intro final

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

A nursing student is giving a presentation to a group of other nursing students about the needs of patients with mental illnesses in the community. The nursing professor needs to clarify the student's presentation when the student states: A) "Many patients with mental illness do not have a permanent home." B) "Unemployment is a common problem experienced by people with a mental illness." C) "The majority of patients with mental illnesses live in long-term care settings." D) "Patients with mental illnesses are often at a higher risk for abuse and assault."

examples of nursing assessment questions that relate to life and self-responsibility:

"How do you feel about the changes this illness has caused?" "How do these changes affect what you now need to do?"

Examples of nursing assessment questions that relate to faith, belief, fellowship and community:

"To what or whom do you look at as a source of strength, hope, or faith in times of difficulty?" "How does your faith help you cope?" "What gives your life meaning?"

Which of the following statements made by an older adult whose husband recently died most indicates the need for follow-up by the nurse? 1 "I planted a tree at church in my husband's honor." 2 "I have been unable to talk with my children lately." 3 "My friends think that I need to go to a grief support group." 4 "I believe that someday I'll meet my husband in heaven."

2

assumptions

"taken for granted" statements that explain the nature of the concepts, definitions, purpose, relationships, and structure of a theory.

The Dimensions of Patient Centered Care

-respect, values, preferences, and expressed needs -coordination and integration of care -information, communication, and education -physical comfort -emotional support -involvement of family and friends -transition and continuity -access to care

2 dimensions of spiritual well-being

1) supports the transcendent relationship between a person and God or a higher power 2) describes positive relationships and connections that people have with others

Goals and Expected outcomes

1. when revising a care plan, review the goal and expected outcomes for necessary changes. 2. Determine if the goals were appropriate, realistic, and time-appropriate

Implementation

4th step in the nursing process; it begins after the nurse develops a plan of care based on clear and relevant nursing diagnoses. The interventions are designed to achieve the goals and expected outcomes needed to support or improve the patient's health status.

5. Which factors does a nurse consider in setting priorities for a pt's nursing diagnoses? (Select all that apply.) 1. Numbered order of diagnosis on the basis of severity 2. Notion of urgency for nursing action 3. Symptom pattern recognition suggesting a problem 4. Mutually agreed on priorities set with pt 5. Time when a specific diagnosis was identified

5. Answer: 2, 3, 4. All factors are considered in setting priorities for a patient's nursing diagnoses or collaborative problems. The numbered order of diagnosis based on severity is inappropriate as a numbering system holds little meaning when a patient's condition changes.

7. The nurse writes an expected outcome statement in measurable terms. An example is: 1. Pt will have normal stool evacuation. 2. Pt will have fewer bowel movements. 3. Pt will take stool softener every 4 hours. 4. Pt will report stool soft/formed with each defecation.

7. Answer: 4. Stool that is soft and formed at each defecation is measurable upon observation. "Patient will have normal stool evacuation" is a goal. "Patient will take fewer bowel movements" is not specific enough for measuring improvement. "Patient will take stool softener every 4 hours" is an intervention.

9. Match the category of direct care on the left with the specific direct care activity on the right. 1. Counseling ___ 2. Lifesaving measure ____ 3. Physical care technique ___ 4. Activity of daily living ____ a. Assisting pt with oral care b. Discussing a pt's options in choosing palliative care c. Protecting a violent pt from injury d. Using safe pt handling during positioning of a pt

9. Answer: 1b, 2c, 3d, 4a.

Nursing process

A critical thinking process that professional nurses use to apply the best available evidence to caregiving and promoting human functions and responses to health and illness.

The patient is in the intensive care unit (ICU), which has strict posted visiting hours and limits the number of visitors to two per patient at any one time. The patient is asking to see his wife and two daughters. The nurse should a. Tell the patient that they will be allowed to visit at the appropriate time. b. Allow the wife and one daughter to enter the ICU, but not the other daughter. c. Allow the two daughters to visit, and let the wife visit when they leave. d. Allow the wife and daughters to visit at the patient's request.

ANS: D Use of support systems is important in any health care setting. When patients depend on family and friends for support, encourage them to visit the patient regularly. As long as no interference with active patient care is involved, there is no reason to limit visitation.

13. A nurse uses SBAR during hand-offs. The purpose of SBAR is to a. Use common courtesy. b. Establish trustworthiness. c. Promote autonomy. d. Standardize communication.

ANS: D When patients move from one nursing unit to another or from one provider to another, also known as hand-offs, a risk of miscommunication arises. Accurate communication is essential to prevent errors. SBAR is a popular communication tool that helps standardize communication among health care providers. Common courtesy is part of professional communication but is not the purpose of SBAR. Being trustworthy means helping others without hesitation. Autonomy is being self-directed and independent in accomplishing goals and advocating for others.

A nurse add the following diagnoses to a patient care plan. Constipation related to decreased gastrointestinal motility secondary to pain medication administration as evidenced by patient reporting no bowel movement in seven days abdominal distention and abdominal pain. Which element did the nurse write as the defining characteristic?

Abdominal distinction

ANCC

American Nurses Credentialing Center

ANA

American Nursing Association establishes a set of standards of care

ADA

American with disabilities act protects the rights of those who have physical or mental illness and prohibits discrimination and guarantees equal opportunity and also says that a provider must respect the autonomy of that person and their choice to share their disability

interprofessional rounding. Which of the following statements correctly describe interprofessional rounding? (Select all that apply.) 1. Allows team members to share information about patients to improve care 2. Provides an opportunity for early patient discharge planning 3. Improves communication among health care team members 4. Allows each of the health care team members to identify separate patient goals 5. Allows each health care provider an opportunity to delegate a task.

Answer: 1, 2, 3. Allowing team members to share information on patients to improve care, providing an opportunity for early patient discharge planning, and improving communication amongst team members all focus on the benefits of interprofessional rounding. This type of rounding has been found to decrease medication errors and improve quality of patient care. During interprofessional rounding all team members focus on the same patient goals.

The nurse manager from the surgical unit was awarded the nursing leadership award for practice of transformational leadership. Which of the following are characteristics or traits of transforma- tional leadership displayed by award winner? (Select all that apply.) 1. The nurse manager regularly rounds on staff to gather input on unit decisions. 2. The nurse manager sends thank-you notes to staff in recogni- tion of a job well done. 3. The nurse manager sends memos to staff about decisions that the manager has made regarding unit policies. 4. The nurse manager has an "innovation idea box" to which staff are encouraged to submit ideas for unit improvements. 5. The nurse develops a philosophy of care for the staff.

Answer: 1, 2, 4. Nurse managers who practice transformational leadership are focused on change and innovation. They motivate and empower their staff with the focus on team development. The manager will spend time on the unit with the staff sharing ideas and listening to staff input. The manager is enthusiastic about opportunities to enhance the team and shows appreciation and recognized team members for good work. The manager holds the team accountable and provides support for the team members in the stressful health care environment.

A registered nurse (RN) is providing care to a patient who had abdominal surgery 2 days ago. Which task is appropriate to delegate to the nursing assistant? 1. Helping the patient ambulate in the hall 2. Changing surgical wound dressing 3. Irrigating the nasogastric tube 4. Providing brochures to the patient on health diet

Answer: 1. Assisting the patient with activity is within the scope of nursing assistive duties. The other activities require the skill and knowledge of the RN.

2. As a nurse, you are assigned to four patients. Which patient do you need to see first? 1. The patient who had abdominal surgery 2 days ago who is requesting pain medication 2. A patient admitted yesterday with atrial fibrillation with decreased level of consciousness 3. A patient with a wound drain who needs teaching before dis- charge in the early afternoon 4. A patient going to surgery for a mastectomy in 3 hours who has a question about the surgery

Answer: 2. This patient is of high priority. The patient is experiencing the physiological problem of decreased level of consciousness that is an immediate threat to the patient's survival and safety. The nurse must intervene promptly and notify the health care provider of the life threatening problem.

Which of the following client cannot legally give consent? A. A married 14-year-old girl. B. A 70-year-old man who is alert and oriented but unable to write his name. C. A 40-year-old client who has been sedated. D. A 50-year-old woman who cannot stop crying during explanation.

C. A 40-year-old client who has been sedated.

A student nurse employed as a nursing assistant may perform care A. As learned in school B. Expected of a nurse at that level C. Identified in the hospital's job description. D. Requiring technical rather than professional skills.

C. Identified in the hospital's job description.

A nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. What would probably cover the nurse in this situation? A. The nurse's automobile insurance B. The nurse's homeowner's insurance C. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence D. The Patient Care Partnership, which may grant immunity from suit if the injured party consents

C. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence

You are about to administer an oral medication and you question the dosage. You should A. Administer the medication B. Notify the physician. C. Withhold the medication D. Document that the dosage appears incorrect.

C. Withhold the medication

CMS

Centers for Medicare and Medicaid Services

this unsafe herb induces liver toxicity in some cases and severe uterine contractions- side effects anticancer, found in "natural" weight loss products

Chaparral

Expected outcomes

Criteria used to determine the effective-ness of a nursing action

10. Coping-stress tolerance pattern

Describes patient's ability to manage stress; sources of support; effectiveness of the patterns in terms of stress tolerance

A nurse assesses a patient has not going did in six hours. Which question should the nurse asked to assist in establishing a nursing diagnosis?

Do you feel like you need to go to the bathroom?

A new nurse writes the following diagnoses on a patient care plan. Which nursing diagnosis will close to the nurse manager to intervene?

Hemorrhage

HCAHPS

Hospital Consumer of Assessment of Healthcare Providers and Systems

A nurse develops a nursing diagnostic statement for a patient with a medical diagnosis of pneumonia with chest x-ray results of the lower lobe infiltrates. Which nursing diagnosis did the nurse write?

Impaired gas exchange related to Alveolar capillary membrane changes

A patient has a bacterial infection and left lower leg. Which nursing diagnosis was the nurse add to the patient care plan?

Impaired skin integrity

middle-range theory

Limited in scope and less abstract

NDNQI

National Database of Nursing Quality Indicators

Community Health Nursing

Nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within the community

Malpractice

One type of negligence and often referred to as professional negligence.

biofield therapy derived from ancient Buddhist rituals; practitioner places hands on or above a body area and transfers "universal life energy", providing strength, harmony, and balance to treat a patients health disturbances

Reiki therapy

When a client-centered goal has not been met in the projected time frame, the most appropriate action by the nurse would be to:

Repeat the entire sequence of the nursing process to discover needed changes

Self-transcendence

Sense of authentically connecting to one's inner self.

Spiritual distress

State of being out of harmony with a system of beliefs, a Supreme Being, or God.

T/F meditation is self directed

T

Inference

Your judgment or interpretation of the cues Example: A patient crying is a cue that possibly implies fear or sadness

Counseling

a direct care method that helps the patient use a problem-solving process to recognize and manage stress to facilitate interpersonal relationships.

Accountability

ability to answer for one's actions

people who believe that there is no known ultimate reality

agnostic

abstract

breif summary of an article

moxibustion

bring moxa, a cone or stick of dried herbs that has healing properties on or near the skin

Grand theory

broad in scope, complex

used for generalized anxiety disorder

chamomile

used for inflammatory diseases of upper GI and upper respiratory tracts

chamomile

Torts

civil wrongdoing against a person

Teach Back

closed-loop communication technique that assesses patient retention of info imparted during a teaching session.

Health Literacy

cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, understand, and use info in ways that promote and maintain good health.

Limitations of relaxation therapy

consideration of the physiological and psychological status of the individual. Techniques such as active progressive relaxation require a moderate expenditure of energy, which often increases fatigue and limits an individual's ability to complete relaxation sessions. Not appropriate for pts with advanced disease or decreased energy reserve (passive or guided imagery is more appropriate for these individuals

islam dietary regulations

consumption of pork and alcohol is prohibited. followers fast during the month of ramadan.

intimate and powerful medium because it is a direct expression of the mind and body, treats people with social, emotional, cognitive, or physical problems

dance therapy

types of movement therapies

dance therapy, pilates

Proxy or power of Attorney

document must be signed that says the pt. is no longer able to make decisions for themselves so they sign it over to a proxy or a power of attorney to make medical decisions for them. But even with a proxy the right to autonomy and refusal is upheld

drug interactions with aloe

furosemide (lasix) and loop diuretics

King

goal attainment

Passive relaxation

goal is to still the mind and body intentionally without the need to tighten and relax any particular body part. Incorporates slow, abdominal breathing exercises while imagining warmth and relaxation flowing through specific body parts such as the lungs or hands

Certified/specialized nurses

have their on standard or code of practice

Suicidal patients

have to have sitters

has several meanings that vary on the basis of how it is being experienced; it usually refers to an energizing source that has an orientation to future goals and outcomes

hope

Parens patriae

hospitals can treat children of abusive or negligent parents without parental consent.

developmental theories

human growth and development are orderly predictive processes that begin with conception and continue through death.

a mind-body therapy that uses the conscious mind to create mental images to stimulate physical changes in the body, improve perceived well-being and or enhance self awareness

imagery

Orem's theory

in practice you assess and interpret data to determine patients self care needs, self care deficits, and self care abilities in management of their disease.

Examples of Tertiary Care

intensive care, subacute care

The nursing process

is central to nursing but not a theory

members avoid food prepared with or containing blood

jehovahs witness

observance of the sabbath is important

judaism

fear

kidney

used for GI disorders, including gastric ulcers, and hep c

licorice

unsafe herb used for menstrual flow stimulant-hepatotoxic

life root

anger

liver

grief/sadness

lung

Capitation

means the providers receive a fixed amount per patient or employee of a health care plan

members abstain from alcohol and caffeine

mormonism

not allowed vodka or chocolate

mormonism

yin and yang

most important concept and principles that guide TCM. Represents opposing yet complementary phenomena that exists in a state of dynamic equilibrium.

using music to address physical, psychological, cognitive, and social needs of individuals with disabilities and illnesses; improve physical movement and or communication, develops emotional expression, evokes memories, and distracts people who are in pain

music therapy

Consent

must be signed by the patient upon admission as well as with each procedure

fungi (mushroom) based products

mycotherapies

using fungi based products is known as what

mycotherapy

practice theory

narrow in scope and focus

tribal traditions are individualistic, but similarities across traditions include the use of sweating and purging, herbal remedies, and ceremonies in which a shaman makes contact with spirits to ask their direction in bringing healing to people to promote wholeness and healing

native american traditional healing

individual tribal beliefs influence food practices

native americans

a system of therapeutics focused on treating the whole person and promoting health and well being rather than an individual disease- includes herbal medicine, nutritional supplementation, homeopathy, mind body therapies-internal capacity for self healing (vitalism)

naturopathic medicine

a nurse is caring for a pt with a seriously advanced infection who asks to have a spiritual care provider come who can offer blessingway, a practice that attempts to remove the ill health. this patient is likely a member of which religion or culture?

navajo

blessingway practice prefer holistic care not on time for appointments don teach about disease prevention

navajos

a psychological phenomenon of people who either have been close to clinical death or have recovered after being declared dead

near death experience (NDE)

Orem's theory

nurse cares for and helps patient attain total self care. (ex. nursing care is needed when the patient is unable to fulfill needs.)

the ability to stop unnecessary goal directed and analytic activity

passivity

integrative

relationship between practitioner and patient/ focuses on whole person

Living Wills

represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition,. With this document a patient is able to declare which medical procedures she wants or does not want when terminally ill or in a persistent vegetative state.

Interdisciplinary care plan

represents the contributions of all disciplines caring for the patient.

Joint Commission

requires hospitals individually make their own standard of care for nurses

Reinforcement

requires use of a stimulus to increase probability of a desired response.

used for benign prostatic hyperplasia and chronic pelvic pain

saw pelmetto

a student nurse is telling a faculty member that her pt talked about gaining spiritual comfort from being focused on her inner self, including her values and principles. the instructor explains that this is an example of?

self transcendence

creative visualization

self-directed imagery based on the principle of mind-body connectivity

Instrumental activities of daily living (IADLs)

skills such as shopping, preparing meals, writing checks, and taking medications.

clinical guidelines

systematically developed statements abotu a plan of care for a specific set of clinical circumstances involving a specific patient population.

acupoints

through which the qi can be influenced and flow reestablished (where the needles gets placed)

what is the goal of passive relaxation?

to still the mind and body intentionally without the need to tighten and relax any particular body part

negligence

unintentional tort where conduct that falls below the generally accepted standard of care of a reasonably prudent person

examples of nursing assessment questions that relate to spirituality and spiritual health:

"What experiences in the past have been most difficult for you?" "What gives you energy during those times?" "Which aspects of your spirituality have been most helpful to you?"

integrative nursing

"a way of being-knowing-doing that advances the health and well being of people, families, and communities through caring healing relationships.

Death with Dignity

"assisted suicide" passed in organ but the ANA thinks assisted suicide violates standard nursing code and the International council for nurses mandates the peaceful care provided by a nurse at end of life. Know your state policies!

a pt who is recovering from a bilateral amputation of the legs below the knee shows transcendence when she states?

"i see gods grace and become relaxed when i watch the sun set at night"

Florence Nightingale

"the nature of nursing as a profession that requires knowledge distinct from medical knowledge"

Criterion-based standards for evaluation are the

- physiological, emotional, behavioral responses that are a patient's goal and expected outcomes.

Evaluation

-Measuring the client's response to nursing interventions and his or her progress toward achieving goals. -is an ongoing process = reassessment positive evaluation= goals reached and intervention were successful

Sources of Data:

-Patient- (Best Source) when conscious, alert, and able to answer questions. -Family & Significant others- (Primary sources of information for infants or children; critically ill adults; and the mentally handicapped, disoriented, or unconscious) -Health Care Team -Medical Records- Medical history, laboratory, diagnostic test results, current physical findings, and the primary health care provider's treatment plan. -Other records and Scientific Literature- Educational, military, and employment records, immunization -Nurse's experience

Institute of Medicine Competencies for the Twenty-First Century

-Provide patient centered care -Work in interdisciplinary teams -Use evidence based practice -Apply quality improvement -Use informatics

what are the 4 components of meditation

-a quiet space -a comfortable position -a receptive attitude -a focus of attention

Patient Protection and Affordable Care Act (PPACA)

-consumer rights and protections -affordable healthcare coverage -increased access to care -stronger medicare to improve care for those most vulnerable in our society

biomedicine is generally less effective in... (4 things)

-decreasing stress induced illness -managing symptoms of chronic disease -caring for the emotional and spiritual needs of individuals -improving quality of life and general well being

Standards of care

-legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care -best known comes from the American Nurses Association (ANA) -set by state and federal laws that govern where nurses work -Joint Commission requires policies and procedures (P&Ps)

4 noble truths of buddhism

-life is suffering, suffering is caused by clinging, suffering can be eliminated by eliminating clinging, eliminate clinging and suffering-one follows an eight

Advances directives

-living wills -health care proxies or durable power of attorney for health care

what does a nursing assessment of a patients spiritual needs contain?

-review of pts faith -connectedness -life and self responsibility - life satisfaction -fellowship and the community

what should you consider when recommending complementary therpapies

-the history of each therapy -history and experience of nursing with a particular therapy -outcomes and safety data-including case study and qualitative research -the cultural influences and context for certain patient populations

10. Which of the following statements best explains the actions of therapeutic touch (TT)? 1. Intentionally mobilizes energy to balance, harmonize, and repattern the recipient's biofield 2. Intentionally heals specific diseases or corrects certain symptoms 3. Is overwhelmingly effective in many conditions 4. Is completely safe and does not warrant any special precautions

1

A 62-year-old male patient has just been told he has a terminal illness. Which of the following statements supports a nursing diagnosis of spiritual distress related to diagnosis of terminal illness? 1 "I have nothing to live for now." 2 "What will happen to my wife when I die?" 3 "How much longer do I have to live?" 4 "I need to go to church and pray for a miracle."

1

A nurse is caring for a patient who refuses to eat until after the sun sets. Which religion does this patient most likely practice? 1 Islam 2 Sikhism 3 Hinduism 4 Catholicism

1

A nurse is working in a health clinic on a Navajo reservation. He or she plans care for the patients knowing which of the following is true? 1 The patients may not be on time for their appointments. 2 The patients most likely do not trust the doctors and nurses. 3 The patients probably are not comfortable if they have to remove their undergarments. 4 Terminally ill patients probably want to receive the sacrament, the anointing of the sick.

1

A patient who is hospitalized with heart failure states that she sees her illness as an opportunity and a challenge. Despite her illness, she is still able to see that life is worth living. This is an example of: 1 Hope. 2 Faith. 3 Values. 4 Connectedness.

1

As the nurse cares for a patient in an outpatient clinic, the patient states that he recently lost his position as a volunteer coordinator at a local community center. He expresses that he is angry with his former boss and with God. The nurse knows that the priority at this time is to assess the patient's spirituality in relation to his: 1 Vocation. 2 Life satisfaction. 3 Fellowship and community. 4 Connectedness with his family and co-workers.

1

the nurse is caring for a 50yo woman visiting the outpatient medicine clinic. the pt has had type 1 diabetes since age 13. she has numerous complications from her disease, including reduced vision, heart disease, and severe numbness and tingling of the extremities. knowing that spirituality helps pts cope with their chronic illness, which of the following principles should the nurse apply in practice? (select all that apply) 1.pay attention to the pts spiritual identity throughout the course of her illness 2.select interventions that you know scientifically support spiritual well being 3.listen to the pts story each visit to the clinic and offer a compassionate presence 4.when the pt questions the reason for her long time suffering, try to provide answers 5.consult with a spiritual care advisor and have the advisor recommend useful interventions

1 3

select the three factors that are evident when a healing relationship develops between the nurse and pt? 1. the nurse being able to realistically mobilize hope for the pt 2.the pt being able to share fears of loss with significant others 3.finding and interpretation or understanding of the pts illness that is acceptable to the pt 4.understanding your own beliefs about spirituality 5.helping the pt use spiritual resources that he or she chooses

1 3 5

Different Types of Assessments

1 patient-centered-interview during a nursing health history. 2 Physical examination 3 periodic assessments you make during rounding or administrating care.

what are the 2 dimensions of spirituality?

1)support of the transcendent relationship between the person and a higher power 2)the positive relationships that they have with other people

15. The nurse manager of a community clinic arranges for staff in-services about various complementary therapies available in the community. What is the purpose of this training? (Select all that apply.) 1. Nurses have a long history of providing some of these therapies and need to be knowledgeable about their positive outcomes. 2. Nurses are often asked for recommendations and strategies that promote well-being and quality of life. 3. Nurses play an essential role in patient education to provide information about the safe use of these healing strategies. 4. Nurses appreciate the cultural aspects of care and recognize that many of these complementary strategies are part of a patient's life. 5. Nurses play an essential role in the safe use of complementary therapies. 6. Nurses learn how to provide all of the complementary modalities during their basic education.

1, 2, 3, 4, 5

An older adult is receiving hospice care. Which nursing intervention(s) help the patient cope with feelings related to death and dying? (Select all that apply.) 1 Teaching the patient how to use guided imagery 2 Encouraging the family to visit the patient frequently 3 Taking the patient's vital signs every time the nurse visits 4 Teaching the patient how to manage pain and take pain medications 5 Helping the patient put significant photographs in a scrapbook for the family

1, 2, 5

Which of the following nursing interventions support(s) a healing relationship with a patient? (Select all that apply): 1 Praying with the patient 2 Giving pain medications before a painful procedure 3 Telling a patient that it is time to take a bath before family arrive to visit 4 Making the patient's bed following hospital protocol 5 Helping a patient see positive aspects related to a chronic illness

1, 5

1. For the nursing diagnosis of Deficient Knowledge a nurse selects an outcome from the Nursing Outcome Classification of pt knowledge of arthritis treatment. Which are outcome indicators for this outcome? (Select all that apply.) 1. Nurse provides four teaching sessions before discharge. 2. Pt denies joint pain following heat application. 3. Pt describes correct schedule for taking antiarthritic medications. 4. Pt explains situations for using heat application on inflamed joints. 5. Pt explains role family caregiver plays in applying heat to inflamed joint.

1. Answer 3, 4. The patient must exhibit behaviors that measure knowledge of arthritis treatment. This would include describing his medication schedule and explaining when to apply heat to inflamed joints. The nurse providing teaching sessions is not a patient outcome. The patient denying joint pain is not an evaluative indicator of knowledge.

1. A nurse working on a surgery floor is assigned five pts and has a pt care technician assisting her. Which of the following shows the nurse's understanding and ability to safely delegate to the pt care tech? (Select all that apply.) 1. The nurse considers the time available to gather routine vital signs on one pt before checking on a second pt arriving from a diagnostic test. 2. Determining what is the pt care technician's current workload. 3. The nurse chooses to delegate the measurement of a stable pt's vital signs and not the assessment of the pt arriving from a diagnostic test. 4. The nurse reviews with the NAP, newly hired to the floor, her experience in measuring a blood pressure. 5. The nurse confers with another registered nurse about organizing priorities.

