Fundamentals test 4

An older adult client diagnosed as being in the early stage of Alzheimer's disease shares with the nurse that her sleep is interrupted by "the noises I hear all through the night." The nurse explains that the most likely reason for this problem is: 1. The client's age 2. A lack of presleep relaxation 3. The amount of noise entering into the client's environment 4. A manifestation of the disease process causing the brain disorder

*The client's age- With aging, sleep becomes more fragmented, and a person spends more time in lighter stages that are easily disturbed by noise. The remaining options may be a factor but not to the degree of normal aging.

How do you identify patient at risk for suicide?

-Conduct risk assessment -Address immediate safety needs -Provided suicide prevention information

. Verify the full name of patient and person giving the order. 2. Obtain verbal/telephone order and write it on the Physician's Order form or enter into the computer as : Also, you want to: 3. Read back the entire order to the caller to verify accuracy 4. Ensure legibility upon documentation of all orders 5. Flag and highlight verbal order

-Date and time -Order -Physician/physician designee's first and last name -First initial, last name and title of employee authorized to accept the order

What is included in a comprehensive sleep assessment?

-Define the problem (include signs/symptoms), onset, duration, severity -Review factors affecting the client's sleep -Evaluate the client's response to sleep disturbances -Explore client's approaches to improve sleep

List the 14 factors that affect sleep

1.Age - Sleep needs depending on age, nocturia and chronic pain in older adults. 2.Sleep habits - (Day naps?) 3.Medications- (Caffeine, Hypnotics, Sedatives) 4.Sleep routines - (Go to bed really late? Never at the same time?) 5.Lifestyle habits - (Work night shift, Exercising within 2 hours before bed, drugs, cigarettes, alcohol use) 6.Psychological stress (Stressed?, Emotional trauma?, Worry?) 7.Don't go to bed with tv on 8.Illness- SOB, 9. positioning of patient based on hospital equipment. 10.Environments - (Clean? Lighting? Limited Noise?) 11.Amount of Fatigue (Moderate=More rest, High Fatigue=Interferes with Sleep) 12.Weight (Overweight=Sleep Longer) 13. Comfort - (Bed comfy?) 14. Emotional Disturbances (Psych disorders)

WE ARE THE BOTTOM LINE! -Only ___% read the name of the pt from the wristband -Only ___% of the time med given at correct time -Only ____% guideline for hand washing before ext/oral meds was followed (more likely to do so for IV meds=96%)

6.5, 41, 4.5

How long does each sleep cycle typically last for?

90 mins

Explain the difference between an archetype and a stereotype.

A cultural stereotype is a widely held but oversimplified and unsubstantiated belief that all people of a certain racial or ethnic group are alike in certain respects. Stereotypes are not always negative. Someone may think, for example, that people of a particular heritage are "naturally intelligent" or "naturally athletic." A cultural archetype is similar to a model, which you learned about in Chapter 8. An archetype is an example of a person or thing—something that is recurrent—and it has its basis in facts. Therefore, it becomes a symbol for remembering some of the culture specifics and is in no way negative

Examples of Core Measures for Acute Myocardial Infarction (AMI)

ASA (aspirin) on arrival ACEI (ace inhibitors) for LVSD Smoking cessation counseling Beta Blockers Fibrinolytic therapy within 30 min arrival Statins at D/C

What are advance directives?

Advance directives are a group of instructions (oral or written) stating what a person would want or not want relative to his health care in the event that he is incapacitated or unable to make that decision

What is the definition of an adverse event?

An injury caused by medical management rather than by the underlying disease or condition of the patient

The nurse teaches a preoperative patient how to use an incentive spirometer. Place the steps of the use of an incentive spirometer in the order in which they should be performed. 1. Inhale slowly 2. Hold the incentive spirometer level 3. Keep the visual indicator at the inspiratory goal for several seconds 4. Maintain a firm seal with the lips around the mouthpiece during inhalation

Answer: 2, 4, 1, 3 2. Holding the incentive spirometer level prevents factors, such as friction and gravity from altering the correct function of the device. 4. A firm seal around the mouthpiece is necessary during inhalation, but the mouthpiece should be removed during exhalation. 1. Inspiration should be accomplished through a slow, deep breath. A rapid, forceful inhalation can collapse the airway and is contraindicated. 3. When the visual indicator reaches the preset goal during inhalation, the inhalation should be maintained for 2 to 4 seconds to ensure ventilation of the alveoli.

Name some sleep related Nursing Diagnoses (as etiology)

Anxiety r/t fear of death Coping, ineffective (individual) r/t decreased functioning due to lack of sleep Fatigue r/t insufficient quantity of sleep Risk for injury r/t sleepwalking

List three nursing diagnosis labels you might consider when dying or grieving is the primary problem.

Any of the following labels would be appropriate answers: ● Grieving ● Complicated Grieving ● Ineffective Denial ● Hopelessness ● Powerlessness ● Caregiver Role Strain ● Chronic Sorrow ● Spiritual Distress

A patient is prescribed a low-sodium, low-fat diet. How can the nurse best ensure that the patient follows the prescribed diet during hospitalization? 1) Make sure dietary services sends a low-sodium, low-fat meal tray. 2) Arrange for meals that accommodate his cultural dietary practices and specified diet. 3) Ask the patient's family to bring in foods from home he typically eats. 4) Sit with the patient while he eats to make sure he consumes the prescribed diet.

Arrange for meals that accommodate his cultural dietary practices and specified diet. Rationale: The nurse can help ensure that the patient consumes the prescribed diet by requesting a culturally appropriate meal tray for the patient. Patients are more likely to follow the prescribed diet when it contains foods that they prefer. Simply providing a tray that is low in fat and sodium does not take into consideration his cultural preferences. The family can provide foods for the patient after they have been instructed about the diet. Sitting with the patient while he eats does not ensure that the patient will follow the diet, and it fosters dependence.

State of intense or severe psychological response that occurs following a loss of a significant object, person, belief, or relationship

Bereavement

Define narcolepsy, and what is the treatment

Can fall asleep at random.uncontrollable. treatment is usually stimulants, onset usually in adolescence, inability to regulate sleep cycles

#1 reason that med errors occur:

Communication factors!!!

Universal protocol for preventing wrong site, wrong procedure, wrong person surgery:

Conduct a pre-procedure verification process Mark the procedure site A time-out is performed before the procedure

Identify at least six culture specifics affecting health.

Cultural specifics include communication, space, time orientation, social organization, environmental control, and biological variations. Another is responses to drugs.

Insomnia, Sleep wake schedule disorders, restless leg syndrome, sleep apnea, and narcolepsy are all called what?

Dyssomnias

A nurse and client of the same race who speak the same language will not experience problems in communication. True or False

False Rationale: Often languages will have different dialects that evolve in different regions and increase communication problems. The nurse and client may also experience differences generationally or based on religion, values, or beliefs.

In Florida, certain serious sentinel events must be reported to the:

Florida's Agency for Health care administration (AHCA)

Pattern of emotional and physical response a person experiences after a loss of a significant object, person, belief, or relationship

Grief

Why was HCAHPS implemented?

Growth in consumerism/pay for performance Industry changes -IOM reports -National Quality Forum efforts -Patient's Bill of Rights debate -Federal Government vested interest

ISBAR (KNOW THIS) stands for :

I - Introduction S - Situation B - Background A - Assessment R - Recommendation

What are accountability measures?

Introduced in June 2010 to assist "hospitals prepare for performance measurement in the new health care environment" Joint commission categorized its performance measures into accountability

A family member asks the nurse to explain the purpose of hospice care. Which of the following is the best response? Hospice care: 1) Is appropriate when the patient desires to intentionally end his life 2) Focuses on minimizing the disease process as rapidly as possible 3) Focuses on symptom management for patients not responding to treatment 4) Is holistic care for patients dying or debilitated and not expected to improve

Is holistic care for patients dying or debilitated and not expected to improve Rationale: Hospice care focuses on holistic care of patients actively dying or not expected to improve. It helps patients face death with dignity and comfort. Euthanasia refers to the deliberate ending of a life. Palliative care is aggressively planned care that manages symptoms of patients whose disease process no longer responds to treatment. Aggressive medical treatment is aimed at stopping the disease process.

Is this a Sentinel event: The natural course of the pt's illness or underlying condition

No

What does an OSA sign on the door of a patient tell you?

Patient has Obstructive Sleep Apnea

What is insomnia related to?

Physical discomfort Stress/Anxiety Impaired sleep pattern Intake of stimulants Environmental/Sensory overload

Why are older people at risk for errors in health care?

Prescribed potentially inappropriate medication in nearly 25% older people in community

Sleep is regulated by the :

RAS and BSR systems in the pons

What info do you communicate when you assume care (you receive report) or someone else assumes (you give report) care of the patient?

Report or handoff includes current and past information about care, treatment, and condition including any recent or anticipated changes There must be minimal interruption and an opportunity to ask questions. CELL PHONES!!

A Sentinel Event is communicated and reported to:

Risk Management

What is the definition of medical error?

The failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim (IOM)

What is folk medicine?

The folk health system or folk medicine is a set of beliefs and practices that are followed by a cultural group that reflects what the people do when they are ill rather than following the conventional standards of healthcare.

List the six cultural specifics affecting health.

The six cultural specific affecting health are as follows: ● Communication ● Space ● Social organization ● Time orientation ● Environmental control ● Biologic variations

Why are children at particular risk for errors in health care?

They don't know any better, and Incorrect dosages

Why is it important to position the body with a pillow under the head and shoulders soon after death?

To prevent blood from settling there and causing discoloration, which would be upsetting to the family.

What do you do when your patient has a critical value?

When a critical value is received, notify the physician if the current plan of care DOES NOT address the critical value (K+????) (Temp???)

If a person is doing a hobby or listening to music, talking to friends are they also resting?

Yes

Core measures help "reduce the risk of ______ prevent recurrences and otherwise treat the majority of patients who come to a hosptial for treatment of a condition or illness"

complications

Define Hypersomnia

excessive sleeping. Don't sleep a lot during the day because it can keep you awake at at night, seen with sleep apnea

Characteristic pattern of emotional and physical responses a person makes to the impending loss (real or imagined) of a significant object, person, belief, or relationship

grieving

Value based purchasing benchmark is :

highest achievement levels - average performance for top 10% of ALL hospitals (ex: top 12 of your class!)

Errors in Health Care Estimates of incidence of medication errors are ___ Many errors go_____or ____ Incidence report only ___ out of 54 people experiencing adverse event <6% 700K ED visits & 120K hospitalizations due to ADR/yr

low, undocumented or unreported, 3

What are CORE MEASURES? Developed by the Joint Commission to "improve the quality of health care by implementing a ______ measurement system." -Each Core Measure has "key actions that are lsited which represent the _____ appropriate care in a particular category." It is considered: -A _____ BLUEPRINT -Care recommendations are subjected to the physician's advice and the patient's condition.

national, standardized performance measurement system, most widely accepted, research-based , Standardized

During REM what is happening in the mind and body?

no dreaming or thinking Increase in cerebral blood flow Increase o2 consumption

In a 2008 study published in the New England Journal of Medicine, Harvard researchers found... "Hospitals with a high level of _____ provided clinical care that was higher in quality for all conditions examined." "A bad hospital experience can sour a patient on health care. If staff treats patients poorly, the patient is less likely to follow discharge instructions and take medications."

patient satisfaction,

Assist hospitals to improve the quality of patient care by focusing on the actual ____ of care.

results

Use at least two patient identifiers when providing care, treatment, and services, not the :

room number !! Why? Not verbal self-identification Should be specific to -Organiztion -Resident Label specimen containers in presence of patient

***YOU WILL SEE THIS AGAIN!!*** All cases of unanticipated death or major permanent loss of function associated with health care associated infection are managed as :

sentinel events

Is quality sleep objective or subjective?

subjective - How did you sleep last night?( one of the first thing we should ask) 2.How do we determine normal sleep pattern- Ask questions- What time do you go to sleep, do you wake up often at night, activities, and Bed rituals. 3.Sleep quantity- How much sleep did you get last night? 4.Determine the client's current sleep pattern 5.If sleep is adequate, assessment is brief

A stereotype is a preconceived and untested belief about people or groups of people. True False

true

Race is defined as the physical characteristics that are shared by a specific ethnic group. True or False

true

Discuss REM sleep Type of sleep experienced: Duration: level of arousal: whats most important to this process?

