prepu questions

(see full question) The nursing student is learning how to do a complete assessment by organizing the data into the different body systems. This is an example of which of the following types of assessment?

Medical model Explanation: Systemic guidelines for nursing assessments help ensure that comprehensive, holistic data are collected. Gordon's framework identifies a11 functional health patterns and organizes data within these patterns. Maslow's hierarchy has five levels of human needs and organize data accordingly. A medical model organizes data collection into body systems and there is no assessment known as the prevention model.

The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system?

Medicare Explanation: The federal government implemented a system of prospective payment in 1983 for people enrolled in Medicare. A prospective payment system uses financial incentives to decrease total health care charges by reimbursing hospitals on a fixed rate basis. Reimbursement is based on the diagnostic-related group, which is a classification system used to group clients with similar diagnoses. Medicaid provides health care through funds obtained from federal, state, and local sources. In capitation strategy, a preset fee per member is paid to a health care provider, regardless of whether the member requires services. AmeriCare provides health care services through employers.

(see full question) A nursing student is describing nursing concepts in class. The student states that these concepts can be put together, along with the relationships described among the concepts. The nursing instructor knows that the student is describing which of the following?

Theory Explanation: Theory is a group of concepts and the relationships among them. Concepts are abstract ideas or objects and their relationships to one another. Deductive reasoning provides a basis for theory development as one studies a general idea to more specific properties. Inductive reasoning is derived from consideration of specific properties to make conclusions about a general idea.

What have the models of health promotion and illness prevention been used for?

To help health care providers understand health-related behaviors. Explanation: Several models of health promotion and illness prevention have been used to help health care providers understand health-related behaviors and adapt care to people from diverse economic and cultural backgrounds. The models include the health belief model, the health promotion model, the health-illness continuum model, and the agent-host-environment model. These models do not define a medical framework in the care of the disabled; these models do not create a forum for improving rehabilitative care; and these models do not formulate care plans for use with the disabled.

(see full question) The American Nurses Association (ANA) has published the standards of care for which the nurse is responsible. The Standards of Practice are:

assessment, diagnosis, outcome identification, planning, implementation, and evaluation. Explanation: The ANA's six Standards of Practice are assessment, diagnosis, outcome identification, planning, implementation, and evaluation. The nursing process encompasses all significant nursing actions and forms the foundation for the nurse's decision making.

After conducting the initial assessment of a new resident of a long-term care facility, the nurse is preparing to terminate the interview. Which question is the most appropriate conclusion to the interview?

"Is there anything else we should know in order to care for you better?" Explanation: A helpful strategy in the termination phase of an interview is to ask the client: "Is there anything else you would like us to know that will help us plan your care?" This gives the client an opportunity to add data the nurse did not think to include. Expectations and previous practices should be addressed during the working phase of an interview.

(see full question) A nurse is conducting a class about health care trends for a group of newly graduated registered nurses at the community hospital. Which of the following six trends stated by the nurse reflects the Institute of Medicine's (IOM) focus?

"The system should be safe, effective, efficient, patient centered, timely, and equitable."

(see full question) When assessing an infant's axillary temperature, it will be:

1 degree lower than an oral temperature. Explanation: Rectal temperatures may be 1 degree higher than oral temperatures, and axillary temperatures are 1 degree lower than oral temperatures.

What is the pulse pressure of a client whose blood pressure is 132/82 mm Hg?

50 Explanation: Blood pressure is measured in millimeters of mercury (mm Hg) and is recorded as a fraction. The numerator is the systolic pressure; the denominator is the diastolic pressure. The difference between the two is called the pulse pressure. (less)

The nurse is palpating a client's precordium. What is an expected clinical finding?

Palpable pulsation over the mitral area Explanation: A palpable pulsation over the mitral area is a normal finding (apical impulse).

Question 7: (see full question) The client is being discharged to the home setting following a stroke. Which activity would the occupational therapist take to assist the client?

Relearning how to cook safely Explanation: The occupational therapist can evaluate the functional level of the client and teach activities to promote self-care in activities of daily living, such as cooking. The physical therapist provides direct care, such as muscle-strengthening exercises, gait training, and massage. The speech therapist assists with speech and language ability, as well as eating and swallowing.

(see full question) The nurse is taking a rectal temperature on a patient who reports feeling lightheaded during the procedure. What would be the nurse's priority action in this situation?

Remove the thermometer and assess the blood pressure and heart rate. Explanation: Vagal nerve stimulation may occur when obtaining a rectal temperature. Vagal nerve stimulation can cause the pulse and blood pressure to drop significantly causing the patient to feel light-headed; therefore the thermometer should be removed immediately and the pulse and blood pressure assessed. The physician can be called after assessing the patient. The temperature is not the priority at this time. Assistance for CPR would be determined if the patient's condition worsens.

A client has just been admitted to the clinical unit. The nurse is providing her with the expectations she may have of the health care she will receive. She is told that she will not be harmed by any errors that might be made and she can expect to be safe in the facility. This assurance represents which expectation of the health care environment?