1. Answer: 1, 2, 3. A nurse must consider priorities of all her assigned patients in deciding what activities should be delegated to NAP. When the decision is vital signs versus a patient arriving from a diagnostic test, delegation of vital signs is appropriate. Assuring a NAP is competent with an activity is also important.

1. A nurse enters the room of a 32-year-old pt newly diagnosed with cancer at the beginning of the 0700 evening/night shift. The nurse noted in the pt's nursing history that this is her first hospitalization. She is scheduled for surgery in the morning to remove a tumor and has questions about what to expect after surgery. She is observed talking with her mother and is crying. The pt says, "This is so unfair." An order has been written for an enema to be given this evening in preparation for the surgery. The nurse establishes priorities for which of the following situations first? 1. Giving the enema on time 2. Talking with the pt about her past experiences with illness 3. Talking with the pt about her concerns and acknowledging her sense of unfairness 4. Beginning instruction on postoperative procedures

1. Answer: 3. The patient is obviously emotionally upset. Her concerns, whether they be about surgery or cancer or both, need to be addressed first for her to be able to be instructed and to be comfortable for the enema. Talking with the patient about her past experiences may be appropriate in the long term, but is less important than the other three priorities.

Nursing Process Five Steps

1. Assessment - Collection, verification, and analysis of data. 2. Diagnose - identify the patient's problems 3. Plan- Set goals of care and desired outcomes and id appropriate nursing actions 4. Implement- perform the nursing actions id in planning 5. Evaluate- determine if goals and expected outcomes are achieved

Nursing Assessment has 2 steps:

1. Collection of information from a primary source (the patient) and secondary sources (family members, health professionals, and medical record) 2. The interpretation and validation of data to ensure a complete database.

Care plan revision

1. Determine if your goals have been met, and then adjust the plan of care accordingly. 2. determine if the plan of care continues or if revisions are necessary. 3. unmet and partially met goals require you to continue intervention.

Modifying a Care plan

1. Identify the factors that interfere with goal achievement or an error in nursing judgment.

Discontinuing a Care plan

1. If the nurse and the patient agree that the expected outcomes and goals have been met, then discontinue that portion of the care plan. 2. documentation of a discontinued plan ensures that other nurses will not unnecessarily continue intervention.

Phase of an Interview

1. Orientation and Setting an agenda (patient's goals, preferences, and concerns, not your agenda) 2. Working phase - collecting assessment or nursing health history: begin with open-ended questions 3. Terminating the interview- summarize your discussion, give a clue when the interview will end

Steps for modifying a care plan

1. Reassessment 2. Redefining diagnoses 3. Goals and expected outcomes 4. Intervention

The evaluation of Interventions examines two factors:

1. The appropriateness of the interventions selected and 2. the correct application of the intervention

4 components of mediation

1. a quite space 2. a comfortable position 3. a receptive attitude 4. a focus of attention

Evaluative measures

1. are assessment skills and technique (observation, physiological measurement, use of measurement scales, patient interviews). 2. are the same as assessment measures, but you perform them at the point of care when your make decisions about a patients status and progress. 3. is used to determine whether the problem as remained the same, improved, worsened, or otherwise changed.

Six steps of EBP

1. ask a clinical question 2. collect the most relevant and best evidence 3. critically appraise the evidence you gather 4. integrate all evidence with ones clinical expertise, patient preferences, and values in making a practice descision or change 5. evaluate the practice descision or change 6. share the outcomes of EBP changes with others

To objectively evaluate the success in achieving outcomes of care, the nurse should use the following steps

1. examine the outcome criteria to identify the exact desired client behavior 2. assess the client's actual behavior or response 3. compare the established outcome criteria with the actual behavior 4. judge the degree of agreement between outcome criteria and the actual behavior 5. if there is no agreement between the outcome criteria and the actual behavior, what are the barriers?

Identify the five elements of the evaluation process

1. identifying evaluative criteria and standards 2. collecting data to determine whether the criteria or standards are met 3. interpreting and summarizing findings 4. documenting findings and any clinical judgment 5. terminating, continuing, or revising the care plan

Reassessment of a care plan

1. is necessary if a nursing diagnosis is unresolved or if you determine that perhaps a new problem has developed. 2. a complete reassessment of a patient factors relating to an existing nursing diagnosis and etiology is necessary when modifying a plan.

The purpose of Nursing outcomes classification (NOC)

1. is to identify, label, validate and classify nurse-sensitive patient outcomes. 2. is to field test and validate the classification. 3. is to define and test measurement procedures for the outcomes and indicators using clinical data.

buddhist four noble truths

1. life is suffering 2. suffering is caused by clinging 3. suffering can be eliminated by eliminating clinging 4. to eliminate clinging and suffering, one follows an eightfold path (i.e., right understanding, intention, speech, action, livelihood, effort, mindfulness, and concentration).

10. A nurse enters a pt's room and begins a conversation. During this time the nurse evaluates how a pt is tolerating a new diet plan. The nurse decides to also evaluate the pt's expectations of care. Which statement is appropriate for evaluating a pt's expectations of care? 1. On a scale of 0 to 10 rate your level of nausea. 2. The nurse weighs the pt. 3. The nurse asks, "Did you believe that you received the information you needed to follow your diet?" 4. The nurse states, "Tell me four different foods included in your diet."

10. Answer 3. Evaluating patient expectations of care involves measuring their perceptions of care, such as did this particular patient feel he/she had received sufficient information.

10. Which of the following factors does a nurse consider for a pt with the nursing diagnosis of Disturbed Sleep Pattern related to noisy home environment in choosing an intervention for enhancing the pt's sleep? (Select all that apply.) 1. The intervention should be directed at reducing noise. 2. The intervention should be one shown to be effective in promoting sleep on the basis of research. 3. The intervention should be one commonly used by the pt's sleep partner. 4. The intervention should be one acceptable to the pt. 5. The intervention should be one you used with other pts in the past.

10. Answer: 1, 2, 4. Select interventions that alter the etiological factor, in this case noise. Choose interventions that have a research base and are acceptable to patients.

10. What is the importance of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey? 1. Measures a nurse's competency in interdisciplinary care 2. Measures the number of adverse events in a hospital 3. Measures quality of care within hospitals 4. Measures referrals to a health care agency

10. Answer: 3. HCAHPS is a survey that has become a standard for measuring and comparing quality of hospitals. It is a survey of patient perceptions.

11. A nurse checks an intravenous (IV) solution container for clarity of the solution, noting that it is infusing into the pt's left arm. The IV solution of 9% NS is infusing freely at 100 mL/hr as ordered. The nurse reviews the nurses' notes from the previous shift to determine if the dressing over the site was changed as scheduled per standard of care. While in the room the nurse inspects the condition of the dressing and notes the date on the dressing label. In which ways did the nurse evaluate the condition of the IV site? (Select all that apply.) 1. Checked the IV infusion rate 2. Checked the type of IV solution 3. Confirmed from nurses' notes the time of dressing change 4. Inspected the condition of the IV dressing at the site 5. Checked clarity of IV solution

11. Answer 1, 4. The condition or status of the IV site is determined by checking the IV infusion rate and condition of the IV site dressing. The checking of the type of solution is important to ensure the correct therapy is being administered but is not a measure of the IV site condition. Confirming a dressing change or the appearance of the IV solution are not indicators of the IV site status.

11. A nurse begins the night shift being assigned to five pts. She learns that the floor will be a registered nurse (RN) short as a result of a call in. A pt care technician from another area is coming to the nursing unit to assist. The nurse is required to do hourly rounds on all pts, so she begins rounds on the pt who has recently asked for a pain medication. As the nurse begins to approach the pt's room, a nurse stops her in the hallway to ask about another pt. Which factors in this nurse's unit environment will affect her ability to set priorities? (Select all that apply.) 1. Policy for conducting hourly rounds 2. Staffing level 3. Interruption by staff nurse colleague 4. RN's years of experience 5. Competency of pt care technician

11. Answer: 1, 2, 3. Many factors within the health care environment affect your ability to set priorities, including model for delivering care, a nursing unit's workflow routine, staffing levels, and interruptions from other care providers. Available resources (e.g., policies and procedures) also affect priority setting. The nurse's years of experience is not part of the environment.

11. Fill in the Blank. A nurse administered an antibiotic 30 minutes ago and returns to the pt's room to determine if the pt is having any unexpected symptoms. This is an example of assessing for a(n) ___________________.

11. Answer: Adverse Reaction. An adverse reaction is a harmful or unintended effect of a medication, diagnostic test, or therapeutic intervention.

12. A pt is being discharged after treatment for colitis (inflammation of the colon). The pt has had no episodes of diarrhea or abdominal pain for 24 hours. Following instruction, the pt identified correctly the need to follow a low-residue diet and the types of food to include if a bout of diarrhea develops at home. These behaviors are examples of: 1. Evaluative measures. 2. Expected outcomes. 3. Reassessments. 4. Standards of care.

12. Answer 2. The absence of diarrhea and abdominal pain and the ability to identify the correct diet are expected outcomes. If outcomes had not been met the nurse would reassess. The low residue diet is a standard of care, but the patient's ability to describe it is an outcome. An evaluative measure is the nurse questioning the patient about symptoms.

12. Which measures does a nurse follow when being asked to perform an unfamiliar procedure? (Select all that apply.) 1. Checks scientific literature or policy and procedure 2. Reassesses the pt's condition 3. Collects all necessary equipment 4. Delegates the procedure to a more experienced nurse 5. Considers all possible consequences of the procedure

12. Answer: 1, 2, 3, 5. the nurse does not delegate a procedure to a more experienced nurse. Instead, the nurse has the nurse (e.g. staff nurse, faculty, nurse specialist) who has completed the procedure correctly and safely provide assistance and guidance.

12. A nursing student is reporting during hand-off to the registered nurse (RN) assuming her pt's care. The student states, "Mr. Roarke had a good day, his intravenous (IV) fluid is infusing at 124 mL/hr with D5 infusing in right forearm. The IV site is intact, and no complaints of tenderness. I ambulated him twice during the shift; he tolerated well walking to end of hall and back with no shortness of breath. He still uses his cane with out difficulty. Mr. Roarke said he slept better last night after I closed his door and gave him a chance to be uninterrupted. If the nurse's goal for Mr. Roarke was to improve activity tolerance, which expected outcomes were shared in the hand-off? (Select all that apply.) 1. IV site not tender 2. Uses cane to walk 3. Walked to end of hall 4. No shortness of breath 5. Slept better during night

12. Answer: 3, 4. The goal for improving activity tolerance will require an outcome that is a measure of changes in activity tolerance, such as no shortness of breath during exercise or walking a set distance.

13. Which of the following does a nurse perform when discontinuing a plan of care for a pt? 1. Confirms with the pt that expected outcomes and goals have been met 2. Talks with the pt about reprioritizing interventions in the plan of care 3. Changes the frequency of interventions provided 4. Reassesses how goals were met

13. Answer 1. When you discontinue a plan of care you determine that expected outcomes and goals have been met and you confirm this evaluation with the patient when possible. If you and the patient agree, you discontinue that portion of the care plan. Reassessing how goals were met is not necessary if you confirm that discontinuation of a plan is appropriate. Talking with the patient about reprioritizing interventions in the plan of care and changing the frequency of the interventions provided are not appropriate when a plan is discontinued.

13. A nurse is conferring with another nurse about the care of a pt with a stage II pressure ulcer. The two decide to review the clinical practice guideline of the hospital for pressure ulcer management. The use of a standardized guideline achieves which of the following? (Select all that apply.) 1. Makes it quicker and easier for nurses to intervene 2. Sets a level of clinical excellence for practice 3. Eliminates need to create an individualized care plan for the pt 4. Delivers evidence-based interventions for stage II pressure ulcer 5. Summarizes the various approaches used for the practice concern or problem

13. Answer: 1, 2, 4. Even though a standardized clinical practice guideline offers evidence based solutions for clinical excellence that nurses can quickly and easily apply in practice, a nurse remains accountable for individualizing even standardized interventions when necessary. A guideline is not a summary of various approaches used by clinicians for a practice issue; it is a summary of the most relevant evidence based information.

13. A nursing student is reporting during hand-off to the RN assuming her pt's care. She explains, "I ambulated him twice during the shift; he tolerated well walking to end of hall and back with no shortness of breath. Mr. Roarke said he slept better last night after I closed his door and gave him a chance to be uninterrupted. I changed the dressing over his intravenous (IV) site and started a new bag of D5 . Which intervention is a dependent intervention? 1. Reporting hand-off at change of shift 2. Ambulating pt down hallway 3. Sleep hygiene 4. IV fluid administration

13. Answer: 4. Administering IV fluids required a physician's order. The other three interventions are independent nursing activities.

14. Purposes of the Nursing Outcomes Classification (NOC) include which of the following? (Select all that apply.) 1. To identify and label nurse-sensitive pt outcomes 2. To test the classification in clinical settings 3. To establish health care reimbursement guidelines 4. To identify nursing interventions for linked nursing diagnoses 5. To define measurement procedures for outcomes

14. Answer: 1, 2, 5. The NOC classification offers a language for the evaluation step of the nursing process. The purposes of NOC are (1) to identify, label, validate, and classify nurse-sensitive patient outcomes; (2) to field test and validate the classification; and (3) to define and test measurement procedures for the outcomes and indicator.

14. A nursing student knows that all pts should be ambulated regularly. The pt to which she is assigned has had reduced activity tolerance. She followed orders to ambulate the pt twice during the shift of care. In what way can the nursing student make the goal of improving the pt's activity tolerance a pt-centered effort? 1. Engage the pt in setting mutual outcomes for distance he is able to walk 2. Confirm with the pt's health care provider about ambulation goals 3. Have physical therapy assist with ambulation 4. Refer to medical record regarding nature of pt's physical problem

14. Answer: 1. All goals and outcomes of care should be patient-centered whenever possible. An approach for ensuring patient-centered goals is having the patient involved so that goals can be mutually set and realistic to the patient. Confirming with the physician and checking the medical record helps the nurse understand the extent of exercise a patient can participate in. But these approaches are not examples of mutual patient-centered goal setting. Having physical therapy assistance would not make a goal patient centered.

14. A nurse reviews all possible consequences before helping a pt ambulate such as how the pt ambulated last time; how mobile the pt was before admission to the health care facility; or any current clinical factors affecting the pt's ability to stand, remain balanced, or walk. Which of the following is an example of a nurse's review of this situation? 1. Critical thinking 2. Managing an adverse event 3. Exercising self-discipline 4. Time management

14. Answer: 1. The process of reviewing consequences for a patient is an example of critical thinking and clinical decision making. Managing an adverse event occurs after consequences have occurred. Exercising self discipline is a critical thinking attitude that guides you in reviewing, modifying, and implementing interventions, which occurs after reviewing consequences. This is not an example of time management.

15. Which of the following statements correctly describes the evaluation process? (Select all that apply.) 1. Evaluation is an ongoing process. 2. Evaluation usually reveals obvious changes in pts. 3. Evaluation involves making clinical decisions. 4. Evaluation requires the use of assessment skills. 5. Evaluation is only done when a pt's condition changes

15. Answer 1, 3, 4. Evaluation is ongoing throughout the nursing process once nursing diagnoses or patient health problems have been identified. It is a process that involves clinical decision making and use of assessment skills as evaluative measures. Evaluation may reveal changes in patients that often are not obvious. Evaluation occurs after any intervention and not only when a patient's condition changes.

15. A pt signals the nurse by turning on the call light. The nurse enters the room and finds the pt's drainage tube disconnected, 100 mL of fluid remaining in the intravenous (IV) line, and the pt asking questions about whether his doctor is coming. Which of the following does the nurse perform first? 1. Reconnect the drainage tubing 2. Inspect the condition of the IV dressing 3. Obtain the next IV fluid bag from medication room 4. Explain when the health care provider is likely to visi

15. Answer: 1. The nurse must reconnect the drainage tube for the priority of patient safety. There is no reason to suspect a problem with the IV dressing unless the fluid is not infusing on time. The nurse must prepare the next bottle of solution after reconnecting the drainage tube. At that time the nurse can check the condition of the IV dressing. As the nurse performs her care she can inform the patient about when the physician will round, unless the nurse is uncertain and needs to contact the physician.

15. A nurse collects equipment needed to administer an enema to a pt. Previously the nurse reviewed the procedure in the policy manual. The nurse raises the pt's bed and adjusts the room lighting to illuminate the work area. A pt care technician comes into the room to assist. Which aspect of organizing resources and care delivery did the nurse omit? 1. Environment 2. Personnel 3. Equipment 4. Pt

15. Answer: 4. In preparing to administer the enema, the nurse did not prepare for the patient's physical and psychological comfort.

Darling v. Charlestone Commuity Memorial Hospital

18 year old man with fractured leg received insufficient care from the physician and developed Gang green but the nurses also failed to tell the supervisor the physician was negligent so the nursing staff in addition to the physician was held liable for filing to adhere to standards of care Life Lesson: Cover your ass even if its a physician who is screwing up

11. Traditional Chinese medicine (TCM) is used by many patients. Which statement most accurately describes intervention(s) offered by TCM providers? 1. Uses acupuncture as its primary intervention modality 2. Uses many modalities based on the individual's needs 3. Uses primarily herbal remedies and exercise 4. Is the equivalent of medical acupuncture

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5. In addition to an adequate patient assessment, when a nurse uses one of the nursing-accessible complementary therapies, he or she must ensure that which of the following has occurred? 1. The family has provided permission. 2. The patient has provided permission and consent. 3. The health care provider has given approval or provided orders for the therapy. 4. He or she has documented that the patient has a complete understanding of complementary and alternative medicine.

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6. What role do patients have in complementary and alternative therapies? 1. Submissive to the practitioner 2. Actively involved in the treatment 3. Allow practitioner to experiment 4. Total believer in what is being taught

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A patient states that he does not believe in the existence of God. This patient most likely is an: 1 Academic. 2 Atheist. 3 Agnostic. 4 Anarchist.

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An emergency department nurse is caring for a patient who was severely injured in a car accident. The patient's family is in the waiting room. They are crying softly. The nurse sits down next to the family, takes the mother's hand, and says, "I can only imagine how you're feeling. What can I do to help you feel more at peace right now?" In this example the nurse is demonstrating: 1 Prayer. 2 Presence. 3 Coaching. 4 Instilling hope.

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Which of the following would be the most appropriate outcome for a patient who has a nursing diagnosis of spiritual distress related to loneliness? 1 Encourage the patient to meditate 2 to 3 times a week. 2 The patient will set up a time to speak to a close friend in 1 week. 3 Encourage the patient to phone his brother and set up a time to go out for dinner. 4 The patient will experience greater connections with family members in 2 months.

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a nurse is preparing to teach an older adult who has chronic arthritis how to practice meditation. which of the following strategies are appropriate? (select all that apply) 1.encourage family members to participate in exercise 2.have pt identify a quiet room in the home that has minimal interruptions 3.suggest use of a quiet fan running in the room 4.explain that it is best to meditate about 5 minutes 4 times a day 5.show the pt how to sit comfortably with the limitation of this arthritis and focus on a prayer

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a nurse is caring for a 78 yo pt with chronic multiple sclerosis. the pt has severe fatigue, muscle weakness, severe muscle spasms, and difficulties with coordination and balance. her disease will most likely worsen. the nurse has gained the patients trust and wants to assess her life satisfaction. which of the following questions should the nurse ask? (select all that apply) 1. how often are you able to attend you synagogue? 2.what about your family makes you proudest? 3.what does your husband do for you at home? 4.looking back, what has been your greatest accomplishment? 5. how has your illness affected the way you live your life spiritually at home?

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7. A nurse is caring for a patient experiencing a stress response. The nurse plans care with the knowledge that systems respond to stress in what manner? (Select all that apply.) 1. Always fail and cause illness and disease 2. Cause negative responses over time 3. React the same way for all individuals 4. Protect an individual from harm in the short term

2, 4

2. A nurse in a community health clinic has been caring for a young teenager with asthma for several months. The nurse's goal of care for this pt is to achieve self-management of asthma medications. Identify appropriate evaluative indicators for self-management for this pt. (Select all that apply.) 1. Quality of life 2. Pt satisfaction 3. Use of clinic services 4. Adherence to use of inhaler 5. Description of side effects of medications

2. Answer 1, 3, 4. Relevant and appropriate evaluative indicators of self-management include self-efficacy, health behavior or attitude, health status, health service utilization, quality of life and psychological indicators. In this case the -patient's quality of life, utilization of clinic services and adherence (behavior) in using inhaler are all appropriate. Patient satisfaction is a perception and not an indicator of self management.

2. A 62-year-old pt had a portion of the large colon removed and a colostomy created for drainage of stool. The nurse has had repeated problems with the pt's colostomy bag not adhering to the skin and thus leaking. The nurse wants to consult with the wound care nurse specialist. Which of the following should the nurse do? (Select all that apply.) 1. Assess condition of skin before making the call 2. Rely on the nurse specialist to know the type of surgery the pt likely had 3. Explain the pt's response emotionally to the repeated leaking of stool 4. Describe the type of bag being used and how long it lasts before leaking 5. Order extra colostomy bags currently being used

2. Answer: 1, 3, 4. The nurse should have as much information available before making the call to the nurse specialist. It is also important for the nurse to interpret and explain the problem. In addition it is important to explain the patient's perspective. Assuming the nurse specialist knows the extent of the surgery is not appropriate.

2. The nurse administers a tube feeding via a pt's nasogastric tube. This is an example of which of the following? 1. Physical care technique 2. Activity of daily living 3. Indirect care measure 4. Lifesaving measure

2. Answer: 1. Administering a tube feeding is an example of a physical care, direct care technique.

a 44 year olf male has just been told that his wife and child were killed in an auto accident while coming to visit him at the hospital. which of the following statements are defining characteristics that support a nursing diagnosis of spiritual distress related to loss of family members? (select all that apply) 1."i need to call my sister for support" 2."i have nothing to live for now" 3."why would god do this to me?" 4. "i need to pray for a miracle" 5. "i want to be more involved in my church"

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12. A nurse is planning care for a group of patients who have requested the use of complementary health modalities. Which patient is not a good candidate for guided imagery? 1. Pregnant patient 2. Hypertensive patient 3. Patient with post-traumatic stress disorder (PTSD) 4. A pediatric patient

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3. Which statement best describes the evidence associated with complementary therapies as a whole? 1. Many clinical trials in complementary therapies support their effectiveness in a wide range of clinical problems. 2. It is difficult to find funding for studies about complementary therapies. Therefore we should not expect to find evidence supporting its use. 3. The science supporting the effectiveness of complementary therapies is early in its development. 4. Most of the research examining complementary and alternative therapies has found little evidence, suggesting that, although people like them, they are not effective.

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4. While planning care for a patient, a nurse understands that providing integrative care includes treating which of the following? 1. Disease, spirit, and family interactions 2. Desires and emotions of the patient 3. Mind-body-spirit of patients and their families 4. Muscles, nerves, and spine disorders

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A Catholic patient with diabetes receives the following items on his meal tray on the Friday before Easter. For which of the foods does the nurse offer to substitute? 1 Apple sauce 2 Cheese and crackers 3 Spaghetti with meat sauce 4 Tossed salad with ranch dressing

3

A patient expresses the desire to learn how to meditate. What does the nurse need to do first? 1 Answer the patient's questions 2 Help the patient get into a comfortable position 3 Select a teaching environment that is free from distractions 4 Encourage the patient to meditate for 10 to 20 minutes 2 times a day

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Which of the following questions would best assess a patient's level of connectedness? 1 What gives your life meaning? 2 Which aspects of your spirituality would you like to discuss right now? 3 Who do you consider to be the most important person in your life at this time? 4 How do you feel about the accomplishments you've made in your life so far?

