PrepU HCDS

The nurse is assessing a 75-year-old woman who had a total hysterectomy when she was 30 years old and normal Pap test results for the past 10 years. The client asks about continuing the Pap test. The nurse states:

You may choose to discontinue this test

A 17-year-old high school senior calls the clinic because she thinks she might have gonorrhea. She wants to be seen but wants assurances that no one will know. Which is the most appropriate response by the nurse?

"We can see you without your parents' consent but have to report any positive results to the public health department." While some areas may specify a minimum age for treatment (usually 12 to 14 years), generally adolescents have the right to seek treatment for sexually transmitted infections without their parents' permission. These medical records are not shared with parents without the client's permission. However, adolescents must be made aware that certain infections, including gonorrhea, must be reported by law to public health agencies. Partner notification will also take place, but methods vary.

Which of the following would be included as a goal of case management?

Appropriateness of services Correct Explanation: The goals of care management are quality, appropriateness, and timeliness of services as well as cost reduction. Case managers do not have prescriptive authority. Fixed price reimbursement is a feature of managed care. Case managers do not utilize the nursing process.

Which precautions should the health care team observe when caring for clients with hepatitis A?

Contact precautions are recommended for clients with hepatitis A. This includes wearing gloves for direct care.

A nurse is working in a clinic where a family member's spouse is treated for a sexually transmitted disease. The nurse is concerned about the risk to her family member. What is the most appropriate action for the nurse to take?

Encouraging the client to talk with his spouse is the nurse's only option. According to the Privacy Acts, a client's diagnosis is confidential information that shouldn't be shared with anyone, including a spouse, without the client's permission. Telling a family member about the diagnosis is a violation of the client's confidentiality. The nurse isn't legally obligated to report the diagnosis to her family member. It isn't appropriate for the nurse to provide information that would allow other agencies to contact the client's spouse.

A student nurse is reviewing physician orders written on a client's chart. Which entry is written incorrectly because it contains material from the "do not use" list of the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission)?

Epoetin alfa 6500 U SQ daily. Explanation: The order written as "Epoetin alfa 6500 U SQ daily" is incorrect according to the Joint Commission's "do not use" list. "U" should not be used because it may be mistaken as zero (0), 4 (four), or cc. The healthcare professional should write "unit" instead. The other medication orders are written correctly. The order for diazepam does not include a trailing zero in the dosage. The order for levothyroxine sodium includes a leading zero prior to the dose. The acetaminophen order is correct in the use of the word "every" instead of Q.D., QD, q.d., or qd.

A health care agency is applying for accreditation, and the accrediting agency is conducting audits of randomly selected medical records. To support the agency's accreditation, these medical records should include:

Evidence that nursing interventions have been evaluated in terms of the client's response. The medical record serves multiple purposes, including a role in accreditation. Accreditors look for evidence of evaluation following interventions. The medical record is not the correct venue for nurses' self-reflection or personal goal-setting. Many clients do not require community-based follow up after they have been discharged.

Which of the following is the leading cause of blindness in the United States?

Glaucoma is one of the leading causes of irreversible blindness in the world and is the leading cause of blindness among adults in the United States.

The nurse is assessing a family parented by a 60-year-old grandmother and her three school-age grandchildren. The nurse is aware that which problem may occur in a single-parent family at a greater level than in other types of families?

Increased financial concerns Correct Explanation: Many single parent families are headed by women. Single parents often have special problems and needs, including financial concerns and role shifts (i.e., having the roles of both parents). Single-parent families are not less knowledgeable about child safety than other family types, nor is there a higher incidence of child abuse, neglect, or conflict among family members.

Which of the following is a factor upon which the financial stability of health maintenance organizations (HMOs) is based?

Keeping patients healthy and out of the hospital through periodic screening, health education, and preventive services. The financial stability of HMOs is based on their ability to keep their members healthy and out of the hospital through periodic screening, health education, and preventive services. HMOs do not maintain the statistics and records of all the patients admitted in hospitals on a regular basis. Keeping patients satisfied by providing them regular financial assistance and looking after their medical needs is not the function of a HMO. Providing entertainment programs for patients in order to distract them from their illness is also not a part of the activities conducted by an HMO.