•Dreaming occurs •Usually begins about 90 minutes after sleep has begun •Duration increases with each cycle and averages 20 minutes •Very difficult to arouse sleeper •Restores and rests the body •Rapid eye movement & irregular muscle movements take place -Essential for our physical and mental well being -Important for restorative processes (protein synthesis, growth hormone, etc.)

Give an example of each: ethnic group, race, religion.

● Ethnic group. Latino or Hispanic, Greek Orthodox, Bosnian Serbs ● Race. White or Caucasian, black or African American, Asian, American Indian, Alaska Natives, Native Hawaiian or Other Pacific Islander ● Religion. Catholic, Greek Orthodox, Baptist, Buddhist, Hindu

List five factors that influence a person's response to loss or grieving.

● Significance of the loss ● Circumstances of the loss ● Previous losses ● Developmental stage of the person ● Spiritual/cultural belief system

The nurse is completing an assessment of the client's sleep patterns. A specific question that the nurse should ask to determine the potential presence of sleep apnea is: 1. "How easily do you fall asleep?" 2. "Do you have vivid, lifelike dreams?" 3. "Do you ever experience loss of muscle control or falling?" 4. "Do you snore loudly or experience headaches?"

* "Do you snore loudly or experience headaches?"- To assess for sleep apnea (unlike assessing for narcolepsy or insomnia), the nurse may ask, "Do you snore loudly?" and "Do you experience headaches after awakening?" A positive response may indicate the client experiences sleep apnea.

An 11-year-old boy in middle school is currently experiencing sleep-related fatigue during classes. Which of the following is the most appropriate response by the school nurse when counseling the child's parents regarding this assessment? 1. "What are the child's usual sleep patterns?" 2. "Establish bedtimes for the child, and withhold his allowance whenever those times are not adhered to." 3. "We need to explore other health-related problems, because sleep problems are not likely the cause of his fatigue." 4. "The bulbar synchronizing region of the child's central nervous system is causing these insomniac problems."

* "What are the child's usual sleep patterns?" A school-age child will be tired the following day if allowed to stay up later than usual. The nurse should ask a question to assess the child's usual sleep patterns. The nurse should first assess the child's usual sleep pattern to determine if the child is adhering to a bedtime. A sleep problem is often the cause of fatigue.

The nurse recognizes that the sleep patterns of older adults differ and older adults generally: 1. Are more difficult to arouse 2. Require more sleep than middle-age adults 3. Take less time to fall asleep 4. Have a decline in stage 4 sleep

* Have a decline in stage 4 sleep- As people age, there is a progressive decrease in stages 3 and 4 NREM sleep; some older adults have almost no stage 4, or deep, sleep. Older people do not become more difficult to arouse, not do they require more sleep than the middle-age adult. An older adult awakens more often during the night, and it may take more time for an older adult to fall asleep.

Teaching for a client who is currently taking a diuretic should include information that he or she may experience: 1. Nocturia 2. Nightmares 3. Increased daytime sleepiness 4. Reduced REM sleep

* Nocturia- For the client who is currently taking a diuretic, the nurse should inform the client that he or she might experience nighttime awakening caused by nocturia. Diuretic use does not cause nightmares or daytime sleepiness or reduce REM sleep.

A client is concerned that her habit of sleeping during the day and being awake at night is not "healthy or normal." The nurse's most therapeutic response to the client's concern is: 1. "What makes you think that sleeping during the day and being up at night is unhealthy or abnormal?" 2. "Many people share your sleep habits. As long as you feel all right, I don't think there is anything to worry about." 3. "Are you interested in changing your sleep habits for any particular reason? Is sleeping during the day a problem for you?" 4. "Everyone has a different biological clock that controls his or her sleep cycle. As long as you are sleeping and functioning well, your habit isn't abnormal or unhealthy."

*"Everyone has a different biological clock that controls his or her sleep cycle. As long as you are sleeping and functioning well, your habit isn't abnormal or unhealthy." All persons have biological clocks that synchronize their sleep cycles. If the sleep pattern does not adversely affect the client's health or ability to function, it is not problematic.

A client is discussing his recent restlessness and increased irritability. Which of the following assessment questions is likely to be most helping in determining the cause of these complaints? 1. "When did you start noticing these changes?" 2. "Has anything caused you to change your usual routine lately?" 3. "Do you have any idea what might be causing these problems?" 4. "What makes you think that you are more irritable than is normal for you?"

*"Has anything caused you to change your usual routine lately?"- When the sleep-wake cycle becomes disrupted (e.g., by working rotating shifts), other physiological functions usually change as well. For example, the person experiences a decreased appetite and loses weight. Anxiety, restlessness, irritability, and impaired judgment are other common symptoms of sleep cycle disturbances. Failure to maintain the individual's usual sleep-wake cycle negatively influences the client's overall health. Although the other options are not inappropriate, they are not as directly aimed at determining the cause of the changes.

A 74-year-old client has been having sleeping difficulties. To have a better idea of the client's problem, the nurse should respond: 1. "What do you do just before going to bed?" 2. "Let's make sure that your bedroom is completely darkened at night." 3. "Why don't you try napping more during the daytime?" 4. "Do you eat a small snack before going to bed?"

*"What do you do just before going to bed?"- To assess the client's sleeping problem, the nurse should inquire about predisposing factors, such as by asking "What do you do just before going to bed?" Assessment is aimed at understanding the characteristics of any sleep problem and the client's usual sleep habits so that ways for promoting sleep can be incorporated into nursing care. Older adults sleep best in softly lit rooms. Napping more during the daytime is often not the best solution. The nurse should first assess the client's sleeping problem. The client does not always have to eat something before going to bed.

The nurse and a client are discussing possible behaviors that might be interfering with the client's ability to fall asleep. Which of the following assessment questions is most likely to identify possible problems with the client's sleep routine that possibly are contributing to the difficulty? 1. "When do you usually retire for the night?" 2. "What do you do to help yourself fall asleep?" 3. "How much time does it usually take for you to fall asleep?" 4. "Have you changed anything about your presleep ritual lately?"

*"What do you do to help yourself fall asleep?"- As people try to fall asleep, they close their eyes and assume relaxed positions. Stimuli to the RAS decline. If the room is dark and quiet, activation of the RAS further declines. At some point the BSR takes over, causing sleep. If the client engages in activities such as reading or watching television as a means of falling asleep, this could be causing the problem. Although the other questions are not inappropriate, they are not as directed toward the cause of the problem.

A 9-year-old client asks the nurse, "Why do I need to sleep?" The nurse's most age-appropriate, informative response is: 1. "Everyone needs to sleep to feel rested." 2. "It gives your body a chance to really rest." 3. "You'll be able to do so much better in school if you're rested." 4. "Your body needs to rest in order to grow and be really healthy."

*"Your body needs to rest in order to grow and be really healthy."- Sleep contributes to physiological and psychological restoration, maintenance, and growth of the body at any age. The remaining options are not as effective at providing a thorough answer to the child's question. The body needs sleep to routinely restore biological processes.

Which outcome best reflects achievement of the goal, "The patient will expectorate lung secretions with no signs of respiratory complications?" 1. Absence of adventitious breath sounds 2. Deep breathing and coughing nonproductively 3. Drinking 3000 mL of fluid in the last 24 hours 4. Expectorating sputum three times between 3 PM and 11 PM

***1. Adventitious breath sounds are unexpected (abnormal) breath sounds that occur when pleural linings are inflamed or when air passes through narrowed airways or through airways filled with fluid. The absence of unexpected (abnormal) sounds is desirable.*** 2. To expectorate secretions, coughing must be productive, not nonproductive. A nonproductive cough is dry, which means that no respiratory secretions are raised and spit out (expectorated) because of coughing. 3. Drinking fluid is an intervention that will liquefy respiratory secretions, facilitating their expectoration. However, just drinking fluid will not ensure that the secretions will be expectorated. 4. Although spitting out sputum reflects achievement of the goal in relation to expectorating lung secretions, it does not address the absence of respiratory complications which is the ultimate goal of decreasing stasis of respiratory secretions.

The nurse is teaching a patient how to use an incentive spirometer. The nurse should assist the patient to assume which position? 1. Sitting 2. Side-lying 3. Orthopneic 4. Low-Fowler's

***1. An upright sitting position in a bed or chair facilitates maximum thoracic excursion because it permits the diaphragm to contract without pressure being exerted against it by abdominal viscera.*** 2. The side-lying position is not ideal for the use of an incentive spirometer because it limits thoracic expansion. The side-lying position allows the abdominal viscera to exert pressure against the diaphragm during inspiration and the lung on the lower side of the body is compressed by the weight of the body. 3. The orthopneic position raises intraabdominal and intrathoracic pressures that can limit thoracic excursion. 4. The low-Fowler's position does not maximize the effects of gravity. Gravity moves abdominal viscera away from the diaphragm and thus facilitates the contraction of the diaphragm, both of which promote thoracic expansion.

The physician orders bed rest for a patient. The nurse understands that bed rest primarily is used to: 1. Conserve energy 2. Maintain strength 3. Reduce peristalsis 4. Enhance protein synthesis

***1. Bed rest reduces cardiopulmonary demands, muscle contraction, and other bodily functions. All of this reduces the basal metabolic rate, which conserves energy.*** 2. Activity, not bed rest, maintains strength. 3. Although bed rest may limit peristalsis, it is not the most common reason bed rest is ordered. 4. Protein synthesis is enhanced by the intake of amino acids, not bed rest.

The nurse is assessing a postoperative patient. Which complication has most likely occurred when the patient experiences purulent sputum, dyspnea, and chest pain? 1. Hypostatic pneumonia 2. Hypovolemic shock 3. Thrombophlebitis 4. Pneumothorax

***1. Hypoventilation, immobility, and ineffective coughing that lead to stasis of respiratory secretions and the multiplication of microorganisms, cause hypostatic pneumonia. Dyspnea results from decreased lung compliance, chest pain results from coughing and the increased work of breathing, and purulent sputum results from fluid and bloodmoving from the capillaries into the alveoli.*** 2. Hypovolemic shock is characterized by tachycardia, tachypnea, and hypotension. 3. Thrombophlebitis is characterized by localized pain, swelling, warmth, and erythema. 4. Pneumothorax is characterized by a sudden onset of sharp pain on inspiration, dyspnea, tachycardia, and hypotension.

The nurse is reviewing the laboratory results of a patient with the preliminary diagnosis of anemia. Which diagnostic test reflects an adaptation to iron deficiency anemia? 1. Hemoglobin 2. Platelet count 3. Serum albumin 4. Blood urea nitrogen

***1. Iron is necessary for hemoglobin synthesis. Therefore, reduced intake of dietary iron results in iron deficiency anemia. Hemoglobin is the main component of red blood cells and transports oxygen and carbon dioxide through the bloodstream.*** 2. Platelets are unrelated to iron deficiency anemia. Platelets (thrombocytes) are nonnucleated, round or oval, flattened, diskshaped, formed elements in the blood that are necessary for blood clotting. 3. Albumin is unrelated to iron deficiency anemia. Albumin is a protein in the blood that helps to maintain blood volume and blood pressure. 4. Blood urea nitrogen is unrelated to iron deficiency anemia. Blood urea nitrogen (BUN) is a test that measures the nitrogen portion of urea present in the blood. It is an index of glomerular function in the production and excretion of urea

When the head of the bed is elevated to facilitate breathing, the main principle that explains how this action facilitates respiration is based on the science of: 1. Physics 2. Biology 3. Anatomy 4. Chemistry

***1. Raising the head of the bed drops the abdominal organs away from the diaphragm via the principle of gravity, facilitating breathing. Gravity, the tendency of weight to be pulled toward the center of the earth, is a physics principle.*** 2. This is not related to biology. Biology is the study of living organisms. 3. This is not related to anatomy. Anatomy is the study of the form and structure of living organisms. 4. This is not related to chemistry. Chemistry is the study of elements, compounds, and atomic relations of matter.