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a student is developing a plan of care for a 74 yo female pt who has spiritual distress over losing a spouse. as the nurse develops appropriate interventions, which characteristics of older adults should be considered? (select all that apply) 1.older adults do not routinely use complementary medicine to cope with illness 2.older adults dislike discussing the afterlife and what might have happened to people who have passed on 3.older adults achieve spiritual resilience through frequent expressions of gratitude 4.have the pt determine if her husband has left a legacy behind 5.offer the pt her choice of rituals or participation in exercise

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13. Several nurses on a busy unit are using relaxation strategies while at work. What is the desired workplace outcome from this intervention? (Select all that apply.) 1. Improved health among the staff 2. Increased patient safety 3. Improved staff satisfaction 4. Improved staff relationships 5. Fewer overtime assignments

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2. Which complementary therapies are most easily learned and applied by a nurse? (Select all that apply.) 1. Massage therapy 2. Traditional Chinese medicine 3. Progressive relaxation 4. Breathwork and guided imagery 5. Therapeutic touch

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A registered nurse performs the following four steps in delegating a task to a nursing assistant. Place the steps in the order of appropriate delegation. 1. Do you have any questions about walking Mr. Malone? 2. Before you take him for his walk to the end of the hallway and back, please take and record his pulse rate. 3. In the next 30 minutes please assist Mr. Malone in room 418 with her afternoon walk. 4. I will make sure that I check with you in about 40 minutes to see how the patient did. 3, 2, 4, 1 2, 3, 4, 1 3, 4, 2, 1 3, 2, 1, 4

3,2,4,1 The nurse delegated the task of walking a patient to the nursing assistant, which is in the scope of the nursing assistant's duties and responsibilities and matched to his skill level. The nurse provided clear directions by describing the task (the walk, taking and recording the pulse), the desired outcome (walk to the end of the hallway and back), and the time period (within the next 30 minutes). The nurse then told the nursing assistant that she would follow up with him to check how the patient did. By asking the nursing assistant if he had any questions, the nurse provided him an opportunity to ask questions for clarification.

3. A nurse caring for a pt with heart failure instructs the pt on foods to eat for a low-sodium diet. The nurse will perform which of the following evaluation measures to determine success of her instruction? 1. Pt weight 2. Asking pt to identify three low-sodium foods to eat for lunch 3. A calorie count of food 4. Pt description of how food selections are made

3. Answer 2. If the nurse is instructing patient on foods to eat, the goal and expected outcome would be knowledge based. Asking the patient to identify 3 low sodium foods to eat for lunch is an evaluative measure for knowledge application.

3. It is time for a nurse hand-off between the night nurse and nurse starting the day shift. The night nurse checks the most recent laboratory results for the pt and then begins to discuss the pt's plan of care to the day nurse using the standard checklist for reporting essential information. The pt has been seriously ill, and his wife is at the bedside. The nurse asks the wife to leave the room for just a few minutes. The night nurse completes the summary of care before the day nurse is able to ask a question. Which of the following activities are strategies for an effective hand-off? (Select all that apply.) 1. Using a standardized checklist for essential information 2. Asking the wife to briefly leave the room 3. Completing the hand-off without inviting questions 4. Doing prework such as checking laboratory results before giving a report 5. Including the wife in the hand-off discussion

3. Answer: 1, 4. Using standardized forms or checklists and doing thorough pre work enhances the nurse's ability to communicate the plan of care effectively during a handoff. The other two options are barriers to an effective hand-off.

3. A nurse is caring for a complicated pt 3 days in a row. The nurse attends an interdisciplinary conference to discuss the pt's plan of care. In which ways can the nurse develop trust with members of the conference team? (Select all that apply.) 1. Is willing to challenge other members' ideas because the nurse disagrees with their rationale 2. Shows competence in how to monitor pts' clinical status and inform the physician of critical changes 3. Asks a more experienced nurse to attend the conference 4. Listens to opinions of members of interdisciplinary team and expresses recommendations for care clearly 5. During the meeting focus on similar problems the nurse has had in delivering care to other pts.

3. Answer: 2, 4. Showing competence and exercising good communication are important for developing trust with interdisciplinary team members. Having another nurse, who might be less familiar with the patient would not promote trust. Challenging other ideas just because of disagreement does not foster trust.

1. When planning patient education, it is important to remember that patients with which of the following illnesses often find relief in complementary therapies? 1. Lupus and diabetes 2. Ulcers and hepatitis 3. Heart disease and pancreatitis 4. Chronic back pain and arthritis

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14. A nursing professor is teaching a nursing student about caring patients who use herbal preparations in addition to prescribed medications. Which of the following statements made by the student indicates that the student understands herbal preparations? 1. "Herbal preparations are regulated by the Food and Drug Administration (FDA); therefore I need to tell patients that they are completely safe." 2. "They are natural products and therefore are safe as long as you use them for the conditions that are indicated." 3. "These preparations are covered by insurance, including Medicare, Medicaid, and private payers." 700 4. "We need to treat herbal preparations as though they are "drugs" because many have active ingredients that can interact with other medications and change physiological responses."

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8. Meditation may compound the effects of which of these medications? 1. Prednisone and antibiotics 2. Insulin and vitamins 3. Cough syrups and aspirin 4. Antihypertensive and thyroid-regulating medications

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9. A patient who has been using relaxation wants a better response. The nurse recommends the addition of biofeedback. What is the expected outcome related to using this additional modality? 1. To eat less food 2. To control diabetes 3. To live longer with acquired immunodeficiency syndrome (AIDS) 4. To learn how to control some autonomic nervous system responses

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A nurse is using the B-E-L-I-E-F tool to complete a spiritual assessment on a 12-year-old male who has recently been diagnosed with acute lymphocytic leukemia. Which of the following questions would the nurse use to assess the child's involvement in the spiritual community? 1 Which church do you attend? 2 Which sports do you like to play? 3 Are there any foods you cannot eat? 4 In which church activities do you participate?

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4. Which principle is most important for a nurse to follow when using a clinical practice guideline for an assigned pt? 1. Knowing the source of the guideline 2. Reviewing evidence used to develop guideline 3. Individualizing how to apply clinical guideline for a pt 4. Explaining to a pt the purpose of the guideline

4. Answer: 3. Individualizing patient care is still the important principle for implementing care, even when a clinical guideline is used. Explaining any interventions in a guideline to the patient is important but not the most critical factor in implementing care. Reviewing the source of the guideline and applicable evidence will not directly benefit a patient.

4. A nurse assesses a 78-year-old pt who is 108.9 kg (240 lbs) and partially immobilized b/c of a stroke. The nurse turns the pt and finds the skin over the sacrum is very red and the pt does not feel sensation in the area. The pt has had fecal incontinence on and off for the last 2 days. The nurse identifies the nursing diagnosis of Risk for Impaired Skin Integrity. Which of the following outcomes is appropriate for the pt? 1. Pt will be turned every 2 hrs within 24 hrs. 2. Pt will have normal bowel function w/i 72 hrs 3. Pt's skin integrity will remain intact thru discharge. 4. Erythema of skin will be mild to none w/i 48 hrs

4. Answer: 4. The statement "Patient will be turned every 2 hours within 24 hours" is an intervention. The statements "Patient will have normal bowel function within 72 hours" and "Patient's skin integrity will remain intact through discharge" are goals.

5. A nurse has been caring for a pt over 2 consecutive days. During that time the pt has had an intravenous (IV) catheter in the right forearm. At the end of shift on the second day the nurse inspects the catheter site, observes for redness, and asks if the pt feels tenderness when the site is palpated. This is an example of which indicator reflecting the nurse's ability to perform evaluation: 1. Examining results of clinical data 2. Comparing achieved effects with outcomes 3. Recognizing error 4. Self-reflection

5. Answer 1. Examination of the IV site is an example of examining results of clinical data. The nurse will next take the results of the exam and compare it to the norms for a normal IV site to decide if the outcome of maintaining a site free of infection is achieved. There were no errors identified in this example and the nurse is not self- reflecting.

5. A nurse is visiting a pt in the home and is assessing the pt's adherence to medications. While talking with the family caregiver, the nurse learns that the pt has been missing doses. The nurse wants to perform interventions to improve the pt's adherence. Which of the following will affect how this nurse will make clinical decisions about how to implement care for this pt? (Select all that apply.) 1. Reviewing the family caregiver's availability during medication administration times 2. Making a judgment of the value of improved adherence for the pt 3. Reviewing the number of medications and time each is to be taken 4. Determining all consequences associated with the pt missing specific medicines 5. Reviewing the therapeutic actions of the medications

5. Answer: 2, 4. Tips for making good clinical decisions during implementation include: Making a judgment of the value of the consequence to the patient, Review all possible consequences associated with each nursing action, determine the probability of all possible consequences and review the set of all possible nursing interventions for a patient's problems.

6. A pt has been febrile and coughing thick secretions; adventitious lung sounds indicate rales in the left lower lobe of the lungs. The nurse decides to perform nasotracheal suction because the pt is not coughing. The nurse inspects the mucus that is suctioned, which is minimal. The nurse again auscultates for lung sounds. Auscultation and mucus inspection are examples of: 1. Evaluative measures. 2. Expected outcomes. 3. Reassessments. 4. Reflection.

6. Answer 1. Auscultation of lung sounds and inspection of mucous after the intervention of suctioning are examples of evaluative measures. An outcome would be clear secretions or clear lung sounds. It is not a reassessment as the nurse has not yet compared findings with expected outcomes. Suctioning is a standard of care.

6. The nurse enters a pt's room and finds that the pt was incontinent of liquid stool. B/c the pt has recurrent redness in the perineal area, the nurse worries about risk of the pt developing a pressure ulcer. The nurse cleanses the pt, inspects the skin, and applies a barrier ointment to the perineal area. The nurse consults the ostomy and wound care nurse specialist for recommended skin care measures. Which of the following correctly describe the nurse's actions? (Select all that apply.) 1. The application of the skin barrier is a dependent care measure. 2. The call to the ostomy and wound care specialist is an indirect care measure. 3. The cleansing of the skin is a direct care measure. 4. The application of the skin barrier is an instrumental activity of daily living. 5. Inspecting the skin is a direct care activity

6. Answer: 2, 3. The call to the specialist is a referral and an indirect care measure on the patient's behalf. Cleansing of the skin is an example of direct care. Application of a skin barrier is an independent measure and it is not an instrumental activity of daily living.

6. A home health nurse visits a 42-year-old woman with diabetes who has a recurrent foot ulcer. The ulcer has prevented the woman from working for over 2 weeks. The pt has had diabetes for 10 years. The ulcer has not been healing; it has drainage with a foul-smelling odor. As the nurse examines the pt, she learns that the pt is not following the ordered diabetic diet. Which of the following is considered a low-priority goal for this pt? 1. Achieving wound healing of the foot ulcer 2. Enhancing pt knowledge about the effects of diabetes 3. Providing a dietitian consultation for diet retraining 4. Improving pt adherence to diabetic diet

6. Answer: 2. The high priority for this patient is wound healing. If the ulcer is left untreated it will cause more serious harm; an infection is likely and it could spread. Providing a diet consult is an intervention. Improving patient adherence to her diet is an intermediate outcome. Adherence to the diet is important but not life threatening when unmet. Since the patient has had diabetes for 10 years, enhancing knowledge is important because of her poor adherence but a lower priority than the others.

7. After caring for a young man newly diagnosed with diabetes, a nurse is reviewing what was completed in his plan of care following discharge. She considers how she related to the pt and whether she selected interventions best suited to his educational level. It was the nurse's first time caring for a new pt with diabetes. The nurse's behavior is an example of which of the following? 1. Reflection-in-action 2. Reassessment 3. Reprioritizing 4. Reflection-on-action

7. Answer 4. The nurse is performing reflection-on-action. This means that when you gather evaluative measures about a patient, reflection on the findings and the exploration about what the findings might mean, improves your ability to problem solve. The other three measures occur during evaluation as the nurse is still actively intervening in the patients care.

7. During the implementation step of the nursing process, a nurse reviews and revises a pt's plan of care. Place the following steps of review and revision in the correct order. ______, ______, ______, _____ 1. Modify care plan as needed. 2. Decide if the nursing interventions remain appropriate. 3. Reassess the pt. 4. Compare assessment findings to validate existing nursing diagnoses.

7. Answer: 3, 4, 2, 1. Reassessment allows you to review a patient's care plan by validating the nursing diagnoses and determine whether the nursing interventions remain the most appropriate for the clinical situation. When changes are needed you modify the plan of care.

8. A nurse has been caring for a pt over the last 10 hours. The pt's plan of care includes the nursing diagnosis of Nausea related to effects of postoperative anesthesia. The nurse has been asking the pt to rate his nausea over the last several hours after administering antiemetics and using comfort measures such as oral hygiene. The nurse reviews the pt's responses over the past 10 hours and notes how the pt's self-report of nausea has changed. This review an example of: 1. Comparing outcome criteria w/ actual response. 2. Gathering outcome criteria. 3. Evaluating the pt's actual response. 4. Reprioritizing interventions

8. Answer 1. The key to this question is observation for change. The nurse compares the patient's actual self-report rating of nausea with the expected outcome of a reduction in nausea. Gathering outcome criteria simply involves having the patient rate nausea. Evaluating the behavior or self report is the determination of the patient's actual response.

8. Before consulting with a physician about a female pt's need for urinary catheterization, the nurse considers the fact that the pt has urinary retention and has been unable to void on her own. The nurse knows that evidence for alternative measures to promote voiding exists, but none has been effective, and that before surgery the pt was voiding normally. This scenario is an example of which implementation skill? 1. Cognitive 2. Interpersonal 3. Psychomotor 4. Consultative

8. Answer: 1. This is an example of a cognitive skill, being used before consultation. It involves critical thinking and decision making so that the nurse is able to deliver a relevant nursing intervention.

8. A pt has the nursing diagnosis of Nausea. The nurse develops a care plan with the following interventions. Which are examples of collaborative interventions? (Select all that apply.) 1. Providing mouth care every 4 hours 2. Maintaining intravenous (IV) infusion at 100 mL/hr 3. Administering prochlorperazine (Compazine) via rectal suppository 4. Consulting with dietitian on initial foods to offer pt 5. Controlling aversive odors or unpleasant visual stimulation that triggers nausea

8. Answer: 2, 4. The options "Provide mouth care every 4 hours" and "Control aversive odors or unpleasant visual stimulation that triggers nausea" are independent nursing interventions. The option "Administer prochlorperazine (Compazine) via rectal suppository" is a dependent intervention.

9. A faculty member is reviewing a nursing student's plan of care, including the interventions the student provided for a pt w/ dementia. The student reviewed clinical guidelines on a professional website to identify interventions successful in reducing wandering in pts w/ dementia. The faculty should evaluate which of the following? (Select all that apply.) 1. Number of interventions 2. Appropriateness of the intervention for the pt 3. Prior use of interventions by other nursing staff 4. Correct application of intervention for pt care setting 5. The time it takes to provide interventions

9. Answer 2, 4. In this situation the faculty member reviews the plan for the appropriateness of the intervention and its correct application. Because the nursing student selected proven interventions from a professional website, it is likely the interventions represent an accepted standard of care and meet the criteria of appropriateness. The number of interventions is not important. Whether an intervention has been used by other nurses is not important in the context of evaluating this nurse's plan of care. However, if other interventions are known to be effective for this patient, the student might choose to revise the plan later and add such interventions.

9. An 82-year-old pt who resides in a nursing home has the following three nursing diagnoses: Risk for Fall, Impaired Physical Mobility related to pain, and Imbalanced Nutrition: Less Than Body Requirements related to reduced ability to feed self. The nursing staff identified several goals of care. Match the goals on the left with the appropriate outcome statements on the right. Goals Outcomes 1. _____ Pt will ambulate independently in 3 days 2. _____ Pt will be injury free for 1 month. 3. _____ Pt will achieve 5-lb weight gain in 1 month. 4. _____ Pt will achieve pain relief by discharge. a. Pt has fewer nonverbal signs of discomfort w/i 24 hrs. b. Pt increases calorie intake to 2500 daily. c. Pt walks 20 feet using a walker in 24 hrs. d. Pt identifies barriers to remove in the home w/i 1 wk.

9. Answer: 1c, 2d, 3b, 4a. In each case the outcome is a measurable behavior or perception that reflects goal achievement.

Tort

A civil wrong made against a person or property

D) Increase life expectancy and quality of life and to eliminate health disparities.

A community nurse in a diverse community is working with health care professionals to provide prenatal care for underemployed and underinsured South African women. Which overall goal of Healthy People 2020 does this represent? A) Assess the health care needs of individuals, families, or communities. B) Develop and implement public health policies and improve access to care. C) Gather info on incident rates of certain diseases and social problems. D) Increase life expectancy and quality of life and to eliminate health disparities.

Orem's Self-Care Deficit Theory

A nurse continually assesses a patient's ability to perform self care and intervenes as needed to ensure patient meets physical, psychological, sociological, and developmental needs. Orem says that people who participate in self care are more likely to improve their health outcomes.

A and C

A nurse in a community health clinic noticed an increase in the number of positive TB skin tests from students in a local high school during the most recent academic year. After comparing these numbers to previous years, 10% increase in positive tests was found. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community nurse was acting in which nursing roles? (All that apply) A) Epidemiologist B) Counselor C) Collaborator D) Case manager E) Caregiver

A, B, and D

A nursing student in the last semester of a baccalaureate nursing program is beginning the community health practicum and will be working in a clinic with a focus on asthma and allergies. What is the primary focus of the community health nurse in this clinic setting? (All that apply) A) Decrease the incidence of asthma attacks in the community B) Increase patients' ability to self-manage their asthma C) Treat acute asthma attack in the hospital D) Provide asthma education programs for the teachers in the local schools E) Provide scheduled immunizations to people who come to the clinic

As a nurse, you are assigned to four patients. Which patient do you need to see first? The patient who had abdominal surgery 2 days ago who is requesting pain medication A patient admitted yesterday with atrial fibrillation with decreased level of consciousness A patient with a wound drain who needs teaching before discharge in the early afternoon A patient going to surgery for a mastectomy in 3 hours who has a question about the surgery

A patient admitted yesterday with atrial fibrillation with decreased level of consciousness This patient is of high priority. The patient is experiencing the physiological problem of decreased level of consciousness, which is an immediate threat to his or her survival and safety. The nurse must intervene promptly and notify the health care provider of the life-threatening problem

B) Lighting, locks, clutter, medications

A patient is worried about her 76-year-old grandmother who is in very good health and wants to live at home. The patient's concerns are related to her grandmother's safety. The neighborhood does not have a lot of crime. Using this scenario, which of the following are the most relevant to assess for safety? A) Crime rate, locks, lighting, neighborhood traffic B) Lighting, locks, clutter, medications C) Crime rate, medications, support system, clutter D) Locks, lighting, neighborhood traffic, crime rate

Informed consent

A person's agreement to allow something to happen such as surgery or an invasive diagnostic procedure, based on full disclosure of risks, benefits, alternatives and consequences of refusal.

types of theories

A prescriptive theory details nursing interventions (meditation) for a specific phenomenon (migraine headaches) and the expected outcome of the care. Grand theories are broad in scope and complex and require further specification through research; it does not provide guidance for specific nursing interventions. Descriptive theories do not direct specific nursing activities but help to explain patient assessment. A middle-range theory tends to focus on a concept found in a specific field of nursing, such as uncertainty, incontinence, social support, quality of life, and caring, rather than reflect on a wide variety of nursing care situations.

Review of systems (ROS)

A systematic approach for collecting the patient's self-reported data on all body systems.

A new graduate nurse is being mentored by a more experienced nurse. They are discussing the ways nurses need to remain active professionally. Which of the statements below indicates the new graduate understands ways to remain involved professionally? (Select all that apply.) A. "I am thinking about joining the health committee at my church." B. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." C. "I will join nursing committees at the hospital after I have several years of experience and better understand the issues affecting nursing." D. "Nurses do not have very much voice in legislation in Washington, DC, because of the shortage of nurses.

A. "I am thinking about joining the health committee at my church." B. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health."

A nursing student has been written up several times for being late with providing patient care and for omitting aspects of patient care and not knowing basic procedures that were taught in the skills course one term earlier. The nursing student says, "I don't understand what the bid deal is. As my instructor, you are there to protect me and make sure I don't make mistakes." What is the best response from the nursing instructor? A. "You are expected to perform at the level of a professional nurse." B. "You are expected to perform at the level of a nursing student." C. "You are practicing under the license of the nurse assigned to the patient." D. "You are expected to perform at the level of a skilled nursing assistant."

A. "You are expected to perform at the level of a professional nurse."

You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. What is the best nursing action to take first? A. Call the nursing supervisor to discuss the situation B. Discuss the problem with a colleague C. Leave the nursing unit and go home D. Say nothing and begin your work

A. Call the nursing supervisor to discuss the situation

15. A nurse is teaching a 27-year-old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this? A. Cognitive B. Affective C. Adaptation D. Psychomotor

A. Cognitive Cognitive learning requires thinking; learning how to adjust insulin requires analysis, synthesis, and evaluation, which are all types of cognitive learning.

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

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

12. A nurse needs to teach a young woman newly diagnosed with asthma how to manage her disease. Which of the following topics does the nurse teach first? A. How to use an inhaler during an asthma attack B. The need to avoid people who smoke to prevent asthma attacks C. Where to purchase a medical alert bracelet that says she has asthma D. The importance of maintaining a healthy diet and exercising regularly

A. How to use an inhaler during an asthma attack It is important to start with essential life-saving information when teaching people because they usually remember what you tell them first.

7. The nurse is teaching a parenting class to a group of pregnant adolescents. The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach did the nurse use? A. Role play B. Discovery C. An analogy D. A demonstration

A. Role play In role play people are asked to play themselves or someone else in a situation to enhance their confidence in handling that situation in the future.

The nurse hears a physician say to the charge nurse that he doesn't want that same nurse caring for his patients because she is stupid and won't follow his orders. The physician also writes on his patient's medical records that the same nurse, by name, is not to care for any of his patients because of her incompetence. What component(s) of defamation has the physician committed? (Select all that apply). A. Slander B. Invasion of privacy C. Libel D. Assault E. Battery

A. Slander C. Libel

Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) A. Taking or selling controlled substances B. Refusing to provide health care information to a patient's child C. Reporting suspected abuse and neglect of children D. Applying physical restraints without a written physician's order

A. Taking or selling controlled substances D. Applying physical restraints without a written physician's order

6. A patient with chest pain is having an emergency cardiac catheterization. Which teaching approach does the nurse use in this situation? A. Telling approach B. Selling approach C. Entrusting approach D. Participating approach

A. Telling approach The telling approach is most appropriate when preparing a patient for an emergency procedure.

An elderly adult fell at home and fractured a hip, which requires surgical repair. After admittance to the emergency department, the client was given sedation for pain before a surgical permit was signed. What is the best action necessary to obtain consent? A. The physician should have the client's wife sign the consent form. B. Since the client has been medicated, the nurse should thoroughly explain the consent form to the client. C. The physician should wait until the effects of the medication wear off and have the client sign. D. This would be considered an emergency situation and consent would be implied.

A. The physician should have the client's wife sign the consent form.

9. A patient has been admitted to the hospital numerous times. The nurse asks the patient to share a personal story about the care that has been received. Which interaction is the nurse using? a. Narrative b. Socializing c. Nonjudgmental d. SBAR

ANS: A ANS: A In a therapeutic relationship, nurses often encourage patients to share personal stories. Sharing stories is called narrative interaction. Socializing is an important initial component of interpersonal communication. It helps people get to know one another and relax. It is easy, superficial, and not deeply personal. Nonjudgmental acceptance of the patient is an important characteristic of the relationship. Acceptance conveys a willingness to hear a message or acknowledge feelings; it is not a technique that involves personal stories. SBAR is a popular communication tool that helps standardize communication among health care providers. SBAR stands for Situation, Background, Assessment, and Recommendation

20. Which situation will cause the nurse to intervene and follow up on the nurse aide's behavior? a. The nurse aide is calling the older adult patient "honey." b. The nurse aide is facing the older adult patient when talking. c. The nurse aide cleans the older adult patient's glasses. d. The nurse aide allows time for the older adult patient to respond.

ANS: A Communicate with older adults on an adult level, and avoid patronizing or speaking in a condescending manner. Avoid terms of endearment such as "honey," "dear," "grandma," or "sweetheart." Facing an older adult patient, making sure the older adult has clean glasses, and allowing time to respond facilitate communication with older adult patients and should be encouraged, not stopped.

22. The staff is having a hard time getting an older adult patient to communicate. Which technique should the nurse suggest the staff use? a. Allow the patient to reminisce. b. Try changing topics often. c. Involve only the patient in conversations. d. Ask the patient for explanations.

ANS: A Encouraging older adults to share life stories and reminisce about the past has a therapeutic effect and increases their sense of well-being. Avoid sudden shifts from subject to subject. It is helpful to include the patient's family and friends and to become familiar with the patient's favorite topics for conversation. Asking for explanations is a nontherapeutic technique.

In caring for the patient's spiritual needs, the nurse understands that a. Establishing presence is part of the art of nursing. b. Presence involves "doing for" the patient. c. A caring presence involves listening to the patient's wishes only. d. The nurse must use her expertise to make decisions for the patient.

ANS: A Establishing presence is part of the art of nursing. Presence involves "being with" a patient versus "doing for" a patient. Demonstrate a caring presence by listening to the patient's concerns and willingly involving family in discussions about the patient's health. Show self-confidence when providing health instruction, and support patients as they make decisions about their health.

