PrepU Chapter 1

A nurse is considering relocating to another state to practice nursing. Which is the most appropriate action by the nurse to ensure ability to practice in the new state?

applying for a reciprocal license in the new state Nurses gain legal rights to practice nursing in another state by applying to that state's board of nursing and receiving reciprocal licensure. The nurse does not need to retake the licensure exam. The nursing licenses are not transferable.

For the nurse become a nurse practitioner, what is the minimal degree the nurse will need to acquire?

A master's degree is the minimal degree for a nurse to become a nurse practitioner. Diploma, associate, and baccalaureate degrees are the minimal degree for an RN.

In what time period did nursing care as we now know it begin?

18th to 19th century From the middle of the 18th century to the 19th century, social reforms changed the roles of nurses and of women in general. It was during this time that nursing as we now know it began, based on the beliefs of Florence Nightingale.

The registered nurse (RN) working with a licensed practical nurse (LPN) understands which about LPNs?

They must take a licensure exam. Schools for practical nursing programs are located in varied settings. Most programs are 1 year in length. Upon completion of the program, graduates can take the National Council Licensure Examination for Practical Nurses (NCLEX-PN) for licensure as an LPN. LPNs work under the direction of a physician or RN to give direct care to clients, focusing on meeting health care needs in hospitals, nursing homes, and home health agencies.

The community health nurse creates a program to promote the health of the community using health promotion principles. Which intervention would the nurse include in this program?

Activities focused on maintaining wellness Health promotion focuses on maintaining wellness and preventing disease; these interventions fall into the category of primary health care. Disease management and the provision of illness care fall into the secondary and tertiary categories of health care.

The nurse is performing an extensive dressing change on a client with burns. The nurse explains each step as it is being performed. The nurse is acting in which role by providing explanation of each step?

Educator Under the overall umbrella of nursing process, the nurse in this situation is performing the the implemention of the care plan interventions.The nurse is acting in the role of educator by explaining each step at a level, and to a degree that the client can process, ask questions if necessary, and understand. The act of changing the dressing is an aspect of the caregiver role. Once the nurse moves beyond the care plan interventions, it may become necessary to make a decision or advocate for the client as a result of the assessment of wound and client learning during the teaching of wound care occurring.

A client is distraught because a recent computed tomography (CT) scan shows that the client's colon cancer has metastasized to the lungs. Which nursing aim should the nurse prioritize in the immediate care of this client?

Facilitating coping This client's care in the coming weeks or months will likely encompass all of the four foundational roles of the nurse. However, because the client has just recently received bad news and is emotionally distraught, helping the client cope is an appropriate priority in immediate care. Preventing illness is focused on preventing an infection or disease from occuring such as through immunizations, hand hygiene, exercising and diet. Restoring health would more appropirately occur after the client has accepted the disease and would involve taking medication and working to get back to baseline with the disease. Health promotion is the process of enabling people to increase control over, and to improve, their health.

Which individual provided community-based care and founded public health nursing?

Lillian Wald Lillian Wald established a neighborhood nursing service for the sick and poor in New York City and is considered the founder of public health nursing. The other women were important to the development of nursing, but not to public health nursing. Nutting helped to found a modern nursing program at the school. Sojourner Truth was an African-American abolitionist and women's rights activist who was a nurse. Clarissa "Clara" Harlowe Barton was a pioneering nurse who founded the American Red Cross.

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. Nursing research requires extensive education and is a uniquely specilized field. Nurse researchers are responsible for the continued development and refinement of nursing. They usually have advanced education post baccalaureate degree in nursing and most often work in large teaching hospitals or research centers. Nurse administrators, not nurse researchers, serve as liaisons between staff members and directors of nursing, Nurse researchers may be found with a school of nursing at academic institutions, but not at community health centers and long-term care units.

The RN is working with hospital administrators to transform care at their facility. Which nursing competency will be critical for the nurse to utilize?