The nurse is caring for a patient receiving oxygen via a nasal cannula. The nurse should: 1. Reassess the nares, cheeks, and ears for signs of pressure every 2 hours 2. Loop the tubing over the patient's ears and adjust the tubing firmly under the chin 3. Ensure physical hygiene includes applying oil-based lubricant to the patient's nares 4. Alternate the position of the prongs curving upward versus downward every 2 hours

***1. This ensures that tissue irritation or capillary compression does not occur from the nasal prongs, tubing, or elastic strap. The elastic strap should be snug enough to keep the nasal prongs from becoming displaced but loose enough not to compress or irritate tissue.*** 2. This is the correct placement of the tubing; however, it should be secured gently, not firmly, under the chin. 3. A water-based, not oil-based, lubricant should be applied to the nares. 4. The nasal prongs should always be curving downward to follow the natural curve of the nares. Placing the nasal prongs curving upward does not follow the natural curve of the nasal passage, which can cause tissue injury.

A meal tray arrives for a patient who is receiving 24% oxygen via a Venturi mask. To meet this patient's needs, the nurse should: 1. Request an order to use a nasal cannula during meals 2. Discontinue the oxygen when the patient is eating meals 3. Obtain an order to change the mask to a nonrebreather mask during meals 4. Arrange for liquid supplements that can be administered via a straw through a valve in the mask

***1. This intervention will help meet both the nutritional and oxygen needs of the patient. A nasal cannula delivers oxygen via prongs placed in the patient's nares leaving the mouth unobstructed, which promotes talking and eating.*** 2. This is unsafe because it can compromise the patient's respiratory status while the oxygen is disconnected. 3. A Venturi mask and a nonrebreather mask are both masks that cover the mouth, which interferes with eating. 4. Liquid supplements are unnecessary. The patient should eat the diet ordered by the physician.

Which nursing assessment best indicates a patient's ability to tolerate activity? 1. Results of vital signs before and after activity 2. Presence of adventitious breath sounds 3. Flexibility of muscles and joints 4. Complaints of weakness

***1. Vital signs reflect cardiopulmonary functioning of the body. Vital signs obtained before and after activity provide data that can be compared to determine the body's response to the energy demands of ambulation.*** 2. The presence of unexpected (abnormal) breath sounds (adventitious sounds) indicates the presence of a respiratory problem (narrowed airways, presence of excessive respiratory secretions, or pleural inflammation), not a response to activity. 3. Flexibility relates to mobility, not one's physiologic capacity to endure activities that require energy. 4. Although this may reflect a response to activity, this evaluation is subjective and vague. Measurable, specific outcomes that are objective are the best way to evaluate a patient's physiologic response to activity.

It is determined that the client will need pharmacological treatment to assist with the client's sleep patterns. The nurse anticipates that treatment with an anxiety-reducing, relaxation-promoting medication will include the use of: 1. Barbiturates 2. Amphetamines 3. Benzodiazepines 4. Tricyclic antidepressants

*Benzodiazepines- The benzodiazepines cause relaxation, antianxiety, and hypnotic effects by facilitating the action of neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal. Withdrawal from CNS depressants, such as barbiturates, can cause insomnia and must be managed carefully. Barbiturates can cause tolerance and dependence. Central nervous system stimulants, such as amphetamines, should be used sparingly and under medical management. Amphetamine sulfate may be used to treat narcolepsy. Prolonged use may cause drug dependence. Tricyclic antidepressants can cause insomnia when withdrawn and should be managed carefully. They are used primarily to treat depression.

Which of the following symptoms should the nurse assess with a client who is deprived of sleep? 1. Elevated blood pressure and confusion 2. Confusion and irritability 3. Inappropriateness and rapid respirations 4. Decreased temperature and talkativeness

*Confusion and irritability-Psychological symptoms of sleep deprivation include confusion and irritability. X- Elevated blood pressure is not a symptom of sleep deprivation. X- Rapid respirations are not a symptom of sleep deprivation. There may be a decreased ability of reasoning and judgment that could lead to inappropriateness. X-Decreased temperature is not a symptom of sleep deprivation. The client with sleep deprivation is often withdrawn, not talkative.

Which of the following may improve the sleep of an older adult client? 1. Drinking an alcoholic beverage before bedtime 2. Using an over-the-counter sleeping agent 3. Eliminating naps during the day 4. Going to bed at a consistent time even if not feeling sleepy

*Eliminating naps during the day- To promote sleep, daytime naps should be eliminated. If naps are used, they should be limited to 20 minutes or less twice a day. Alcohol should be limited in the late afternoon and evening because it has an insomnia-producing effect. The use of nonprescription sleeping medications is not advisable. Over the long term, these drugs can lead to further sleep disruption even when they initially seemed to be effective. Following a bedtime routine should be consistent, not necessarily going to bed. The client should engage in quiet activities that promote relaxation and then may go to bed. If the client has not fallen asleep in 30 minutes, the client should get up out of bed and do some quiet activity until feeling sleepy enough to go back to bed.

Which of the following information provided by the client's bed partner is most associated with sleep apnea? 1. Restlessness 2. Talking during sleep 3. Somnambulism 4. Excessive snoring

*Excessive snoring- Partners of clients with sleep apnea often complain that the client's snoring disturbs their sleep. Restlessness is not most associated with sleep apnea. Sleep talking is associated with sleep-wake transition disorders; somnambulism is associated with parasomnias (specifically, arousal disorders and sleep-wake transition disorders).

The nurse knows that which of the following habits may interfere with a client's sleep? 1. Listening to classical music 2. Finishing office work 3. Reading novels 4. Drinking warm milk

*Finishing office work- At home a client should not try to finish office work or resolve family problems before bedtime. Noise should be kept to a minimum. Soft music may be used to mask noise if necessary. Reading a light novel, watching an enjoyable television program, or listening to music helps a person to relax. Relaxation exercises can be useful at bedtime. A dairy product snack such as warm milk or cocoa that contains L-tryptophan may be helpful in promoting sleep.

The mother of a 2-year-old child is frustrated because the child does not want to go to bed at the scheduled bedtime. The nurse should suggest that the parent: 1. Offer the child a bedtime snack 2. Eliminate one of the naps during the day 3. Allow the child to sleep longer in the mornings 4. Maintain consistency in the same bedtime ritual

*Maintain consistency in the same bedtime ritual-The nurse should advise the parent to maintain a regular bedtime and wake-up schedule and to reinforce patterns of preparing for bedtime. A bedtime routine (e.g., same hour for bedtime, quiet activity) used consistently helps young children avoid delaying sleep. It is most important that the parent maintains a consistent bedtime routine. X-If a bedtime snack is already part of that routine, then this is allowable. If it is not, then the child may only use having a snack as a measure of procrastination. X-After 3 years of age the child may give up daytime naps. A bedtime routine used consistently will be more effective in helping the child who resists going to sleep. The same regular bedtime and wake-up schedule should be maintained.

The nurse understands that the client with which of the following conditions is at risk for obstructive sleep apnea? 1. Heart disease 2. Respiratory tract infections 3. Nasal polyps 4. Obesity

*Nasal polyps- Structural abnormalities, such as a deviated septum, nasal polyps, certain jaw configurations, or enlarged tonsils predispose a client to obstructive apnea. Individuals with mixed apnea often have signs and symptoms of right-sided heart failure. Respiratory tract infections do not predispose a client to obstructive sleep apnea. Clients with obstructive apnea are often middle-age, obese men. Obesity itself does not predispose a client to obstructive sleep apnea.

New research indicates that to increase safety the nurse should instruct parents to do which of the following? 1. Provide a stuffed toy for comfort. 2. Cover the infant loosely with a blanket. 3. Place the infant on his or her back. 4. Use small pillows in the crib.

*Place the infant on his or her back.- Infants are usually placed on their backs to prevent suffocation or on their sides to prevent aspiration of stomach contents. To reduce the chance of suffocation, pillows, stuffed toys, or the ends of loose blankets should not be placed in cribs. Infants should not be covered loosely with a blanket because infants might pull them over their faces and suffocate.

1. The physiology of sleep is complex. Which of the following is the most appropriate statement in regard to this process? 1. Ultradian rhythms occur in a cycle longer than 24 hours. 2. Nonrapid eye movement (NREM) refers to the cycle that most clients experience when in a high-stimulus environment. 3. The reticular activating system is partly responsible for the level of consciousness of a person. 4. The bulbar synchronizing region (BSR) causes the rapid eye movement (REM) sleep in most normal adults.

*The ascending reticular activating system (RAS) located in the upper brain stem is believed to contain special cells that maintain alertness and wakefulness. Infradian rhythms, not ultradian rhythms, occur in a cycle longer than 24 hours. X- Nonrapid eye movement refers to the sleep cycle that most clients experience in a low-stimulus environment. X- The reticular activating system is only partly responsible for the level of consciousness of a person. X- The bulbar synchronizing region is the area of the brain where serotonin is released to produce sleep. It is not responsible for REM sleep.

The nurse should instruct the client to do which of the following to promote good sleep hygiene at home? 1. Use the bedroom only for sleep or sexual activity. 2. Eat a large meal 1 to 2 hours before bedtime. 3. Exercise vigorously before bedtime. 4. Stay in bed if sleep does not come after 1/2 hour.

*Use the bedroom only for sleep or sexual activity.- The nurse should explain that, if possible, the bedroom should not be used for intensive studying, snacking, TV watching, or other nonsleep activity, besides sex. The nurse should instruct the client to avoid heavy meals for 3 hours before bedtime; a light snack may help. The nurse should also instruct the client to try to exercise daily, preferably in morning or afternoon, and to avoid vigorous exercise in the evening within 2 hours of bedtime. Getting out of bed and doing some quiet activity until feeling sleepy enough to go back to bed if the client does not fall asleep within 30 minutes of going to bed may also help.

Name some ways to reduce/prevent med errors:

- use 2 Patient Identifiers (Name & DOB) -No Interruptions during medication administration -Two nurse verification • proper Dosage calculations -Clarify Order - Read back -Question medication order if unsure -Document medication immediately after giving -Learn your medications AND adverse effects -Report all errors - even near miss -Non-punitive reporting system -Determine how to prevent medical errors

How do you reduce the risk of health care associated infections

-Comply with either the current CDC and Prevention hand hygiene guidelines or the WH hand hygiene guidelines -All cases of unanticipated death or major permanent loss of function associated with health care associated infection are managed as sentinel events

Describe common prescribing errors:

-Decline in renal or hepatic function -History of allergy (pt at FH Alt) -Wrong drug, dosage form or abbreviation -Incorrect dosage calculation -Illegible handwriting or incomplete orders -Use of error-prone terms -Language barriers

Give some examples of who gets the surveys...(adult med/surg pts)

-Discharged from short term medical-surgical/acute care hospital -Overnight stay -Over age of 18 -Alive at discharge -All patients ( not only Medicare) -Sample is random

Name 2 kinds of medical errors:

-Error in execution -Error in planning

What is VBP? Value Based Purchasing

-Established 2011 Affordable Care Act -CMS paying based on Quality and Patient Satisfaction Measures • CMS to withhold portion of baseline DxRG payment for each patient • Hospitals lose reimbursement unless performance is at benchmark levels • Hospitals earn back a percentage of withheld funds based on performance -Incentive/Penalties to improve quality of care DETAILS LEFT TO CMS!! CMS has great discretion

Name some other reasons that medical errors occur:

-Human problems such as fatigue, illness, and drug use THIS COULD BE YOU!! -Patient-related issues such as ID, assessment, and education -Training deficiencies -Staffing patterns Equipment errors -Distractions and Complacency -Inadequate policies and procedures

What are the 5 characteristics of The Circadian Rhythm:

1 .Influences biological clock and behavioral functions 2. 24-hour; day/night cycle 3.Biological clocks 4.Different people function best at different times of the day (example morning person vs night owl) 5.Relationship between Rest/Sleep and Illness

The nurse is caring for a patient who is terminally ill with lung cancer. Recently, the patient's blood pressure has been decreasing and heart rate increasing. He is experiencing temperature fluctuations and perspires profusely with limited movement. Based on these findings, the patient will most likely die within which time period? 1) 1 to 3 months 2) 1 to 2 weeks 3) Days to hours 4) Moments

1 to 2 weeks Rationale: One to 2 weeks before death, patients typically exhibit decreased blood pressure, increased heart rate, increased perspiration, and temperature fluctuations; 1 to 3 months before death the patient withdraws from the world: sleep increases and appetite decreases. Days to hours before death, the patient may experience a surge in energy. Very near the time of death, the dying patient is typically not responsive to touch or sound.