17. A nurse is using SOLER to facilitate active listening. Which technique should the nurse use for R? a. Relax b. Respect c. Reminisce d. Reassure

ANS: A In SOLER, the R stands for relax. It is important to communicate a sense of being relaxed and comfortable with the patient. Active listening enhances trust because the nurse communicates acceptance and respect for the patient, but it is not the R in SOLAR. Reminisce is a therapeutic communication technique, especially when used with the elderly. Reassuring can be therapeutic if the nurse reassures patients that there are many kinds of hope, and that meaning and personal growth can come from illness experiences. However, false reassurance can block communication.

The nurse is admitting a patient who is a member of the Seventh Day Adventist religion. The physician has written an order for specific tests to be done the next day, which is Saturday. The nurse should a. Discuss the patient's beliefs about the Sabbath. b. Order the tests without questioning. c. Inform the physician that the tests cannot be performed. d. Reorder the tests for Sunday.

ANS: A It is essential to consider cultural differences and explore personal preferences when determining nursing interventions to enhance spiritual well-being. Some Seventh Day Adventists may not mind having tests on the Sabbath. Others might. Ordering the tests without questioning may lead to patient refusal later and to wasted resources as well as spiritual distress for the patient. Informing the physician that the tests cannot be performed is premature without speaking with the patient first. It is not in the realm of the nurse to reorder tests. Some tests may be critical and may need to be done on the Sabbath.

1. Nurses who make the best communicators a. Develop critical thinking skills. b. Like different kinds of people. c. Learn effective psychomotor skills. d. Maintain perceptual biases.

ANS: A Nurses who develop critical thinking skills make the best communicators. Just liking people does not make an effective communicator because it is important to apply critical thinking standards to ensure sound effective communication. Just learning psychomotor skills does not ensure that the nurse will use those techniques and communication involves more than psychomotor skills. Critical thinking helps the nurse overcome perceptual biases or human tendencies that interfere with accurately perceiving and interpreting messages from others. Nurses who maintain perceptual biases do not make good communicators.

In assessing the spiritual health of her patients, the nurse understands that a. Spiritual beliefs change as patients grow and develop. b. Spiritual health in older adults leads to peace and acceptance of others. c. Older adults often express spirituality by focusing on themselves. d. The basis of beliefs among older people is focused on one or two factors.

ANS: A Spiritual beliefs change as patients grow and develop. Health spirituality in older adults leads to peace and acceptance of self. However, older adults often express their spirituality by turning to important relationships and giving of themselves to others. Beliefs among older people vary based on many factors, such as gender, past experience, religion, economic status, and ethnic background.

A complex concept that is unique to each individual; is dependent upon a person's culture, development, life experiences, beliefs, and ideas about life; and is a unifying theme in peoples' lives is called a. Spirituality. b. Religion. c. Self-transcendence. d. Faith.

ANS: A Spirituality is a complex concept that is unique to each individual; is dependent upon a person's culture, development, life experiences, beliefs, and ideas about life; and is a unifying theme in peoples' lives. Religion refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. Self-transcendence is the belief that there is a force outside of and greater than the person. Faith allows people to have firm beliefs despite lack of physical evidence.

10. Before meeting the patient, a nurse talks to other caregivers about the patient. The nurse is in which phase of the helping relationship? a. Pre-interaction b. Orientation c. Working d. Termination

ANS: A The time before the nurse meets the patient is called the pre-interaction phase. This phase can involve such things as reviewing available data, including the medical and nursing history, talking to other caregivers who have information about the patient, or anticipating health concerns or issues that can arise

The word spirituality derives from the Latin word spiritus, which refers to breath or wind. Today, spirituality is a. Awareness of one's inner self and a sense of connection to a higher being. b. Less important than coping with the patient's illness. c. Patient centered and has no bearing on the nurse's belief patterns. d. Equated to formal religious practice and has a minor effect on health care.

ANS: A Today, spirituality is often defined as an awareness of one's inner self and a sense of connection to a higher being, to nature, or to some purpose greater than oneself. Spirituality is an important factor that helps individuals achieve the balance needed to maintain health and well-being and to cope with illness. It positively affects and enhances health, quality of life, health promotion behaviors, and disease prevention activities. Nurses need an awareness of their own spirituality to provide appropriate and relevant spiritual care to others. The concepts of spirituality and religion are often interchanged, but spirituality is a much broader and more unifying concept than religion. The human spirit is powerful, and spirituality has different meanings for different people.

24. A patient is aphasic, and the nurse notices that the patient's hands shake intermittently. Which nursing action is most appropriate to facilitate communication? a. Use a picture board. b. Use pen and paper. c. Use an interpreter. d. Use a hearing aid.

ANS: A Using a pen and paper can be frustrating for a nonverbal (aphasic) patient whose handwriting is shaky; the nurse can revise the care plan to include use of a picture board instead. An interpreter is used for a patient who speaks a foreign language. A hearing aid is used for the hard of hearing, not for an aphasic patient.

When evaluating a patient's risk for spiritual crises, which of the following are part of the evaluation process? (Select all that apply.) a. Review the patient's self-perception regarding spiritual health. b. Review the patient's view of his/her purpose in life. c. Discuss with family and associates the patient's connectedness. d. Ask whether the patient's expectations are being met. e. Impress on the patient that spiritual health is permanent once obtained.

ANS: A, B, C, D One critical thinking model for spiritual health evaluation lists the evaluation process as including a review of the patient's self-perception regarding spiritual health, the patient's view of his/her purpose in life, discussion with the family and close associates about the patient's connectedness, and determining whether the patient's expectations are being met. Attainment of spiritual health is a lifelong goal.

Spiritual distress has been identified in a patient who has been diagnosed with AIDS. Upon evaluating the following interventions, which are appropriate for the diagnosis of Spiritual distress? (Select all that apply.) a. Develop activities to heal body, mind, and spirit. b. Assess for potential suicide. c. Offer to pray with the patient. d. Teach relaxation, guided imagery, and meditation. e. Have patient avoid church attendance.

ANS: A, C, D Interventions that are appropriate for the nursing diagnosis of Spiritual distress include (1) helping the patient develop/identify activities to heal body, mind, and spirit; (2) offering to pray with the patient; and (3) teaching relaxation, guided imagery, and medication. Assessing for potential suicide would be appropriate for the nursing diagnosis of Hopelessness. Attendance at church should be encouraged.

15. A patient has trouble speaking words, and the patient's speech is garbled. Which nursing diagnosis is most appropriate for this patient? a. Hopelessness b. Impaired verbal communication c. Hearing loss d. Self-care deficit

ANS: B A patient with impaired verbal communication has defining characteristics such as an inability to articulate words, inappropriate verbalization, difficulty forming words, and difficulty comprehending. Hopelessness implies that the patient has no hope for the future. Hearing loss is not a nursing diagnosis. Just because a patient has garbled speech does not mean that a hearing loss has occurred; a physical problem such as a stroke could cause the garbled speech. Self-care deficit does not apply in this situation because this usually relates to bathing, grooming, etc.

7. A smiling patient angrily states, "I will not cough and deep breathe." How will the nurse interpret this finding? a. The patient's personal space was violated. b. The patient's affect is inappropriate. c. The patient's vocabulary is poor. d. The patient's denotative meaning is wrong.

ANS: B ANS: B An inappropriate affect is a facial expression that does not match the content of a verbal message (e.g., smiling when describing a sad situation). The patient is smiling but is angry, which indicates an inappropriate affect. The patient's personal space was not violated. The patient's vocabulary is not poor. Individuals who use a common language share denotative meaning: baseball has the same meaning for everyone who speaks English, but code denotes cardiac arrest primarily to health care providers. The patient's denotative meaning is correct for cough and deep breathe.

21. A confused older adult patient is wearing thick glasses and a hearing aid. Which intervention is priority to facilitate communication? a. Focus on tasks to be completed. b. Allow time for the patient to respond. c. Limit conversations with the patient. d. Use gestures and other nonverbal cues.

ANS: B Allowing time for the patient to respond will facilitate communication, especially for an older confused patient. Focusing on tasks to be completed and limiting conversations do not facilitate communication; in fact, they block communication. Using gestures and other nonverbal cues is not effective for visually impaired or cognitively impaired patients.

26. A patient says, "You are the worst nurse I have ever had." Which response by the nurse is the most assertive? a. "If I were you, I'd feel grateful for a nurse like me." b. "I feel uncomfortable hearing that statement." c. "How can you say that when I have been checking on you regularly?" d. "You shouldn't say things like that, it is not right."

ANS: B Assertive responses contain "I" messages such as "I want," "I need," "I think," or "I feel." Giving personal opinions ("If I were you") is nontherapeutic and not assertive. Arguing ("How can you say that?") is not assertive or therapeutic. Showing disapproval (using words like should, good, bad, right) is not assertive or therapeutic.

The patient is admitted with chronic back pain. The nurse who is caring for this patient should a. Focus on finding quick remedies for the back pain. b. Look at how pain influences the patient's ability to function. c. Realize that the patient's only goal is relief of the back pain. d. Help the patient realize that there is little hope of relief from chronic pain.

ANS: B Do not just look at the patient's back pain as a problem to solve with quick remedies, but rather look at how the pain influences the patient's ability to function and achieve goals established in life (not just pain relief). Mobilizing the patient's hope is central to a healing relationship.

11. During the initial home visit, a home health nurse lets the patient know that the visits are expected to end in about a month. The nurse is in which phase of the helping relationship? a. Pre-interaction b. Orientation c. Working d. Termination

ANS: B Letting the patient know when to expect the relationship to be terminated occurs in the orientation phase. Pre-interaction occurs before the nurse meets the patient. Working occurs when the nurse and the patient work together to solve problems and accomplish goals. Termination occurs during the ending of the relationship.

18. An elderly patient is wearing a hearing aid. Which technique should the nurse use to facilitate communication? a. Speak clearly and loudly. b. Turn off the television. c. Chew gum. d. Use at least 14-point print.

ANS: B Patients who are hearing impaired benefit when the following techniques are used: Check for hearing aids and glasses, reduce environmental noise, get the patient's attention before speaking, do not chew gum, and speak at normal volume—do not shout. Using at least 14-point print is for sight/visually impaired, not hearing impaired.

6. A nurse is sitting at the patient's bedside taking a nursing history. Which zone of personal space is the nurse using? a. Intimate b. Personal c. Social d. Public

ANS: B Personal space is 18 inches to 4 feet and involves such things as sitting at a patient's bedside, taking a patient's nursing history, or teaching an individual patient. Intimate space is 0 to 18 inches and involves such things as performing a physical assessment, bathing, grooming, dressing, feeding, and toileting a patient. Social zone is 4 to 12 feet and involves such things as making rounds with a physician, sitting at the head of a conference table, or teaching a class for patients with diabetes. Public zone is 12 feet and greater and involves such things as speaking at a community forum, testifying at a legislative hearing, or lecturing.

3. A nurse wants to present information about flu immunizations to the elderly in the community. Which type of communication should the nurse use? a. Interpersonal b. Public c. Transpersonal d. Small group

ANS: B Public communication is interaction with an audience. Nurses have opportunities to speak with groups of consumers about health-related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students. Intrapersonal communication is a powerful form of communication that occurs within an individual. Transpersonal communication is interaction that occurs within a person's spiritual domain. When nurses work on committees, lead patient support groups, form research teams, or participate in patient care conferences, they use a small group communication process.

The nurse is caring for a patient who claims that he does not believe in God, nor does he believe in an "ultimate reality." The nurse realizes that this patient a. Is devoid of spirituality. b. Is an atheist/agnostic. c. Finds no meaning through relationships with others. d. Believes that what he does is meaningless.

ANS: B Some individuals do not believe in the existence of God (atheist) or believe that there is no known ultimate reality (agnostic). This does not mean that spirituality is not an important concept for the atheist or the agnostic. Atheists search for meaning in life through their work and their relationships with others. Agnostics discover meaning in what they do or how they live because they find no ultimate meaning for the way things are. They believe that people bring meaning to what they do.

Which of the following statement about religion and spirituality is true? a. Religion is a unifying theme in people's lives. b. Spirituality is unique to the individual. c. Spirituality encompasses religion. d. Religion and spirituality are synonymous.

ANS: B Spirituality is a complex concept that is unique to each individual. Religion refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. People from different religions view spirituality differently. Although closely associated, spirituality and religion are not synonymous. Religious practices encompass spirituality, but spirituality does not need to include religious practice.

In discussing spiritual well-being, the nurse identifies that the vertical dimension involves a. The positive relationships and connections people have with others. b. The transcendent relationship between a person and God. c. Confidence in something for which there is no proof. d. Providing an attitude of something to live for and look forward to.

ANS: B The concept of spiritual well-being is often described as having two dimensions. The vertical dimension supports the transcendent relationship between a person and God or some other higher power. The horizontal dimension describes positive relationships and connections people have with others. Faith provides confidence in something for which there is no proof. When a person has the attitude of something to live for and look forward to, hope is present.

The nurse and the patient have the same religious affiliation. Because of this, the nurse a. Can assume that they have the same spiritual beliefs. b. Should not impose her personal values on the patient. c. Must use an assessment tool to assess the patient's beliefs. d. Can skip the spiritual belief assessment.

ANS: B The nurse can use an assessment tool or direct an assessment with questions based on principles of spirituality, but it is important not to impose personal value systems on the patient. This is particularly true when the patient's values and beliefs are similar to those of the nurse because it then becomes very easy to make false assumptions. It is important to conduct the spiritual belief assessment; conducting an assessment is therapeutic because it expresses a level of caring and support.

The patient is having a difficult time dealing with his AIDS diagnosis. He states, "It's not fair. I'm totally isolated from my family because of this. Even my father hates me for this. He won't even speak to me." The nurse needs to a. Assure the patient that his father will accept his situation soon. b. Use therapeutic communication to establish trust and caring. c. Point out that the patient has no control and that he has to face the consequences. d. Tell the patient, "If your father can't get over it, forget it. You have to move on."

ANS: B The nurse needs to use therapeutic communication to establish trust and a caring presence because providing spiritual care requires caring, compassion, and respect. The nurse should not offer false hope. The nurse should help the patient maintain feelings of control. The nurse should encourage renewing relationships if possible and establishing connections with self, significant others, and God.

8. The nurse asks a patient where the pain is, and the patient responds by pointing to the area of pain. Which form of communication did the patient use? a. Verbal b. Nonverbal c. Intonation d. Vocabulary

ANS: B The patient gestured (pointed), which is a type of nonverbal communication. Gestures emphasize, punctuate, and clarify the spoken word. Pointing to an area of pain is sometimes more accurate than describing its location. Verbal is the spoken word or message. Intonation or tone of voice dramatically affects the meaning of a message. Vocabulary consists of words used for verbal communication.

The nurse is caring for a patient who is terminally ill with very little time left to live. The patient states, "I always believed that there was life after death. Now, I'm not so sure. Do you think there is?" The nurse states, "I believe there is." The nurse has attempted to a. Strengthen the patient's religion. b. Provide hope. c. Support the patient's agnostic beliefs. d. Support the horizontal dimension of spiritual well-being.

ANS: B When a person has the attitude of something to look forward to, hope is present. Religion refers to the system of organized beliefs and worship that a person practices to outwardly express spirituality. This is not evident here. Agnostics believe that there is no known ultimate reality. This would indicate a lack of belief in life after death. The horizontal dimension of spiritual well-being describes positive relationships and connections people have with others. In this case, the patient is more concerned with the vertical dimension, which supports the transcendent relationship with God or some other higher power.

2. Which types of patients can cause challenging communication situations? (Select all that apply.) a. A male patient who is cooperative with treatments b. A female patient who is outgoing and flirty c. An older adult patient who is demanding d. An elderly patient who can clearly see small print e. A teenager frightened by the prospect of impending surgery f. A child who is developmentally delayed

ANS: B, C, E, F Challenging communication situations include patients who are flirtatious, demanding, frightened, or developmentally delayed. A child who has received little environmental stimulation possibly is behind in language development, thus making communication more challenging. Patients who are cooperative and have good eyesight (see small print) do not cause challenging communication situations.

16. Which person is the best referral for a patient who speaks a foreign language? a. A family member b. A speech therapist c. An interpreter d. A mental health nurse specialist

ANS: C ANS: C Interpreters are often necessary for patients who speak a foreign language. A family member can lead to legal issues, speech therapists help patients with aphasia, and mental health nurse specialists help angry or highly anxious patients to communicate more effectively.

2. A nurse believes that the nurse-patient relationship is a partnership, and that both are equal participants. Which term should the nurse use to describe this belief? a. Critical thinking b. Authentic c. Mutuality d. Attend

ANS: C Effective interpersonal communication requires a sense of mutuality, a belief that the nurse-patient relationship is a partnership, and that both are equal participants. Critical thinking in nursing, based on established standards of nursing care and ethical standards, promotes effective communication and uses such standards as humility, self-confidence, independent attitude, and fairness. To be authentic (one's self) and to respond appropriately to the other person are important for interpersonal relationships but do not mean mutuality. Attending is giving all of your attention to the patient.

The nurse is caring for a patient who is in the final stages of his terminal disease. The patient is very weak but refuses to use a bedpan, and wants to get up to use the bedside commode. What should the nurse do? a. Explain to the patient that he is too weak and needs to use the bedpan. b. Insert a rectal tube so that the patient no longer needs to actively defecate. c. Enlist assistance from family members if possible and assist the patient to get up. d. Put the patient on a bedpan and stay with him until he is finished.

ANS: C Establishing presence is part of the art of nursing. Presence involves "being with" a patient versus "doing for" a patient. Demonstrate a caring presence by listening to the patient's concerns and willingly involving family in discussions about the patient's health. The nurse should support patients as they make decisions about their health. If at all possible, the nurse should encourage the patient to maintain as much independence as possible. Inserting a rectal tube involves "doing for" instead of "being with." Placing the patient on the bedpan is against the patient's wishes and is another form of "doing for."

25. The nurse using critical thinking to enhance communication with patients is one who a. Shows sympathy appropriately. b. Uses automatic responses fluently. c. Self-examines personal communication skills. d. Demonstrates passive remarks accurately.

ANS: C Nurses who use critical thinking skills interpret messages received from others, analyze their content, make inferences about their meaning, evaluate their effects, explain rationales for communication techniques used, and self-examine personal communication skills. Sympathy is concern, sorrow, or pity felt for the patient and is nontherapeutic. Clichés and stereotyped remarks are automatic phrases that communicate that the nurse is not taking concerns seriously or responding thoughtfully. Passive responses serve to avoid conflict or to sidestep issues.

The nurse creates a referral to pastoral care when he/she realizes that the patient is in need of a. Psychiatric care. b. Return to religious affiliation. c. Spiritual care. d. Transfer to the psychiatric unit.

ANS: C Spiritual care helps people identify meaning and purpose in life, look beyond the present, and maintain personal relationships, as well as a relationship with a higher being or life force. The patient may need psychiatric care and may be transferred to the psychiatric unit, but referral to pastoral care will not provide that. Return to a religious affiliation may follow a return to spiritual health.

14. A patient was admitted 2 days ago with pneumonia and a history of angina. The patient is now having chest pain with a pulse rate of 108. Using the SBAR, which piece of data will the nurse use for B? a. Having chest pain b. Pulse rate of 108 c. History of angina d. Oxygen is needed.

ANS: C The B in SBAR stands for background information. The background information in this situation is the history of angina. Having chest pain is the Situation (S). Pulse rate of 108 is the Assessment (A). Oxygen is needed is the Recommendation (R).

When caring for a terminally ill patient, the nurse should focus on the fact that a. Spiritual care is possibly the least important nursing intervention. b. Spiritual needs often need to be sacrificed for physical care priorities. c. The nurse's relationship with the patient allows for an understanding of patient priorities. d. Members of the church or synagogue play no part in the patient's plan of care

ANS: C The nurse's relationship with the patient allows the nurse to understand the patient's priorities. Spiritual priorities do not need to be sacrificed for physical care priorities. When a patient is terminally ill, spiritual care is possibly the most important nursing intervention. If the patient participates in a formal religion, involve in the plan of care members of the clergy or members of the church, temple, mosque, or synagogue.

12. A nurse and patient take action to meet health-related goals. The nurse is in which phase of the helping relationship? a. Pre-interaction b. Orientation c. Working d. Termination

ANS: C The working phase occurs when the nurse and the patient work together to solve problems and accomplish goals. Pre-interaction occurs before the nurse meets the patient. Orientation occurs when the nurse and the patient meet and get to know each other. Termination occurs during the ending of the relationship

1. Which critical thinking standards should the nurse use to ensure sound effective communication with patients? (Select all that apply.) a. Faith b. Supportiveness c. Self-confidence d. Humility e. Independent attitude f. Spiritual expression

ANS: C, D, E A self-confident attitude is important because the nurse who conveys confidence and comfort while communicating more readily establishes an interpersonal helping-trusting relationship. In addition, an independent attitude encourages the nurse to communicate with colleagues and share ideas about nursing interventions. An attitude of humility is necessary to recognize and communicate the need for more information before making a decision. Faith, supportiveness, and spiritual expression are attributes of caring, not critical thinking standards.

19. When making rounds, the nurse finds a patient who is not able to sleep because of surgery in the morning. Which therapeutic response is most appropriate? a. "It will be okay. Your surgeon will talk to you in the morning." b. "Why can't you sleep? You have the best surgeon in the hospital." c. "Don't worry. The surgeon ordered a sleeping pill to help you sleep." d. "It must be difficult not to know what the surgeon will find. What can I do to help?"

ANS: D "It must be difficult not to know what the surgeon will find. What can I do to help?" is using therapeutic communication techniques of empathy and offering of self. False reassurances ("It will be okay" and "Don't worry") tend to block communication. Patients frequently interpret "why" questions as accusations or think the nurse knows the reason and is simply testing them.

The nurse is caring for a patient who has been diagnosed with a terminal illness. The patient states, "I just don't feel like going to work. I have no energy, and I can't eat or sleep." The patient shows no interest in taking part in his care. The nurse should a. Not be concerned about self-harm because the patient has not indicated any desire toward suicide. b. Ignore individual patient goals until the current crisis is over. c. Encourage the patient to purchase over-the-counter sleep aids to help him sleep. d. Assess the potential for suicide and make appropriate referrals.

ANS: D A decreased appetite and level of energy and not wanting to be involved in care are signs of hopelessness. The nurse should assess for risk of the patient harming himself or others. The nurse should set goals that are important to the patient. Recommending good sleep hygiene habits is more appropriate than giving over-the-counter sleep aids.

5. A nurse is standing beside the patient's bed. Nurse: How are you doing? Patient: I don't feel good. In this situation, which element is the feedback? a. Nurse b. Patient c. How are you doing? d. I don't feel good.

ANS: D ANS: D "I don't feel good" is the feedback because the feedback is the message the receiver returns. The sender is the person who encodes and delivers the message, and the receiver is the person who receives and decodes the message. The nurse is the sender. The patient is the receiver. "How are you doing?" is the message.

23. The patient that will cause the greatest communication concerns for a nurse is the patient who is a. Alert, has strong self-esteem, and is hungry. b. Oriented, pain free, and blind. c. Cooperative, depressed, and hard of hearing. d. Dyspneic, has a tracheostomy, and is anxious.

ANS: D Facial trauma, laryngeal cancer, or endotracheal intubation often prevents movement of air past vocal cords or mobility of the tongue, resulting in inability to articulate words. An extremely breathless person needs to use oxygen to breathe rather than speak. Persons with high anxiety are sometimes unable to perceive environmental stimuli or hear explanations. People who are alert, have strong self-esteem, and are cooperative and pain free do not cause communication concerns. Although hunger, blindness, and difficulty hearing can cause communication concerns, dyspnea, a tracheostomy, and anxiety all contribute to communication concerns.

The nurse is admitting a patient to the hospital. The patient states that he is a very spiritual person but does not practice any specific religion. The nurse understands that these statements a. Are contradictory. b. Indicate a strong religious affiliation. c. Indicate a lack of faith. d. Are reasonable.

ANS: D These statements are reasonable and are not contradictory. Many people tend to use the terms spirituality and religion interchangeably. Although closely associated, these terms are not synonymous. Religious practices encompass spirituality, but spirituality does not need to include religious practice. When a person has the attitude of something to live for and look forward to, hope is present.

4. Which technique will be most successful in ensuring effective communication? The nurse uses a. Interpersonal communication to change negative self-talk to positive self-talk. b. Small group communication to present information to an audience. c. Intrapersonal communication to build strong teams. d. Transpersonal communication to enhance meditation.

