PN PERSPECTIVES TEST 1 CHAPTERS 1&2
The registered nurse is performing a nutritional assessment to ensure that the client's diet is optimal for wound healing. The nurse's intervention can be traced back to which of nursing's key people's contributions to nursing?
Florence Nightingale
Which contributor to the nursing profession established two missions: sick nursing and health nursing?
Florence Nightingale
Which nurse posited a theory that can be practically applied to nursing as follows: "Nurses modify unhealthy aspects of the environment to put the client in the best condition for nature to act."
Florence Nightingale
nutritional diet for optimal wound healing
Florence Nightingale
Integrating Nursing Theory
Florence Nightingale and others have examined the relationships among humans, health, the environment, and nursing. The outcome of such analysis becomes the basis for nursing theory (proposed ideas about what is involved in the process called nursing). Nursing programs then adopt a theory to serve as the conceptual framework or model for their philosophy, curriculum, and most importantly, approach to clients.
governmental responsibilities
Loan repayment programs and scholarships for nursing students Funding for public service announcements to encourage more people to enter nursing Career ladder programs to facilitate advancement to higher levels of nursing practice Establishment of nurse retention and client safety enhancement grants Grants to incorporate gerontology into nursing curricula Loan repayment programs for nursing students who agree to teach after graduation
What association meets every 2 years to further progress in defining, classifying, and describing nursing diagnoses?
NANDA
The nurse is discussing entry level for professional nursing practices. Which is the most accurate statement by the nurse?
"BSN is the recommended entry level by national nursing organization."
How should a nurse best document the assessment findings that have caused her to suspect that a client is depressed following his below-the-knee amputation?
"Client states, 'I don't see the point in trying anymore.'"
The nurse cares for a client with hemiparesis following cerebrovascular accident (CVA). Place the nursing diagnoses in the order of priority for this client. Use all options.
1 Impaired urinary elimination 2 Self-care deficit: dressing 3 Sexual dysfunction 4 Risk for social isolation
In what time period did nursing care as we now know it begin?
18TH TO 19TH CENTURY*******
A nursing student is obtaining an associate's degree in preparation to sit for the NCLEX-RN. How many years will the student likely be in the program? Record your answer using a whole number.
2
After assessing a client, a nurse identifies the nursing diagnosis, "Ineffective Airway Clearance related to thick tracheobronchial secretions." The nurse would classify this nursing diagnosis as which type?
ACTUAL
TYPES OF NURSING DIAGNOSES????
ACTUAL OR RISK OR??
After hearing a presentation about the American Nurses Association (ANA), a nurse decides to join the organization based on the understanding that
ANA aims at fostering high standards of nursing in the United States.
Assessment Skills
Acts that involve collecting data, which include interviewing, observing, and examining the client, and in some cases, the client's family ( family is used loosely to refer to the people with whom the client lives and associates).
Which nursing diagnosis is validated by the presence of major defining characteristics?
Actual Nursing Diagnosis
SISTER CALLISTA ROY
Adaptation Theory Nurses assess biologic, psychological, and social factors interfering with health; alter the stimuli causing the maladaptation; and evaluate the effectiveness of the action taken.
Associates degree
After the end of the war, Mildred Montag, a doctoral nursing student at the time, began to question whether it was necessary for students in RN programs to spend 3 years acquiring a basic education. ADN preparation has proven extremely popular and now commands the highest enrollment among all RN programs.
Which is an appropriately stated nursing intervention?
Ambulate 30 ft. twice a day with assistance of a walker.
The nurse is performing care for a client in the end stage of cancer. How can the nurse best facilitate the client and family's ability to cope? Select all that apply.
Assist the client with activities of daily living (ADL) Assist the client and family with the preparation for end-of-life Refer the client and family to hospice services
Defining Nursing
Nightingale is credited with the earliest modern definition: "putting individuals in the best possible condition for nature to restore and preserve health." One such authority was Virginia Henderson (1897 to 1996). Her definition, adopted by the International Council of Nurses, broadened the description of nursing to include health promotion, not just illness care. As stated in 1966, The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he could perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible. NOT JUST ILLNESS CARE-VIRGINIA HENDERSON
lists reasons why nurses, in particular, pursue continuing education.
