issues. Such data will offer a clear understanding to help the nurse identify the patient's needs. This is an example of which of the following concepts? (Select all that apply.) 1. Diagnostic reasoning 2. Deductive reasoning 3. Inductive reasoning 4. Assessment 5. Problem solving

2. Deductive reasoning 4. Assessment

A nurse newly hired at a community hospital learns about intentional hourly rounding during orientation. Which of the following are known evidence-based outcomes from intentional rounding? (Select all that apply.) 1. Reduction in nurse staffing requirements 2. Improved patient satisfaction 3. Reduction in patient falls 4. Increased costs 5. Reduction in patient use of nurse call system

2. Improved patient satisfaction 3. Reduction in patient falls 5. Reduction in patient use of nurse call system

Which of the following are strategies for creating work environments that support nurse caring interventions? (Select all that apply.) 1. Increasing technological support 2. Improving flexibility for scheduling 3. Providing opportunities to discuss care practices 4. Promoting autonomy of practice 5. Encouraging increased input concerning nursing functions from health care providers

2. Improving flexibility for scheduling 3. Providing opportunities to discuss care practices 4. Promoting autonomy of practice

Which of the following are symptoms of secondary traumatic stress and burnout that commonly affect nurses? (Select all that apply.) 1. Regular participation in a book club 2. Lack of interest in exercise 3. Difficulty falling asleep 4. Lack of desire to go to work 5. Anxiety while working

2. Lack of interest in exercise 3. Difficulty falling asleep 4. Lack of desire to go to work 5. Anxiety while working

A nurse encounters the patient's wife, who is tearful and worried. Her husband was just transferred from his room to the operating room for a complex cardiovascular surgery. The nurse brings the wife a glass of water and encourages her to talk about her fears. The nurse remains in the room quietly listening. What caring behaviors is the nurse demonstrating? (Select all that apply.) 1. Touching 2. Listening 3. Knowing 4. Presence 5. Spiritual care

2. Listening 4. Presence

A nurse is caring for a patient admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. The nurse assumes responsibility for bathing and feeding the patient until the patient can begin performing these activities. The nurse in this situation is applying the theory developed by: 1. Johnson. 2. Orem. 3. Roy. 4. Peplau.

2. Orem.

Which techniques demonstrate a therapeutic response to an adult patient who is anxious? (Select all that apply.) 1. Matching the rate of speech to be the same as that of the patient 2. Providing good eye contact 3. Demonstrating a calm presence 4. Spending time attentively with the patient 5. Assuring the patient that all will be well

2. Providing good eye contact 3. Demonstrating a calm presence 4. Spending time attentively with the patient

The nurse is using the QSEN competency of EBP when working with the unit council to initiate a change related to pain management. Which behaviors demonstrate that the nurse is practicing behaviors associated with EBP? (Select all that apply.) 1. Initiating plan for self-development as a team member 2. Reading original research related to pain management 3. Demonstrating effective use of strategies to reduce risk of harm to self or others 4. Valuing EBP as critical to the development of pain management guidelines for the unit 5. Describing to the unit council reliable sources for locating clinical guidelines 6. Applying technology and information management tools to support safe processes of care

2. Reading original research related to pain management 4. Valuing EBP as critical to the development of pain management guidelines for the unit 5. Describing to the unit council reliable sources for locating clinical guidelines

A nurse is giving a patient a medication and notices the dosage. From the nurse's experience, the dosage is higher than what is normally given. Which of the following steps should the nurse take to ensure a safe outcome for the patient? (Select all that apply.) 1. Wait until end of shift when there is time to check dosage with pharmacy reference. 2. Recognize how the nursing team communicates problems, and consult with charge nurse. 3. Hold the dose and confer with the ordering health care provider now. 4. Assess patient knowledge of what has been the routine dose for this medication. 5. Administer the medication and closely monitor patient response.

2. Recognize how the nursing team communicates problems, and consult with charge nurse. 3. Hold the dose and confer with the ordering health care provider now. 4. Assess patient knowledge of what has been the routine dose for this medication.