ANS: D Transpersonal communication is interaction that occurs within a person's spiritual domain. Many people use prayer, meditation, guided reflection, religious rituals, or other means to communicate with their "higher power." Interpersonal communication is one-on-one interaction between the nurse and another person that often occurs face to face. Meaningful interpersonal communication results in exchange of ideas, problem solving, expression of feelings, decision making, goal accomplishment, team building, and personal growth. Small group communication is interaction that occurs when a small number of persons meet. This type of communication is usually goal directed and requires an understanding of group dynamics. When nurses work on committees, lead patient support groups, form research teams, or participate in patient care conferences, they use a small group communication process. Intrapersonal communication is a powerful form of communication that occurs within an individual. For example, you improve your health and self-esteem through positive self-talk by replacing negative thoughts with positive assertions.

While administering medications, a nurse realizes that a prescribed dose of a medication was not given. The nurse acts by completing an incident report and notifying the patient's health care provider. The nurse is exercising: Authority. Responsibility. Accountability. Decision making.

Accountability. Accountability is nurses being answerable for their actions. It means that nurses accept the commitment to provide excellent patient care and the responsibility for the outcomes of the actions in providing it. Following institutional policy for reporting medication errors demonstrates the nurse's commitment to safe patient care.

applying digital pressure in a specified way on designated points on the body to relieve pain, produce analgesia, or regulate a body function

Acupressure

A patient presents to the emergency department following a motor vehicle crash and suffers a right femur fracture. The leg is stabilized and a full leg cast. Otherwise the patient has no major injuries, is in good health, and reports only moderate discomfort. Which is the most pertinent nursing diagnosis the nurse will include in the plan of care?

Acute pain

Which diagnosis will the nurse document in a patient's care plan that is NANDA approved?

Acute pain

Roy

Adaptation - nurses help patients cope/adapt to changes

therapeutic touch

Affects the energy field that surround and penetrate the human body with the conscious intent to help or heal. Blends ancient eastern traditions with modern nursing theory, TT uses energy of the provider to positively influence the pt's energy field. Evidence is inconclusive, may be effective in treating pain, dementia, trauma, and anxiety during acute and chronic illnesses. Contraindicated in situations when pts are sensitive to human interaction and touch

Evaluation

Allows nurses to determine whether nursing interventions are successful in improving a client's condition or well-being

The staff on the nursing unit are discussing implementing interprofessional rounding. Which of the following statements correctly describe interprofessional rounding? (Select all that apply.) Allows team members to share information about patients to improve care Provides an opportunity for early patient discharge planning Improves communication among health care team members Allows each of the health care team members to identify separate patient goals Allows each health care provider an opportunity to delegate a task.

Allows team members to share information about patients to improve care Provides an opportunity for early patient discharge planning Improves communication among health care team members Allowing team members to share information about patients to improve care, providing an opportunity for early patient discharge planning, and improving communication among team members all focus on the benefits of interprofessional rounding. This type of rounding has been found to decrease medication errors and improve quality of patient care. During interprofessional rounding all team members focus on the same patient goals.

Quality Improvement

An approach to the continuous study and improvement of the processes of providing health care services to meet the needs of clients and others

Evaluation involves what two components

An examination of a condition or situation and a judgment as to whether change has occurred.

11 Functional health patterns

An example of a structured database format, one approach to perform a comprehensive assessment. Gordon's functional health patterns model offers a holistic framework for assessment of any health problem. The health patterns are listed below.

Physical examination

An investigation of the body to determine its state of health. Techniques used: Inspection, palpation, percussion, auscultation, and smell. Examination includes: patient's height, weight, vital signs, and a head-to-toe examination of all the body systems.

Risk management

An organization's system of ensuring appropriate nursing care by identifying potential hazards and eliminating them before harm occurs.

Organ transplants

Anatomical Gift act says that if your 18 you can choose to donate. Their is an order of asking when in need of an organ donation as well, and the physician that pronounces the patient death cannot be the patient who does the transplant

A nurse asks a nursing assistive personnel (NAP) to help the patient in room 418 walk to the bathroom right now. The nurse tells the NAP that the patient needs the assistance of one person and the use of a walker. The nurse also tells the NAP that the patient's oxygen can be removed while he goes to the bathroom but to make sure that it is put back on at 2 L. The nurse also instructs the NAP to make sure the side rails are up and the bed alarm is reset after the patient gets back in bed. Which of the fol- lowing components of the "Five Rights of Delegation" were used by the nurse? (Select all that apply.) 1. Right task 2. Right circumstances 3. Right person 4. Right direction/communication 5. Right supervision/evaluation

Answer: 1, 2, 3, 4. The nurse provided 4 of the 5 components but did not provide the right supervision/evaluation. The nurse delegated the task of a patient to the bathroom to the NA, which is in the scope of an NAP's duties and responsibilities and matched to the NAP skill level. The nurse did provide clear directions by describing the task and the time period to complete the task. The nurse did not use "please" and "thank you" in the request. The nurse did not ask the if there were any questions which would provide the NAP an opportunity for get clarification if there were questions. The nurse did not ask the NAP to follow up to check on how the patient did or if there were any problems. The nurse did not provide appropriate monitoring, evaluation, intervention as needed, or feedback.

At 1200 the registered nurse (RN) says to the nursing assistive personnel (NAP), "You did a good job walking Mrs. Taylor by 0930. I saw that you recorded her pulse before and after the walk. I saw that Mrs. Taylor walked in the hallway barefoot. For safety, the next time you walk a patient, you need to make sure that the patient wears slippers or shoes. Please walk Mrs. Taylor again by 1500." Which characteristics of positive feedback did the RN use when talking to the nursing assistant? (Select all that apply.) 1. Feedback is given immediately. 2. Feedback focuses on one issue. 3. Feedback offers concrete details. 4. Feedback identifies ways to improve. 5. Feedback focuses on changeable things. 6. Feedback is specific about what is done incorrectly only.

Answer: 2, 3, 4, 5. These are characteristics of good feedback. The other options are not appropriate because the RN did not provide feedback immediately (the nursing assistant performed the task in the morning but the feedback was not given until the afternoon) and you should give both positive feedback as well as feedback to improve the incorrectly done tasks.

Which of the following are components of interprofessional collaboration? (Select all that apply.) 1. Interprofessional education does not impact the collaboration among interprofessional team members. 2. Nurses are often viewed as the team leader because of their decisions related coordination of patient care. 3. Effective interprofessional collaboration requires mutual respect and trust from all team members. 4. Open communication improves the collaboration among the interprofessional team members. 5. The goal of interprofessional collaboration is to improve the quality of patient care.

Answer: 2, 3, 4, 5. The nurse plays a critical role within the team and is often viewed as the team leader through coordination of communication and patient care. Open communication, cooperation, trust, mutual respect, and understanding of team member roles and responsibilities are critical for successful interprofessional collaboration. The development of these competencies comes through interprofessional education. A change in education and team training of healthcare practitioners is needed to build effective teams to improve interprofessional.

A patient asks a nurse what the patient-centered care model for the hospital means. What is the nurse's best answer? 1. "This model ensures that all patients have private rooms when they are admitted to the hospital." 2. "In this model you and the health care team are full partners 3. "This model focuses on making the patient experience a good one by providing amenities such as restaurant-style food service." 4. "Patients and families sign a document providing them full access to their medical charts."

Answer: 2. Patient- and family-centered care is based on the development of mutual partnerships between the patient, family and healthcare team to plan, implement, and evaluated the patient's health care. The patient and the family are at the center of the care and are full partners in decision making.

A nurse is teaching a patient about wound care that will need to be done daily at home after the patient is discharged. This is which priority nursing need for this patient? 1. Low priority 2. High priority 3. Intermediate priority 4. Nonemergency priority

Answer: 2. Teaching patients wound care for discharge is an intermediate priority. Intermediate priorities are nonemergency, non-life-threatening actual or potential needs that the patient and family members are experiencing.

A registered nurse performs the following four steps in delegating a task to a nursing assistant. Place the steps in the order of appro- priate delegation. 1. Do you have any questions about walking Mr. Malone? 2. Before you take him for his walk to the end of the hallway and back, please take and record his pulse rate. 3. In the next 30 minutes please assist Mr. Malone in room 418 with her afternoon walk. 4. I will make sure that I check with you in about 40 minutes to see how the patient did.

Answer: 3, 2, 4, 1. This is the sequence of effective delegation. Sandy delegated the task of walking a patient to Tony, which is in the scope of his duties and responsibilities and matched to his skill level. She provided clear directions by describing the task (the walk, taking and recording the pulse), the desired outcome (walk to the end of the hallway and back), and the time period (within the next 30 minutes). Sandy then told Tony that she would follow up with him to check how the patient did. By asking Tony if he had any questions she provided him an opportunity to ask questions for clarification.

5. While administering medications, a nurse realizes that a pre- scribed dose of a medication was not given. The nurse acts by completing an incident report and notifying the patient's health care provider. The nurse is exercising: 1. Authority. 2. Responsibility. 3. Accountability. 4. Decision making. 6. The staff on the nursing unit are discussing implementing

Answer: 3. Accountability is nurses being answerable for their actions. It means nurses accept the commitment to provide excellent patient care and the responsibility for the outcomes of the actions in providing that. Following institutional policy for reporting medication errors demonstrates the nurse's commitment to safe patient care.

Which example demonstrates a nurse performing the skill of evaluation? 1. The nurse explains the side effects of the new blood pressure medication ordered for the patient. 2. The nurse asks a patient to rate pain on a scale of 0 to 10 before administering the pain medication. 3. After completing the teaching, the nurse observes a patient draw up and administer an insulin injection. 4. The nurse changes a patient's leg ulcer dressing using aseptic technique.

Answer: 3. Evaluation is one of the most important aspects of clinical care coordination, involving the determination of patient outcomes. Observing a patient do a return demonstration of teaching is evaluation to ensure that patient has understood teaching. Option 2 is not evaluation, as it occurs prior to administering a pain medication. The other options are interventions.

After a nurse receives a change-of-shift report on his assigned patients, he prioritizes the tasks that need to be completed. This is an example of a nurse displaying which practice? 1. Organizational skills 2. Use of resources 3. Time management 4. Evaluation

Answer: 3. Completing a priority to-do list is a useful time-management skill. Change of shift report can help you sequence activities based on what you learn about the patients' conditions and the care the patient has received.

A nurse assesses patients and uses assessment findings to identify patient problems and develop an individualized plan of care. The nurse is displaying: 1. Organizational skills. 2. Use of resources. 3. Priority setting. 4. Clinical decision making.

Answer: 4. Clinical decision making depends on the application of the nursing process. You first complete a patient assessment so you are able to make accurate judgment about the patient's nursing diagnoses and health problems. The next step is to complete a plan of care for the patient. You use critical thinking in the clinical decision process.

Which task is appropriate for a registered nurse (RN) to delegate to a nursing assistant? 1. Explaining to the patient the preoperative preparation before the surgery in the morning 2. Administering the ordered antibiotic to the patient before surgery 3. Obtaining the patient's signature on the surgical informed consent 4. Helping the patient to the bathroom before leaving for the operating room

Answer: 4. Assisting the patient with toileting activities is within the scope of nursing assistive duties. The other activities require the skill and knowledge of the RN

Nursing Interventions

Any treatment, based on clinical judgment and knowledge, that a nurse performs to enhance patient outcomes.

Standards of care

Are legal requirements for nursing practice that describe minimum acceptable nursing care.

Types of Intentional:

Assault, Battery, false imprisonment

A nurse administers an antihypertensive medication to a patient at the scheduled time of 900. The nursing assistive personnel then reports to the nurse at the patient's blood pressure was low when it was taking at 08 30. The NAP states she was busy and had not had a chance to tell the nurse. The patient begins to complain of dizziness and light headed. The blood pressure is rechecked and it has dropped even lower. In which phase of the nursing process did the nurse first make an error?

Assessment

Which task is appropriate for a registered nurse (RN) to delegate to a nursing assistant? Explaining to the patient the preoperative preparation before the surgery in the morning Administering the ordered antibiotic to the patient before surgery Obtaining the patient's signature on the surgical informed consent Helping the patient to the bathroom before leaving for the operating room

Assisting the patient with toileting activities is within the scope of nursing assistive duties. The other activities require the skill and knowledge of the RN

based on the belief that health and wellness depend on a delicate balance between the mind, body and spirit.

Ayurvedic

one of the oldest systems of medicine practiced in india since the first century AD. treatments balance the doshas with a combination of dietary and lifestyle changes, herbal remedies and purgatives, massage, meditation and exercise

Ayurvedic medicine

14. A nurse is planning a teaching session about healthy nutrition with a group of children who are in first grade. The nurse determines that after the teaching session the children will be able to name three examples of foods that are fruits. This is an example of: A. A teaching plan. B. A learning objective. C. Reinforcement of content. D. Enhancing the children's self-efficacy.

B. A learning objective. A learning objective describes what the learner will do after the teaching session.

The nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline the nurse will follow? A. A living will allows an appointed person to make health care decisions when the patient is in an incapacitated state. B. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. C. The patient cannot make changes in the advance directive once admitted to the hospital. D. A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.

B. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state.

11. When a nurse is teaching a patient about how to administer an epinephrine injection in case of a severe allergic reaction, he or she tells the patient to hold the injection like a dart. Which of the following instructional methods did the nurse use? A. Telling B. Analogy C. Demonstration D. Simulation

B. Analogy Analogies use familiar images when teaching to help explain complex information.

A client comes to the clinic and is found to have an STD (sexually transmitted disease). The client states to the nurse, "Promise you won't tell anyone about my condition." the nurse, according to the Health Insurance Portability and Accountability (HIPAA) of 1996, must do which of the following? A. Honor the client's wishes B. Communicate only necessary information C. Not disclose any information to anyone D. Respect the client's privacy and confidentiality

B. Communicate only necessary information

10. A patient who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. Which teaching method does the nurse use? A. Simulation B. Demonstration C. Group instruction D. One-on-one discussion

B. Demonstration Demonstration is used to help patients learn psychomotor skills.

9. A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? A. Describing difficulties a family member has had in taking insulin B. Expressing the importance of learning the skill correctly C. Being able to see and understand the markings on the syringe D. Having the dexterity needed to prepare and inject the medication

B. Expressing the importance of learning the skill correctly Patients are ready to learn when they understand the importance of learning and are motivated to learn.

A 17-year-old patient, dying of heart failure, wants to have his organs removed for transplantation after his death. What action by the nurse is correct? A. Prepare the organ donation form for the patient to sign while he is still oriented. B. Instruct the patient to talk with his parents about his desire to donate his organs. C. Notify the physician about the patient's desire to donate his organs. D. Contact the United Network for Organ Sharing after talking with the patient.

B. Instruct the patient to talk with his parents about his desire to donate his organs.

A nurse is caring for a patient who recently had coronary bypass surgery. Which are legal sources of standards of care the nurse uses to deliver safe health care? (Select all that apply.) A. Information provided by the head nurse B. Policies and procedures of the employing hospital C. State Nurse Practice Act D. Regulations identified in The Joint Commission's manual E. The American Nurses Association standards of nursing practice

B. Policies and procedures of the employing hospital C. State Nurse Practice Act D. Regulations identified in The Joint Commission's manual E. The American Nurses Association standards of nursing practice

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? A. Family member B. Surgeon C. Nurse D. Nurse Manager

B. Surgeon

2. The nurse is planning to teach a patient about the importance of exercise. When is the best time for teaching to occur? (Select all that apply.) A. When there are visitors in the room B. When the patient's pain medications are working C. Just before lunch, when the patient is most awake and alert D. When the patient is talking about current stressors in his or her life

B. When the patient's pain medications are working C. Just before lunch, when the patient is most awake and alert Plan teaching when the patient is most attentive, receptive, alert, and comfortable.

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

C. Contact a child abuse hotline

4. The school nurse is about to teach a freshman-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes? A. Provide information using a lecture B. Use simple words to promote understanding C. Develop topics for discussion that require problem solving D. Complete an extensive literature search focusing on eating disorders

C. Develop topics for discussion that require problem solving Adolescents learn best when they are able to use problem solving to help them make choices.

You are the night shift nurse and are caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the first nursing action to take? A. Give the family the record B. Give the patient the record C. Discuss the issues that concern the family with them D. Call the nursing supervisor

C. Discuss the issues that concern the family with them

A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nursing manager because this action is a violation of which act? A. Mental Health Parity Act B. Patient Self-Determination Act (PSDA) C. Health Insurance Portability and Accountability Act (HIPAA) D. Emergency Medical Treatment and Active Labor Act

C. Health Insurance Portability and Accountability Act (HIPAA)

A nurse forgets to put the call light within the client's reach and then leaves the room. The client reaches for it and falls out of bed. The nurse could be charged with which of the following? A. Assault B. Battery C. Negligence D. Criminal Intent

C. Negligence

The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)? A. Discussing patient conditions in the nursing report room at the change of shift B. Allowing nursing students to review patient charts before caring for patients to whom they are assigned C. Posting medical information about the patient on a message board in the patient's room D. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

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

3. A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient? A. Teach the patient's spouse B. Focus on knowledge the patient will need in a few weeks C. Provide only the information that the patient needs to go home D. Convince the patient that learning about her health is necessary

C. Provide only the information that the patient needs to go home This patient is in denial; thus it is appropriate to only give her information that is needed immediately.

5. A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A. The patient will verbalize the steps involved in breast self-examination within 1 week. B. The nurse will explain the importance of performing breast self-examination once a month. C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. D. The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society.

C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. Return demonstration provides an excellent source of feedback and reinforcement to evaluate learning.

A nurse is sued for failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.) A. The nurse represents the plaintiff. B. The defendant must prove injury, damage, or loss. C. The person filing the lawsuit has the burden of proof. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury.

C. The person filing the lawsuit has the burden of proof. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury.

an array of health care approaches with a history of use or origins outside of mainstream medicine

CAM - complementary and alternative medicine

A nurse assesses patients and uses assessment findings to identify patient problems and develop an individualized plan of care. The nurse is displaying: Organizational skills. Use of resources. Priority setting. Clinical decision making.

Clinical decision making depends on the application of the nursing process. You first complete a patient assessment so you are able to make accurate judgment about the patient's nursing diagnoses and health problems. The next step is to complete a plan of care for the patient. You use critical thinking in the clinical decision process.

Defamation

Communications that are false

Negligence

Conduct that falls below a standard of care

Hope

Confident but uncertain expectation of achieving a future goal.

Limitations of meditation

Contraindicated for someone who has a strong fear of losing control. Also pts can become hypertensive during meditation and require a much shorter session than the average 15-20 session Also increases the effects of certain drugs. Prolong practice sometimes reduces the need of antihypertensive, thyroid- regulating, and psychotropic medications

mexican-american healing tradition. it encompasses acupuncture and homeopathy among other alternative modalities

Curanderismo

A client is to undergo an invasive procedure by a physician. The client is questioning some of the terminology in the consent form. Which of the following is the best response by the nurse? A. "You should have asked your physician when he was in here." B. "I'll explain whatever you don't understand." C. "Just sign the form, and I'll make sure your physician talks to you before he begins the procedure." D. "I'll call your physician back in the room to answer your questions."

D. "I'll call your physician back in the room to answer your questions."

A woman who is a Jehovah's Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood. What is the nurse's responsibility? A. Obtain a court order to give the blood B. Coerce the husband into giving the blood C. all security and have the husband removed from the hospital D. Abide by the husband's wishes and inform the health care provider

D. Abide by the husband's wishes and inform the health care provider

8. An older adult is being started on a new antihypertensive medication. In teaching the patient about the medication, the nurse: A. Speaks loudly. B. Presents the information once. C. Expects the patient to understand the information quickly. D. Allows the patient time to express himself or herself and ask questions.

D. Allows the patient time to express himself or herself and ask questions When teaching older adults, it is important to establish rapport, involve them in their care, and allow them to progress at their own pace.

Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. The administrator of the hospital decides to settle the lawsuit because the nurse is most likely to be found guilty of which of the following? A. An unintentional tort B. Assault C. Invasion of privacy D. Battery

D. Battery

Which of the following can be delegated to an UAP? A. Giving pain medication. B. Reporting to the doctor for an abnormal laboratory result. C. Inserting an IV catheter. D. Checking oral temperature.

D. Checking oral temperature.

A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws? A. Health Insurance Portability and Accountability Act (HIPAA) B. Americans with Disabilities Act (ADA) C. Patient Self-Determination Act (PSDA) D. Emergency Medical Treatment and Active Labor Act (EMTALA)

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

13. A nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing? A. Simulation B. Restoring health C. Coping with impaired function D. Health promotion and illness prevention

D. Health promotion and illness prevention Health promotion and illness prevention are the focus when nurses provide information to help patients improve their health and avoid illness.

1. A patient needs to learn to use a walker. Which domain is required for learning this skill? A. Affective domain B. Cognitive domain C. Attentional domain D. Psychomotor domain

D. Psychomotor domain Using a walker requires the integration of mental and muscular activity.

A nurse adds a nursing diagnosis to a patient care plan. Which information did the nurse document?

Decreased cardiac output it related to altered myocardial contractility

The patient database reviews that a patient has decreased oral take, decreased oxygen saturation when ambulating, reports shortness of breath when getting out of bed, and a productive cough. Which elements will the nurse identify as defining characteristics for the diagnostic label of activity intolerance?

Decreased oxygen saturation when ambulating and reports of shortness of breath when you getting out of bed

Libel

Defamation by means of print, writing or picture

Slander

Defamation by spoken word

A patient exhibits the following symptoms. Tachycardia, increased thirst, headache, decreased urine output it, and increased body temperature. The nurse analyzes the data. Which nursing diagnosis will the nurse assign to the patient?

Deficient fluid volume

Nursing Practice Acts

Describe and define the legal boundaries of nursing practice within each state.

2. Nutritional-metabolic pattern

Describes patient's daily/weekly pattern of food and fluid intake. Example: food preferences or restrictions, special diet, appetite; actual weight, weight loss or gain

8. Role-relationship pattern

Describes patient's patterns of role engagements and relationships

9. Sexuality-reproductive pattern

Describes patient's patterns of satisfaction and dissatisfaction with sexuality pattern; patient's reproductive patterns; premenopausal and postmenopausal problems

7. Self-perception-self-concept pattern

Describes patient's self-concept pattern and perceptions of self. Example: self-concept/worth, emotional patterns, body image

1. Health perception-health management pattern

Describes patient's self-report of health and well-being; how patient manages health. Example: frequency of health care provider visits, adherence to therapies at home; knowledge of preventative health practices

3. Elimination pattern

Describes pattern of excretory function. Example: bowel, bladder, and skin

4. Activity-exercise pattern

Describes patterns of exercise, activity, leisure, and recreation; ability to perform activities of daily living

5. Sleep-rest pattern

Describes patterns of sleep, rest, and relaxation.

11. Value-belief pattern

Describes patterns of values, beliefs including spiritual practices, and goals that guide patient's choices or decisions

6. Cognitive-perceptual pattern

Describes sensory-perceptual patterns; language adequacy, memory, decision-making ability

Nursing process- Study design

Design study protocol- select research design/methodlogy, identify sample population, select data collection method, select instrumentation, formulate analysis.

A charge nurse is evaluating a new nurses plan of care. Which finding the charge nurse to follow up?

Developing nursing diagnoses before completing the database

The nurse is reviewing a patient database for significant changes and discovers that the patient has not voided in over eight hours. The patients kidney function lab results are abnormal and the patient's oral intake has significantly decreased since previous shift. Which step of the nursing process should the nurse proceed to after this review?

Diagnosis

A nurse is using assessment data gathered about a patient in combining critical thinking to develop a nursing diagnosis. What is the nurse doing?

Diagnostic reasoning

A nurse performs an assessment on a patient. Which assessment data will the nurse use as an etiology for acute pain?

Disruption of tissue integrity

Data Documentation

Documentation should be timely, thorough, and accurate. Record all observations succinctly Pay attention to facts and be descriptive. Record objective information in correct, accurate terminology. Do not generalize or form judgements when entering data.

Who is by far the hottest Nursing student at lsue? (Hint not Ruby)

Dougie Fresh

Clinical application of relaxation therapy

Effectively lower blood pressure and heart rate, decrease muscle tension, improve well-being, and reduce symptom distress in people experiencing a variety of situations. Also reduces hypotension, depression, and menopausal symptoms Enables individuals to exert control over their lives.

Statutory Law

Elected legislative bodies such as state legislatures and the U.S. Congress

EMTALA

Emergency Medical Act Labor Act says that a screening occurs upon admission to the ER and that a patient can discharge the patient till they are stable to be transferred/discharged

Healthy People Initiative (by USDHHS) Healthy People 2020

Establishes ongoing health care goals; goals are to increase life expectancy, increase quality of life, eliminate health disparities through improved delivery of health care services

The nurse is reviewing a patient's plan of care, which includes the nursing diagnostic statement, impaired physical mobility related to tibial fracture as evidenced by patient inability to ambulate. Which part of the diagnostic statement does the nurse need to revise?