The Henry Street Settlement was founded by

Lillian Wald Correct Explanation: Lillian Wald and Mary Brewster established the Henry Street Settlement, which was the first public health service for the sick and poor

The family of a patient in hospice decides to place their loved one in a long-term care setting to establish an effective pain control regimen. Which of the following aspects of hospice care is the family utilizing?

Palliative care Correct Explanation: Long-term care is increasing as a setting to provide palliative care addressing symptom management, such as pain. Inpatient respite care is a 5-day inpatient stay, provided on an occasional basis to relieve the family caregivers. Continuous care is provided in the home for management of a medical crisis. General inpatient care provides inpatient stay for symptoms management that cannot be provided in the home.

The central figure in health care services is the

Patient

The nursing is caring for a client who requests to see a copy of his or her medical records. What action by the nurse is most appropriate?

Review the hospital's process for allowing clients to view their medical records.

Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest?

Symptoms of cardiac insufficiency at rest are classified as IV, according to the New York Heart Association Classification of Heart Failure. In Class I, ordinary activity does not cause undue fatigue, dyspnea, palpitations, or chest pain. In Class II there is a slight limitation of ADLs. In Class III there is marked limitation on ADLs.

The nurse is preparing a community education program about preventing hepatitis B infection. Which information should be incorporated into the teaching plan?

The use of a condom is advised for sexual intercourse. Explanation: Hepatitis B is spread through exposure to blood or blood products and through high-risk sexual activity. Hepatitis B is considered to be a sexually transmitted disease. High-risk sexual activities include sex with multiple partners, unprotected sex with an infected individual, male homosexual activity, and sexual activity with IV drug users. College students are at high risk for development of hepatitis B and are encouraged to be immunized. Alcohol intake by itself does not predispose an individual to hepatitis B, but it can lead to high-risk behaviors such as unprotected sex. Good personal hygiene alone will not prevent the transmission of hepatitis B.

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

World War II. Esther Lucille Brown, in her report on nursing education published at that time, wrote that nursing education belonged in colleges and universities, not in hospitals.

Because of an outbreak of influenza among the nursing staff, the hospital is very short staffed. The nurse manager prioritizes client needs on the surgical unit by which strategy?

ensuring that clients receive medications but omitting full bathing when possible Explanation: Daily bathing is not required to meet standards of care. Rescheduling surgeries is not a strategy for meeting nursing care needs of clients. Medications are required to be given as prescribed to maintain standards of care and efficacy of the medication. UAPs are not licensed to administer analgesics.

A nurse is performing health promotion activities for patients at a local health care clinic. Which nursing actions exemplify the focus of secondary preventive care? (Select all that apply.)

• Screening patients for hypertension • Scheduling a mammogram for a patient • Referring a patient to family counseling

A nurse is reading a journal article about the U.S. health care delivery system. When reading this article, which of the following would the nurse expect to find? Select all that apply.

• View of a person's state of health as ever-changing • Diverse cultural backgrounds affecting responses to health care • Increased ethical issues related to technological advancements Explanation: In the United States, there is a shift from a disease-oriented focus to increased emphasis on health and health promotion. Health and illness are viewed on a continuum, allowing a person to simultaneously possess degrees of both health and illness. Thus, a person's state of health is ever-changing, and rarely is a person completely healthy or completely ill. The cultural composition of the population is changing, with people from diverse sociocultural groups bringing various health care beliefs, values, and practices to the health care setting, in addition to risk factors for some disease conditions and unique reactions to treatment. This change affects the care delivered and potential outcomes. The prevalence of chronic illnesses and disability is increasing because of the lengthening of the lifespan, advances in care, and expanding treatment options. However, these advances have also resulted in many ethical issues for health care providers, clients, family, and society.