A nurse enters a patient's room at the beginning of a shift to assess his condition following a blood transfusion. The nurse cared for the patient on the previous day as well. The patient has several issues he wishes to share with the nurse, who takes time to explore each issue. The nurse also assesses the patient and finds no signs or symptoms of a reaction to the blood product. The nurse observed the patient the prior day and sees a change in his behavior—a reluctance to get out of bed and ambulate. Which of the following actions improve the nurse's ability to make clinical decisions about this patient? (Select all that apply.) 1. Working the same shift each day 2. Spending time during the patient assessment 3. Knowing the early mobility protocol guidelines 4. Caring for the patient on consecutive days 5. Knowing the pattern of patient behavior about ambulation

2. Spending time during the patient assessment 4. Caring for the patient on consecutive days 5. Knowing the pattern of patient behavior about ambulation

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1. Family member 2. Surgeon 3. Nurse 4. Nurse manager

2. Surgeon

A nurse sends a text message to the oncoming nurse that states, "Mr. Kodro in room 3348-1 refused to take his sertraline hydrochloride as ordered this morning because he said he was feeling better." What should the oncoming nurse do? (Select all that apply.) 1. Add this information to the board hanging at the patient's bedside. 2. Tell the nurse who sent the text that the text is a HIPAA violation. 3. Inform the nursing supervisor. 4. Forward the text to the charge nurse. 5. Thank the nurse for sending the information.

2. Tell the nurse who sent the text that the text is a HIPAA violation. 3. Inform the nursing supervisor.

The school nurse has been following a 9-year-old student who has shown behavioral problems in class. The student acts out and does not follow teacher instructions. The nurse plans to meet with the student's family to learn more about social determinants of health that might be affecting the student. Which of the following potential social determinants should the nurse assess? (Select all that apply.) 1. The student's seating placement in the classroom 2. The level of support parents offer when the student completes homework 3. The level of violence in the family's neighborhood 4. The age at which the child first began having behavioral problems 5. The cultural values about education held by the family

2. The level of support parents offer when the student completes homework 3. The level of violence in the family's neighborhood 5. The cultural values about education held by the family

A nurse works with a patient using therapeutic communication during all phases of the therapeutic relationship. Place the nurse's statements in order according to these phases. 1. The nurse states, "Let's work on learning injection techniques." 2. The nurse is mindful of biases and knowledge in working with the patient with B12 deficiency. 3. The nurse summarizes progress made during the nursing relationship. 4. After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship.

2. The nurse is mindful of biases and knowledge in working with the patient with B12 deficiency. 4. After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship. 1. The nurse states, "Let's work on learning injection techniques." 3. The nurse summarizes progress made during the nursing relationship.

A nurse is assigned to care for an 82-year-old patient who will be transferred from the hospital to a rehabilitation center. The patient and her husband have selected the rehabilitation center closest to their home. The nurse learns that the patient will be discharged in 3 days and decides to make the referral on the day of discharge. The nurse reviews the recommendations for physical therapy and applies the information to fall prevention strategies in the hospital. What discharge planning action by the nurse has not been addressed correctly? 1. Patient and family involvement in referral 2. Timing of referral 3. Incorporation of referral discipline recommendations into plan of care 4. Determination of discharge date

2. Timing of referral

A patient has gone through a number of treatment changes during a shift of care. During the hand-off report, the nurse plans to communicate effectively with the nurse who will be caring next for the patient for which of the following reasons? (Select all that apply.) 1. To improve the nurse's status with the health team members 2. To reduce the risk of errors to the patient 3. To provide an optimum level of patient care 4. To improve patient outcomes 5. To prevent issues that need to be reported to outside agencies

2. To reduce the risk of errors to the patient 3. To provide an optimum level of patient care 4. To improve patient outcomes

A nursing student is giving a presentation to a group of other nursing students about the needs of patients with mental illnesses in the community. Which statement by the student indicates that the nursing professor needs to provide further teaching? 1. "Many patients with mental illness do not have a permanent home." 2. "Unemployment is a common problem experienced by people with a mental illness." 3. "The majority of patients with mental illnesses live in long-term care settings." 4. "Patients with mental illnesses are often at a higher risk for abuse and assault."

3. "The majority of patients with mental illnesses live in long-term care settings."

Based on the Transtheoretical Model of Change, what is the most appropriate response to a patient who states: "Me, stop smoking? I've been smoking since I was 16!" 1. "That's fine. Some people who smoke live a long life." 2. "OK. I want you to decrease the number of cigarettes you smoke by one each day, and I'll see you in 1 month." 3. "What do you think is the greatest reason why stopping smoking would be challenging for you?" 4. "I'd like you to attend a smoking-cessation class this week and use nicotine replacement patches as directed."

3. "What do you think is the greatest reason why stopping smoking would be challenging for you?"