Work effectively in interdisciplinary teams The RN working with administrators to transform care will need to be able to work effectively as part of an interdisciplinary team. The nurse will need to work as a team member with members of the administration, as well as representatives from other health disciplines involved in the project. The ability to use and troubleshoot equipment and to navigate the electronic medical records are important to the nurse, but will not necessarily help when working with administration to transform care. Doing things the way they have always been done is a barrier to transformation of care.

A registered nurse (RN) is caring for four clients on a medical-surgical unit. Which task is most appropriate for the nurse to delegate to the licensed practical nurse (LPN)?

administering bedside blood glucose testing The LPN, under the nurse practice act (NPA), is permitted to administer testing for bedside blood glucose. The nurse must recognize the scope of practice of the delegate, and remember that client needs and activities delegated must be matched to skill level. The RN would not delegate administration of blood products, intravenous push medication, or chemotherapy to the LPN, as these tasks are not covered under the LPN's NPA.

Which social force has most significantly impacted the future supply and demand of nurses?

aging Social forces--such as the aging of a population (and thus the increased need for nursing care), a nursing retirement rate that exceeds the replacement rate, and attrition of aging nursing faculty--significantly impact the future supply and demand of nurses. Technology, economics, and science are not social forces that have impacted the future supply and demand of nurses.

Trends in managed care have resulted in an increased focus on the care of clients by nurses in which settings?

community-based settings Health care is increasingly provided in community-based settings such as clinics, outpatient settings, and homes. The impetus for this change has largely been the implementation of a system of managed care to control and monitor health care services to minimize costs. Clients admitted to the critical care unit may need to progress to a floor and a long-term setting after hospitalization.

The first nursing journal owned, operated, and published by nurses was:

American Journal of Nursing The American Journal of Nursing was first published in 1900 and was owned, operated, and published by nurses. It continues to provide information that may be of interest to nurses in all nursing specialities, and those who practice general nursing. Nurse Educator is a more recently developed journal which specializes in nursing education and targets nurse eductors. Nursing Research is also a more recently developed nursing journal with a focus on nursing research and targets nurses interested in research. Standards of Clinical Nursing Practice are directives and guidelines that may be published as books available to nurses for purchase and review. It is not a nursing journal.

The need for university-based nursing education programs was brought to light during which important historical time?

World War II During the middle of the twentieth century, Esther Lucile Brown, in her report on nursing education published at that time, wrote that nursing education belonged in colleges and universities, not in hospitals. During the Spanish-American War, nursing was still in its earliest phase of development. Even with the input of Florence Nightingale and her followers after WWI, nursing continued to struggle. Professional nursing began during the period and crisis needs of WWII. Nursing continues to evolve today.

What was one barrier to the development of the nursing profession in the United States after the Civil War?

lack of educational standards A lack of educational standards was one barrier to the development of the nursing profession after the Civil War. Other barriers included a male dominance of health care and the pervading belief that women were dependent on men. The location of nursing schools, a lack of influence from nursing leaders, and independent nursing orders were not barriers to the development of the nursing profession after the Civil War.

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. ANA aims at fostering high standards of nursing in the United States. Membership is not open to all nurses in the United States; only registered nurses can become members. Members of the National League for Nursing, not the ANA, include nurses, other health care providers, and lay people. Sigma Theta Tau, not ANA, invites students showing excellence in scholarship to become members.

A nurse documents on a client's electronic chart that the client has an advance directive, makes a copy of the advance directive, and immediately informs the client's physician. Which role is the nurse demonstrating?

Advocate The nursing role that focuses on advocacy involves the protection of human or legal rights and the securing of care for all clients, based on the belief that clients have the right to make informed decisions about their own health. In this situation, the nurse recognizes the client's right to make end-of-life decisions and advocates for the client by documenting that the client has an advance directive. The nurse also demonstrates advocacy by communicating this information to the client's physician. Nurse counselors help clients identify goals and potential solutions to problems which cause emotional turmoil; seek to improve communication and coping skills; strengthen self-esteem; and promote behavior change and optimal mental health. Nurse leaders work with an organization to lead nurses. A nurse researcher is a person who carries out academic or scientific research.