After a patient dies of ovarian cancer, her daughter says to the nurse, "You'll probably think I'm terrible, but I'm glad she can finally rest peacefully." Which response by the nurse is best? 1) "Your feelings are a normal response to watching your loved one suffer." 2) "It's unusual for family members to be grateful that a loved one has died." 3) "Your mother's death has been very hard on you; you should seek counseling." 4) "I don't understand what you mean by this comment."

1) "Your feelings are a normal response to watching your loved one suffer." Rationale: The nurse should reassure the patient's daughter that her feelings are normal; there is no need for the daughter to seek counseling based on the information provided in this situation. Keep in mind that people can grieve in a dysfunctional manner for which they would benefit from counseling or other mental health support services. By responding, "It's unusual for family members to be grateful that a loved one has died," the nurse is being judgmental. The nurse who states she doesn't understand the family member's comment should at least seek clarification and prompt further exploration of the person's feelings. A comment of this nature can be a discussion starter for the daughter to release feelings and begin the grieving process.

A patient is hospitalized with severe depression after her divorce is finalized. Which type of loss is the patient experiencing? 1) Actual 2) Perceived 3) Physical 4) External

1) Actual Rationale: The loss of a relationship is an actual loss. An actual loss is a reality that can be identified by others, not just by the person experiencing it. Perceived loss is internal; it can only be identified by the person experiencing the loss. Physical loss includes injuries, removal of an organ or body part, or loss of function. An external loss is an actual loss of an object.

The nurse is caring for a patient whose primary language is Vietnamese. When working with the interpreter, the nurse should do which of the following? Select all that apply. 1) Make eye contact with the interpreter. 2) Speak a little more loudly than usual. 3) Use an interpreter who is socially compatible with the patient. 4) Try to find a family member to help interpret.

1) Make eye contact with the interpreter. 3) Use an interpreter who is socially compatible with the patient. Rationale: When choosing an interpreter, the nurse should use one who is socially compatible with the patient. The nurse should maintain eye contact with both the patient and interpreter. She should not speak loudly. It is best to not ask family members to interpret because of privacy issues.

To increase both the respiratory and the circulatory functions of a patient in a coma, what is the most important thing the nurse should do? 1. Encourage the patient to cough 2. Massage the patient's bony areas 3. Assist the patient with breathing exercises 4. Change the patient's position every two hours

1. A patient in a coma is unable to respond. 2. This helps only skin circulation in the small area being massaged. 3. A patient in a coma is unable to respond. ***4. This helps respirations by preventing fluid from collecting in the lung, which can cause infection; it helps circulation since activity increases circulation, and it relieves local pressure.***

When assessing a patient, which adaptation indicates the presence of respiratory distress? 1. Rate of fourteen breaths per minute 2. Productive cough 3. Sore throat 4. Orthopnea

1. A respiratory rate of 14 in an adult is within the expected range of 12 to 20 breaths per minute. 2. A productive cough indicates that the person is managing respiratory secretions adequately and keeping the airway patent. 3. A sore throat indicates posterior oropharyngeal irritation or inflammation. This may or may not progress to respiratory distress. ***4. Orthopnea, the ability to breathe easily only in an upright (standing or sitting) position, is a classic sign of respiratory distress. The upright position permits maximum thoracic expansion because the abdominal organs do not press against the diaphragm and inspiration is aided by the principle of gravity.***

When administering oxygen via a wall-outlet system, the nursing action that is unnecessary for a low liter flow as opposed to a high liter flow is: 1. Attaching a flowmeter to the wall outlet 2. Providing oral hygiene whenever necessary 3. Hanging an Oxygen in Use sign outside the patient's room 4. Humidifying the oxygen before it is delivered to the patient

1. All oxygen systems should have a flowmeter to control and maintain the flow of oxygen gas. 2. All oxygen is drying to the oral mucosa.Therefore, oral hygiene should be provided frequently to moisten the mucous membranes. 3. Oxygen in use signs should be displayed prominently on the patient's door and bed to alert others that oxygen is in use and that safety precautions should be implemented. ***4. A low liter flow system administers a volume of oxygen designed to supplement the inspired room air to provide airflow equal to the person's minute ventilation. A high liter flow system administers a volume of oxygen designed to exceed the volume of air required for the person's minute ventilation. The low liter flow system is less drying than the high liter flow system and humidification is unnecessary. A humidifier is a mechanical device that adds water vapor to air in a particle size that can carry moisture to the small airways.***

The nurse understands that the physiological factor that places the older adult at the greatest risk during surgery is a decrease in: 1. Skin elasticity 2. Bladder emptying 3. Tolerance for pain 4. Respiratory excursion

1. Although healing of an incision may take longer in an older adult, it is not as serious as another age-related change. In the older adult, there is atrophy and thinning of both the epithelial and subcutaneous layers of tissue, collagenous attachments become less effective, sebaceous gland activity decreases, and interstitial fluid decreases. These changes lead to decreased skin elasticity. 2. Although there is a greater risk of postoperative urinary complications in older adults, they are not as serious as problems caused by other age-related changes. In the older adult, bladder muscles weaken, bladder capacity decreases, the micturition reflex is delayed, emptying of the bladder becomes more difficult, and residual volume increases. 3. Although an incision in an older adult may be painful, it is not as serious as other age-related changes. In addition, in the older adult there is an increased threshold for sensations of pain, touch, and temperature because of age-related changes in the nerves and nerve conduction. ***4. Age-related changes in the older adult include calcification of costal cartilage (making the trachea and rib cage more rigid), an increase in the anteriorposterior chest diameter, and weakening of the thoracic inspiratory and expiratory muscles. These changes decrease respiratory excursion, which can result in multiple life-threatening postoperative complications, such as atelectasis and hypostatic pneumonia.***

An obese patient has limited mobility after an open reduction and internal fixation of a fractured hip. The nurse should monitor this patient for the most serious complication of increased blood coagulability precipitated by immobility which is: 1. Muscle atrophy 2. Pain in the calf 3. Hypotension 4. Bradypnea

1. Although muscle atrophy can occur with immobility, it is unrelated to hypercoagulability. Muscle atrophy is the decrease in the size of a muscle resulting from disuse. ***2. Immobility promotes venous vasodilation, venous stasis and hypercoagulability of the blood, which can precipitate the formation of a clot in a vein of the leg (venous thrombosis) and inflammation of the vein (phlebitis).*** 3. Hypotension, an abnormally low systolic blood pressure (less than 100 mm Hg), is not related to hypercoagulability precipitated by immobility. 4. Bradypnea, abnormally slow breathing (less than 10 breaths per minute), is unrelated to hypercoagulability caused by immobility

The nurse teaches a patient how to use an incentive spirometer. The nurse understands that the most appropriate expected outcome associated with the use of an incentive spirometer is: 1. Coughing will be stimulated 2. Sputum will be expectorated 3. Inspiratory volume will be increased 4. Supplemental oxygen use will be reduced

1. Although the deep breathing associated with the use of an incentive spirometer may stimulate coughing, this is not the primary reason for its use. 2. Although sputum may be expectorated after the use of an incentive spirometer, this is not the primary reason for its use. ***3. An incentive spirometer provides a visual goal for and measurement of inspiration. It encourages the patient to execute and maintain a sustained inspiration. A sustained inspiration opens airways, increases the inspiratory volume, and reduces atelectasis.*** 4. Patients who use an incentive spirometer may or may not be receiving oxygen.

An unconscious patient who had oral surgery is admitted to the post-anesthesia care unit. In which position should the nurse place the patient? 1. Prone position 2. Supine position 3. Lateral position 4. Fowler's position

1. Although the prone position allows for drainage from the mouth, it is contraindicated because lying on the side of the face compresses oral tissues, impedes assessment, complicates oral suctioning, and may compromise the airway. 2. The supine position is unsafe. In an unconscious patient, the gag and swallowing reflexes may be impaired, which increases the risk for aspiration as the tongue falls to the back of the oropharynx occluding the airway. ***3. The lateral position facilitates the flow of secretions out of the mouth by gravity, keeps the tongue to the side of the mouth maintaining the airway, and permits effective assessment of the oropharynx and respiratory status.*** 4. The Fowler's position is unsafe. An unconscious patient is unable to maintain an upright position.

Which adaptation is of most concern when the nurse assesses pulmonary changes associated with immobility? 1. Shallow respirations 2. Increased oxygen saturation 3. Decreased chest wall expansion 4. Respirations that sound gurgling

1. Although this is a concern, it is not as serious as an adaptation in another option. 2. Oxygen saturation may be decreased, not increased, with immobility. 3. Although this is a concern, it is not as serious as an adaptation in another option. ***4. Respirations that sound gurgling (gurgles, rhonchi) indicate air passing through narrowed air passages because of secretions, swelling, or tumors. A partial or total obstruction of the airway can occur, which is life threatening.***

Which action is most effective in meeting the needs of a patient experiencing laryngospasm after extubation? 1. Ensuring hyperextension of the head 2. Providing positive pressure ventilation 3. Instituting cardiopulmonary resuscitation 4. Administering oxygen by using a face mask

1. Although tilting the head backward (hyperextension of the neck) elongates the pharynx, reducing airway resistance, this will do nothing to correct the obstruction at the glottis (opening through the vocal cords). Also, the tongue will block the airway unless there is forward pressure applied on the lower angle of the jaw (jaw thrust maneuver). ***2. Positive pressure will push the vocal cords backward toward the wall of the larynx, opening the glottis (space between the vocal cords), which allows ventilation of the lung.*** 3. This is unnecessary. The patient is having a respiratory, not cardiac, problem. 4. This is useless because the glottis is obstructed and the oxygenated air will not enter the lung.

The nurse is assessing a patient with a respiratory problem. Which is most reflective of an early adaptation to hypoxia? 1. Apnea 2. Cyanosis 3. Restlessness 4. Dysrhythmias

1. Apnea, a complete absence of respirations, is the cause of, not an adaptation to, hypoxia. 2. Cyanosis, a bluish discoloration of the skin and mucous membranes caused by reduced oxygen in the blood, is a late sign of hypoxia. ***3. Hypoxia is insufficient oxygen anywhere in the body. An early sign of hypoxia is restlessness, which is caused by the lack of cerebral perfusion of oxygen.*** 4. A dysrhythmia, a pulse with an irregular rhythm, can occur with hypoxia but it is a late adaptation.