No basic program provides all the knowledge and skills needed for a lifetime career. Current advances in technology make previous methods of practice obsolete. Assuming responsibility for self-learning demonstrates personal accountability. To ensure the public's confidence, nurses must demonstrate evidence of current competence. Practicing according to current nursing standards helps to ensure that care is legally safe. Renewal of state licensure often is contingent on evidence of continuing education.
What is true of nursing responsibilities with regard to a physician-initiated intervention (physician's order)?
Nurses do carry out interventions in response to Physicians orders
During morning report, the night nurse tells the day nurse that the client refused to allow the technician to draw blood for laboratory testing. What step would be essential for the day nurse to complete before selecting a nursing diagnosis to address this issue?
The nurse should determine the reason for the client's refusal.
During a home health care visit, the nurse identifies a nursing diagnosis of Caregiver Role Strain for a parent who is caring for a child dependent on a ventilator. What subjective assessment data would support the nurse's diagnosis?
The parent states "I cannot allow anyone else to help because they won't do it right"
The postoperative patient's plan of care contains an intervention to ambulate twice a day 200 feet with assistance of one member of the healthcare team. The intervention was not completed one morning due to his pain. Which of the following would be the appropriate way to document the missed event?
The patient reported his pain at a level of 8/10 at 30 minutes after dosing. The patient was returned to bed and the physician was notified of the uncontrolled pain level with the current medication order.
Unlicensed Assistive Personnel UAP
The role of UAPs is to assist licensed nurses with client care activities. UAPs must be trained and demonstrate competence for tasks carried out in a clinical setting. Client care provided by a UAP must be supervised by the delegating nurse who is ultimately accountable for the UAP's actions.
A registered nurse wishes to work as a nurse researcher. Which is true regarding nurse researchers?
They are responsible for the continued development and advancement of nursing
Nightingale is accredited with
Training women for future work Selecting only those with upstanding characters as potential nurses Improving sanitary conditions for the sick and injured Significantly reducing the death rate of British soldiers Providing classroom education and clinical teaching Advocating that nursing education should be lifelong
Nursing in the United States
Unfortunately, however, the standards of these schools deviated substantially from those of the Nightingale paradigm While planned and consistent formal education was the priority in Nightingale's schools, the training of nurses in the United States was like an unsubsidized apprenticeship Eventually, the curricula and content of US training schools became more organized and uniform. Training periods lengthened from 6 months to 3 full years. Graduate nurses received a diploma attesting to their successful completion of training.
The need for university-based nursing education programs was brought to light during which important historical time?
World War II
A nurse is assigned to care for a client diagnosed with asthma who has just been admitted to the health care facility. The nurse determines the client's priorities for care using:
assessment skills
The nurse is caring for a postoperative client. The physician has written orders for a pain medication, and the order gives a dosage range for the amount the nurse may give depending on the severity of the client's pain. This type of functioning within the health care team is called:
collaborative functioning
In keeping with Nightingale's traditions,
contemporary nursing practice continues to include assessment skills, caring skills, counseling skills, and comforting skills.
empathy sympathy
empathy is intuitive awareness of what the client is experiencing sympathy is
ANA, the National League for Nursing (NLN), and the Institute of Medicine (IOM)
establish baccalaureate education as the entry level into nursing practice.
Which description depicts the role of the nurse practitioner?
functions independently, is skilled at doing nursing assessments, performing physical examinations, counseling, teaching, and treating health problems.