Which is an appropriately stated nursing intervention?

Ambulate 30 ft (9 m) twice a day with the assistance of a walker. Correctly stated nursing intervenions are specific, measurable, and realistic. The other choices are poorly defined and do not specify when, how or by whom the activity is to be accomplished or monitored. As stated, each is also unmeasurable.

The nurse is attempting to provide anticipatory guidance for the parents of an 18-month-old child. Which statement would be best for the nurse to make?

"Keep all medications in a locked cabinet." Anticipatory guidance provides the parent with information that the child will need as the child continues to grow and develop to promote his or her health. The best example of this is telling the parents to keep all medications in a locked cabinet, as the 18-month-old can climb and reach for medications that were placed high where the parents thought the child could not reach. This could prevent accidental medication overdose. An 18-month-old would have difficulty communicating fears about nightmares to the parents. Reporting the weight is health promotion, which lets the parents know that the child is growing. Telling the parents not to give the child a bottle would be inappropriate as the child should be using a cup at this age.

A nurse is moving to another state and will be working at an acute care facility. Prior to beginning practice, what actions should the nurse take to be compliant with state guidelines for nursing practice? Select all that apply.

1. Define the legal requirements and titles for registered nurses (RNs) and licensed practical nurses (LPNs) 2. Locate the state nursing practice acts 3. Access educational resources related to nursing practice in another state 4. Research the laws and regulations that govern nursing practice in the new state Prior to practicing in a new state, the nurse should understand that each state may have different rules and regulations even if it is a member of the compact. The nurse should research the laws and regulations that govern present practice to ensure adherence with any different practice laws, including the legal requirements and titles for RNs and LPNs. The nurse should locate the state nursing practice acts and refer to them often for any changes. The nurse should access educational resources related to nursing practice, such as the NCSBN. It is not necessary for the nurse to either visit the office of the new state board of nursing or let the past state know that the nurse will be practicing in another state, if it is in the compact.

The nurse is evaluating client health. Which client should the nurse determine to be exhibiting the most signs of health?

A client with a leg amputation who performs activities of daily living with a prosthesis As defined by the World Health Organization, one's health includes physical, social, and mental components and is not merely the absence of disease or infirmity. Health is often a subjective state—a person may be medically diagnosed with an illness, but still consider himself or herself healthy. The client with an amputation is performing activities of daily living, thereby demonstrating healthy behaviors. A client with diabetes who is refusing to take insulin is in denial of the illness. A client in acute emotional distress related to the spouse's death is experiencing a normal pattern but not demonstrating a healthy behavior. A client with depression who will not get out of bed is also experiencing denial as opposed to a healthy behavior and coping.

Which advanced nurse practitioner is best qualified to provide prenatal care for a pregnant client?

A nurse-midwife A nurse-midwife provides prenatal and postnatal care and also delivers babies for women with uncomplicated pregnancies. A nurse anesthetist carries out preoperative visits and assessments; administers and monitors anesthesia during surgery; and evaluates the postoperative status of clients. A clinical nurse specialist is considered to be an expert in a specialized area of nursing and carries out direct client care; consultation; teaching of client, families, and staff; and research. A nurse educator teaches in educational or clinical settings, teaches theoretical knowledge and clinical skills, and conducts research.

Which organization has established standards that help the nurse determine which clinical actions fall under the scope of nursing practice?

American Nurses Association The American Nurses Association (ANA) has established standards of clinical nursing practice that define the specific and unique activities of nurses. Standards serve as protection for the nurse, the client, and the institution where health care is given. The other organizations provide valuable services that differ from those of ANA. The National Council of State Boards of Nursing have the nurse practice acts which define state specific guidelines for nurses to practice. The National League for Nursing is a national organization for faculty nurses and leaders in nurse education. The International Council of Nurses is a federation of more than 130 national nurses associations.