When documenting an assessment of a patient's cardiac system in an EHR, the nurse uses the computer mouse to select the "WNL" statement to document the following findings: "Heart sounds S1 & S2 auscultated. Heart rate between 80 and 100 beats/min, and regular. Denies chest pain." This is an example of using which of the following documentation formats? 1. Focus charting incorporating data, action, and response (DAR) 2. Problem-intervention-evaluation (PIE) 3. Charting by exception (CBE) 4. Narrative documentation

3. Charting by exception (CBE)

The nurse is administering a dose of metoprolol to a patient and is completing the steps of bar-code medication administration within the EHR. As the bar-code information on the medication is scanned, an alert that states, "Do not administer dose if apical heart rate (HR) is <60 beats/min or systolic blood pressure (SBP) is <90 mm Hg" appears on the computer screen. The alert that appeared on the computer screen is an example of what type of system? 1. Electronic health record (EHR) 2. Charting by exception 3. Clinical decision support system (CDSS) 4. Computerized provider order entry (CPOE)

3. Clinical decision support system (CDSS)

A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? 1. Document her findings and treat the patient. 2. Instruct the mother on safe handling of a 2-year-old child. 3. Contact a child abuse hotline. 4. Discuss this story with a colleague.

3. Contact a child abuse hotline.

A nurse is caring for a patient who has poor pain control. The patient has a history of opioid abuse. During the day, the patient made frequent requests for a pain medication. To make an effective clinical decision about this patient, the nurse needs to ask questions about the data available on the patient to make a thorough and thoughtful decision. The nurse asks herself, "How does my view about the patient's pain tolerance compare with the patient's, and does that pose a problem?" This is an example of: 1. A question about assumptions 2. A question about evidence 3. A question about procedure 4. A question about perspective

4. A question about perspective

The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology? 1. The emphasis on relationships feels uncomfortable to decision makers who want more structure in deciding the best action. 2. The single focus on power imbalances does not apply to all situations in which ethical problems occur. 3. In a diverse community it can be difficult to find agreement on which principles or rules are most important. 4. The focus on consequences rather than on the "goodness" of an action makes decision makers uncomfortable.

3. In a diverse community it can be difficult to find agreement on which principles or rules are most important.

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: 1. Creativity 2. Fairness 3. Clinical reasoning 4. Applying ethical criteria

4. Applying ethical criteria

A nurse received a bedside report at the change of shift with the night-shift nurse and the patient. The nursing student assigned to the patient asks to review the patient's medical record. The nurse lists patients' medical diagnoses on the message boards in the patients' rooms. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of HIPAA? 1. Discussing patient conditions at the bedside at the change of shift 2. Allowing the nursing student to review the assigned patient's chart before providing care during the clinical experience 3. Posting medical information about the patient on a message board in the patient's room 4. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

3. Posting medical information about the patient on a message board in the patient's room

The examination for RN licensure is the same in every state in the United States. This examination: 1. Guarantees safe nursing care for all patients 2. Ensures standard nursing care for all patients 3. Provides the minimal standard of knowledge for an RN in practice 4. Guarantees standardized education across all prelicensure programs

3. Provides the minimal standard of knowledge for an RN in practice

A young woman comes to a clinic for the first time for a gynecological examination. She asks about the procedure, who will be in the room with her, and does she have to remove all her clothes. Which nursing behavior applies Swanson's caring process of "knowing" the patient? 1. Sharing feelings about the importance of having regular gynecological examinations 2. Explaining risk factors for cervical cancer 3. Recognizing that the patient is modest and maintaining her privacy during the examination 4. Asking the patient what it means to have a vaginal examination

3. Recognizing that the patient is modest and maintaining her privacy during the examination

A nurse has been caring for a patient with a chronic wound that has not been healing. The nurse talks with a nurse specialist in wound care to find alternative approaches from what the health care provider ordered for dressing the wound. The two decide that because of the patient's allergy to tape, a nonallergenic dressing will be used. The nurse obtains an order from the health care provider for the new dressing. After 2 days there is improvement in the wound. This is an example of which critical thinking standards? (Select all that apply.) 1. Clarity 2. Broadness 3. Relevance 4. Risk taking 5. Creativity

3. Relevance 4. Risk taking

A patient discharged a week ago following a stroke is currently participating in rehabilitation sessions provided by nurses, physical therapists, and registered dietitians in an outpatient setting. In what level of prevention is the patient participating? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Transtheoretical prevention

3. Tertiary prevention

A nurse is reading a research article discussing a new practice to decrease the incidence of catheter-associated urinary tract infections. One section of the article describes who was studied and how the data were collected to answer the research questions and hypotheses. What section of the research article is currently being read? 1. The literature review 2. The data analysis 3. The methods 4. The implications for practice

3. The methods

What outcome demonstrates the effective use of silence as a therapeutic communication technique? 1. The nurse feels like there was enough time to be therapeutic when communicating with the patient. 2. The patient states a preference to talk with another staff member. 3. The patient perceives having gained insight into the issue after the conversation. 4. The patient was able to drift off to sleep more easily.