Etiology

Which example demonstrates a nurse performing the skill of evaluation? The nurse explains the side effects of the new blood pressure medication ordered for the patient. The nurse asks a patient to rate pain on a scale of 0 to 10 before administering the pain medication. After completing the teaching, the nurse observes a patient draw up and administer an insulin injection. The nurse changes a patient's leg ulcer dressing using aseptic technique.

Evaluation is one of the most important aspects of clinical care coordination, involving the determination of patient outcomes. Observing a patient do a return demonstration of teaching is evaluation to ensure that patient has understood teaching. Asking a patient to rate their pain on a scale is not evaluation but rather an assessment of the patient's pain because it occurs before administering a pain medication. The other options are interventions

(T or F) Evaluation is not integrated, ongoing nursing care activity

False

At 1200 the registered nurse (RN) says to the nursing assistive personnel (NAP), "You did a good job walking Mrs. Taylor by 0930. I saw that you recorded her pulse before and after the walk. I saw that Mrs. Taylor walked in the hallway barefoot. For safety, the next time you walk a patient, you need to make sure that the patient wears slippers or shoes. Please walk Mrs. Taylor again by 1500." Which characteristics of positive feedback did the RN use when talking to the nursing assistant? (Select all that apply.) Feedback is given immediately. Feedback focuses on one issue. Feedback offers concrete details. Feedback identifies ways to improve. Feedback focuses on changeable things. Feedback is specific about what is done incorrectly only.

Feedback focuses on one issue. Feedback offers concrete details. Feedback identifies ways to improve. Feedback focuses on changeable things. The other options (1 and 6) are not appropriate because the RN did not provide feedback immediately (the NAP performed the task in the morning, but the feedback was not given until the afternoon) and you should give both positive feedback and feedback to improve the incorrectly done tasks

Maslow's Hierarchy

Fifth Level-need for self-actualization, the state of fully achieving potential.

Maslow's Hierarchy

First Level-physiological needs like air, water, and food

Community-based Care

Focuses on health promotion, disease prevention, and restorative care; important because patients spend less time in acute care settings now

B) Counselor

Following a community assessment that focused on adolescent health behaviors, a nurse determines that a large number of adolescents smoke and designs a smoking cessation program at the youth community center. This is an example of which nursing role: A) Educator B) Counselor C) Collaborator D) Case manager

Maslow's Hierarchy

Fourth Level-encompasses esteem and self-esteem needs

Learning

Functional acquisition of new knowledge, attitudes, behaviors and skills through an expertise or external stimulus Glossary: acquisition of new knowledge and skills as a result of reinforcement, practice and experience

4. From the following list of indicators, determine which indicators are goals (G) and which indicators are outcomes (O). 1. _____ Will achieve pain relief 2. _____ Ambulates 10 feet down hallway 3. _____ Will remain free of infection 4. _____ Will be afebrile 5. _____ Reports pain severity reduced from 6 to a 4 on scale of 0 to 10 6. _____ Will gain improved mobility

GOGOOG

Vulnerable Populations

Groups of patients who are more likely to develop health problems as a result of excessive health risk, limited access to health care services, and dependency on others for their care

Confidentiality

HIPPA mandates the protection of patients personal health information

Coonnectedness

Having close spiritual relationships with oneself, others, and God or another spiritual being.

A patient with a spinal cord injury is seeking to enhance urinary elimination abilities by learning self catheterization versus assisted catheterization by home health nurses and family members. The nurse adds readiness for enhanced urinary elimination in the care plan. Which type of diagnosis did the nurse write

Health promotion

HEDIS

Healthcare Effectiveness Data & Information Set

Magnet Status

Healthcare that apply for this status must demonstrate quality patient care nursing excellence and innovations in professional practice.

A registered nurse (RN) is providing care to a patient who had abdominal surgery 2 days ago. Which task is appropriate to delegate to the nursing assistant? Helping the patient ambulate in the hall Changing surgical wound dressing Irrigating the nasogastric tube Providing brochures to the patient on health diet

Helping the patient with activity is within the scope of nursing assistive duties. The other activities require the skill and knowledge of the RN.

Which question would be most appropriate for a nurse to ask a patient to assist in establishing a nursing diagnosis of diarrhea?

How many bowel movement a day have you had?

Nursing process- Problem identification

Identify area of interest or clinical problem- review literature, formulate theoretical framework, identify study variables, devise research questions/hypothesis

E) All of the above

In identifying needs for health policy and health program development and services, a community assessment focuses on which of the following elements? A) Structure B) People C) Social systems D) Environments E) All of the above

Agnostic

Individual who believes that any ultimate reality is unknown or unknownable

Atheist

Individual who does not believe in the existence of God

Spiritual well-being

Individual's spirituality that enables a person to love, have faith and hope, seek meaning in life, and nurture relationships with others.

Cue

Information that a nurse obtain through the use of the senses (hearing, visual observations, touch, and smell).

A nurse is teaching a patient about wound care that will need to be done daily at home after the patient is discharged. This is which priority nursing need for this patient? Low priority High priority Intermediate priority Nonemergency priority

Intermediate priority Teaching patients wound care for discharge is an intermediate priority. Intermediate priorities are nonemergency, nonlife-threatening, actual or potential needs that the patient and family members are experiencing.

Type os Quasi Intentional

Invasion of privacy

Felony

Is a crime of serious nature that has a penalty of imprisonment for longer than 1 year or even death.

Misdemeanor

Is a less serious crime that has a penalty of a fine or imprisonment for less than 1 year.

organ transplantation or donation is not considered

Islam

Common Law

Judicial decisions made in court when individual legal cases are decided.

example of Magnet Status

Leadership, structural empowerment, exemplary, professional practice, new knowledge innovation and improvements and empirical quality results.

Health Care Proxy or Durable power of Attorney for health care (DPAHC)

Legal document that designates a person or persons of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf.

Nightingale"s Environmental Theory

Links patient's health with their environment Ex.) sanitary conditions, ventilation, light, nutrition

Common databases

MEDLINE, CINAHL, PubMed

Observational overview using cues and forming inferences.

Male patient in bed, looks uncomfortable. Patient presents with discomfort in surgical area. Cues - Lies still with arms along sides; tense - States has not turned for some time - Reports pain a 7 on a scale of 0 to 10 Inferences - Pain is severe - Pain limits patient's ability to move and reposition self

Unintentional tort

Malpractice/ negligence

Outcomes management

Managing the individual clinical outcomes of clients as a result of prescribed treatments

Clinical applications of meditation

Mediation reduces overall systolic and diastolic blood pressures and significantly reduce hypertensive risk and reduce relapses in alcohol treatment programs. Pts suffering from PTSD and chronic pain also benefit from mindfulness meditation. Increases productivity, improves mood, increases sense of identity, and lowers irritability.

MHPA

Mental Health Parity Act requires that insurance companies offer as much care for mental health as they do for surgical or medical care

By comparing the client's actual response (e.g., behaviors and physiological signs and symptoms) to nursing interventions with expected outcomes established during planning, you determine if goals of care are

Met

NCQA

National Committee for Quality Assurance

Uninentional Torts

Negligence or Malpractice

Unintentional Tort

Negligence, malpractice

Systems theory

Neuman's system theory defines a total person model of wholism and an open-systems approach,

Henderson

Nurse assists patient with 14 activities until patient can meet needs for themselves or to help patient have a peaceful death.

Which of the following are components of interprofessional collaboration? (Select all that apply.) Interprofessional education does not impact the collaboration among interprofessional team members. Nurses are often viewed as the team leader because of their coordination of patient care. Effective interprofessional collaboration requires mutual respect and trust from all team members. Open communication improves the collaboration among the interprofessional team members. The goal of interprofessional collaboration is to improve the quality of patient care.

Nurses are often viewed as the team leader because of their coordination of patient care. Effective interprofessional collaboration requires mutual respect and trust from all team members. Open communication improves the collaboration among the interprofessional team members. The goal of interprofessional collaboration is to improve the quality of patient care. The nurse plays a critical role within the team and is often viewed as the team leader through coordination of communication and patient care. Open communication, cooperation, trust, mutual respect, and understanding of team member roles and responsibilities are critical for successful interprofessional collaboration. Developing these competencies comes through interprofessional education. A change in education and team training of health care practitioners is needed to build effective teams to improve interprofessional collaboration

Interview Techniques

Observation, Open-ended questions, Back Channeling, proving, direct Closed-ended questions(to acquire specific info accurately such as symptoms), Leading Qs(can be risky and limiting)

Community-Based Nursing

Occurs in community settings; focuses on the needs of an individual or family; enhances capacity for self-care and promotes autonomy; reduces costs for the patient by providing care near homes

Holistic

Of or pertaining to the whole; considering all factors

Restraints

Omnibus Reconciliation act-includes chemical restraints in with restraints restraint protocol is strict because restraints are emotionally and physically harmful

A, B, C, and E

On the basis of an assessment, the nurse identifies an increase in the immigrant population group in the community. How would the nurse determine the health needs of this population? (All that apply) A) Identify what the immigrant population views as the two most important health needs. B) Apply info from Healthy People 2020. C) Determine how the population uses available health care resources. D) Determine which health care agencies will accept immigrant populations. E) Identify perceived barriers for health care.

system

Output is the end product of a system and, in the case of the nursing process, it is defined as whether the patient's health status improves or remains stable as a result of nursing care. Input consists of the data that come from a patient's assessment. Feedback serves to inform a system about how it functions. Content is the product and information obtained from the system.

developing a PICOT question

P-patient population of interest I-intervention of interest C-comparison of interest O-outcome T-time

Present Illness or Health Concerns

PQRST - Provoks: Precipitating factors -Quality: describe what the symptoms feels like -Radiate -Severity: on a scale of 0 to 10 is baseline to compare in follow-up assessments. - Time: Onset and duration & Concomitant symptoms - other symptoms along with the primary symptom

Patient bill of rights

Part of PPACA that prevents health care institutions from denying coverage due to prior conditions, limits of care, or paperwork mistakes (this made a bunch of "pre-existing conditions" Eligible for health care as of 2014 and did away with life limits on who deserves care)

A patient asks a nurse what the patient-centered care model for the hospital means. What is the nurse's best answer? "This model ensures that all patients have private rooms when they are admitted to the hospital." "In this model you and the health care team are full partners in decisions related to your health care." "This model focuses on making the patient experience a good one by providing amenities such as restaurant-style food service." "Patients and families sign a document providing them full access to their medical charts."

Patient- and family-centered care is based on the development of mutual partnerships among the patient, family, and health care team to plan, implement, and evaluate the patient's health care. The patient and the family are at the center of the care and are full partners in decision making

Patient adherence

Patients and families invest time in carrying out required treatments to achieve patient goals.

Model for quality improvement and performance improvement: PDSA

Plan-review data Do-select an intervention and implement the change Study-evaluate the results of the change Act-incorporate practices if change is sucessful

Health disparities

Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations

Criminal Laws

Protect society as a whole and provide punishment for crimes, which are defined by municipal, state and federal legislation.

Civil Laws

Protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrong or violations occur.

Confidentiality

Protects private patient information once it ha been disclosed in health care settings.

Leininger's Culture Care Theory

Provide the patient with culturally specific care

Informed Consent

Pt right to know all the risks/ benefits prior to signing consent for care Key Elements: 1) the patient receives an explanation of procedure/treatment 2) knows the names and qualifications of those providing care 3) knows the risks/harm 4) knows alternatives to the care option 5) knows that they can refuse 6) know that they can still refuse after the procedure has begun

Licensure and NCLEX

RN have to take the NCLEX and get licensure in their state. The state board of nursing will also revoke a license if they violate the Nurse practice Act

Regulatory Law or Administrative Law

Reflects decisions made by administrative bodes such as State Boards of Nursing when they pass rules and regulations

Holistic Nursing

Regards and treats the mind-body- spirit of the patient; interventions such as relaxation therapy, music therapy, touch therapies, and guided imagery

Limitations of imagery

Relative few side effects May cause increase anxiety and fear when used to treat PTSD and social anxiety. Pts with COPD and asthma experience increased airway constriction when using

Living wills

Represent written documents that direct treatment in accordance with a patient's wishes in the even of a terminal illness or condition.

Restraints

Restraints can be used only to (1) ensure the physical safety of the patient or other patients (2) when less restrictive interventions are not successful (3)only on the written order of a health provider

A nurse asks a nursing assistive personnel (NAP) to help the patient in room 418 walk to the bathroom right now. The nurse tells the NAP that the patient needs the assistance of one person and the use of a walker. The nurse also tells the NAP that the patient's oxygen can be removed while he goes to the bathroom but to make sure that it is put back on at 2 L. The nurse also instructs the NAP to make sure the side rails are up and the bed alarm is reset after the patient gets back in bed. Which of the following components of the "Five Rights of Delegation" were used by the nurse? (Select all that apply.) Right task Right circumstances Right person Right direction/communication Right supervision/evaluation

Right task Right circumstances Right person Right direction/communication The nurse provided four of the five components but did not provide the right supervision/evaluation. The nurse delegated the task of taking a patient to the bathroom to the NAP, which is in the scope of an NAP's duties and responsibilities and matched to the NAP skill level. The nurse provided clear directions by describing the task and the time period to complete the task. The nurse did not use "please" and "thank you" in the request. The nurse did not ask the if there were any questions, which would provide the NAP an opportunity to get clarification if there were questions. The nurse did not ask the NAP to follow up to check on how the patient did or if there were any problems. The nurse did not provide appropriate monitoring, evaluation, intervention as needed

Counselor

Role: Help patients identify and clarify health problems and choose appropriate courses of action to solve those problems

Educator

Role: Help your patients assume responsibility for their own health care

Change Agent

Role: Identifying and implementing new and more effective approaches to problems

Epidemiologist

Role: Involved in case finding, health teaching, and tracking incident rates of an illness

Caregiver

Role: Manage and care for the health of patients and families in the community; use a critical thinking approach to apply the nursing process and ensure appropriate, individualized nursing care for specific patients and their families

Patient Advocate

Role: Provide the info necessary for patients to make informed decisions in choosing and using services appropriately; support and defend patients' decisions

Case Manager

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

Collaborator

Role: Working in a combined effort with all those involved in care delivery

it is Wednesday, and the hospital menu contains Salisbury steak. which religion would you have to order something different for the patient?

Russian Orthodox

Webster v. Reproductive Health Services

Says that viability tests must be conducted terminations if over 28 weeks

Maslow's Hierarchy

Second Level-safety and security needs

Faith

Set of beliefs and a way of relating to self, others and a Supreme Being

Values

Set of standard that influence behavior; personal beliefs about the worth of a given idea, attitude, custom, or an object

a practitioner that provides rituals for healing and normally enters a trance state during. usually seen in native american cultures

Shaman

Spirituality

Spiritual dimension of a person, including the relationship with humanity, nature, and a supreme being

Nursing students

Students are liable for their actions being within their scope of practice and held to the standards that RN are now. Only when at school though, when working as a CNA, your scope of practice is as a CNA

Types of Data:

Subjective data- Patients' verbal descriptions of their health problems. Includes feelings, perceptions, and self-report of symptoms. Objective data- Observations or measurements of a patient's health status. Be clear, precise and consistent.

incorporating breath, movement, and meditation to cleanse, strengthen and circulate vital life energy and blood, stimulate the immune system; and maintain external and internal balance

Tai chi

Transcendence

The belief that there is a force outside of and greater than the person that exists beyond the material world.

short staffing

The community of Health Accreditation Program (CHAP) and other state and federal standards require agencies to have guidelines for determining the number( staffing ratios) of nurses required to give care to a specific number of patients.

Validation of Assessment Data

The comparison of data with another source to determine data accuracy. Compare with unclear interview information and physical examination findings.

Assessment

The deliberate and systematic collection of information about a patient to determine his or her current and past health and functional status and his or her present and past coping patterns.

A, B, and D

The nurse caring for a Bosnian community identifies that the children are undervaccinated and the community is unaware of the resources. The nurse assesses the community and determines that there is a health clinic within a 5-mile radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources. Which of the following practices is the nurse providing? (All that apply) A) Providing community resources for the children B) Teaching the community about health promotion and illness prevention C) Providing autonomy in decision-making about health practices D) Improving the health care of the community's children E) Participating in professional development activities to maintain nursing competency

A, C, B

The nurse in a new community-based clinic is requested to complete a community assessment. Order the steps for completing this assessment. A) Structure or locale B) Social systems C) Population

The nurse manager from the surgical unit was awarded the nursing leadership award for practice of transformational leadership. Which of the following are characteristics or traits of transformational leadership displayed by award winner? (Select all that apply.) The nurse manager regularly rounds on staff to gather input on unit decisions. The nurse manager sends thank-you notes to staff in recognition of a job well done. The nurse manager sends memos to staff about decisions that the manager has made regarding unit policies. The nurse manager has an "innovation idea box" to which staff are encouraged to submit ideas for unit improvements. The nurse develops a philosophy of care for the staff.

The nurse manager regularly rounds on staff to gather input on unit decisions. The nurse manager sends thank-you notes to staff in recognition of a job well done The nurse develops a philosophy of care for the staff. . Nurse managers who practice transformational leadership are focused on change and innovation. They motivate and empower their staff with the focus on team development. The manager will spend time on the unit with the staff, sharing ideas and listening to staff input. The manager is enthusiastic about opportunities to enhance the team and shows appreciation and recognizes team members for good work. The manager holds the team accountable and provides support for the team members in the stressful health care environment

Interpreting Assessment Data:

The patterns of data reveal meaningful and usable clusters. Data cluster- A set of signs or symptoms that you group together in a logical way.

Health Care Provider's Order

The physician writes the orders and the nurse carries them out but if the nurse feels that they providers orders harm the patient or violate agency policy you need to tell a supervisor. Also, if you don't keep your physician informed of the patient condition since that is the nurses job, you can be sued for malpractice

A, B, and C

The public health nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2020. In the immigrant community, most of the population does not have a primary care provider, nor do they participate in health promotion activities; the unemployment rate in the community is 25%. How does the nurse determine which goals need to be included or updated? (All that apply) A) Assess the health care resources within the community. B) Assess the existing health care programs offered by the county health department. C) Compare existing resources and programs with Healthy People 2020 goals. D) Initiate new programs to meet Healthy People 2020 goals. E) Implement educational sessions in the schools to focus on nutritional needs of the children.

Privacy

The right of patients to keep personal information from being disclosed.

maslows levels

The third level contains love and belonging needs, including family and friends. The first level includes physiological needs. The second level includes safety and security needs. The fourth level encompasses esteem and self-esteem needs. The fifth and final level is the need for self-actualization.

Delegation

The transfer of a responsibility for the performance of an activity from one person to another while retaining accountability for the outcome

Peplau's Interpersonal Theory

Therapeutic relationship between nurse and patient; pre-orientation, orientation, working phase, resolution

Maslow's Hierarchy

Third Level-love and belonging needs like friendship, social relationships, and sexual love

After a nurse receives a change-of-shift report on his assigned patients, he prioritizes the tasks that need to be completed. This is an example of a nurse displaying which practice? Organizational skills Use of resources Time management Evaluation

Time management Completing a priority to-do list is a useful time-management skill. Change-of-shift report can help you sequence activities on the basis of what you learn about the patients' conditions and the care the patient has received

The purpose of conducting evaluative measures is

To determine if you met the expected outcomes, not if the nursing interventions were completed. They are the standards against which the nurse judges if goals have been met and if care is successful

After assessing a patient, a nurse develops a standard formal nursing diagnosis. What is the rationale for the nurses actions?

To distinguish the nurses role from the physicians role

"life in balance" -which manifests as lustrous hair, a radiant complexion, engaged interactions, a body that functions without limitations and emotional balance

Traditional Chinese medicine

Standards of death

Uniform determination of death act- 2 standards of death 1) cardiopulmonary cessation of respiratory and pulmonary function 2) irreversible cessation of brain function These are important especially for organ donors and organ preservation

clinical applications of imagery

Use in a number of pediatric and adult pts. Helps control or relive pain, decrease nightmares, and improve sleep. Aids in treatment of chronic conditions such as asthma, cancer, sickle cell anemia, migraines, auto immune disorders, atrial fib, functional urinary disorders, menstrual and premenstrual syndromes, gastrointestinal disorders such as irritable bowel syndromes and ulcerative colitis, and rheumatoid arthritis

A, B, D, and E

Using Healthy People 2020 as a guide, which of the following would improve delivery of care to a community? (All that apply) A) Community assessment B) Implementation of public health policies C) Home safety assessment D) Increased access to care E) Determining rates of specific illnesses

Imagery

Visualization is a mind-body therapy that uses the conscious mind to create mental images to stimulate physical changes in the body, improve perceived well-being, and/or enhance self-awareness. Being with slow breathing, then direct pt to visualize a specific image such as ocean waves... then instruct the pt to take notice of the smells, sounds, and temperatures that he/she is experiencing

belief that "living organisms are fundamentally different from on living entities because they contain some non-physical element or are governed by different principles than are inanimate things"

Vitalist

B and C

Vulnerable populations of patients are those who are more likely to develop health problems as a result of...(All that apply) A) Living at home B) Abusive habits C) Immigration D) Middle age

theorists

When applying Orem's theory, a nurse continually assesses a patient's ability to perform self-care and intervenes as needed to ensure that the patients meet physical, psychological, sociological, and developmental needs. According to Orem, people who participate in self-care activities are more likely to improve their health outcomes. Leiniger's culture care theory focuses on culture diversity and provides culturally specific nursing care. According to Peplau, nurses help patients reduce anxiety by converting it into constructive actions, using therapeutic communication. Nightingale's grand theory is a patient's environment can be manipulated by nurses to restore a patient to health. Neuman views a patient as being an open system that is in constant energy exchange with the environment that the nurse must help cope with stressors. King views a patient as a unique personal system that is constantly interacting/transacting with other systems that the nurse helps with goal attainment. Levine believes nurses promote balance between nursing interventions and patient participation to assist in conserving energy needed for healing. Johnson perceives patients as a collection of subsystems that forms an overall behavioral system focusing on balance.

A, B, C, and E

Which of the following are major public health problems commonly affecting older adults? (All that apply) A) Substance abuse B) Confusional states C) Financial limitations D) Communicable diseases E) Acute and chronic physical illnesses

Intentional tort

Willful acts that violate another's rights such as assault, battery, and false imprisonment.

nursing theory

a conceptualization of some aspect of nursing that describes, explains, predicts or prescribes nursing care.

Felony

a criminal law that has a serious offense that results in significant harm to another person or society in general. these crimes carry penalties of monetary restitution, imprisonment for greater than 1 year, or death.

CAM

a group of diverse medical and health care systems, practice, and products that are not presently considered to be part of conventional medicine

Adverse reaction

a harmful or unintended effect of a medication, diagnostic test, or therapeutic intervention.

Health Care Proxies or durable power of attorney for Heath care (DPAHC)

a legal document that designates a person or people of one's choosing to make health care decisions when a patient is no longer able to make health care decisions on his or her own behalf.

biofeedback

a mind-body technique that uses instruments to teach self-regulation and voluntary self-control over specific physiological response. Electronic and electromechanical instruments measure, process, and provide information to pts about their muscle tension, cardiac activity, respiratory rate, brain-wave patterns, and autonomic nervous system activity. Increases the persons awareness of internal processes that are linked to illness and distress. Can change thinking, emotions, and behaviors Immediately demonstrates to pts their ability to control some physiological responses and the relationship among thoughts, feelings, and physiological responses (more effective to traditional relaxation)

informed consent

a patient's agreement to have a medical procedure after receiving full disclosure of risks, benefits, alternatives, and consequences of refusal. Failure to obtain consent in situations other than emergencies can result in a claim of battery -key elements of informed consent include: (1) the patient receives an explanation of the procedure or treatment; (2)the patient receives the names and qualifications of people performing and assisting in the procedure; (3) the patient receives a description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort; (4)the patient receives an explanation of alternative therapies to the proposed procedure/treatment and the risks of doing nothing; (5)the patient knows that he or she has the right to refuse the procedure/treatment without discontinuing supportive care; (6) the patient knows that he or she may refuse the procedure/treatment even after the procedure has begun

autopsy

a postmortem examination, the priority for giving consent is (1) the patient, in writing before death (2) durable power (3) surviving spouse (4)surviving child, parent, or sibling in the order named

Standing order

a preprinted document containing orders for the conduct of routine therapies, monitoring guidelines, or diagnostic procedures for patients with identified clinical problems.

evidence-based practice

a problem solving approach to clinical practice that integrates the conscientious use of best evidence incombination with a clinicians expertise in making descisions about patients care.

invasion of privacy

a quasi-intentional tort that protects a patient's right to be free from unwanted intrusion into his or her private affairs.

problem focused trigger

a question you face while caring for a client

meta-analysis and systematic review

a researcher asks a PICOT question, reviews the evidence available, summarizes what is currently known, and reports of evidence supports a change in practice or if furthur study is needed.

self-transendence

a sens of authentically connecting to one's inner self. this contrasts with transcendence, the belief that a force outside of an greater than the person exists beyond the material world.