A nurse is caring for a client with diabetes mellitus. The client takes insulin 2 times per day. The nurse makes sure the client's meals arrive in coordination with the insulin's effect. The knowledge used by the nurse is:
integrated
Counseling Skills
interventions that include communicating with clients, actively listening during exchanges of information, offering pertinent health teaching, and providing emotional support
evidece based practice
it is now possible to predict which nursing interventions are most likely to produce desired outcomes
Caring Skills
nursing interventions that restore or maintain a person's health
Nurses must use multiple mechanical devices in the workplace to assess their patients. The data collected from these devices supply what type of information?
objective
Due to the rising cost of health care services, many procedures and treatments are being delivered in what type of setting?
outpatient facility
When assessing the client's pulse, the nurse should us which assessment technique?
palpation
A licensed practice nurse (LPN) is working as a staff nurse. What role do the LPNs working as staff nurses play?
provide direct nursing care to the clients in the health care facility
During the preparatory phase of interviewing for the purpose of obtaining information for the nursing history, the nurse should:
review as much information as possible
DOROTHEA OREM
self care theory Nurses assist clients with self-care to improve or to maintain health.
capitation
strategy for controlling health care costs by paying a fixed amount per member)
A licensed practical nurse is planning a move to a new state and intends to begin practicing as soon as possible. This nurse should be aware that:
there may be differences in the scope of practice when a practical nurse relocates to a new state.
The expected outcome for a client with a new diagnosis of diabetes mellitus is: "client will describe appropriate actions when implementing the prescribed medication routine." Which statement by the client indicates the outcome expectation has been met?
"I will test my glucose level before meals and use sliding scale insulin."
The ANA (2010) further attests that six essential features characterize nursing:
(1) provision of a caring relationship that facilitates health and healing, (2) attention to the range of human experiences and responses to health and illness within the physical and social environments, (3) integration of objective data with knowledge gained from an appreciation of the client's or group's subjective experience, (4) application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking, (5) advancement of professional nursing knowledge through scholarly inquiry, and (6) influence on social and public policy to promote social justice.
Qualified applicants are being rejected or waitlisted because
(1) there is a shortage of master's and doctoral-prepared nursing faculty who are available to teach required courses, (2) there is a lack of placements for clinical experiences, (3) there is a lack of space in educational institutions, (4) there are budget cuts among institutions that provide nursing programs, and (5) there is intense competition for selective admissions (American Association of Colleges of Nursing, 2014a).
A nurse mentoring second-year nursing students from a community college plans clinical experiences for them. These students will most likely graduate in which time frame?
At the end of the year
A student is choosing her educational path and desires a nursing degree with a track that contains community nursing and leadership, as well as liberal arts. The student would best be suited in which type of program?
BACHELORETTE
VIRGINIA HENDERSON
Basic needs Theory Nurses assist in performing those activities that the client would perform if he or she had the strength, will, and knowledge.
26s A nurse practitioner is caring for a couple who are the parents of an infant diagnosed with Down syndrome. The nurse makes referrals for a parent support group for the family. This is an example of which nursing role?
COUSELOR
A nurse administers an antihypertensive medication according to the standardized plan of care for a client admitted with uncontrolled hypertension. Which assessment information indicates the expected client outcome has been met within the first 24 hours?
Client is normal tensive.
The Quality and Safety Education for Nurses (QSEN) initiative has identified which key competencies for nurses? Select all that apply.
Client-centered care Teamwork and collaboration Evidence-based practice Quality improvement
Which of the following statements accurately decribes the formulation of a nursing diagnosis?
Collection of assessment data provides the basis for identifying nursing diagnoses
What cognitive processes must the nurse use to measure client achievement of outcomes during evaluation?
Critical Thinking
EXPANDING HORIZONS OF PRACTICE
Diplomas in hand, nurses trained in the United States began the 20th century by distinguishing themselves in caring for the sick and disadvantaged outside of hospitals Some nurses moved into communities and established "settlement houses" where they lived and worked among poor immigrants. During World Wars I and II community hospitals needed more staff to assist nurses caring for civilians. Consequently, greater numbers of practical nurses and Red Cross-trained aides were hired (Fig. 1-5). They helped replenish the deficit caused by nurses pursuing careers.
KOREAN WAR
During the Korean War, nurses acquired knowledge about trauma care that later would help reduce the mortality rate of US soldiers in Vietnam.