3. The patient perceives having gained insight into the issue after the conversation.

Nurses in a community clinic are conducting an EBP project focused on improving the outcomes of children with asthma. The PICO question asked by the nurses is "In school-age children, does the use of an electronic gaming education module versus educational book affect the usage of inhalers?" In the question, what is the "O"? 1. School-age children 2. Educational book 3. Use of inhalers 4. Electronic gaming education

3. Use of inhalers

A patient is fearful of upcoming surgery and a possible cancer diagnosis. He discusses his love for the Bible with his nurse, who recommends a favorite Bible verse. Another nurse tells the patient's nurse that there is no place in nursing for spiritual caring. What is the best response by the patient's nurse? 1. "You're correct; spiritual care should be left to a pastoral care professional." 2. "You're correct; religion is a personal decision." 3. "Nurses should explain their own religious beliefs to patients." 4. "Spiritual, mind, and body connections can affect health."

4. "Spiritual, mind, and body connections can affect health."

A nurse prepares to contact a patient's health care provider about a change in the patient's condition. Put the following statements in the correct order using SBAR (Situation, Background, Assessment, and Recommendation) communication. 1. "She is a 53-year-old woman who was admitted 2 days ago with pneumonia and was started on levofloxacin at 5 p.m. yesterday. She states she has a poor appetite; her weight has remained stable over the past 2 days." 2. "The patient reported feeling very nauseated after her dose of levofloxacin an hour ago." 3. "Is it possible to make a change in antibiotics, or could we give her a nutritional supplement before her medication?" 4. "The patient started to complain of nausea yesterday evening and vomited several times during the night."

4. "The patient started to complain of nausea yesterday evening and vomited several times during the night." 1. "She is a 53-year-old woman who was admitted 2 days ago with pneumonia and was started on levofloxacin at 5 p.m. yesterday. She states she has a poor appetite; her weight has remained stable over the past 2 days." 2. "The patient reported feeling very nauseated after her dose of levofloxacin an hour ago." 3. "Is it possible to make a change in antibiotics, or could we give her a nutritional supplement before her medication?"

The nurse is changing the dressing over the midline incision of a patient who had surgery. Assessment of the incision reveals changes from what was documented by the previous nurse. After documenting the current wound assessment, the nurse contacts the surgeon by telephone to discuss changes in the incision that are of concern. Which of the following illustrates the most appropriate way for the nurse to document this conversation? 1. Health care provider notified about change in assessment of abdominal incision. T. Wright, RN 2. 09-3-21: Notified the surgeon by phone that there is a new area of redness around the patient's incision. T. Wright, RN 3. 1015: Contacted the surgeon and notified about changes in abdominal incision. T. Wright, RN 4. 09-3-21 (1015): Surgeon contacted by phone. Notified about new area of bright red erythema extending approximately 1 inch around circumference of midline abdominal incision and oral temperature of 101.5 F. No orders received. T. Wright, RN

4. 09-3-21 (1015): Surgeon contacted by phone. Notified about new area of bright red erythema extending approximately 1 inch around circumference of midline abdominal incision and oral temperature of 101.5 F. No orders received. T. Wright, RN

An example of a nurse caring behavior that families of patients who are acutely ill perceive as important to patients' well-being is: 1. Making health care decisions for patients. 2. Having family members provide a patient's total personal hygiene. 3. Injecting the nurse's perceptions about the level of care provided. 4. Asking permission before performing a procedure on a patient.

4. Asking permission before performing a procedure on a patient.

1. Which activity performed by a nurse is related to maintaining competency in nursing practice?1. Asking another nurse about how to change the settings on a medication pump 2. Regularly attending unit staff meetings 3. Participating as a member of the professional nursing council 4. Attending a review course in preparation for a certification examination

4. Attending a review course in preparation for a certification examination

The nurse is discussing the advantages of using CPOE with a nursing colleague. Which statement best describes the major advantage of a CPOE system within an EHR? 1. CPOE reduces the time necessary for health care providers to write orders. 2. CPOE reduces the time needed for nurses to communicate with health care providers. 3. Nurses do not need to acknowledge orders entered by CPOE in an EHR. 4. CPOE improves patient safety by reducing transcription errors.