Code of Ethics

a set of guidelines that all professional accept; ANA code of Ethics is( a nurse in all professional relationships, practices with compassion and respect for the inherent dignity, worth, ad uniqueness of every individual, unrestricted by consideration of social or economic status, personal attributes, or the nature of health problems)

spiritual distress

a state of suffering related to the impaired ability to experience meaning in life through connections with self, others, the world, or a superior being. spiritual distress also occurs when there is conflict between a person's beliefs and prescribed health regimens or the inability to practice usual rituals.

Deontology

a system of ethics that defines actions as hight or wrong based on their "right-making characteristics such as fidelity to promises, truthfulness, and justice" doesn't look at the consequences of actions

Hospice

a system of family centered care that eases the pain of terminal illness

phenomenon

a term description or label given to describe an idea or responses about an event, situation, process, a group of events or situations.

concept mapping

a visual representation that allows you to show the connections among a patient's many health problems.

Clinical practice guideline

a.k.a. "protocol"; is a document that guides decisions and interventions for specific health care problems or conditions.

christianity (health care beliefs, response to illness, and implications for health and nursing)

accepts modern medical science. complementary or alternative medicine often followed. followers use prayer, faith healing. they appreciate visits form clergy. some use laying on of hands. holy communion is sometimes practiced. anointing of the sick is given when patient is ill or near death (catholic). christians usually favor of organ donation. health is important to maintain. allow time for patients to pray by themselves or with family or friends.

Sikhism (health care beliefs, response to illness, and implications for health and nursing)

accepts modern medical science. females are to be examined by females. removing undergarments causes great distress. provide time for devotional prayer. allow use of religious symbols.

Buddhism (health care beliefs and response to illness)

accepts modern medical science. followers sometimes refuse treatment on Holy Days. nonhuman spirits invading body cause illness. followers may want a buddhist priest. followers usually accept death as last stage of life and permit withdrawal of life support. followers of not practice euthanasia. they often do not take time off from work or family responsibilities when sick.

Hinduism (health care beliefs, response to illness, and implications for health and nursing)

accepts modern medical science. past sins cause illness. prolonging life is discouraged. allow time for prayer and purity rituals. allow use of amulets, rituals, and symbols.

Psychomotor Learning

acquiring motor skills that require coordination and integration of mental and physical movements such as the ability to walk or use an eating utensil

Activities of daily living (ADLs)

activities usually performed in the course of a normal day such as ambulation, eating, dressing, bathing, and grooming.

quasi-intentional torts

acts in which intent is lacking but volitional action and direct causation occur such as in invasion of privacy and defamation of character

acupuncturists insert needles into the skin in specific areas aling channels called

acupoints

types of manipulative and body based therapies:

acupressure, chiropractic med, craniosacral therapy, massage therapy

Regulates or realigns vital energy (qi), which flows through channels in the form of a system of pathways called meridians

acupuncture

regulates or realigns the vital energy (qi), which flows like a river through the body channels that form a system of 20 pathways called meridians. an obstruction in these channels blocks energy flow in other parts of the body

acupuncture

prescriptive theories

address nursing interventions for a phenomenon, describe the conditions under which nursing interventions occur.

prescriptive

address nursing interventions, guide practice change, predict consequences

active progressive relaxation is not appropriate for patients with...? what is more appropriate?

advanced disease or decreased energy reserves- passive relaxation or guided imagery is more appropriate

Abandoning an Assignment

after establishing a patient-provider relationship you cannot abandon their care or it is abandonment. *BEFORE* establishing that relationship a nurse can refuse an assignment if: 1) you lack knowledge of skills to do the assignment 2) care exceeds the Nurse care act expectations 3) nurse or unborn child is threatened by assignment 4) orientation not done for the unit 5) basis of moral, ethical, or religious grounds 6) clinical judgement impaired due to fatigue resulting in risk to patients

a pt states that he does not believe in a higher power but instead believes that people bring meaning to what they do. this patient is most likely an?

agnostic

these people discover meaning in what they do or how they live because they find no ultimate meaning for the way things are. they believe that people bring meaning to what they do

agnostic

Fidelity

agreement to keep promises and the unwillingness to abandon patients

some baptists, evangelicals and pentecostals discourage the use of what?

alcohol ad caffiene

Documentation of evaluative findings allows...

all members of the health team to know whether a client is progressing or not

licensure

all states use NCLEX for RNs and licensed practical nurse examinations. Licensure permits people to offer special skills to the public, and it also provides legal guidelines for protection of the public.The State Board of Nursing suspends or revokes a license if a nurse's conduct violates the Nurse Practice Act, which is a state law.Due process means that the state must required to notify nurses of the charges brought against them.

conventional western medicine

allopathic or biomedicine

faith

allows people to have firm beliefs despite lack of physical evidence.

used for skin disorders, including inflammation and acute injuries (used topically)

aloe

when ________ is taken orally, it may enhance the effects of laxatives

aloe

Health Care Financing Administration

also protects privacy in health care like HIPAA

Imagery evokes:

alterations in gastric secretions, body chemistry, blood flow, wound healing, and heart rate and use of senses.

a patient decides that a meditative practice that includes yoga and other lifestyle changes is more helpful than allopthic approach-this patient decides to use this as a primary approach. in this case what is yoga?

alternative therapy

these therapies sometimes include the same interventions as complementary therapies; but they become the primary treatment

alternative therapy

quality improvement

an approach to the continuous study and improvement of the process of providing health care services

assault

an intentional threat toward another person that places the person in reasonable fear or harmful, imminent, or unwelcome contact. no actual contact is required for assault to occur. For example , it is an assault for a nurse to threaten to give a patient an injection or to threaten to restrain a patient for an x-ray film procedure when the patient has refused consent.

research proces

an orderly series of steps that allow a researcher to answer a question.

performance improvement

an organization analyzes and evaluates current performance and uses the results to improve actions.

Nursing process- data analysis

analyze the results of the study, interpret demographics of study population, results, conclusions, and limitations.

Meditation

any activity that limits stimulus input by directing attention to a single unchanging or repetitive stimulus so the person is able to become more aware of self. It's purpose so to become mindful, increasing our ability to live freely and escape destructive patterns of negativity. It is self-directed; it does not necessarily require a teacher and can be learned through books or audiotapes. Involve slow, relaxed, deep, abdominal breathing that evokes a restful state, lowers oxygen consumptions, reduces respiratory and heart rates, and reduce anxiety

dislike hospitals external locus of control folk healers tend to not follow medical regimens

appalachians

nature controls life and health

appalachians

Nurse Practice Acts

are specific to each state and they define the legal limits of nursing and scope of care. It defines nursing role

Occurrence Report or incident reports

are used in conjunction with risk managment and institutions study for recurrence and high risk situations prone to incidence

outcomes research

assesses and documents then effectiveness of health care services and interventions

Examples of Continuing Care

assisted living, psychiatric, older adult day care

people who do not believe in the existence of god

atheist

Nonmaleficence

avoidance of harm or hurt

types of whole medical systems:

ayurvedic medicine, homeopathic medicine, Latin american traditional healing, native american traditional healing, naturopathic medicine, and traditional Chinese medicine

you are caring for a hospitalized pt who is muslim and has diabetes. which of the following items do you need to remove from the meal tray when it is delivered to the pt?

bacon and eggs

when would allopathic therapy be used

bacterial infections chronic diseases

Levine

balance between nurse and patient to conserve energy for healing

whole medical systems

based on different philosophies and life systems

Discharge Planning

begins the moment a patient is admitted to a health care facility

connectedness

being interpersonally connected within oneself.

Judaism (health care beliefs, response to illness)

believes in sanctity of life. balance between God and medicine. observance of sabbath important. treatments sometimes refused on sabbath. visiting sick is obligation. there is an obligation to seek care, exercise, sleep, eat well, and avoid drug and alcohol abuse. euthanasia is forbidden. life support is discouraged.

a mind body technique that uses instruments to teach self regulation and voluntary self control over specific physiological responses

biofeedback

electronic or electromechanical instruments measure process and proved info to patients about their muscle tension, cardiac activity, respiratory rates, brain wave patterns, and autonomic nervous system activity

biofeedback

mind body technique that uses instruments to teach self regulation and voluntary self control over specific physiological responses is what

biofeedback

process providing a person with visual or auditory information about autonomic physiological functions of the body such as muscle tension, skin temp, and brain wave activity through the use of instruments

biofeedback

Training-specific therapies

biofeedback, acupuncture, therapeutic touch, traditional Chinese medicine, chiropractic therapy, natural products and herbal therapies

types pf mind body interventions:

biofeedback, breathwork, guided imagery, meditation, music therapy, tai chi, yoga

Components of the Nursing health history

biographical information, reason for seeking health care(patient's statement is not diagnostic, it is perception), patient expectations, present illness or health concerns, health history, family history, psychosocial history(stress coping, parent's support system), spiritual health, review of systems(subject data)

Examples of Preventative Care

blood pressure and cancer screening, immunizations, mental health counseling, crisis prevention, seat belts/airbags, helmets

homeopathic medicine

body heals itself

using a variety of breathing patterns to relax, invigorate, or open emotional channels

breathwork

fast only on holy days and only vegetable broth

buddhism

followers sometimes refuse treatment on holy days nonhuman spirits invading body cause illness followers usually accept death as the last stage of life and permit withdraw of life support

buddhism

nonhuman spirits invading the body cause illness

buddhism

some are vegetarians and do not use alcohol. many fast on holy days

buddhism

this unsafe herb contains varying amounts of carcinogenic cis-isoasarone-side effects include fever and digestive aid

calamus (indian type is most toxic)

Autopsy

can be requested or required by family or institution. Post-mordum examination

Examples of Restorative Care

cardiovascular and pulmonary rehabilitation, sports medicine, spinal cord injury programs, home care

external factors outside the patient system

changes in health care policy or an increase in the crime rate.

Vulnerable Populations

children, women and older adults are most threatened by urbanization

manipulating the spinal column, includes physiotherapy and diet therapy

chiropractic therapy

followers use prayer appreciate visits from clergy holy communion is sometimes practiced anointing of the sick

christianity

Torts

civil wrongful acts or omissions made against a person or property. they are classified as intentional, quasi-intentional or unintentional

results or conclusions

clinical and research articles summary section.

Evaluative measures are assessment skills or techniques that you use to

collect data for evaluation

unsafe herb that is an antitussive that contains carcinogens-hepatotoxic

coltsfoot

unsafe herb used for wound healing and acute injuries, used as antiinlammatory

comfrey

Autonomy

commitment to include patients in decisions about care; freedom from external control; protecting a patient's independence

surveys

common in quantitative research, obtain information from populations

"to whom do you go to for support in times of difficulty"

community

therapies used in addition to or together with conventional treatment recommended by a persons health care provider

complementary therapies

a person with chronic pain uses yoga to encourage flexibility and relaxation at the same time that non-steroidal antiinflammatory or opioid meds are prescribed. in this case, what kind of therapy is yoga?

complementary therapy

what kind of therapy is chiropractic therapy?

complementary therapy

alternative

complementary treatment used as primary treatment

Self-Efficacy

concept included in social learning theory, refers to a persons perceived ability to successfully complete a task.

variable

concept, chracteristic, or trait that vary among subjects.

navajos (health care beliefs, response to illness, and implications for health and nursing)

concepts of health have fundamental place in their concept of humans and their place in the universe. blessing way is practice that attempts to remove ill health by means of stories, songs, rituals, prayers, symbols, and sand paintings.

the pulses provide information of what in TCM?

condition of the balance of the qi

transpersonally

connected with God, or an unseen higher power.

interpersonally

connected with other and the environment

being intrapersonally connected within oneself; interpersonally connected with others and the environment; and transpersonally connected with God or an unseen higher power

connectedness

theory

contains a set of concepts, definitions, and assumptions or propositions that explain a phenomenon.

introduction

contains info about the purpose of the article

Malpractice Insurance

contract between a provider and insurance company that provides professional defense coverage in the instance that malpractice occurs

allopathic

conventional western medicine

allopathic or biomedical

conventional western medicine

Skills during interview for Effective communication

courtesy(greeting, HIPPA), comfort(set aside 10-15min, do not overtire the patient), connection(eue cpmtact. open-ended Q), confirmation(ask the patient to summarize the discussion)

assessing the craniosacral motion for rate, amplitude, symmetry, and quality and attuning/aligning the spinal column, cerebrospinal fluid and rhythmic processes, releasing restrictions or abnormal barriers to motion

craniosacral therapy

Professional Standards Review Organizations(PSRO)

created by the government to review quality, quantity, and cost of health care

self directed imagery based on the principle of mind body connectivity

creative visualization

self directed imagery based on the principle of mind body connectivity-every mental image leads to physical or emotional changes

creative visualization

misdemeanor

crime that causes injury but not serious harm

Misdemeanor

criminal law, crime that causes injury but does not inflict serious harm. For example parking in a no-parking zone is this type of violation of traffic laws. This usually has a penalty of a monetary fine, forfeiture, or brief imprisonment.

During evaluation you should apply

critical thinking to make clinical decisions and redirect nursing care to best meet client needs

spirituality depends on:

culture, development, life experiences, beliefs and ideas about life

TCM: placing a heated cup on the skin to create a slight suction

cupping

placing a heated cup on the skin to create a slight suction

cupping

Regulatory law or administrative law

decisions made by administrative bodies such as State boards of Nursing when rules and regulations are passed. An example of a regulatory law is the requirement to report incompetent or unethical nursing conduct to the State Board of Nursing

what characterizes the relaxation response?

decreased heart rate and respiratory rate, blood pressure, and oxygen consumption and increased alpha brain activity and peripheral skin temperature

nursing diagnoses for patient education

deficient knowledge bad health/home maintenance and self-health management noncompliance

Intentional Tort

deliberate acts that violate another's right

intentional torts

deliberate acts that violate another's rights such as assault, battery, and false imprisonment

descriptive theory

describe phenomena and identify circumstances in which phenomena occur

Learning Objective

described behaviors the learner will exhibit as a result of successful instruction

Managed Care

describes health care systems where the provider receives a predetermined capitated payment for each patient

nonexperimental research

descriptive studies that explain or predict phenomna

Positive evaluations occur when you meet... and they also lead you to conclude ....

desired outcomes your interventions were effective

It sometimes becomes necessary to collect evaluative measures over time to

determine if a pattern of change exists

Peplau's theory

develop interaction between nurse and patient. (ex. nurse facilitates interpersonal relationships)

inductive reasonig

develops generalizations or theories from specific observations

Secondary and Tertiary Care

diagnosis and treatment of illness are traditionally the most common services

types of biologically based therapies:

dietary supplements, herbal medicines, mycotherapies, probiotics

DNR

do not resuscitate order or "no code" Provider and patient has to agree to this. If not DNR you still have to resuscitate

drug interactions with chamomile

drugs that cause drowsiness (alcohol, barbituates, benzodaizepines, narcotics, antidepressents)

drug interactions with echinacea

drugs that weaken the immune system

Diagnosis Related Groups(DRG's)

each group has a fixed reimbursement amount

used for upper respiratory tract infections

echinacea

Examples of Secondary Acute Care

emergency care, acute medical surgical care, radiologic procedures for acute problems

Integrative health care

emphasize the importance of the relationship between practitioner and patient; focuses on the whole person; is informed by evidence; an makes use of appropriate therapeutic approaches, health care professional and disciplines to achieve optimal health

PSDA

enacted in 1991 required that health care institutions provide written information to patients concerning their rights to make decisions including refusing treatment

Patient- Self Determination Act

enacted in 1991 requires health care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives. under PSDA a patent's record needs to document whether or not the patient has signed an advanced directive. For living wills or durable powers of attorney for health care to be enforced, a patient must be declared legally incompetent or lack the capacity to make decisions regarding their own health care treatment.

Good Samaritan Laws

encourage health care professionals to assist in emergencies and protect them from liabilty if you stop and help within *your scope of practice*

unsafe herb used as a central nervous system stimulant, bronchodilator, weight loss and cardiac stimulation-unsafe for people with hypertension

ephedra

Prospective Payment System (PPS)

established by congress, eliminated cost-based reimbursement

the FICA assessment tool

evaluates spirituality and is closely correlated to quality of life. F- Faith or Belief I- Importance and Influence C- Community A- Address (interventions to address)

Health care organizations are responsible for

evaluating and improving the quality of client care services they provide

Input

ex.how the patient interacts with the environment and the patients physiological function.

Interdisciplinary theory

explains a systematic view of phenomenon specific to the discipline of inquiry.

methods or design

explains how research study was organized and conducted to answer the research question.

clinical implications

explains if the findings from a study should be applied in practice

Affective Learning

expressions and feelings and development of values, attitudes and beliefs.

HITECH Act

extended HIPAA to the new social media demands and extended the privacy to include social media/networking

appalachians (health care beliefs, response to illness, and implications for health and nursing)

external locus of control. nature controls life and health. accept folk healers. they dislike hospitals. tend to not follow medical regimens but expect to be helped directly when seeking episodic treatment. they become anxious in unfamiliar settings. encourage communication with family and friends when ill.

What does FICA stand for?

f-faith or belief i-importance and influence c-community a-address

Nightingales theory

facilitate the reparative processes of the body by manipulating the patients environment. (ex. noise, nutrition, hygiene, light, comfort, socialization, and hope.)

Justice

fairness

"tell me if you have a higher power or authority that helps you act on your beliefs"

faith

allows people to have firm beliefs despite lack of physical evidence

faith

used for wound healing and arthritis

feverfew

what does yang represent?

fire, light and excitement-outer part -bowels, stomach, and bladder

yang

fire, light, and excitement outer part (bowels, stomach, and bladder)

descriptive theories

first level of theory development, explain patient assessments.

Return Demonstration

first watch the educator, then pt. has a chance to practice (preparing a syringe, bathing an infant, crutch walking, etc.)

Concept Mapping

fist step organize the assessment data you collect. Placing all of the cues together into the clusters then look for patterns leads to next step of the nursing process, nursing diagnosis.

Feminist ethics

focus of inequalities between people; they look to the nature of relationships for guidance

Primary Health Care

focuses on improved health outcomes for an entire population, health promotion ex. health education, family planning, immunizations

Mischel's theory of uncertainty in illness

focuses on patients experiences with cancer while living with continual uncertainty, helps nurses understand how patients cope.

Benner and Wrubel's theory

focuses on patients need for caring as a means of coping with illness. Caring is central to the essence of nursing.

Ethics of care

focuses on understanding relationships, especially personal narratives; issues beyond the individual relationships such as ethical concerns about the structures win which individual caring occurs such a health care facilities

Neuman

focuses on wellness and disease prevention

the ability to identify, differentiate, maintain attention on and return attention to simple stimuli for an extended period

focusing

Cognitive skills included in relaxation therapy

focusing (ability to identify, differentiate, maintain attention on, and return attention to simple stimuli for extended period) Passivity (ability to stop unnecessary goal-directed and analytic activity) Receptivity (ability to tolerate and accept experiences that are uncertain, unfamiliar, or paradoxical)

russian orthodox church dietary regulations

followers observe fast days and a no-meat rule on wednesdays and fridays. during lent all animal products, including dairy products and butter, are forbidden.

what is the long term goal of relaxation therapy?

for people to continually monitor themselves for indicators of tension and consciously let go and release the tension contained in various body parts

Motivation

force that acts on or within a person to cause the person to behave in a particular way (idea, emotion, physical need). Glossary: Internal impulse that causes a person to take action

Nursing process- Use of the findings

formulate recommendations for further research, determine implications for nursing, disseminate the findings

the scientific method

foundation of research and most reliable and objective method to gain knowledge.

Problem-oriented assessment

from the specific to the general

used for elevated cholesterol levels and hypertension

garlic

most common natural products

garlic, echinacea, saw palmetto, ginkgo biloba, cranberry, soy, ginseng, black cohos, St. John's wort, glucosamine, peppermint, fish oil/omega 3, and milk thistle

empirical data

gathered through the use of observations and assessments and use the data to discover new knowledge

used for nausea and vomiting

ginger

used for alzheimers disease and dementia

gingko biloba

used for age related diseases

ginseng

chiropractic touch

goal: restore structural and functional imbalances Joint manipulation, physical therapies, lifestyle counseling Improves acute pain and disability, enhances conventional treatment of pediatric asthma Contraindicated for: bone infections, fractures, dislocations, osteoporosis

confidentiality

guarantees that any information a subject provides will not be reported in any manner that identifies the subject.

concentrating on an image or series of images to treat pathological conditions

guided imagery

spiritual well being scale (SWB)

has 20 questions that assesses a patient's relationship with God and his or her sense of life purpose and life satisfaction.

hope

has several meanings that vary on the basis of how it is being experienced; it usually refers to an energizing source that has an orientation of future goals and outcomes.

spiritual well-being

has two dimensions; one dimension supports the transcendent relationship between a person and God or a higher power. the other dimension describes positive relationships and connections that people have with others.

biofield therapy; uses gentle touch directly or closely on or close to body to influence and support the human energy system and bring balance to the whole body (physical, spiritual, emotional, and mental); a formal education and certification system provides credentials for practitioners

healing touch

types of energy therapies:

healing touch, Reiki therapy, therapeutic touch,

Buddhism (cont.) (implications for health and nursing)

health is an important part of life. good health is maintained by caring for self and others. medications are not always accepted because of belief that chemical substances in body are harmful.

joy

heart

shock

heart/kidney

Neuman's theory

help individuals obtain total wellness through interventions. (ex. stress reduction)

Restorative Care

help individuals regain maximal functional status and enhance quality of life through promotion of independence and self care

plant based therapies used in whole systems of medicine or as individual preparations by allopathic providers and consumers for specific symptoms or issues

herbal medicine

accepts modern medical science past sins cause illness prolonging life is discouraged

hinduism

not allowed chicken

hinduism

some sects are vegetarians. the belief is to not kill any living creature

hinduism

example of transcendent moment

holding a new baby or looking at a beautiful sunset

developed in germany and practiced in the US since the mid 1800s. it is a system of medical treatments based on the theory that certain diseases can be cured by giving, small, highly diluted doses of substances made from naturally occuring plant, animal or mineral substances that stimulate the vital force of the body so it can heal itself

homeopathic medicine

Roy's theory

identifies types of demands placed on patients. (ex. we help patient adapt to them)

Risk Management

identify possible risks, analyze them, act to reduce the risks, and evaluate the steps that you need to take to reduce them. Also requires complete documentation

nursing research

identifys new knowledge, improves professional education and practice, and uses resources effectively.

mind body therapy that uses the conscious mind to create mental images to stimulate physical changes in the body.....

imagery

Teaching

imparting knowledge through a series of directed activities

"your illness has kept you from attending church. is that a problem for you"

importance of spirituality

quality improvement

improves work processes to improve patient outcomes and efficiency of health systems.

Using Neuman's theory

in practice nurses focus their care on the systems response to stressors.

biofeedback may be helpful:

in stroke recovery, smoking cessation, ADHD, epilepsy, headache disorders, and a variety of gastrointestinal and urinary tract disorders.

Functional Illiteracy

inability to read above a 5th grade level

Considerations for the appropriateness of meditation

include a persons's degree of self-discipline' it requires ongoing practice to achieve lasting results.

Integrated Delivery Networks (IDNs)

include a set of providers and services organized to deliver a continuum of care to a population of patients at a capitated cost in a particular setting

Integrative nursing role (priorities)

include assessing the public use of complementary therapies, teaching the principles of integrative health care across all professional educational programs, teaching the public to inform health care providers when using various therapeutics as self-care and health promotion strategies, improving public education about these therapies, and supporting studies that examine the safety and effectiveness of these therapies.

unintentional tort

include negligence or malpractice

the evidence supporting the effectiveness of TT is...

inconclusive

native americans dietary regulations

individual tribal beliefs influence food practices.

feedback

informs the system of how it functions

exploratory research

initial study designed to develop or refine the dimensions of phenomena.

fosters calm, positive, and peaceful feelings despite life experiences of chaos, fear and uncertainty

inner peace

this emphasizes the importance of the relationship between practitioner and patient;focuses on the whole person; is informed by evidence; and makes use of appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health

integrative health care

defined as a "way of being-knowing-doing that advances the health and well being of people, families, and communities through caring-healing relationships"

integrative nursing

Focus of teaching

intellectual growth or the acquisition of new knowledge or psychomotor skills.