Safety Explanation: Safety is represented by the expectation that the client won't be harmed by any errors and they will be safe in the facility. The other choices represent expectations of the health care environment but do not define safety.

A male client has been recently diagnosed with diabetes after receiving emergency treatment for a hyperglycemic episode. Which of the client's actions indicates that he has achieved a cognitive outcome in the management of his new health problem?

The client is able to explain when and why he needs to check his blood sugar. Explanation: The ability to describe the rationale and technique for blood glucose monitoring indicates that the client has achieved a cognitive outcome. Demonstration of the technique constitutes a psychomotor outcome, while the expression of a desire for change is an affective outcome. The maintenance of healthy blood sugars is a physiologic outcome.

A nurse is evaluating nursing care and patient outcomes by using a retrospective evaluation. Which action would the nurse perform in this approach?

The nurse devises a post-discharge questionnaire to evaluate patient satisfaction. Explanation: Evaluations can be conducted concurrent with care (conducted by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met), or retrospective (postdischarge questionnaires, patient interviews by telephone or face to face, or chart review to collect data).

The Joint Commission encourages patients to become active, involved, and informed participants on the health care team. What nursing action follows TJC recommendations for improving patient safety by encouraging patients to speak up?

The nurse encourages the patient to participate in all treatment decisions as the center of the health care team. Explanation: The Joint Commission (TJC) encourages patients to become active, involved, and informed participants on the health care team. By becoming involved and "speaking up" research shows that patients who take part in decisions about their health care are more likely to have better outcomes. The nurse should never want to prevent patient questions. While patients are encouraged to be independent, trusted family members and friends can be an asset to the patient's care. The nurse should investigate the possibility of an error if the patient questions the nurse about a medication.

When conducting an education program for a group preparing for retirement, the nurse would include information about applying for Social Security benefits and Medicare insurance. The nurse would include in the education that Medicare is a federally funded insurance program which bases the fee for payment on what?

A prospective payment plan based on a predetermined fixed cost. Explanation: The nurse must understand that Medicare is a federal insurance program for the elderly. It is based on a prospective payment plan which pays a predetermined fixed amount for in-hospital costs. Medicare does not pay physician groups, and is not for the poor or indigent to save on costs. Retrospective payment plans pay for services after they have been received.

A 90-year-old woman has a staphylococcus infection in her decubitus ulcer. Staphylococcus is the:

Agent Explanation: The agent is any factor that leads to illness

(see full question) The nurse is performing an assessment on a client who presents with a rash. The client states that the rash is on his back and is red and raised. What would be the most appropriate nursing action?

Assess the client's back visually. Explanation: Assessment is the collection of data that enables the nurse to make judgments about the level of care the client needs. Assessment should be documented accurately, completely, concisely, factually, and timely. For the nurse to document an accurate and concise assessment, a visual assessment of the rash is necessary. This assessment should be performed before it is reported or documented and before a nursing diagnosis can be formulated.

A nurse is justified in independently identifying and documenting which diagnosis related to impaired elimination?

Bowel Incontinence Explanation: Bowel incontinence is a NANDA-I-approved nursing diagnosis under the domain of Elimination. Ulcerative colitis, irritable bowel syndrome, and small bowel obstruction are medical diagnoses.

The nurse is caring for a client who is undergoing treatment for infertility caused by endometriosis. Which outcome statement is structured correctly?

By discharge from the clinic, client will achieve full-term pregnancy. Explanation: Outcomes should be specific, measurable, attainable, realistic, and timebound. Achieving a full-term pregnancy is a specific and reasonably attainable goal. Common errors to avoid when writing outcomes are writing the outcome as a nursing intervention, including more than one client behavior in a short-term outcome, using verbs that are not observable, and using verbs that are not measurable such as "know" and "understand." The other options do not directly measure resolution of the problem or they lack a time element.

A nurse is formulating a clinical question in PICO format. Which of the following is represented by the letter I?

Clearly defined, focused literature review P represents explicit descriptions. I represents a clearly defined, focused literature review. The C is PICO represents comparison to another similar treatment, while the O is the specific identification of the desired outcome.

(see full question) A client at a local health fair asks the nurse what is meant by secondary health care. Which of the following reflects the intent of secondary care?

In secondary care, one would expect that psychiatric care, same-day surgery, and general hospital care for patients be provided. Explanation: Secondary care involves some specialists who provide care, generally in the hospital setting. Common health problems are generally consigned to primary care in an outpatient setting. Complex, rare disease states are cared for in tertiary care centers.

The nurse working with the hospital's infection control team is attempting to decrease the transmission of health care-associated pathogens. Which of the following will be most effective?

Incentivizing health care workers to utilize hand hygiene Explanation: Most health care-associated pathogens are transmitted via the contaminated hands of health care workers. Therefore, the most effective strategies for decreasing transmission are those that educate or encourage health care workers to utilize effective hand hygiene.

As the nurse bathes a patient, she notes his skin color and integrity, his ability to respond to simple directions, and his muscle tone. Which statement best explains why such continuing data collection is so important?