4. CPOE improves patient safety by reducing transcription errors.

A nurse implements an EBP change that teaches patients the importance of taking their diabetes medications correctly and regularly on time using videos streamed on the Internet. The nurse measures the patients' behavioral outcome from the practice change by using which type of measurement? 1. Measuring the patients' weight 2. Chart auditing teaching sessions 3. Observing patients viewing the videos 4. Checking patients' blood sugars

4. Checking patients' blood sugars

The nurse applying effective communication skills throughout the nursing process should: (Place the following interventions in the correct order.) 1. Validate health care needs through verbal discussion with the patient. 2. Compare actual and expected patient care outcomes with the patient. 3. Provide support through therapeutic communication techniques. 4. Complete a nursing history using verbal communication techniques.

4. Complete a nursing history using verbal communication techniques. 1. Validate health care needs through verbal discussion with the patient. 3. Provide support through therapeutic communication techniques. 2. Compare actual and expected patient care outcomes with the patient.

A nurse ensures that each patient's room is clean; well ventilated; and free from clutter, excessive noise, and extremes in temperature. Which theorist's work is the nurse practicing in this example? 1. Henderson 2. Orem 3. King 4. Nightingale

4. Nightingale

You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient with terminal cancer. As part of the preparation, you have your classmates read the Nursing Code of Ethics for Professional Registered Nurses. Your instructor asks the class why this document is important. Which statement best describes this code? 1. Improves self-health care 2. Protects the patient's confidentiality 3. Ensures identical care to all patients 4. Defines the principles of right and wrong to provide patient care

4. Defines the principles of right and wrong to provide patient care

A man who is homeless enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the city hospital for care before assessing the patient. This action is most likely a violation of which of the following laws? 1. Health Insurance Portability and Accountability Act (HIPAA) 2. Americans With Disabilities Act (ADA) 3. Patient Self-Determination Act (PSDA) 4. Emergency Medical Treatment and Active Labor Act (EMTALA)

4. Emergency Medical Treatment and Active Labor Act (EMTALA)

A woman has severe life-threatening injuries, is unresponsive, and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse's responsibility? 1. Obtain a court order to give the blood. 2. Convince the husband to allow the nurse to give the blood. 3. Call security and have the husband removed from the hospital. 4. Gather more information about the wife's preferences and determine whether the husband has her power of attorney for health care.

4. Gather more information about the wife's preferences and determine whether the husband has her power of attorney for health care.

The nurse is reviewing health care provider orders that were handwritten on paper when all computers were down during a system upgrade. Which of the following orders contains an inappropriate abbreviation included on TJC's "do not use" list and should be clarified with the health care provider? 1. Change open midline abdominal incision daily using wet-to-moist normal saline and gauze. 2. Lorazepam 0.5 mg PO every 4 hours prn anxiety 3. Morphine sulfate 1 mg IVP every 2 hours prn severe pain 4. Insulin aspart 8u SQ every morning before breakfast

4. Insulin aspart 8u SQ every morning before breakfast

What factor results in vulnerable populations being more likely to develop health problems? 1. The ability to use available resources to find housing 2. Adequate transportation to the grocery store and community clinics 3. Availability of others to help provide care 4. Limited access to health care services

4. Limited access to health care services

Which of the following statements is true regarding Magnet® status recognition for a hospital? 1. Nursing is run by a Magnet® manager who makes decisions for the nursing units. 2. Nurses in Magnet® hospitals make all of the decisions on the clinical units. 3. Magnet® is a term that is used to describe hospitals that are able to hire the nurses they need. 4. Magnet® is a special designation for hospitals that achieve excellence in nursing practice.