Skilled Nursing Facility

intermediate care, offers skilled care from a licensed nursing staff

causes of disease according to TCM: originate in emotions and affect different organs

internal causes

"describe which activities give you comfort spiritually"

interventions to address spiritual needs

Involuntary/voluntary admission

involuntary occurs when the patient is determined to be a danger to themselves or others and when this happens the hospital has to get it approved by a court within 96 hours and if that is granted the hospital can hold the individual up to 21 days for psychiatric treatment

natural product

is a chemical compound or substance produced by a living organism and includes herbal medicines (as known as botanicals), dietary supplements, vitamins, minerals, mycotherapies (fungi based), essential oils (aromatherapy), and probiotics

traditional Chinese medicine

is a whole system of medicine that began approximately 3600 years ago. Views health as "life in balance", which manifest as lustrous hair, a radiant complexion, engaged interactions, a body that functions without limitation, and emotional balanced. Disease occurs when there is an imbalance in yin and yang

battery

is an intentional offensive touching without consent or lawful justification. the contact can be harmful to the patient and cause an injury, or it can merely be offensive to the patient's personal dignity.

acupuncture

is one of the oldest practices in the world. regulates or reigns the vital energy (qi)

Relaxation response

is the state of generalized decreased cognitive, physiological, and/or behavioral arousal. This process elongates the muscle fibers, reduces the neural impulses sent to the brain, and thus decreases the activity of the brain and other body systems. Causes a decreased heart and respiratory rate, blood pressure, oxygen consumptions and increased alpha brain activity and peripheral skin temperature/

consumption of pork and alcohol is prohibited. followers fast during the month of ramadan

islam

not allowed bacon, pork chops, ham, alcohol and fast during ramadan

islam

use faith healing family members are comfort group prayer is strengthening believe that time of death is predetermined and cannot be changed

islam

will not eat blood pudding because it contains blood from the sausage

jehovahs witnesses

believes in sanctity of life visiting sick is an obligation life support is discouraged observance of the sabbath

judaism

some observe the kosher dietary restrictions

judaism

this group only eats kosher foods

judaism

Common law

judicial decisions on individual legal cases establishes common law ex. pt. right to refuse treatment, negligence, malpractice

Legal limits of nursing

know your limits legally as an RN so that you can advocate for your patient and care for them but not venture out of your scope of practice

All nurses are responsible for ____

knowing their state practice acts of nursing and what the rules and regulations are that they must abide by as well as the policies and procedures of the actual institution that you work for

Quasi-intentional Tort

lacking intent but still violates another's rights

curanderismo is a latin american traditional healing system that includes a humoral model for classifying food, activity, illnesses and series or fold illnesses. the goal is to create a balance between the patient and his or her environment, therby sustaining health

latin american traditional healing

Statutory Law

laws made based on past decisions made by courts/ judicial systems or institutions can be civil or criminal

Assisted Living

long term care setting with an environment more like home & greater resident autonomy.

American Holistic Nurses Association

maintains Standards of Holistic Nursing Practice

manipulating soft tissue through stroking, rubbing, or kneading to increase circulation, improve muscle tone and provide relaxation

massage therapy

activity that limits stimulus input by directing alteration to a single unchanging or repetitive stimulus so the person is able to become more aware of self

meditation

any activity that limits stimulus input by directing attention to a single unchanging or repetitive stimulus so the person is able to become aware of self

meditation

self directed practice for relaxing the body and calming the mind with focused rhythmic beat

meditation

this therapy increases productivity, improves mood, increases sense of identity, and lowers irritability

meditation

what can sometimes increase the effects of certain drugs?

meditation

mormonism dietary regulations

members abstain from alcohol and caffeine.

jehovah's witnesses dietary regulations

members avoid food prepared with or containing blood.

attentional set

mental state that allows learner to focus

manuscript narrative

middle section, or narrative of the article

middle-range theories

more limited in scope and less abstract, focuses on a specific field of nursing.

When professional nurses think in terms of outcomes management, their actions become

more purposeful and focused on improving the condition of their client's health

TCM: burning moxa, a cone or stick of dried herbs that has healing properties on or near the skin

moxibustion

burning moxa, cone or stick of dried herbs that has healing properties on or near the skin

moxibustion

Islam (health care beliefs and response to illness)

must be able to practice five pillars of islam. sometimes has fatalistic view of health. muslims use faith healing. family members are comfort. group prayer is strengthening. they often permit withdrawal of life support. they do not practice euthaniasia. they believe that time of death is predetermined and cannot be changed. they maintain sense of hope and often avoid discussions of death.

causes of disease according to TCM: additional causes of disharmony include congenital weak constitutions (birth defects), trauma overexertion, excessive sexual activity, poor quality diet and parasites/poison

non external, noninternal causes

King's theory

nurse uses communication to help patient adapt (ex. adapt to environment)

Henderson

nurse works with other health care professionals to help patient gain independence. ex. Henderson's 14 basic needs

Floating

nurses who are required to float must inform their supervisors of inexperience or lack of skill they may have

care delivery outcomes

observable and measurable effects of some intervention or action

TCM four methods of evaluating pt's conditions

observing hearing/smelling asking/interviewing touching/palpating

what are the 4 methods TCM practitioners use to evaluate a patients condition?

observing, hearing/smelling, asking/interviewing, and touching/palpating

Nursing process- conducting the study

obtain necessary approvals and recruit subjects, implement the study protocol and collect data.

slander

occurs when one speaks falsely about another

literaure review or background

offers an argument about what led the author to conduct the study

spirituality

often defined as an awareness of one's inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself.

malpractice

one type of negligence and often referred to as professional negligence. when nursing care falls below a standard of care, this results. Certain criteria are necessary to fall under nursing malpractice: (1)the nurse (defendant) owed a duty of care to the patient (plaintiff) (2) the nurse did not carry out or breached that duty (3)the patient was injured, and (4)the nurse's failure to carry out the duty caused the injury

tai chi

originally a martial art that is now viewed as a moving meditation in which pts move their bodies slowly, gently, and with awareness while breathing deeply

qi gong

originally a martial art, now viewed as a series of carefully choreographed movements or gestures that are designed to promote and manipulate the flow of qi within the body

slow abdominal breathing exercises while imagining warmth and relaxation flowing through specific body parts such as lungs or hands

passive relaxation

to still the mind and body intentionally w/o the need to tighten or relax any particular body part

passive relaxation

Nursing Sensitive Outcomes

patient outcomes and select nursing workforce characteristics that are directly related to nursing care

paradigm

pattern of thought, used to describe the domain of a discipline. The elements of the NURSING PARADIGM direct the activity of the nursing profession.

Value

personal belief about the worth of a given idea, attitude, custom or object that sets standard that influence behavior

Domain

perspective of a profession, provides bot a practical and theoretical aspect of the discipline.

Lifesaving measures

physical care techniques that are used with a patient's physiological or psychological state is threatened.

internal factors that exist within a patient system

physiological and behavioral responses to illnesses

method of body movement used to strengthen, lengthen and improve the voluntary control of muscles and muscle groups, especially those used for posture and core strengthening

pilates

cupping

placing a heated cup on the skin to create a slight suction

unsafe herb used for antirrhuematic and anticancer-do not use with children

pokewood

hypotheses

predictions made about the relationship or difference between study variables

Cautions using acupuncture when:

pregnancy, history of seizures, and immunosuppression Contraindicated in people who have bleeding disorders and skin infections

Never events

preventable errors including falls, urinary tract infections, and pressure ulcers

HIPAA

prevents employees from losing health insurance when transferring jobs and ensures confidentiality and privacy in health care

what are the external six "evils" causes of disease

primarily linked to weather and climate ( wind, cold, fire, damp, summer heat, and dryness)

live microorganisms (most cases bacteria) that are similar to beneficial microorganisms found in the human gastrointestinal system; also called good bacteria

probiotics

content

product and information obtained from the system.

Pay for Performance

program along with public reporting of hospital data designed to promote quality, effective, and safe patient care

person learns how to effectively rest and reduce tension in the body is what

progressive relaxation

slow, deep abdominal breathing while tightening and relaxing an ordered succession of muscle groups, focusing on associated bodily sensations while letting go of extraneous thoughts

progressive relaxation

this training teaches an individual how to effectively rest and reduce tension in the body

progressive relaxation

with this relaxation, a person learns to differentiate between high intensity tension, subtle tension and relaxation by practicing with different muscle groups

progressive relaxation

National Organ Transplant Act

prohibits the sale or purchase of transplant organs

Preventive nursing actions

promote health and prevent illness to avoid the need for acute or rehabilitative health care.

Watson's theory

promote health, restore health, and prevent illness (ex. involves the science of caring)

Public Health Laws

protect populations, advocate for the rights of people, regulate health care and health care financing, and ensure professional accountability for care provided.

criminal law

protect society as a whole and provide punishment for crimes, which are defined by municipal, state, and federal legislation. Separated into misdemeanor or felonies

Civil Law

protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur. The consequences of civil laws are fines or specific performance of good works such as public service. Nursing negligence or malpractice is an example of civil law violation

Civil (statutory) laws

protect the rights of individuals when civil violations occur ex. protect the patient when civil violation like malpractice or negligence occurs

Patient Protection and Affordable Care Act

protects 1) consumer rights and protections 2) Affordable Health Care coverage 3) Increased access to care 4) stronger medicare to improve the vulnerable

Americans with Disability Act (ADA)

protects rights of people with physical or mental disabilities

Adult Day Care Centers

provide a variety of health and social services to specific patient populations who live alone or with family in the community

Extended Care Facility

provide intermediate medical, nursing, or custodial care for patients recovering from acute or chronic illness or disability

standard-based/theoretical assessment

provides for a comprehensive review of a patient's health care problems. (e.g. functional health patterns: from the general to the specific)

Health Insurance Portability and Accountability Act (HIPAA)

provides rights to patients and protects employees. It protects individual employees from losing their health insurance when changing jobs by providing portability. It allows individual employees to change jobs without losing their coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group health insurance coverage. In the privacy section of HIPAA there are standards regarding accountability in the health care setting. These rules create patient right to consent to the use and disclosure of their protected health information, to inspect and copy one's medical record, and to amend mistaken or incomplete information.

Respite Care

provides short term relief or time off for people providing home care to an older adult.

Leininger's theory

providing care with knowledge and caring as central force. (ex using emerging science)

Home Care

provision of medically related professional services provided to families in their homes

evidence based practice

purpose is to use information from research, professional experts, personal experience, and patient preference to determine safe and effective nursing care.

research

purpose is to use systematic inquiry to answer questions, solve problems, and contribute to the general knowledge base of nursing.

TCM: originally a martial art that is now viewed as a series of carefully choreographed movements or gestures that are designed to promote and manipulate the flow of qi within the body

qi gong

originally a martial art, now viewed as a series of carefully choreographed movements or gestures that are designed to promote and manipulate the flow of qi in the body

qi gong

rapid cycle improvement/rapid improvement event

quality improvement model where a group gets together to make radial changes to current processes.

Six Sigma/Lean

quality improvement model where organizations reduce costs and enhance teamwork using the fewest resources.

knowledge focused trigger

questions regarding new information on a topic

RCT

randomnized controlled trials: most precise experimental study

Short staffing

ratios of patients to providers are set by the Community Health Accredition program but short staffing puts patient and providers in danger and needs to be avoided

provides confidence in something for which there is no proof. it is an acceptance of what reasoning cannot explain

reasoning faith

the ability to tolerate and accept experiences that are uncertain, unfamiliar or paradoxical

receptivity

Regulatory Law or Administrative Law

reflex decisions made by administrative bodies after laws are passed. Kind of like clarifications

Public Health Laws

regulations put in place that outline when it is appropriate/necessary to report outbreak in disease, school immunizations and other risks. OHSA and CDC tie into these

the state of generalized decreased cognitive, physiological, and behavioral arousal is what

relaxation response

the state of generalized, decreased, cognitive, physiological and or behavioral arousal

relaxation response

Nursing Accessible Therapies

relaxation therapy, meditation and breathing, imagery

holistic nursing treats the mind body spirit of patients using interventions such as...

relaxation, music therapy, touch therapy, and guided imagery

complementary therapies include:

relaxation, therapeutic touch, breathwork, prayer, reflexology, biofeedback, hypnotherapy, meditation

imagery helps do what?

relieve pain, decrease nightmares and improve sleep

a system of organized beliefs and worships that a person practices to outwardly express spirituality

religion

Cognitive Learning

requires thinking and encompasses the acquisition of knowledge and intellectual skills. Hierarchy: remembering, understanding, applying, analyzing, evaluating, creating.

informed consent

research subjects are given full and complete information

Minimum Data Set

resident assessment protocols and utilization guidelines of each state.

patient centered care

respect and dignity, sharing of information participation in care & care decisions, & collaboration.

Rehabilitation

restores person to the fullest physical and mental, social, vocational, and economic potential possible

Common law

results from judicial decisions made by courts when individual legal cases are decided. an example of common law includes informed consent, a patient's right to refuse treatment, negligence, and malpractice.

Utilization Review Committees (UR)

review admissions and identify and eliminate overuse of diagnostic and treatment services for patients on medicare

peer-reviewed

reviewed by a panel of experts familiar with subject before it is published

fast on ash wednesday and good friday. do not eat meat on friday during lent

roman catholics

natural products and herbal therapies

roughly 25,000 plant species are used medically throughout the world

Roe v. Wade

ruled that women have the right to terminate pregnancy

followers observe fast days and no meat rule on wednesdays and fridays. during lent all animal products, including dairy products are forbidden

russian orthodox

Physical care techniques

safe and competent administration of nursing procedures.

a sense of authentically connecting to ones inner self

self-transcendence

felony

serious offense resulting in significant harm to a person or society

what does yin represent?

shade, cold and inhibition- also the inner part of the body (viscera)-liver, heart, spleen, lung and kidney

yin

shade, cold, and inhibition inner part of the body (viscera, liver, heart, spleen, lung, and kidney)

females are to be examined by females removing undergarments causes great distress

sikhism

a nurse begins a night shift, assuming care for a critically ill pt who was resuscitated earlier in the day from cardiac arrest. he survived and is physically stable, alert, oriented, and responding appropriately to the nurses questions. knowing that the pt experienced a period when his heart stopped beating, what would be the best approach for the nurse to use with him?

sit and encourage the pt to share what he experienced during resuscitation

a pt has just learned she has been diagnosed with a malignant brain tumor. she is alone; her family will not be arriving from out of town for an hour. you have cared for her for only 2 hours but have a good relationship with her. what might be the most appropriate intervention for support of her spiritual well being at this time?

sit down and talk with the pt; have her discuss her feelings and listen attentively

buddhism dietary regulations

some are vegetarians and do not use alcohol. many fast on Holy Days.

christianity dietary regulations

some baptists, evangelicals, and pentecostals discourage use of alcohol and caffeine. some roman catholics fast on Ash Wednesday and Good Friday. some do not eat meat on fridays during lent.

judaism dietary regulations

some observe the kosher dietary restrictions (e.g., avoid pork and shellfish, do not prepare and eat milk and meat at same time).

hinduism dietary regulation

some sects are vegetations. the belief is not to kill ANY living creature.

a state of suffering related to the impaired ability to experience meaning in life through connections with self, others, the world or a superior being

spiritual distress

an awareness of ones inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself

spirituality

what is an inherent human characteristic that gives individuals the energy needed to discover themselves, cope with difficult situations, and maintain health?

spirituality

pensiveness/worry

spleen

Nurse practice acts

standards of care designed to distinguish between nursing scope and medical scope and establish what the education and licensure requirements are for all nurses

The Uniform Determination of Death Act

states that health care providers can use either cardiopulmonary or the whole-brain definition to determine death. The cardiopulmonary standards requires irreversible cessation of circulatory and respiratory functions. The whole-brain standard requires irreversible cessation of all functions of the entire brain, including the brain stem.

Death with dignity or Physician assisted suicide

statute stated that a competent individual with a terminal disease is defined as an "incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within 6 months. ANA believes that nurses' participation in assisted suicide violates the code of ethics for nurses

integrative health care

strategy that is gaining popularity, involves interprofessional group practices in which pts receive care simultaneously from more than one type of practitioner. is pt centered and is focused on the whole pt well-being and health.

Mental Health Parity Act as Enacted Under PPACA

strengthens mental health services

psychosocial theories

strive to meet the physiological, psychological, sociocultural, developmental and spiritual needs of patients.

historical research

studies designed to establish facts and relationship concerning past events.

controlled trials with randomnization

studies that test interventions, but where the researchers have not randomized the subjects into control or treatment groups

quantitative nursing research

study of nursing phenomena that offers precise measurements and qualification.

qualitative nursing research

study of phenomena that are difficult to quantify or categorize. ex. patients perception of illness

correlational research

study that explores the interrelationships among variables of interest without any active intervention by the researcher.

descriptive research

study that measures characteristics of persons situations, or groups and the frequency with which certain events or characteristics occur.

evaluation research

study that tests how well a program, practice, or policy s working.

experimental research

study where the investigator controls the study variable and randomly assigns subjects to different conditions to test the variable.

Analogies

supplement verbal instruction with familiar images Glossary: resemblance made between things otherwise unalike

grand theories

systematic and broad in scope, complex, and therefore require further specification through research.

originally a martial art that is now viewed as moving meditation in which patients move their bodies slowly, gently, and w awareness while breathing deeply

ta chi

TCM: originally a martial art that is now viewed as a moving meditation in which patients move their bodies slowly, gently and with awareness while deep breathing

tai chi

Concerns with Chinese herbal treatments

tea, remedies, and supplements are not regulated, inspected, or ensured by the FDA

Veracity

telling the truth

Beneficence

the best interest for the patient remain more important than self interest

Value formation

the development of values that begins in childhood; it is shaped by experiences within the family unit with individual experiences influencing further value formation

nursing

the diagnoses and treatment of the human responses to actual or potential health problems

Output

the end product, ex. whether the patient's health status improves, declines, or remains stable

the color shape and coating of the tongue reflect what in TCM?

the general condition of the internal organs

health care provider orders

the health care provider is responsible for directing medical treatment. Nurses follow health care provider orders unless they believe that the orders are in error, violate agency policy, or are harmful to the patient

Theory-based nursing practice

the integration of theory into nursing practice

Values clarification

the need to distinguish among values, facts, and opinions

In a malpractice lawsuit

the nurse will be expected to justify her actions to the jury and ignorance of the law/standard is not a justification for actions (you shouldn't be ignorant)

defamation of character

the publication of false statements that result in damage to a person's reputation

Ethics

the study of conduct and character concerned with determining what is good or valuable for individuals and society at large. What is morally right!

Advocacy

the support of a particular cause; the health, safety and rights of patients.(Pt.'s voice)

Libel

the written defamation of character

'touch therapies" this affects the energy fields that surround and penetrate the human body with the conscious intent to help or heal. blending ancient eastern traditions with modern nursing theory, TT uses the energy of the provider to positively influence the patients energy field

therapeutic touch

affects energy fields that surround the body

therapeutic touch

biofield therapy involving direction of a practitioners balanced energies in an intentional manner toward those of a patient; practitioners hands lay on or close to a patients body

therapeutic touch

consists of placing a practitioners open palms either on or close to the body of a person. with five phases; centering, assessing, unruffling, treating, and evaluating

therapeutic touch

Alternative

therapies that replace allopathic medical care

Complementary

therapies used in addition to conventional treatment (aka integrative therapies)

complementary therapy

therapies used in addition together w conventional treatment

Standards of Care

these are legal requirements for nursing practice that describe what the minimum requirements of a nurse is

Good Samaritan Laws

these laws limit liability and offer legal immunity if a nurse helps at the scene of an accident. for example of you stop at the scene of an automobile accident and give appropriate emergency care such as applying pressure to stop hemorrhage, you are acting within accepted standards, even though proper equipment is not available. if the patient subsequently develops complications as a result of your actions, you are immune from liability as long as you acted without gross negligence

Criminal (statutory) laws

these laws protect society as a whole and punish misdemeanors

Nursing Interventions Classification (NIC) interventions

these offer a level of standardization to enhance communication of nursing care across setting and to compare outcomes.

judaism (implications for health and nursing)

they believe that it is important to stay healthy. jews expect a nurse to provide competent health care. allow patients to express their feelings. allow family to stay with dying patient.

agnostic

they believe that there is no known ultimate reality

consent

this signed is necessary for administration to a health care agency, invasive procedures such as intravenous central line insertion, surgery, some treatment programs such as chemotherapy, and general consent form for treatment when admitted to a health care agency or other health care facility.

false imprisonment

this tort occurs with unjustified restraint of a person without a legal reason

how do atheist search for meaning in life?

through their work and their relationships with others

experimental study

tightly controls conditions to eliminate bias and ensure that findings can be generalized to similar groups of subjects.

PPACA cost initiatives

to reduce cost to the consumer and increase the liability of the insurance company as well as increase the number of insurance companies that patients have to choose from to best suit their needs

Work Redesign

to retain costs many hospitals have redesigned nursing units

an ancient healing tradition identified in the first century AD focused on balancing yin and yang energies. it is a set of systmetic techniques and methods, including acupuncture, herbal meds, massage, acupressure, moxibustin, cupping. fundamental concepts are from Taosim, Confucianism, and Buddhism

traditional chinese medicine

ayurvedic medicine

traditional medical system native to India; based on the 3 doshas (humours)

Progressive relaxation

training teaches an individual how to effectively rest and reduce tension in the body. Learns to detect subtle localized muscle tension sequentially, one muscle group at a time.

the belief that a force outside of and greater than the person exists beyond the material world

transcendence

Indirect care

treatments performed away from the patient but on behalf of the patient.

Direct care

treatments performed through interactions with patients.

nurses already practice: (integrative nursing role)

use of touch, relaxation techniques, imagery, and breathwork

Nursing Informatics

uses information and technology to communicate, manage knowledge, mitigate error, and support decision making

used for sleep disorders, mild anxiety and restlessness

valerian

The scientific method is a systematic, step by step process that provides support that the findings from a study are_______,_______, and ________.

valid, reliable, and generalizable

drug interactions with feverfew

warfarin, blood thinners, aspirin

during imagery what should you tell the patient to experience entering the body during inspiration and leaving the body during expiration?

warmth entering during inspiration, and tension leaving during expiration

Health Information Technology Act (HITECH)

was passed in conjunction wit HIPAA in response to new technology and social media. HITECH expands the principles extended under the HIPAA, especially when a security breach of personal health information (PHI) occurs.Under the HITECH Act nurses must ensure that patient PHI is not inadvertently conveyed on social media and in particular that protected date are not disclosed other than as permitted by the patient.

evaluation of spiritual care is necessary to determine if a pts level of spiritual health has changed following intervention. if the use of rituals was part of a nurses care plan, which of the following questions is most appropriate to evaluate its efficacy?

were prayer or meditation helpful to you?

joint commission

what sets standards for patient and family education

abandonment and assignment issues

when a nurse refuses to provide care for a patient after having established a patient-nurse relationship. Before having established that relationship, a nurse may refuse an assignment when (1) the nurse lacks the knowledge or skill required to provide competent care; (2) care exceeding the Nurse Practice Act is expected; (3) health of the nurse or her unborn child is directly threatened by the type of assignment; (4) orientation to the unit has not been completed and safety is at risk; (5) the nurse clearly states and documents a conscientious objection on the basis of moral, ethical, or religious grounds; or (6) the nurse's clinical judgement is impaired as a result of fatigue, resulting in a safety risk for the patient

Emergency Medical Treatment and Active Labor Act

when a patient presents to an emergency department, they must be treated

Utilitarianism

when the value of something is determined by its usefulness; the main emphasis is on the outcome or consequence of actions(consequentialism)

case control study

where researchers study one group one group of subjects with a certain condition(ex. asthma) at the same time as another group of subjects who do not have the condition.

vital energy (qi)

which flows like a river through the body in channels that form a system of 20 pathways called meridians. An obstruction in these channels energy flow in other parts of the body

Responsibility

willingness to respect one's professional obligations and follow through on promises

Islam (implications for health and nursing)

women prefer female health care providers. during month of ramadan muslims do not eat until after sun goes down. health and spirituality are connected. family and friends visit during time of illness. they usually do not consider organ transplantation or donation and postmortem examinations.

Living wills

written documents that direct treatment in accordance with the patient's desires in the case of terminal illness or condition

what is the normal diet of an islamic patient? can they eat beef?

yes but no pork

represents opposing yet complementary phenomena that exist in a state of dynamic equilibrium

yin and yang

the most important concept of TCM- represents opposing yet complimentary phenomena that exist in a state of dynamic equilibrium

yin and yang

blood provides what info of what in TCM?

yin and yang and internal organs

focuses on body musculature, posture, breathing mechanisms and consciousness; goal is attainment of physical and mental well being through mastery of body achieved through exercise, holding of postures, proper breathing and meditation

yoga