When applying a warm compress, the nurse explains to the patient that the primary reason heat is used instead of cold is that heat: 1. Minimizes muscle spasms 2. Prevents hemorrhage 3. Increases circulation 4. Reduces discomfort

1. Both cold and heat relax muscles and thus minimize muscle spasms. 2. Heat promotes, not prevents, bleeding because it causes vasodilation. Cold causes vasoconstriction, which limits bleeding. ***3. Heat raises the skin surface temperature promoting vasodilation, which increases blood flow to the area.*** 4. Cold reduces discomfort by numbing the area, slowing the transmission of pain impulses, and increasing the pain threshold. Heat reduces discomfort by relaxing the muscles.

A patient has thick tenacious respiratory secretions. To best help liquefy the patient's respiratory secretions, the nurse should: 1. Change the patient's position every two hours 2. Encourage the patient to drink more fluid 3. Obtain an order for an antitussive agent 4. Teach effective deep breathing

1. Changing positions will mobilize, not liquefy, respiratory secretions. ***2. A fl uid intake of 2500 to 3000 mL is recommended to maintain the moisture of the respiratory mucous membranes. Adequate fl uid keeps respiratory secretions thin so that they can be moved by ciliary action or coughed up and spit out (expectorated).*** 3. Mucolytics, not antitussives, liquefy respiratory secretions. Antitussives prevent or relieve coughing. 4. Deep breathing will mobilize, not liquefy, respiratory secretions.

A physician orders chest physiotherapy with percussion and vibration for a patient. After the physician leaves, the patient says, "I still don't understand the purpose of this therapy." The nurse's best reply is, "It: 1. Eliminates the need to cough." 2. Limits the production of bronchial mucus." 3. Helps clear the airways of excessive secretions." 4. Promotes the fl ow of secretions to the base of the lungs."

1. Chest physiotherapy promotes, not eliminates, the need for coughing. 2. Chest physiotherapy promotes the expectoration of, not limits the production of, bronchial mucus. ***3. The forceful striking of the skin over the lung (percussion, clapping) and fine, vigorous, shaking pressure with the hands on the chest wall during exhalation (vibration) mobilize secretions so that they can be coughed up and expectorated.*** 4. Chest physiotherapy mobilizes secretions facilitating expectoration, interfering with the flow of secretions to the base of the lungs.

What are the HCAHPS Composites?

1. Communication with Doctors 2. Communication with Nurses 3. Responsiveness of the Hospital Staff 4. Pain Control 5. Communication about Medicines 6. Physical Environment - Cleanliness, Quiet 7. Discharge Information

The nurse teaches a patient about pursed-lip breathing. The nurse identifies that the teaching is effective when the patient says its purpose is to: 1. Precipitate coughing 2. Help maintain open airways 3. Decrease intrathoracic pressure 4. Facilitate expectoration of mucus

1. Deep breathing and huff coughing, not pursed-lip breathing, stimulate effective coughing. ***2. Pursed-lip breathing involves deep inspiration and prolonged expiration against slightly closed lips. The pursed lips create a resistance to the air fl owing out of the lungs, which prolongs exhalation and maintains positive airway pressure, thereby maintaining an open airway and preventing airway collapse.*** 3. Pursed-lip breathing increases, not decreases, intrathoracic pressure. 4. The huff cough stimulates the natural cough refl ex and is effective for clearing the central airways of sputum. Saying the word huff with short, forceful exhalations keeps the glottis open, mobilizes sputum, and stimulates a cough.

Which are the most effective leg exercises the nurse should encourage a patient to perform to prevent circulatory complications during the postoperative period? 1. Flexing the knees 2. Isometric exercises 3. Dorsiflexion exercises 4. Passive range of motion

1. Flexing the knee exerts pressure on the veins in the popliteal space; this reduces venous return, which increases, not decreases, the risk of postoperative circulatory complications. 2. These exercises strengthen muscles; they do not prevent postoperative circulatory complications. Isometric exercises change the muscle tension but do not change the muscle length or move joints. ***3. Alternating dorsiflexion and plantar flexion (calf pumping) alternately contracts and relaxes the calf muscles, including the gastrocnemius muscles. This muscle contraction promotes venous return, preventing the venous stasis that contributes to the development of postoperative thrombophlebitis.*** 4. Passive range-of-motion exercises are exercises that are done by another person moving patient's joints through their complete range of movement. This does not prevent postoperative circulatory complications because the power is supplied by a person other than the patient.

The major difference between pursed-lip breathing and diaphragmatic breathing is with diaphragmatic breathing the patient: 1. Inhales through the mouth 2. Exhales through pursed lips 3. Raises both shoulders while breathing deeply 4. Tightens the abdominal muscles while exhaling

1. Inhalation is through the nose for both diaphragmatic and pursed-lip breathing. 2. Exhalation through pursed lips is performed only with pursed-lip breathing. 3. This action is not part of diaphragmatic or pursed-lip breathing. The use of these accessory muscles of respiration is a compensatory mechanism that helps to increase thoracic excursion when inhaling. ***4. With diaphragmatic breathing, the contraction of abdominal muscles at the end of expiration helps to reduce the amount of air left in the lungs at the end of expiration (residual volume).***

The nurse in the Post-Anesthesia Care Unit is monitoring several patients who received general anesthesia. Which patient adaptation causes the most concern? 1. Pain 2. Stridor 3. Lethargy 4. Diaphoresis

1. Pain is an expected response to the trauma of surgery and usually can be managed effectively. ***2. Stridor is an obvious audible shrill, harsh sound caused by laryngeal obstruction. The larynx can become edematous because of the trauma of intubation associated with general anesthesia. Obstruction of the larynx is life-threatening because it prevents the exchange of gases between the lungs and atmospheric air.*** 3. Lethargy, which is drowsiness or sluggishness, is an expected response to anesthesia and narcotic medications because these medications depress the central nervous system. 4. Although diaphoresis is a cause for concern, it is not as immediately life-threatening as an adaptation in another option. Diaphoresis can be related to a warm environment, impaired thermoregulation, the General Adaptation Syndrome, or shock.

The nurse understands that the most serious complication associated with thrombophlebitis caused by immobility is: 1. Postural hypotension 2. Blanchable erythema 3. Dependent edema 4. Acute chest pain

1. Postural hypotension is unrelated to phlebitis caused by immobility. Postural hypotension (orthostatic hypotension) is a decrease in blood pressure related to positional or postural changes from the lying down to sitting or standing positions. 2. Blanchable erythema is unrelated to phlebitis caused by immobility. Blanchable erythema (reactive hyperemia) is a reddened area caused by localized vasodilation in response to lack of blood fl ow to the underlying tissue. The reddened area will turn pale with fingertip pressure. 3. Dependent edema is unrelated to phlebitis caused by immobility. Although fluid will collect in the interstitial compartment (edema) around the phlebitis, it is localized, not dependent, edema. Dependent edema is the collection of fl uid in the interstitial tissues below the level of the heart; it occurs bilaterally and usually is caused by cardiopulmonary problems. ***4. Immobility promotes venous stasis, which in conjunction with hypercoagulability and injury to vessel walls predisposes patients to thrombophlebitis. These three factors are known as Virchow's triad. A thrombus can break loose from the vein wall and travel through the circulation (embolus) where eventually it obstructs a pulmonary artery or one of its branches causing sudden, acute chest pain, dyspnea, coughing, and frothy sputum.***

The nurse teaches a patient to make a series of short, forceful exhalations just before actually coughing (huffing). The purpose of this action is to: 1. Conserve the patient's energy 2. Liquefy the respiratory secretions 3. Limit the pain precipitated by coughing 4. Raise the sputum to a level where it can be expectorated

1. Regardless of the type of cough, coughing uses, not conserves, energy. However, after the airway is cleared of sputum, the patient's oxygen demands will be met more effectively. 2. An increased fluid intake, not coughing, liquefi es respiratory secretions. 3. This is not the purpose of huff coughing. Coughing usually is not painful unless the thoracic muscles are strained or the patient has had abdominal or pelvic surgery. ***4. The huff cough stimulates the natural cough reflex and is effective for clearing the central airways of sputum. Saying the word huff with short, forceful exhalations keeps the glottis open and raises sputum to a level where it can be coughed up and expectorated.***

Define Sleep vs Rest

1. Rest- Inactive or mild activity person is available to the environment. 2.Sleep- Decreased motor activity and perception, decreased metabolism, rejuvenated and rested

What is sleeping and what are some of it's functions?

1. Sleep- cyclic physiological process 2. Decreases physical demands -Protects body function -Conserves energy Decreases psychological demands Physiological and psychological restoration (memory storage) Change to cerebral blood flow, cortical activity Decreased oxygen consumption Promotes healing

When attempting to apply a pulse oximetry probe, the nurse identifes that a patient's hands are edematous. The priority action should be to: 1. Attach the probe to one of the patient's toes 2. Connect the probe to one of the patient's earlobes 3. Wash the patient's hand before attaching the probe to the finger 4. Encourage the patient to perform active range-of-motion exercises of the hand

1. The use of a toe for pulse oximetry can result in inaccurate results because of concurrent problems, such as vasoconstriction, hypothermia, impaired peripheral circulation, and movement of the foot. ***2. An earlobe is an excellent site to monitor pulse oximetry. It is least affected by decreased blood flow, has greater accuracy at lower saturations, and rarely is edematous. This site is used for intermittent, not continuous, monitoring.*** 3. Soap and water will not resolve the edema. In addition, attaching a pulse oximeter clip sensor to an edematous finger is contraindicated because interstitial fluid interferes with obtaining an accurate oxygen saturation level. 4. The cause of the edema must be identified first because range-of-motion exercises may be contraindicated.

The physician orders chest physiotherapy with percussion and vibration for a newly admitted patient. The nurse should question this order when, during the admission assessment, the patient informs the nurse of a history of: 1. Emphysema 2. Osteoporosis 3. Cystic fibrosis 4. Chronic bronchitis

1. These are appropriate interventions for a patient with emphysema. Emphysema is a chronic pulmonary disease characterized by an abnormal increase in the size of air spaces distal to the terminal bronchioles with destructive changes in their walls. ***2. This intervention provides for patient safety because percussion and vibration with a patient who has osteoporosis abnormal loss of bone mass and strength.*** 3. These are appropriate interventions for a patient with cystic fibrosis. Cystic fibrosis causes widespread dysfunction of the exocrine glands. It is characterized by thick, tenacious secretions in the respiratory system that block the bronchioles, creating breathing difficulties. 4. These are appropriate interventions for a patient with chronic bronchitis. Bronchitis is an inflammation of the mucous membranes of the bronchial airways.

What should the nurse do first if a patient is choking on food? 1. Sweep the patient's mouth with a finger 2. Hit the middle of the patient's back firmly 3. Determine if the patient can make any verbal sounds 4. Apply sharp upward thrusts over the patient's xiphoid process

1. This can force the bolus of food further down the trachea and is contraindicated. 2. This should never be done with an adult because if it is a partial obstruction it interferes with the person's own efforts to clear the airway or can cause the bolus of food to lodge further down the trachea. If it is a total obstruction, slapping the back will be useless and delay the initiation of the abdominal thrust maneuver. ***3. When a person is choking on food, the first intervention is to determine if the person can speak because the next intervention will depend on if it is a partial or total airway obstruction. With a partial airway obstruction, the person will be able to make sounds because some air can pass from the lungs through the vocal cords. In this situation, the person's own efforts (gagging and coughing) should be allowed to clear the airway. With a total airway obstruction, the person will not be able to make a sound because the airway is blocked and the nurse should immediately initiate the abdominal thrust maneuver (Heimlich maneuver).*** 4. Thrusts to the xiphoid process may cause a fracture that may result in a pneumothorax

The nurse is caring for a patient who has a chest tube after thoracic surgery. The nurse should: 1. Clamp the tube when providing for activities of daily living 2. Position the collection device at the same level as the chest 3. Maintain an airtight dressing over the puncture wound 4. Empty chest tube drainage every eight hours

1. This is contraindicated because clamping a chest tube may cause a tension pneumothorax. 2. The chest drainage system should be kept below the level of the insertion site to promote the flow of drainage from the pleural space and prevent the flow of drainage back into the pleural space. ***3. An airtight dressing seals the pleural space from the environment. If left open to the environment, atmospheric pressure causes air to enter the pleural space, which results in a tension pneumothorax.*** 4. This is unnecessary. Chest drainage systems are closed, self-contained systems that have a chamber for drainage. At routine intervals, as per hospital policy, the date, time, and nurse's initials mark the level of drainage on the drainage collection chamber.