4. Magnet® is a special designation for hospitals that achieve excellence in nursing practice.

The nurses on a medical unit have seen an increase in the number of pressure injuries developing in their patients. The nurses decide to initiate a PI project using the PDSA model. Which of the following is an example of "Plan" from that model? 1. Orienting patients to the unit's practice of hourly rounding on patients 2. Reviewing the incidence of pressure injuries on patients cared for using the protocol 3. Based on findings from patients who developed injuries, implementing an evidence-based skin care protocol on all units 4. Meeting with all disciplines to develop a multidisciplinary approach for reducing pressure injuries

4. Meeting with all disciplines to develop a multidisciplinary approach for reducing pressure injuries

The nurses on an acute care medical floor notice an increase in pressure injury formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure injury risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career? 1. Clinical nurse specialist 2. Nurse administrator 3. Nurse educator 4. Nurse researcher

4. Nurse researcher

The nurse is working in a tertiary care setting. Which activity does the nurse perform while providing tertiary care? 1. Conducting blood pressure screenings at a local food bank 2. Administering influenza vaccines for older adults at the local senior center 3. Inserting an indwelling catheter for a patient on a medical-surgical unit 4. Performing endotracheal suctioning for a patient on a ventilator in the medical ICU

4. Performing endotracheal suctioning for a patient on a ventilator in the medical ICU

The components of the nursing metaparadigm include: 1. Person, health, environment, and theory. 2. Health, theory, concepts, and environment. 3. Nurses, physicians, health, and patient needs. 4. Person, health, environment, and nursing.

4. Person, health, environment, and nursing.

The nurse manager meets with the registered nursing staff about an increase in urinary tract infections in patients with a Foley catheter. The staff work together to review the literature on catheter-associated urinary tract infections (CAUTIs), identifies at-risk patients, and establishes new catheter care practices. This is an example of which QSEN competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Quality improvement

4. Quality improvement

Meleis et al.'s transitions theory

A mindfulness-based transition program was applied to mothers with premature rupture of membranes to measure acceptance of pregnancy, readiness to give birth, maternal attachment, and competency in the role of motherhood

Competent

A nurse who has been in the same clinical position for 2 to 3 years. This nurse understands the organization and specific care required by the type of patients. This nurse is a competent practitioner who is able to anticipate nursing care and establish long range goals. In this phase the nurse has usually had experience with all types of psychomotor skills required by this specific group of patients.

Advanced beginner

A nurse who has some level of experience with a situation. The nurse is able to identify meaningful aspects or principles of nursing care.

Expert

A nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem. This nurse is able to zero in on the problem and focus on multiple dimensions of the situation. He or she is skilled at identifying both patient-centered problems and problems related to the health care system or perhaps the needs of the novice nurse.

Proficient

A nurse with more than 2 to 3 years of experience in the same clinical position. This nurse perceives a patient's clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. This nurse focuses on managing care as opposed to managing and performing skills.

ANA code of ethics

A statement of philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. There is 9 provisions.

SURETY

Active listening. Sit at angle facing pt, uncross legs and arms, relax, eye contact, touch respectfully, your intuition

Middle-range theory

Addresses a specific phenomenon and reflects practice

Curiosity

Always ask why. Be willing to challenge tradition. A clinical sign or symptom often indicates a variety of problems. Explore and learn more about a patient so as to make appropriate clinical judgments.

Uniform Anitomical gift act

An individual who is at least 18 years of age can make an organ donation (defined as a "donation of all or part of a human body to take effect upon or after death"). Donors make the gift in writing.

Shared theory

Applies theory from other disciplines to nursing practice

Thinking independently

As you acquire new knowledge and experiences, examine your beliefs under new evidence (Papathanasiou et al., 2014). Be open-minded about different interventions. Read the scientific literature, especially when there are different views on the same subject. Talk with other nurses and share ideas about nursing interventions.

Responsibility and authority

Ask for help if you are uncertain about how to perform a nursing skill. Refer to a policy and procedure manual to review steps of a skill. Report any problems immediately. Follow standards of practice in your care.

Knowing (caring behavior)

Asking a patient to talk about what the loss of a loved one means for the patient and the family.

Nontherapeutic Communication Techniques

Asking personal questions Giving personal opinions Changing the subject Automatic responses False reassurance Sympathy Asking for explanations Approval or disapproval Defensive responses Passive or aggressive responses Arguing

Educator role

Assess your patient's learning needs and readiness to learn within the context of the individual, the systems with which the individual interacts (e.g., family, business, and school), and the resources available for support.

Perseverance

Be cautious of an easy answer that avoids uncomfortable situations. If co-workers give you information about a patient and some fact seems to be missing, clarify the information or talk to the patient directly. If problems of the same type continue to occur on a nursing division, bring co-workers together, look for a pattern, and find a solution.

Truth Seeking (Critical Thinking Skill)

Be objective in asking patient questions.

Discipline

Be thorough in whatever you do. Use known scientific and practice-based criteria for activities such as assessment and evaluation. Take time to be thorough and manage your time effectively.