Post Civil War
Following the Civil War, there was an influx of immigrants into large US cities with the promise of employment in the evolving wave of industrialization. The burgeoning population, however, was accompanied by overcrowding, poverty, and lack of health care resources. There were few, if any, family members—let alone strangers—who were available for nursing care. In 1890, one of the first courses for training "attendants for the sick" was begun in New York by the Brooklyn Young Women's Christian Association (Johnston, 1966). The brief training that lasted 8 weeks to 3 months focused on caring for chronic invalids, elderly persons, and children. It did not include any hospital experience. Later, the condensed training was extended to include home nursing skills such as household duties, hygiene, bowel regulation, bed changing, reading a thermometer, counting the pulse, and care of bedsores Attendants for the sick were now referred to as practical nurse attendants. Later their title changed from attendant nurses to practical nurses.
FLORENCE NIGHTINGALE
Founder of modern nursing Environmental Theory Nurses modify unhealthy aspects of the environment to put the client in the best condition for nature to act.
Virginia Henderson
Henderson proposed that nursing is more than carrying out medical orders. It involves a special relationship and service between the nurse and the client (and his or her family). According to Henderson, the nurse acts as a temporary proxy, meeting the client's health needs, with knowledge and skills that neither the client nor family members can provide.
A client recently diagnosed with pancreatic cancer tells the nurse, "I don't see any hope for my future." What would be the most appropriate nursing diagnosis for the nurse to formulate to address this health problem?
Hopelessness related to difficulty coping secondary to pancreatic cancer diagnosis
Colonial Period
In colonial times, there were no hospitals. By the late 1700s, a very few were located in larger, more populous cities like Philadelphia and New York. For the most part, itinerant physicians practiced in isolated rural settings. local women provided nursing care and temporarily carried out tasks such as housekeeping, laundry, and meal preparation for those entrusted to their care
retirement age
In the next 10 to 15 years, about one-third of the current nursing workforce will reach retirement age (National League for Nursing, 2013a).
some factors contributing to the nursing shortage include the following:
Increased aging population requiring health care Disappointing salaries for nurses with longevity employment Job dissatisfaction as a result of stress and the unrelenting rigor of working in health care Heavier workloads and sicker clients Policies regarding mandatory overtime Downsizing nursing staff from dwindling revenues and managed care policies Negative stereotypes about traditionally female occupations like nursing More lucrative opportunities in nonnursing fields
A client with diabetes mellitus has been admitted to the hospital in diabetic ketoacidosis. During the admission assessment of the client, the nurse learns that the client is not following the prescribed therapeutic regimen. The client states, "I don't really have diabetes. My doctor overreacts." What is the most appropriate diagnosis for this client's health prob
Ineffective Health Maintenance related to client's denial of illness
A teenager on life support after a diving accident has no brain wave activity. The parents tell the nurse that they are sure their child will wake up soon. Which nursing diagnosis would the nurse identify to assist the parents of the child?
Interrupted Family Processes related to inability to accept their child's inevitable death as evidenced by the parents' statement that their child will wake soon
Which description is consistent with the nurse's use of empathy during client care?
Intuitive awareness of what the client is experiencing
A nurse is planning education about prescription medications for a client newly diagnosed with asthma. What nursing diagnosis would be most appropriate for the nurse to select?
Knowledge deficit: Medications related to new medical diagnosis
A prospective nursing student desires a career that will allow him to provide client care and to assist professional nurses with routine technical procedures. The prospective student needs to be employed in a full-time position quickly due to economic hardship. What type of nursing program would best suit this student?
LPN
CONTEMPORARY NURSING
Nursing is both an art and a science. During the 20th century, nursing theories and nursing organizations developed to qualify, quantify, and codify what is now the profession of nursing.
A nurse assesses the vital signs of a client who is one day postoperative in which a colostomy was performed. The nurse then uses the data to update the client plan of care. What are these actions considered?
Ongoing Planning
In Nursing's Social Policy Statement, 3rd edition (2010), the American Nurses Association (ANA) defines nursing as follows:
Protection, promotion, and optimization of health and abilities Prevention of illness and injury Alleviation of suffering through the diagnosis and treatment of human response Advocacy in the care of individuals, families, communities, and populations
The nurse is to delegate certain tasks to unlicensed assistive personnel (UAP). Which of the following tasks can be appropriately assigned to a UAP?