Which is the most important action by the nurse after a patient has a thoracotomy? 1. Ensure the patient's intake is at least 3000 mL of fluid per 24 hours 2. Provide the patient with adequate medication for pain relief 3. Maintain the integrity of the patient's chest tube 4. Reposition the patient every 2 hours

1. This is unnecessary. A fluid intake of approximately 2000 mL of fluid is adequate. 2. Although this is extremely important, it is not the priority. ***3. A tension pneumothorax may occur if the integrity of the chest drainage system becomes compromised (e.g., open to atmospheric pressure, clogged drainage tube, or mechanical dysfunction). Maintaining respiratory functioning is the priority.*** 4. Although repositioning is done to promote drainage of secretions from lung segments and aeration of lung tissue, it is not the priority.

A patient is admitted with the diagnosis of peripheral arterial disease. Which is a specific desirable outcome for a patient with this diagnosis? 1. Respirations within the expected range 2. Oriented to the environment 3. Palpable peripheral pulses 4. Prolonged capillary refill

1. This is unrelated to peripheral arterial disease. 2. Peripheral arterial disease usually involves inadequate circulation in the lower extremities, not the brain. ***3. This is an appropriate expected outcome for a patient with arterial vascular disease, which is a decrease in nutrition and respiration at the peripheral cellular level because of a decrease in capillary blood supply. A physiologic adaptation is diminished or absent arterial pulses.*** 4. A prolonged capillary refill indicates a continued problem with peripheral tissue perfusion. After compression, blanched tissue should return to its original color within2 seconds (blanch test).

The practitioner's order reads, "6 L Oxygen Via Face Mask." The patient, who has been extremely confused since being in the unfamiliar environment of the hospital, becomes agitated and repeatedly pulls off the mask. The nurse should: 1. Tighten the strap around the head 2. Reapply the mask every time the patient pulls it off 3. Provide an explanation of why the oxygen is necessary 4. Request that the order for oxygen be changed to a nasal cannula

1. This is unsafe because it can compress the capillaries under the strap, which may interfere with tissue perfusion and result in pressure ulcers. 2. This may increase the patient's agitation and it is impractical. 3. This will probably be useless because an agitated patient often does not understand cause and effect. ***4. Agitated, confused patients generally tolerate a nasal cannula better than a face mask. A nasal cannula (nasal prongs) is less intrusive than a mask; masks are oppressive and may cause a patient to feel claustrophobic.***

The nurse is caring for a male patient. Which laboratory results place this patient at risk for an impaired ability to tolerate activity? Check all that apply. 1. _____ Hct of 45% 2. _____ Hgb of 14 g/dL 3. _____ O2 saturation of 90% 4. _____ RBC of 3.8 × 106/mm3 5. _____ WBC of 7.5 × 106/mm3

1. This is within the expected range for hematocrit for men (42%-52%) and women (36%-48%). 2. This is within the expected range for hemoglobin for men (14.0 to 17.4 g/dL) and women (12.0 to 16.0 g/dL). ***3. An oxygen saturation of 90% is below the expected level of 95% or greater. Adequate oxygen levels are necessary to meet the metabolic demands of activity that requires muscle contraction.*** ***4. This is below the expected range of 4.71 to 5.14 106/mm3 for red blood cells for men. Hemoglobin, which carries oxygen, is a component of red blood cells.*** 5. This is within the expected range of 4.5 to 11 106/mm3 for white blood cells (WBCs). WBCs are not related to a patient's oxygenation status; they are related to protecting the patient from infection.

What should the nurse do first when caring for an infant, a toddler, or a nonverbal patient who is restless, agitated, and irritable? 1. Administer oxygen 2. Suction the oropharynx 3. Reduce environmental stimuli 4. Determine patency of the airway

1. This may or may not be necessary. The need for oxygen administration will depend on the results of other interventions that should be done first. 2. This is premature. Mucus or sputum may not be the cause of the problem. 3. This intervention is useless at this time and is not the priority. ***4. Early signs of hypoxia are restlessness, agitation, and irritability due to reduced oxygen to brain cells. A partial or completely obstructed airway prevents the passage of gases into and out of the lungs. The ABCs of emergency care identify airway as the priority.***

A patient sucking on a hard candy inhales while laughing and develops a total airway obstruction. When the nurse implements abdominal thrusts, the nurse is attempting to: 1. Produce a burp 2. Pump the heart 3. Push air out of the lungs 4. Put pressure on the stomach

1. Whatever is causing the obstruction is not caught in the esophagus, which leads to the stomach, but in the respiratory system. 2. Pressing on the heart (compression) is used in cardiopulmonary resuscitation (CPR). ***3. When trapped air behind an obstruction is forced out, it pushes out what is causing the obstruction.*** 4. Whatever is causing the obstruction is not caught in the esophagus, which leads to the stomach, but in the respiratory system.

A patient's hemoglobin saturation via pulse oximetry indicates inadequate oxygenation. What should the nurse do first? 1. Administer oxygen at three liters per minute 2. Encourage deep breathing 3. Raise the head of the bed 4. Call the physician

1. When administering oxygen in an emergency, the nurse should not exceed two liters per minute because high oxygen levels can depress respirations in people with chronic obstructive lung diseases. Obtaining and setting up the equipment takes time that can be used for other more appropriate interventions fIrst. 2. Although this might be done eventually, it is not the priority at this time. This may or may not help. Inadequate oxygenation can be caused by a variety of problems other than shallow breathing. ***3. A nurse can implement this immediate, independent action. Nurses are permitted to treat human responses. Raising the head of the bed facilitates the dropping of the abdominal organs by gravity away from the diaphragm, which permits the greatest lung expansion.*** 4. This is premature. The patient's needs must be met first.

What 4 factors affect the Circadian Rhythm?

1.Blindness 2.People changing time zones 3.exposure to sun 4.Hospitalized patients -because the lights are on all the time, Lack of Sleep ,Pain , and Increased susceptibility to illness

Discuss 5 reasons why Older adults often do not feel rested.

1.Quality of sleep tends to decrease- 2.Stage 4 Non-REM sleep decreases or is essentially eliminated 3.REM sleep shorter 4.Awaken more often during the night -Nocturia -Use of diuretics -chronic pain 5.May take more time to fall asleep

Which 2 systems regulate the Physiology of sleep

1.Reticular Activating System (RAS) - Maintains alertness & wakefulness 2.Bulbar Synchronizing Region (BSR) - causes sleep when RAS stimulation decreases

List the parasomnia sleep disorders (where you are asleep but doing something) and what do they involve?

1.Somnambulism- sleep walking, aggravated by stress, fatigue, medications 2.Sleep talking 3.Bruxism- grinding teeth in sleep 4.Night terrors - Wake in the night and scream, act out, etc. Patients cannot see or hear you while this happens, Patients have no memory of this. 5.REM sleep behavior disorders- Acting out dreams, Sleep talking, shouting, screaming, hitting, punching, jumping out of bed 6.Nocturnal enuresis- Bedwetting

Discuss the sleep requirements for the following age groups 1. Neonate 2.Toddlers 3.Children 4. Adolescent 5.Adult

1.The neonate (average 16- 20) - Nap frequently -Wake hungry -Sleep through the night by 3-4 months of age -SIDS risk during REM sleep 2.Toddlers- 12-12.5 hrs 3.Children - 10-11 hrs 4.to the adolescent (average 8 - 9) 5.to the adult (average 6 - 8½)

Discuss Sleep Apnea further 1. What is it? 2.What are some factors that cause it? 3.The different types 4.Treatments

1.Waking up from lack of airflow through the nose/mouth for a period of 10 secs or longer during sleep. Sleepers might experience snoring. 2.obesity, enlarged tonsils, 15-17inches sized neck, deviated septum, polyps in nose, chronic illness 3. Obstructive Sleep Apnea: Most common form Upper airway becomes blocked o Central Sleep Apnea occurs 10% of the time • Dysfunction in the brain's respiratory center o Mixed sleep apnea- both obstructive and central. 4. Treatment-Cipap and weightloss o CPAP- forces airway through the respiratory tract.(continuous positive airway pressure)

Florida legislature (2001) mandates a ___ hr preventing Medical Errors Course for healthcare professionals

2

A long-term care facility has started a program to increase the cultural competence of its employees. When notified of this, a nurse thinks to himself, "I don't have time for this nonsense. I already know all I need to about culture, and I don't really like taking care of so many different kinds of people anyway." This most clearly illustrates the nurse's lack of cultural: 1) Awareness 2) Desire 3) Exposure 4) Knowledge

2) Desire Rationale: Cultural desire is the wish to be culturally competent. This nurse clearly does not want to improve in that area. He seems to be aware of his personal biases ("I don't like taking care of different kinds of people . . ."). Exposure refers to the actual face-to-face encounters with patients from diverse cultural backgrounds. This scenario does not state clearly whether this nurse has had many encounters, but nothing in the scenario indicates that he is lacking in encounters. Apparently he has had enough encounters to develop a negative bias. Cultural knowledge refers to principles and theories. There is nothing in this scenario to indicate that the nurse lacks cultural knowledge, although it is not beyond the realm of possibility. The question asks, though, not what is possible, but what the nurse's thinking "most clearly illustrates."

What are the HCAHPS questions?

27 survey items -20 behavior/action -1 overall rating -1 likelihood to recommend -5 demographic SCALE 1 to 5: NEVER, RARELY, SOMETIMES, USUALLY, ALWAYS COACHING THE PATIENT

Dreams are more vivid and recorded to memory for consolidation and dreams occur in what stage:

3 & 4

A new mother is concerned that her 2-week-old daughter is not sleeping through the night. The nurse should respond that infants usually develop a nighttime pattern of sleep by: 1. 1 month 2. 2 months 3. 3 months 4. 6 months

3 months Infants usually develop a nighttime pattern of sleep by 3 months of age.

When taking a cultural history, all of the following are important. Which one is most important in order to later plan for patient safety? 1) Obtain data directly from the patient. 2) Show empathy and respect; build rapport. 3) Ask about use of alternative medicine and folk remedies. 4) Ask open-ended questions when beginning the assessment. Answer:

3) Ask about use of alternative medicine and folk remedies. Rationale: Always ask patients about their use of alternative medicine and folk remedies so that their effects on traditional biomedical medications and treatments can be evaluated. Some remedies may interfere with traditional treatments; others can be dangerous. Many people use folk remedies, but they may be reluctant to tell you so because they fear ridicule or at least disapproval. It is best to obtain data directly from the client, but this includes all data, not just that contributing to safety. Empathy and respect help to build trust and encourage the patient to provide data; but this includes all kinds of data. Asking open-ended questions encourages patients to talk and therefore supply more of all types of data.

How many stages are there in the sleep cycle?

4 Stages of Non-REM sleep 1 Stage of REM sleep

While admitting a patient with a particular religious heritage, the nurse comments to another nurse, "This is going to be a pain. This kind of patient always has a million family members in and out, and they're always so noisy and demanding." This illustrates: 1) Discrimination 2) Sexism 3) Ethnocentrism 4) Prejudice

4) Prejudice Rationale: Prejudice refers to negative attitudes toward other people, which are based on faulty and rigid stereotypes about race, gender, sexual orientation, and so on. Discrimination refers to behavioral manifestations of prejudice; the nurse is not discriminating because she has not yet taken any action. Sexism is the assumption that members of one sex are superior to those of the other sex; there is no mention of gender in the scenario. Ethnocentrism is a positive bias toward one's own culture, believing that their beliefs and values are right and those of other cultures are wrong or at least bizarre. It is broader than prejudice and is not directed toward a specific cultural group.