It enables the nurse to revise the care plan appropriately. Explanation: Continuous data collection ensures that the nurse has the most current patient data to evaluate, which allows for updating the care plan as needed. A complete assessment is performed upon admission, but the patient's condition is always changing. The purpose of continued data collection is to provide good patient care; it does not related directly to efficiency of nursing care. While continuous data collection meets standards of care, it is not the primary reason for ongoing assessments.

The nurse in a free clinic caring for clients uses the Health Belief Model, which is based on three components. What is the main focus for this model?

It focuses on what people believe to be true about their health. Explanation: The Health Belief Model focuses on what people perceive or believe to be true about themselves in relation to their health. The Health Promotion Model focuses on how people interact with their environments, as they pursue health. The Health Illness Continuum Model focuses on health as a constantly ever-chaining state, while The Agent-Host-Environment Model explains how certain factors place a person at risk for an infectious disease.

A nurse is caring for a 78-year-old male patient who has been hospitalized following a stroke. Which nursing action has the highest priority for this patient?

Measuring the patient's I&O during recovery Explanation: In nursing, both the physical and psychosocial needs of each individual patient are considered. Abraham Maslow (1968) developed a hierarchy of basic human needs that describes which needs of a person are the most important at any given time. Certain needs are more basic or essential than others and must be at least minimally met before other needs can be considered. Maslow's hierarchy is useful for understanding relationships among basic human needs and for establishing priorities of care. Maslow arranged the hierarchy to show that certain needs are more basic than others. The five levels of needs, beginning with the most basic, are as follows: Level 1: Physiologic needs Level 2: Safety and security needs Level 3: Love and belonging needs Level 4: Self-esteem needs Level 5: Self-actualization needs. Maslow's hierarchy provides a framework for nursing assessment and for understanding the needs of patients at all levels, so that interventions to meet priority needs become a part of the plan of care. Measuring the client's I&O during recovery is a Level 1 need. Ensuring that the client has family and friends visit him is a Level 3 need. Helping the client fill out an advanced directives form is a Level 4 need. Finding a safe environment for the client upon discharge is a Level 2 need. By using Maslow's hierarchy, the Level 1 need is the highest priority.

Which nursing actions reflect the evaluation stage of the nursing process? Select all that apply.

• The nurse identifies that a client's pain is not being adequately treated. • The nurse documents the client's response to suctioning. • The nurse determines the client did not lose the expected two pounds. Explanation: Examples of evaluation include documenting the client's response to suctioning and making a judgment that the client did not reach the expected outcome of a 2-pound loss or adequate pain control. Setting an anxiety rating with the client is an example of planning. Performing tracheostomy care is an example of implementation.

A nurse is evaluating the plan of care for a client in the clinic. Which actions will she perform as a classic element of evaluation? Select all that apply.

• identifying evaluative criteria and standards • collecting data to determine if criteria or standards are being met • interpreting and summarizing findings • terminating, continuing, or modifying the plan of care Explanation: The nurse must document findings as they relate to the plan of care but should also include the nurse's judgement as to whether the outcomes are being met. All of the other choices are criteria for evaluation.

(see full question) The nurse completes the admission assessment. As part of the admission database, the nurse would determine and record functional abilities, which include:

• if the patient wears eyeglasses. • the patient's ability to ambulate. • the patient's comprehension. Explanation: In order to determine functional ability the nurse, must assess the patient's ability to care for himself and what devices or assistance may be needed.

A 16-year-old girl has been injured in an accident and is receiving home care due to fractures and multiple trauma-related injuries. She states, "I don't know why I survived and not my best friend." It is most important to:

communicate her feelings to family and friends. Explanation: The home care nurse can assist in coordinating care needs and encouraging family, teachers, schoolmates, and friends to understand the client's struggles and help support her needs.

(see full question) The young adult client is awaiting diagnostic test results for cancer. The client will not sit in the chair and is pacing in the room. The client's heart rate is 112 beats/minute and respirations are 32 breaths/minute. The client's speech is rapid and makes little sense. The nurse assesses the client level of anxiety as

severe. Explanation: Severe anxiety is manifested by difficulty communicating verbally, increased motor activity, tachycardia, and hyperventilating. Mild anxiety is present in everyday living and is manifested by restlessness and increased questioning. Moderate anxiety is manifested by a quavering voice, tremors, increased muscle tension, and slight increases in heart and respiration rates. Panic is manifested by difficulty with verbal communication, agitation, poor motor control, tachycardia, hyperventilation, palpitations, choking sensation, and chest pain or pressure.

(see full question) What are examples of psychosocial stressors?

terrorism, accidents

(see full question) What is the primary purpose of standards of nursing practice?

to ensure knowledgeable, safe, comprehensive nursing care Explanation: Each nurse is accountable for her own quality of practice and is responsible for using standards to ensure knowledgeable, safe, comprehensive care. Standards of practice do not provide the ability to safely perform skills, establish nursing as a profession and discipline, or enable nurses to have a voice in health care policy.