A nurse is planning to pursue further education in the hopes of becoming an expert in geriatric nursing who carries out direct care. For which expanded career role is the nurse preparing?

Clinical nurse specialist Clinical nurse specialists are nurses with an advanced degree who are considered experts in a specialized area of care. They also provide direct care, consultation, and education of clients, families, and staff. Nurse managers do not normally provide direct care. Nurse-midwives specialize in obstetrical care. Physician assistants are not nurses.

Florence Nightingale introduced the concept of apprenticeship for nurses. Which statement is an example of this?

Completing clinical hours supervised by a nursing instructor Florence Nightingale's concept of apprenticeship involved training student nurses in a hospital setting. Completing clinical hours is an example of this. Passing the NCLEX exam is required to work as an RN. Participating in a paid internship is outside of the student nurse training supported by the apprenticeship model. Taking an online class at a university is not part of an apprenticeship model.

During the course of any given day of work in the acute care setting, the nurse may need to perform which roles? Select all that apply.

Counselor, Teacher, Communicator The roles and functions of the nurse are many and include caregiver, communicator, teacher, counselor, leader, researcher, and advocate. Acting as financier and statistician are not the roles of the nurse.

The new nursing graduate is concerned about some of the critical changes that will be occuring in nursing. What changes does the nurse anticipate will impact nursing care?

Difficulty for nurses to remain current in a rapidly changing medical and technology environment The National Advisory Council on Nurse Education and Practice (NACNEP) identifies critical challenges to nursing practice in the 21st century: a growing population of hospitalized clients who are older and more acutely ill, increasing health care costs, and the need to stay current with rapid advances in medical knowledge and technology. Nursing is limitless and, with opportunities for furthering education, there are many various ways nurses can practice. Health costs are rising and there are more citizens needing health care. There is a projected nursing shortage that may be severe and there are no shortages of jobs for nurses.

What is the best nursing intervention to promote health in a client at risk for heart disease?

Emphasizing a client's strengths to encourage weight loss Nurses promote health by identifying, analyzing, and maximizing each client's own individual strengths as components of preventing illness, restoring health, and facilitating coping with disability or death. Emphasizing the client's strengths to encourage weight loss is the most effective way to promote this client's health. Informing the client that the client must lose weight would not help the client use his or her strengths to accomplish the goal. Low-sodium diets can prevent heart disease. Taking the pulse daily would not prevent heart disease.

Which action should the nurse implement when working with a medically homeless client?

Encourage client to utilize the free health care clinic. According to the Association of American Medical Colleges, many Americans are medically homeless and find it difficult to navigate the health care system. Encouraging the client to utilize the free health care clinic will help the client navigate the system and obtain access to health care. While utilizing the emergency room when needed is appropriate, the emergency room should not be utilized for all illnesses, as it increases the burden on the health care system. Assisting the client to find housing or a job will help the client, but is outside of the scope of nursing practice.

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 key contributor to nursing?

Florence Nightingale Florence Nightingale's contributions to nursing included the recognition of the importance of nutrition to health. Clara Barton established the Red Cross. Dorothea Dix was a pioneer for reform of treatment for the mentally ill. Linda Richards began the practice of keeping records and writing orders.

The primary aim of the Healthy People 2020 initiative is:

Health promotion Healthy People 2020 establishes health promotion guidelines for the nation as a whole. The guidelines contain 12 Leading Health Indicators, which are used to measure the health of the nation over a 10-year period. Illness prevention, health restoration, and coping with disability are components of the Healthy People 2020 guidelines, but are not considered as the primary goal of the initiative.

A nurse manager is teaching staff how to use a new piece of hospital equipment. Which educational setting would be most appropriate for this process?