Provide client assistance to the bedside commode
What is meant by intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new meanings and appreciations?
Reflection
Regardless of whether it is an RN delegating to an LPN or a UAP or an LPN delegating to an UAP, delegation requires adhering to the following five guidelines:
Right task: matching the client's needs with the caregiver's skills Right circumstance: ensuring that the situation is appropriate Right person: knowing the unique competencies of the caregiver Right directions and communication: providing sufficient information Right supervision and evaluation: being available for assistance; validating that the task was completed, obtaining the results, and analyzing if further actions are necessary (American Nurses Association & National Council of State Boards of Nursing, 2005)
Combining Nursing Art with Science
Students learned this art by watching and imitating the techniques performed by other, more experienced nurses. In this way, mentors informally passed skills on to students. A science (body of knowledge unique to a particular subject) develops from observing and studying the relationship of one phenomenon to another.
The nurse has selected a nursing diagnosis of "Impaired Home Maintenance" for an older adult client. What assessment data would evidence this diagnosis?
The nurse observes unsafe conditions in the client's home.
Proactive strategies Nurses are dealing with the unique challenges of the 21st century by:
Switching from part-time to full-time positions. Delaying retirement. Pursuing postlicensure education. Training for advanced practice roles (nurse practitioner, nurse midwifery) to provide cost-effective health care in areas in which numbers of primary care physicians are inadequate. Becoming cross-trained (able to assume nonnursing jobs, depending on the census or levels of client acuity on any given day). For example, nurses may be trained to provide respiratory treatments and to obtain electrocardiograms, duties that nonnursing health care workers previously performed. Learning more about multicultural diversity (unique characteristics of ethnic groups) as it affects health beliefs and values, food preferences, language, communication, roles, and relationships. Supporting legislative efforts toward national health insurance and other health care reforms that involve nurses in primary care (the first health care worker to assess a person with a health need). Promoting wellness through home health and community-based programs. Helping clients with chronic diseases learn techniques for living healthier and, consequently, longer lives. Referring clients with health problems for early treatment, a practice that requires the fewest resources and thus minimizes expenses. Coordinating nursing services across health care settings—that is, discharge planning (managing transitional needs and ensuring continuity). Providing older adults with a variety of nursing services such as physical assessment during periods of illness, teaching, and managing medications, in assisted-living facilities at less cost than care in nursing homes. Developing and implementing clinical pathways, standardized multidisciplinary plans for a specific diagnosis or procedure that identify aspects of care to be performed during a designated length of stay (Fig. 1-10). Participating in quality assurance (process of identifying and evaluating outcomes). Concentrating on the knowledge and skills to manage the health needs of older Americans over age 65, whose numbers will reach 71 million by 2030
The nurse is caring for a client with a new diagnosis of cancer, and allows the client to verbalize fears relating to how to tell the children. The nurse's intervention reflects which aspect of nursing?
THE ART OF NURSING
A nurse practitioner has a private practice in conjunction with a physician. She is providing psychiatric care to a woman who has a past history of being abused by her husband. During the last visit, the client stated that she was planning to leave her husband. On the next visit in two weeks, the nurse practitioner will assess her client's commitment to changing her life situation and her ability to feel empowered. What type of assessment is the nurse practitioner implementing?
TIME LAPSE
Civil War Period
The American Civil War occurred around the same time as the Nightingale reformation. out of necessity, the Union government appointed Dorothea Lynde Dix, a social worker who had proven her worth by reforming health conditions for the mentally ill, to select and organize women volunteers to care for the troops. In 1862, Dix followed Nightingale's advice and established the following selection criteria. Applicants were to be Thirty-five to 50 years old Matronly and plain-looking Educated Neat, orderly, sober, and industrious, with a serious disposition applicants also had to submit two letters of recommendation attesting to their moral character, integrity, and capacity to care for the sick. Once selected, a volunteer nurse was to dress plainly in brown, gray, or black and had to agree to serve for at least 6 months.
The definition of implementation would include which of the following?
The action phase of the nursing process in which nursing care is provided.
Which of the following reflects the diagnosis phase?
The nurse identifies that the client does not tolerate activity.