Open-mindedness (critical thinking skill)

Be tolerant of other views, be sensitive to the possibility of your own prejudices, respect the rights of others to have different opinions

Novice

Beginning nursing student or any nurse entering a situation in which there is no previous level of experience. The learner learns via a specific set of rules or procedures, which are usually stepwise and linear.

Leininger's Theory

Culture care theory. Human caring varies among cultures in its expressions, processes, and patterns. Social structure factors such as a patient's politics, culture, and traditions are significant forces affecting care and influencing the patient's health and illness patterns.

ANA Standards of Professional Performance

Describes a competent level of behavior in the professional nursing role. Ethics, advocacy, respectful and equitable practice, communication, collaboration, leadership, education, scholarly inquiry, quality of practice, professional practice evaluation, resource stewardship, environmental health.

Watson's Theory of Human Caring

Emphasizes humanistic side of nursing and caring comes from the heart. Caring in nursing vs caring in medication. Focuses on lived experiences of relationship like being present and being in the here and now. Being focused on the patient.

Maintaining belief (caring behavior)

Encouraging a patient or family to use resources and trust previous decisions that have helped to resolve issues.

What is a clinical nurse specialist?

Expert clinician in a specialized area of practice such as adult diabetes care

quality documentation

Factual Accurate Only approved abbreviations correct grammar and spelling date and time signed with name and credentials organized

Mary Mahoney

First professionally trained African American nurse

Florence Nightingale

Founder of modern nursing. Environmental theory. which focusses on nurses improving ventilation, light, decreased noise, hygiene, and nutrition. Through observation and data collection, she linked patient's health status and environmental factors which initiated improved hygiene and sanitation conditions.

ISBAR

How to communicate critical information. Introduce self, situation, background, assessment, recommendations

Risk taking

If your knowledge causes you to question a health care provider's order, do so. Be willing to recommend alternative approaches to nursing care when colleagues are having little success with patients, especially if your ideas are supported by scientific evidence.

Primary care

In settings in which patients receive preventive and primary care, such as schools, physicians' offices, and occupational health clinics, health promotion is a major theme. Deals with diagnosis of common illness, management of chronic diseases, and family planning

Peplau's Theory

Interpersonal theory. Considered the mother of psychiatric nursing. The focus is on patient nurse/family relationships. Nurses help reduce anxiety by converting it into constructive actions. Nurses develop therapeutic relations by being respectful, empathetic, and nonjudgemental.

Kolcaba's theory of comfort

Kolcaba's theory was used to better understand how older adults' perception of comfort is related to feelings of well-being

Fairness

Listen to both sides of a discussion. If a patient or family member complains about a co-worker, listen to the story, and speak with the co-worker as well. If a staff member labels a patient uncooperative, assume the care of that patient with openness and a desire to meet the patient's needs.

Creativity

Look for different approaches if interventions are not working for a patient. For example, a patient in pain may need a different positioning or distraction technique. When appropriate, involve the patient's family in adapting your approaches to care methods used at home.

Many older homes in a neighborhood are undergoing a lot of restoration. Lead paint was used to paint the homes when they were built. The community clinic in the neighborhood is initiating a lead screening program. This activity is based on which social determinant of health?

Physical environment

What is Benner's theory?

Novice to expert

HIPAA

establishes patient rights regarding privacy of their health care information and records.

Bioethics

ethics in healthcare

Systematicity (critical thinking skill)

Organize assessment on the basis of patient priorities

Restorative care

Patients recovering from an acute or chronic illness or disability often require additional services in order to return to their previous level of function or to reach a new level of function limited by their illness or disability.

What is a nurse anesthetist?

Plans and delivers anesthesia and pain management to patients across the life span

What is a nurse practitioner?

Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients

What is a nurse midwife?

Provides independent care, including pregnancy and gynecological services

Doing for (caring behavior)

Providing an opportunity for a patient's specific religious practice as the patient would do it.

Humility

Recognize when you need more information to make a decision. When you are new to a clinical division, ask for an orientation to the area. Ask registered nurses (RNs) regularly assigned to the area for assistance with approaches to care.

Integrity

Recognize when your opinions conflict with those of a patient; review your position and decide how best to proceed to reach outcomes that will satisfy everyone. Do not compromise nursing standards or honesty in delivering nursing care.

You tell your patient that you will return in 30 minutes to give him his next pain medication.