Neonates are in REM __% of the time and will usually sleep through the night by what age?

50% of time , 3-4 months

As a nurse, in which of the following cultural health practices would you support your client: efficacious, neutral, dysfunctional, uncertain? Why?

A nurse should allow and even promote efficacious health practices because they are beneficial. Dysfunctional practices are harmful and should be discouraged. Neutral or uncertain practices can be allowed to continue if they are important to the client until a time they are considered to be harmful.

Define Root Cause Analysis:

A process for identifying the basic or casual factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event Analyze How and WHY it happened

Creating a Culture of Safety involves : Having a clear picture as to what is actually happening so that appropriate steps can be taken that will prevent such occurrences. What is the best method to accomplish this goal?

A systems approach that emphasizes prevention not punishment

The process a person goes through to adapt to a new culture is referred to as which of the following? A. Acculturation B. Cultural competence C. Culture shock D. Phenomena of culture

A. Acculturation Rationale: Acculturation is a learning process in which an individual assumes the characteristics of the dominant culture, whereas cultural competence can be defined as a set of congruent behaviors, attitudes, and practices that enable us to provide such care. Culture shock is the experience of not comprehending the culture one is living or situated in. The phenomena of culture are a set of organizing phenomena that influence health, including communication, space, time orientation, social organization, environmental control, and biological variations.

Your patient has died. She was 76 and married for 53 years. The doctor told her husband about 20 minutes ago. He appears calm and exhibits no sadness or signs of grief. Which of the following would be your most appropriate action? A. Ask him if he would like to spend a few moments with his wife (body) B. Tell him it is okay to cry after such a significant loss C. Assume he is coping well with the death of his wife D. Contact the unit social worker to talk with the patient because he is experiencing dysfunctional grief

A. Ask him if he would like to spend a few moments with his wife (body) Rationale: Offering the family or significant others an opportunity to spend personal time with their loved one's body respects their individual desires and approach to grief. If they prefer not to spend time, respect that as well and inquire as to their needs. Option B may be appropriate, but it would require you to have a greater understanding of their relationship. Option C is inappropriate because the husband is giving no evidence of his reaction to his wife's death. Option D is incorrect because there is no evidence of an inappropriate grief response.

A 30-year-old man is recently divorced. Which of the following responses is a normal adult response to loss? A. Experiencing intermittent periods of grief through the 4-year period following the divorce B. Avoiding family, friends, and social activities except for work for the next 6 months C. Developing numerous physical problems shortly after the divorce decree D. Three years later, talking about the divorce as if it just occurred

A. Experiencing intermittent periods of grief through the 4-year period following the divorce Rationale: It is common to experience intermittent episodic periods of grief for years following a significant loss. While responses B, C, and D may occur, they demonstrate an inability to realistically adapt to the loss or use one's support system.

Stereotyping in nursing may result in which of the following? A. Inaccurate assessments and inappropriate interventions B. More frustration on the part of the nurse than the client C. Less frustration on the part of the nurse and the client D. Enhanced participation of family and patients

A. Inaccurate assessments and inappropriate interventions Rationale: Stereotyping is the preconceived and untested beliefs about people. This can lead to frustration for both patients and nurses and can inhibit cooperation and participation.

What are the main tasks of the grieving process?

According to Worden, there are four stages of the grieving process: ● Acknowledging the loss ● Feeling the emotions and pain ● Adjusting to the environment without the loved one ● Investing emotional energy into something or someone else

How do you maintain and communicate accurate medication information?

Accurately and completely reconcile medications across the continuum of care - Medication Reconciliation Compare mediations taken prior to admission with those ordered at admission Provide list of medications when patient is referred or transferred to another Setting, service, practitioner, or level of care Within or outside the organization

A nurse is preparing to care for her newly admitted patient. The person who accompanied the patient informs her that he is from the Middle East and speaks very little English. He is unsure of the patient's primary language. The hospital has no interpreters available who speak any Middle Eastern language. List at least four alternative interventions the nurse can use to communicate with the patient.

Alternative interventions include the following: ● Greet the client with respect, and be aware of nonverbal cues. ● If you are able to identify one, use a third language that is similar to their spoken language (e.g. French is spoken by some Vietnamese). ● Speak in English slowly and clearly using simple sentences to talk about one problem or need at a time, using gestures. ● Restate information in different words if it appears the client does not understand your initial attempts. ● Use pictures or diagrams. ● Use written language in short, simple sentences.

How do the cultural norms of the North American healthcare system differ from those of other cultural groups?

Although there may be some similarities, the major difference between the norms of the healthcare system and those of other cultural groups is that the professional healthcare system is run by a set of professionals who have been formally educated and trained for their roles and responsibilities. Other differences are linked to the influence of the dominant culture in U.S. society: that of white European American Protestant (and some would add, males). North American healthcare system values that may be different from some other cultures include the following: ● Standardized definitions of health and illness ● Significance of technology ● Maintenance of health and prevention of disease through such practices as immunizations and avoidance of stress ● Annual physical examinations and diagnostic tests ● Punctuality ● Neatness and organization ● Compliance (e.g., with medical "orders") ● The surgical procedure ● Dislike for tardiness or disorganization ● Handwashing

What is a disturbed sleep pattern related to?

Ambient temperature, humidity, lighting, noise change in daylight-darkness exposure Caregiving responsibilities Lack of sleep privacy or sleep control Unfamiliar sleep surroundings Interruptions in sleep

Give an example of acculturation.

An example of acculturation that many immigrants have to face is related to language. For example, a family moves to the United States from Mexico. To survive, they attempt to learn the language of the dominant culture, English.

What is the definition of a Sentinel event?

An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Includes loss of limb/function. --A sentinel event signals the need for IMMEDIATE investigation and response "sentinel" & "med error" NOT synonymous

List three nursing diagnoses labels that might occur as a result of dying or grieving.

Any of the following labels would be appropriate answers: ● Acute or Chronic Low Self-Esteem ● Anxiety ● Altered Comfort (not a NANDA diagnosis) ● Death Anxiety (or Fear) ● Decisional Conflict ● Deficient Knowledge ● Disturbed Sensory Perception ● Fatigue ● Imbalanced Nutrition: Less Than Body Requirements ● Spiritual Distress ● Self-Care Deficit

A patient has been in the dying process for about 10 days. His wife has left his side only for very short periods during that time, and she looks pale and exhausted. The nurse, realizing the wife has not eaten much, suggests that she take a break to eat and rest. The woman refuses, saying, "I don't want to leave him. I won't have him much longer, and I don't want him to go when I'm gone." What should the nurse do? 1) Explain that she will be of more help to her husband if she is rested and well. 2) Tell the wife that it is safe to leave her husband for an hour or two because he won't die that soon. 3) Call the primary care provider to come and try to persuade her to take physical care of herself. 4) Arrange for a cot for her at the bedside and arrange to have food brought to her.

Arrange for a cot for her at the bedside and arrange to have food brought to her. Rationale: The nurse was correct to suggest that the woman needs to eat and rest. However, this is primarily for the woman's well-being, not because she needs to be of more help to her husband. The nurse should not assure her that her husband will not die in an hour or two, because she does not know exactly when he will die. It would be inappropriate to ask anyone else to try to persuade her to change her mind; the nurse should support the wife's decisions in a therapeutic manner and not try to change them. The nurse should not rely on the physician to encourage basic care and comfort for the family. She should make the wife as comfortable as possible if she does not wish to leave the room. This would include arranging for her to rest in the patient's room and having food and drink brought to the room.

In what way does a person's culture and social support system influence his grieving process? A. Traditions dictate the type and length of grieving and mourning. B. Culture provides the norms, but each person grieves in his own time and individual manner. C. Family and community members will be immediately available and supportive. D. Culture has little effect; grieving generally follows the same pattern for all persons.

B. Culture provides the norms, but each person grieves in his own time and individual manner. Rationale: Cultural and community norms provide a framework for grief and mourning, but each individual will proceed through the stages at her own pace. While traditions may dictate specific practices and values related to mourning, grief is an individual process. In some cultures, mourning is a private affair and community members provide a respectful period of time before engaging with the grieving person. The stages of grief are the same for each person, but each person will proceed through them in her own time and not necessarily in a linear manner.

The grief process is: A. predictable and progresses at the same pace for all persons. B. predictable and progresses at a different rate for each person. C. a physical, emotional, and spiritual response to a loss that is too complex to evaluate. D. unpredictable and difficult to assess in person's experiencing a loss.

B. predictable and progresses at a different rate for each person. Rationale: Grief consists of stages of emotional, physical, or psychological responses experienced as a result of a significant loss. The stages are predictable but occur at varying rates depending on a variety of factors that influence the person's perception of the loss; therefore, responses A, C, and D are incorrect.

What are some reasons for common medication errors?

Brand names look or sound alike Labels hard to read Look-alike packaging Lack of standards in contents display Inconsistent warnings Cerebrex (arthritis, Cerebryx)

You are assigned a patient who speaks Vietnamese. He is to begin chemotherapy in the morning. To explain his treatment to him, you will use which of the following people? A. Family member B. Asian staff member C. Hospital interpreter D. Friend of the patient

C. Hospital interpreter Rationale: The hospital interpreter can objectively assist you in explaining procedures or treatments to the patient in a linguistically appropriate manner. A friend or family member may not be able to adequately explain treatment or may be frightened or intimidated by the task. Choosing a staff member who may be of the same ethnic background does not mean that he can speak the same language.

What is Restless leg syndrome and what characteristics define it? What is used to treat it?

CNS Disorder, creepy crawling, tingling, pain, low iron level or anemia- they use anti depressant to treat it. Heat and cold therapy, acupuncture

Examples of goals relating to a patient's sleep- (individualize to patient, be realistic)

Client will report waking up no more than 2x during the night Client will report feeling rested within 2 weeks Client will verbalize adherence to a regular bedtime routine within 1 week Client will fall asleep within one hour of going to bed within 2 weeks Client will report sleeping 7 hours nightly within 2 weeks

Define cultural competence.

Cultural competence is what we are all attempting to achieve in providing care to clients that is appropriate, congruent, and nonbiased. Cultural competence can be defined as a set of congruent behaviors, attitudes, and practices that enable us to provide such care. It includes developing an awareness of our own beliefs and those of others, accepting and respecting cultural differences, being open to cultural encounters, and adapting care so that it is congruent to those of other cultures. This attribute is conscious and nonlinear. While cultural competence can be considered to be a developmental process, healthcare providers must continue to work toward its achievement.

Define culture

Culture is both universal and dynamic. Culture can be defined as the totality of socially transmitted behavior patterns, arts, beliefs, values, customs, and other products of human thought and work characteristics of a population of people, which can guide their worldview and decision making.

Of the following cultural groups, which is at high risk for sickle cell anemia? A. Alaskan Native B. Pacific Islander C. Hispanic D. Black

D. Black Rationale: Sickle cell anemia is hereditary and occurs primarily in people of African ancestry and occasionally in people of Mediterranean descent.

The Patient Self-Determination Act of 1990 requires that healthcare organizations admitting patients do which of the following? A. Have all "no code" orders signed by a physician B. Inform nurses of the client's preferences regarding treatment for trauma. C. Educate nurses about their role in witnessing a living will D. Inform clients about their rights regarding end-of-life decisions

D. Inform clients about their rights regarding end-of-life decisions Rationale: Healthcare organizations must inform all patients or their guardians of their rights regarding end-of-life care, such as advance directives, healthcare surrogate, and living will. Exercise 4

What are some of the effects of sleep deprivation?