In-service education In-service education is designed to increase the knowledge and skills of the nursing staff. Education about a new piece of hospital equipment would fall into this category. Continuing education is educational experiences designed to enrich the nurse's contribution to health. Many state nursing organizations require continuing education hours to maintain licensure. Undergraduate studies are the educational programs for pre-licensure in the field of nursing. For the nurse, this could be a diploma, associate degree, or baccalaureate in nursing. Graduate education would include the educational programs for the advanced practice nurse. This could be master's degree or doctoral preparation.

A nurse educator is discussing the role of nursing based on the American Nurses Association (ANA). Which statement best describes this role?

It is the role of nursing to provide a caring relationship that facilitates health and healing. The American Nurses Association (ANA) defines nursing as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations" (ANA, 2010). The ANA does not see nursing as dependent upon medicine. The ANA sees one of the roles of the nurse as assisting clients in understanding their health problems. The ANA does not address essential components of professional nursing care with terms such as strength, endurance, and cure.

The founder of public health nursing is:

Lillian Wald Lillian Wald established a neighborhood nursing service for the sick and poor of the Lower East Side in New York City and was the founder of public health nursing. Clara Barton established the Red Cross in the United States in 1882. Linda Richards was the first trained nurse in the United States. Dorothea Dix was a pioneering crusader for the reform of the treatment of the mentally ill.

A nurse identifies a client's health care needs and devises a plan of care to meet those needs. Which guideline is being followed in this case?

Nursing process Devising a plan of care is based on the nursing process. This process identifies the client's health care needs and strengths to establish and carry out a plan of care to meet those needs, and to evaluate the effectiveness of the plan to meet established outcomes. Nursing standards allow nurses to carry out professional roles, serving as protection for the nurse, the client, and the institution where health care is given. Nurse practice acts are laws established in each state in the United States to regulate the practice of nursing. Nursing orders prescribe the nursing care to be given to assist the client to meet health goals.

What might a nurse need to do to ensure the continuation of his or her nursing license?

Obtain continuing education credits. In many states, continuing education is required for an RN to maintain licensure. These are defined as professional development experiences designed to enrich the nurse's contribution to health. Obtainment of an ongoing degree is not necessary to maintain licensure. While hospital in-services may provide continuing education, not all in-services are designed to do so.

Which nursing intervention would be most appropriate for a new mother that calls the nursery for help with breastfeeding?

Refer the mother for a home care visit. It is the role of the nurse to encourage health promotion by providing information and referrals; therefore, the nurse should refer the mother for a home care visit, as this will enable the mother to receive all of the breastfeeding help that is needed. Emailing a link for breastfeeding provides information, but not the support that is needed if a mother is having difficulty with breastfeeding. Suggesting bottle feeding and/or going to the emergency room is inappropriate and does not encourage using available resources.

Which explanation accurately differentiates the role of the registered nurse (RN) from that of the licensed practical/vocational nurse (LPN/LVN)?

The LPN/LVN should work under the supervision of an RN. LPNs/LVNs are employed in hospitals, long-term care facilities, and rehabilitation centers and by health care providers such as physicians. LPNs/LVNs differ from RNs in two areas: educational preparation and scope of practice. LPNs always practice under the supervision of an RN. LPNs have a scope of practice and the workload is not directed by the RN. RNs are not permitted to prescribe medications. Nurse practitioners may prescribe medications.

The registered nurse communicates with the physical therapist that a client is now on strict bed rest due to bradycardia. Which statement best explains the standard exemplified by the nurse?

The RN coordinates care delivery. There are 12 Standards of Practice: assessment, diagnosis, outcomes identification, planning, implementation, evaluation, ethics, culturally congruent practice, communication, collaboration, leadership, and education. The standard exemplified by the nurse is 5a, implementation via coordination of care in which the RN coordinates care delivery. Standard 5b is health teaching and health promotion in which the registered nurse employs strategies to promote health and a safe environment. Standard 3 is outcomes identification, in which the registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation. Standard 2, diagnosis, is when the registered nurse analyzes the assessment data to determine the actual or potential diagnoses, problems, and issues. Standard 1 is assessment, in which the registered nurse collects pertinent data and information relative to the health care consumer's health or the situation.