Responsibility

Orem's theory

Self-care deficit theory focuses on helping the patient perform self-care and manage his or her health problems

Practice theory

Specific to a particular situation; brings theory to the bedside

The nurse in a new community-based clinic is requested to complete a community assessment. Order the steps for completing this assessment. 1. Structure or locale 2. Social systems 3. Population

Structure or locale, population, social systems

Mishel's uncertainty in illness theory

Study results indicate that young adults with congenital heart disease are at risk for posttraumatic stress disorder (PTSD) and long-term stress due to chronic uncertainty

Being with (caring behavior)

Telling a family that you understand their anger about the side effects of chemotherapy.

Confidence

The nurse, gaining more experience in reasoning and decision making, does not hesitate to disagree and be troubled, thereby acting as a role model to colleagues (Papathanasiou et al., 2014). Speak with conviction to a patient when you begin an intervention. Do not lead a patient to think that you are unable to perform care safely. Always be well prepared before performing a nursing activity. Encourage a patient to ask questions

Change agent role

This involves identifying and implementing new and more effective approaches to problems.

Dorthea Dix

Tireless reformer, who worked mightily to improve the treatment of the mentally ill. Appointed superintendant of women nurses for the Union forces.

Do not use list of abbreviations

U-use unit IU- use international unit Qx- spell out how often Trailing and leading zero- do not use trailing zeros and always use leading zeros spell out compounds

When does discharge planning begin?

Upon admission

Grand theory

Very abstract; attempts to describe nursing in a global context

Confidentiality

You see an open medical record on the computer and close it so that no one else can read the record without proper access.

value

a deeply held belief about the worth of an idea, attitude, custom, or object that affects choices and behaviors

Continuing care

a variety of health, personal, and social services provided over a prolonged period. These services are for people who have disabilities, who were never functionally independent, or who have a terminal disease.

AIDET

acknowledge, introduce, duration, explanation, thank you

key elements to informed consent

explanation of procedure, names of people performing and assisting with procedure, descriptions of seriousness and complications to the procedure, right to refuse procedure or treatment without discontinuing care, right to refuse even after procedure has begun

vulnerable zone

face, neck, front of body

Intellectual and professional standards of clinical judgement

clear, precise, specific, accurate, relevant, plausible, consistent, logical, deep, broad, complete, significant, adequate

Collaborator role

communicating and working with patients, their families, and other members of the health care team.

What is health influenced by?

culture and lifestyle

Linda Richards

first trained nurse in the US, first community health center

5 categories of social determinants of health

economic stability, education, social and community context, health and healthcare, neighborhood and built environment

Pt advocate role

ensure patients have the information necessary to make informed decisions in choosing and using services appropriately.

Case manager role

establish an appropriate plan of care based on assessment of patients and families and coordinate needed resources and services for a patient's well-being across a continuum of care.

Community based nursing

focuses on health promotion, disease prevention, and restorative care. Encompasses social determinents of health, health disparities, and vulnerable populations.

Lillian Wald

founded the Henry Street Settlement and Visiting Nurse Service which provided nursing and social services and organized educational and cultural activities. She is considered the founder of public health nursing

intimate zone

genitalia, rectum

social zone

hands, arms, shoulders, back

Patient Protection and Affordable Care Act

health care reform law passed in 2010 that includes incentives and penalties for employers providing health insurance as a benefit. Insurance can't deny you for pre existing conditions.

Counselor role

helps patients identify and clarify health problems as well as choose appropriate courses of action to solve those problems.

Barriers to discharge planning

ineffective communication, lack of role clarity among health care team members, and lack of resources.

Swanson's Theory of Caring

knowing, being with, doing for, enabling, maintaining belief

consent zone

mouth, wrists, feet

Health information technology act

nurses must ensure that patient PHI is not inadvertently conveyed on social media and that protected data are not disclosed other than as permitted by patients.

SACCIA

one way to assist nurses in communicating effectively with other team members. The acronym stands for Sufficiency, Accuracy, Clarity, Contextualization, and Interpersonal Adaptation.

PICOT question

population (P), intervention (I), comparison (C), outcome (O), and time (T)

PIE note

problem, intervention, evaluation

Emergency medical treatment and active labor act

prohibits the transfer of patients from private to public hospitals without appropriate screening and stabilization. It is intended to prevent patient dumping.

Secondary care

provided by a specialist or agency on referral by a primary health care provider. It requires more specialized knowledge, skill, or equipment than the primary care physician or nurse practitioner can provide. Urgent care, ER, acute med/surg, radiologic procedures

Narrative note

pt statement

Evaluation of clinical judgement

reflection, meeting with colleagues, concept mapping, critical thinking synthesis (debriefing)