DEATH via decrease in mental function, coordination, reaction times. via depletion of serotonin, imbalance of hormones, and cardiac issues. 1. Irritability 2. Slurred speech 3. Disorientation 4. Decreased reasoning 5. Deteriorated mental status 6. Psychotic behaviors 7. Decreased motivation 8. Increased sensitivity to pain 9. Stressful attitude

How do you implement evidence based practices to prevent central line associated bloodstream infections?

Education for Healthcare workers, Patients, families Implement p & p Conduct periodic risk assessments Perform hand hygiene prior to catheter insertion or manipulation

Why might members of some cultural groups seek out the local folk healer rather than the conventional healthcare provider?

Folk healers are sought out for a number of reasons, including access to care, lack of money and trust in the traditional healthcare system, and familiarity with the folk healer who knows and understands the culture, speaks the language, and makes house calls.

What is HCAHPS?

Hospital Consumer Assessment of Healthcare Providers and Systems -A nationally standardized patient satisfaction survey -Center for Medicare and Medicaid Services (CMS) Measures and publicly reports patient's experiences in our country's hospitals

Why do some people experience ICU-itis in the hospital

Hospital care does not adapt care to individuals circadian rhythms, constant RAS stimulation, Sleep is fragmented, sleep is interrupted, Monitors beeping, suction, vents, lights, people, patient can become psychotic in behavior activity, unable to differentiate between night and day

How do you Improve the safety of using medications?

Identify a list of "look-alike-sound-alike" drugs used in the hospital. Lists commonly found in med rooms Label all meds, med containers, and other solutions Labels Must include Drug name, strength, quantity, diluents and volume, expiration date, time and whether the medication will expire in less than 24 hours. If not labeled, do not use - discard All medications and solutions drawn up, diluted or otherwise removed from its original container are to be discarded at the end of the procedure/shift.

How do you reduce the likelihood of patient harm associated with the use of anticoagulant therapy?

Implement a defined anticoagulant management program Use only oral unit dose products and pre-mixed infusions Approved protocols for the initiation and maintenance of anticoagulant therapy Policy for baseline and on-going lab tests Education for staff, patients, and families

Why do hospitals collect patient satisfaction data?

Improve quality Improve operations Foster relationships HCAHPS!!!!!!

Get important results to right person on time Prohibited abbreviations and acronyms Improve timeliness of reporting critical test results Telephone orders or telephone reporting of critical test results Standardized approach to "hands-off" communication - are all ways to:

Improve the effectiveness of communication among caregivers

How do you reduce the harm associated with clinical alarm systems?

Improve the safety of clinical alarm systems - There are some problems with alarms -Dont have too many alarms in patient care areas As staff dont become desensitized or ignore alarms Dont disable alarms

What types of losses commonly occur in our lives?

Losses occur whenever there is change or growth. Some examples include developmental changes, moving, marriage, divorce, surgery, death of significant others, job loss, and retirement. Losses are actual, perceived, physical, and psychological.

What are some things that contribute to preventing medical errors?

Major force in improving patient safety Intrinsic motivation of health care providers Organizational factors Strong leadership Culture that encourages recognition and learning from errors Effective patient safety program ***Internal risk management system in place to handle incident reporting

Which intervention by the nurse best indicates that she values a Native American patient's beliefs and indigenous healthcare system? 1) Incorporating Native American practices into care based on consultation with a cultural resource book 2) Explaining the values and beliefs of the traditional healthcare system to the patient so that the patient understands what is occurring 3) Contacting a Native American resource group for information about the culture 4) Planning how to incorporate traditional practices and beliefs through discussion with the patient

Planning how to incorporate traditional practices and beliefs through discussion with the patient Rationale: "Incorporating traditional practices and beliefs . . ." is the only answer that indicates that the nurse has assessed to determine what the patient's beliefs actually are. When consulting a cultural resource book or a Native American resource group for information, the nurse would be assuming that the patient's wishes will conform to her cultural group. By explaining the traditional healthcare system, the nurse would not even be attempting to deal with the patient's beliefs but would be trying to convince the patient that the mainstream way is preferred.

Examples of core measures for Pneumonia (PN)

Pneumococcal vaccination Blood cultures Smoking cessation counseling Antibiotics Influenza vaccination

What are two of the approved four patient identifiers do you use to identify a patient?

Pt's FULL NAME (MAY HAVE 3 PTS WITH SAME) Name is always one of the two identifiers Account Number MRI Number Date of Birth Is the comparison of the info, not the info itself that makes up the pt ID process

Emphasis on an organization's performance - quality measures that meet what 4 criteria designed to identify measures that produce the greatest positive impact on patient outcomes when hospitals demonstrate improvement:"

Research Prosimity Accuracy Adverse effects "All but six of the Joint Commission's core measures are accountability measures"

Why is it important to close the eyes and mouth of the deceased and position the body within at least 2 to 4 hours after death?

Rigor mortis occurs about 2 to 4 hours after death. It does not disappear until about 96 hours after death. You would not be able to do these things after the body becomes rigid.

Which Nuerotransmitters are involved in the sleep process

Serotonoin & Gaba

Trends: ___ ____ hospitals do best. All hospitals and states are improving. Communication is key.

Smaller rural

What are some common folk medicine practices?

Some of the more common healthcare practices may include hot and cold therapies; use of medals, jewelry, and amulets; herbs and roots; massage; rituals; incantations and prayers; use of certain foods; acupuncture; and meditation.

The national Patient safety goals created a manual Obtained from the Joint Commission Website is :

Specific to type of healthcare organization Published in July of each year Effective January 1 of the following year 16 goals but nall related to hospitals Ambulatory care facilities, long term care facilities etc

Discuss Stage 1 of sleep- Type of sleep experienced: Duration: Level of arousal:

Stage 1: Non-REM Lightest level of sleep Lasts a few minutes Person is easily aroused If woken, will feel as though they have had a day dream

Discuss Stage 2 of sleep Type of sleep experienced: Duration: level of arousal:

Stage 2: Non-REM Period of sounder sleep Lasts 10-20 minutes Arousal is still relatively easy body functions slow.

Discuss Stage 3 of sleep Type of sleep experienced: Duration: level of arousal:

Stage 3: Non-REM Initial stages of deep sleep Lasts 15-30 minutes Sleeper is difficult to arouse Muscles become completely relaxed and VS decline. GH is secreted.

In which stage does enuresis and sleep walking happen?

Stage 4 Non-REM Sleep

Discuss Stage 4 of sleep Type of sleep experienced: Duration: level of arousal: whats most important to this process?

Stage 4: Non-REM Deepest stage of sleep Lasts 15-30 minutes Very difficult to arouse sleeper Important for restorative processes VS are significantly lower.

Name the steps of the Universal Protocol "Pause for the Cause" or "Time Out" :

Step 1: Confirm the following: Signed consent form H&P present and updated Physician Order Available imaging Patient or physician confirm procedure Step 2 mark the site/side with "Yes" when applicable Step 3 "Time OUT" by physician and attending staff immediately prior to procedure

How do the barriers of ethnocentrism and language impede nursing care of diverse populations?

Such barriers can impede the nurse's ability to provide culturally competent care to clients and families by interfering with perceptions and communication.

Give some examples of A Sentinel Event:

Suicide Unanticipated death of full-term infant Infant abduction or D/C to wrong family Rape Hemolytic transfusion rx Surgery on wrong pt or body part A near miss (failed to cause injury or stopped)

Universal Protocol "Pause for the Cause" or "Time Out" applies to:

Surgical areas, Procedural areas, and bedside procedures that require a consent form Use the Surgical Site verification checklist (Surgery) or Bedside procedure Verification checklist form

What is sleep deprivation related to?

Sustained environmental stimulation Sustained inadequate sleep hygiene Nightmare, sleep terrors, sleep walking Sleep apnea (OSA) Cognitive impairment

A nurse is caring for a dying patient who is nonresponsive. Which of the following is it important for the nurse to do? 1) Be alert to the patient's nonverbal cues. 2) Direct explanations about care to family members. 3) Tell the patient when the nurse is about to leave the room. 4) Sit by the head of the bed when speaking to the patient.

Tell the patient when the nurse is about to leave the room. Rationale: The nurse should continue to communicate with dying patients even if they are nonresponsive. Research indicates that patients continue to hear even though the level of consciousness is low, sometimes up to the moment of death. Nonverbal actions would not communicate meaning for a patient who is nonresponsive; nor would the patient be aware that the nurse is sitting instead of standing when speaking. The nurse should direct explanations of care to the patient, as always; nurses should not talk about the patient to others in the patient's presence, even when the patient is comatose.

What is the ANA position on assisted suicide?

The ANA position is that the nurse should not participate in assisted suicide because such an act is a violation of the Code for Nurses and the ethical traditions of the profession.

What are magicoreligious belief systems?

The magicoreligious belief systems are alternative belief systems (different from conventional Western medicine) in which supernatural forces dominate and practices and rites such as voodoo are fairly common.

What factors affect the grieving process?

The meaning of the loss is the most significant factor indicating the way a person will grieve. Some other factors include the following: ● Number of previous losses ● Person's coping mechanisms ● Circumstances of the loss ● Developmental stage of the grieving person ● Person's spiritual/cultural supports

How does culture provide identity for an individual?

The values, beliefs, and practices of the culture provide identity for an individual. These can guide many, if not all, aspects of the individual's life. They may include, dress, food, dance, song, and even what one believes and does to keep well and fight diseases

List three types of alternative healthcare that are delivered by formally trained practitioners as a part of the professional healthcare system.

Types of alternative healthcare include diet therapy, mind-body control methods, therapeutic touch, acupressure, reflexology, naturopathy, kinesiology, and chiropractic therapy.

How do you communicate Meds to the Next Provider?

Upon transfer, the medication reconciliation form will be placed in the physician order section of the chart for the physician to complete upon discharge (telephone orders are accepted). Upon discharge, complete the medication reconciliation form with the addiction of any new medication, make copies for patient, keep original on chart.

What assessments should you make for your terminally ill patient and her family?

When a patient is dying or has experienced a loss, you must carefully assess the patient and significant others for common grief reactions. Other important areas to assess include knowledge base, history of loss, coping patterns and abilities, meaning of the loss/illness, support systems, cultural and spiritual needs, and physical status.

What should be the focus of your interventions when the patient is very near death?

When the patient is very near death, focus on relieving symptoms (e.g., pain, nausea) and emotional distress. ● If the person can communicate, ask about immediate concerns (Pitorak, 2003): ● "Are you in pain?" ● "Are you comfortable?" ● "What are you afraid of now?" ● "What can we do to help you go peacefully?" ● "Who do you want in the room with you right now?" ● If the patient asks whether he is dying, be honest. ● If the patient cannot communicate, ask the family, who may know what the patient would want.

What about hospitals that don't meet standards? Accreditation may be affected Publicly resorted ____ ____!! (Texas Presbyterian - Ebola) Threat of Medicare payment penalties

bad press

Define and list characteristics of Insomnia

difficulty falling and staying asleep, never reach restorative cycle of sleep, occurs more frequently in women, associated with poor sleep rituals/hygiene, complain of sleepiness

Preventable or avoidable adverse events are a direct result of :

failure(s) to follow recognized, evidence-based best practices or guidelines at the individual and/or system level.

Value based purchashing threshold is:

median (average) performance score: minimum achievement level (ex: average score of all students; 78 minimum)

The socially prescribed behaviors and rituals engaged in after the death of a significant person

mourning

Define sleep apnea, what may be needed?

obstructive sleep disorder, may need CPAP

Who is most likely to experience sleep wake schedule disorders?

people who work night shift, or have jet lag

Limiting Catheter-Associated Urinary Tract Infections (CAUTI) -Limit ___and ____ to situations necessary for patient care -Use ____ technique -Secure catheters for ___ ___ ___ -Maintain sterility of urine collection system -Replace collection system when required -Collecting urine samples

use and duration, aseptic, unobstructed urine flow