The nurse conducts a home safety assessment for a client. Which statement best explains the standard of care being implemented?

The RN promotes a safe environment. The standard of care being exemplified is standard 5b: health teaching and promotion: The RN employs strategies to promote health and a safe environment. Standard 3, which is outcomes identification, involves the registered nurse identifying expected outcomes for a plan individualized to the health care consumer or the situation. Standard 12 is education, in which the registered nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking. Standard 4 is planning, in which the registered nurse develops a plan that prescribes strategies and alternatives to attain expected, measurable outcomes.

A nurse is providing care for clients in a long-term care facility. What should be the central focus of this care?

The client receiving the care The client receiving the care is always the central focus of the nursing care provided. The central focus is not the nurse, the nursing actions, or nursing as a profession.

Which is the best example of a client-centered approach to care?

The nurse asks the client about health goals. Client-centered care is one of the quality and safety education requirements for nursing competencies (QSEN). The intent of client-centered care is to ensure that care is centered on the client, and not the needs of the nurse. An example of this is the nurse asking the client about personal health goals so that they can be addressed on the client's plan of care. Helping the client ambulate, asking the client what he or she would like from the menu, and drawing a blood sample are examples of client care, but are not client-centered care.

The nurse is caring for a client after a stroke rendered the client's right side weaker than the left. The nurse coordinates the plan of care with the physical therapist. The nurse's interventions reflect which one of nursing's four broad goals?

To restore health The four broad aims of nursing practice are to promote health, prevent illness, restore health, and facilitate coping with death and/or disability. In the example, the nurse is coordinating care with the other disciplines in an attempt regain some of the strength in the client's right side. This is an example of restoring a client's health. The nurse is not preventing the stroke or promoting health prior to the stroke. The nurse is not facilitating coping with the stroke.

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?

art of nursing In this example, the nurse is utilizing a holistic approach to the provision of nursing care based on the knowledge of providing psychosocial interventions, such as allowing the client to verbalize feelings/fears. This application of knowledge is the art of nursing. The science of nursing is the knowledge base for the provision of care. Evidence-based practice and application of research are using research to make decisions on how to care for clients.

The nurse is caring for a client who is on a ventilator. The nurse is bathing and talking to the client, including telling the client what is going to happen next. The nurse speaks to the client in a soothing manner. The nurse is acting in which role? Select all that apply.

caregiver, communicator, educator The nurse is fulfilling the role of caregiver by providing the care and speaking to the client in a soothing manner. The nurse is also acting as a communicator by talking to the client, even if the client cannot respond. The nurse is also acting as an educator by informing the client of the care that will be performed. The nurse is not assisting in making any decisions or speaking on behalf of the client.

The primary aim of the Healthy People 2020 initiative is:

health promotion. Healthy People 2020 establishes health promotion guidelines for the nation as a whole. The guidelines contain 12 Leading Health Indicators, which are used to measure the health of the nation over a 10-year period. Illness prevention, health restoration, and coping with disability are components of the Healthy People 2020 guidelines, but are not considered as the primary goal of the initiative.

In the role of entrepreneur, the nurse's primary responsibility is:

managing a health-related business. A nurse entrepreneur is primarily concerned with organizing, developing, and managing a clinic or health-related business. Although a nurse entrepreneur may also administer resources, manage personnel, and teach, the primary responsibiity of this role is managing a health-related business. A nurse administrator is primarily concerned with administering resources and managing personnel. A nurse educator is primarily concerned with teaching in a clinical setting.

Although all of the following are nursing responsibilities, which one would be expected of a nurse with a baccalaureate degree?

using research findings to improve practice Nurses with baccalaureate degrees are expected to use research findings to improve practice. Graduates from vocational, diploma, and associate degree programs do not have coursework in nursing research and are not expected to independently use it in clinical practice. Nurses from all levels of education provide direct care, administer medications, and collaborate with other health care providers.