Professional Practice final - cumulative chapters

The primary benefit of a well-written cover letter is to demonstrate the nurse's to do what? A. Identify an interest in this specific position. B. Communicate well by writing. C. Work willingly D. Express a desire to arrange an interview.

A. Identify an interest in this specific position. A convincing cover letter will show how this candidate is different and convey to the recruiter why he/she is the best fit for the position. The letter should also address why this institution is the applicant's first choice. The other options are secondary benefits of a concise, well-written cover letter.

Which example of discharge teaching addresses a never event as identified by The Centers for Medicare & Medicaid Services? A. Signs and symptoms of both hypo- and hyperglycemia B. Food choices for a low-fat, low-carbohydrate diet C. Suggested exercise options for the immediate postdelivery period D. Need for good medication compliance in managing schizophrenia

A. Signs and symptoms of both hypo- and hyperglycemia The manifestations of poor glycemic control have been identified as a never event by The Centers for Medicare & Medicaid Services. The other options, although they are appropriate subjects for discharge education for specific clients, do not address never events.

Which infections are currently considered a Never Event by Medicare and Medicaid? (Select all that apply.) A. Eye infection post cataract surgery B. Site of implanted cardiac electronic device (ICED) C. Abdominal incision site associated with bariatric surgery D. Catheter-associated urinary tract infection E. Coronary artery bypass graft site

B, C, D, E Never Events currently include infections associated with surgical site following coronary artery bypass graft; certain orthopedic procedures; bariatric surgery for obesity; cardiac implantable electronic device (CIED). Postcataract surgery infection is not included.

Which factor has the greatest impact on whether safe delegation of nursing tasks is possible? A. The degree of trust shared between the nurse and the client B. Whether the client's physical condition is considered stable at the time C. The level of competency displayed by the unlicensed assistive personnel (UAP) D. Whether the client is experiencing an acute or a chronic medical health issue

B. Whether the client's physical condition is considered stable at the time Generally the more stable the patient, the more likely delegation is to be safe. However, it is also important to remember many tasks that can be delegated may also carry with them a nursing responsibility. The other options are to be considered but they are not as impactful as is the physical condition of the client at the time tasks are being delegated.

Considering Tanner's clinical judgement model and the nursing process, what nursing activity is best associated with the both the process of noticing and assessment? A. Revising the patient's care plan to accommodate newly developed depression B. Initiating a new patient's plan of care C. Collecting objective client related data D. Postponing ambulating a patient until their visitors leave

C. Collecting objective client related data The noticing phase of the clinical judgment model consists of remarkably similar skills that are used during the assessment phase of the nursing process. These skills include assessment techniques such as a physical assessment and subjective and objective data collection. The interpreting phase of the clinical judgment model aligns with the planning phase of the nursing process demonstrated by initiating a plan of care. During the responding phase, the nurse implements and intervenes. The nurse decides on the best course of action based on the patient situation. When responding, the nurse may find to take immediate action or no action at all. Temporarily postponing ambulation depicts responding and implementing care. The nurse engaging in reflection evaluates the care outcomes of their patient and conducts a self-analysis. The nurse makes changes to the plan of care as new developments occur through reflection of the patient's condition and achievement of treatment goals.

Based on current trends, which nursing care environment has the greatest employment potential for new nurses? A. Primary health care provider practices B. Hospital emergency departments C. Long-term care facilities D. Pre- and post surgical departments

C. Long-term care facilities Employment will not grow at the same rate in every setting—hospital employment will grow more slowly because many procedures and care are shifting to outpatient and home health settings, more sophisticated procedures can safely be done outside the hospital, and home health and long-term care facilities will see employment growth due to the aging population. The other options are more traditional environments and so are not as likely to show increased employment growth.

How can nursing best ensure effective use of point-of-care advanced technologies in the future? A. Health promotion and illness prevention programs must embrace technology in order to reach more clients. B. Additional monies must be dedicated to research and development of such health care-related tools. C. Potential clients must be well educated concerning the use and reliability of health care technologies. D. The cost of health care technologies must be within the reach of all health care delivery facilities.

C. Potential clients must be well educated concerning the use and reliability of health care technologies. Although some clients trust technology, others do not and may be reluctant to accept care that is driven by technology. Their fears and concerns must be addressed in order for new, more advanced technologies to be accepted and utilized to their fullest. The other options, while true, do not have as great an impact as client acceptance on the use of future technologies.

After first having a strong understanding of the standards of practice that govern delegation, what information must the registered nurse possess? A. The expected outcomes of the care to be delegated B. The skill and knowledge level of the staff member who is being delegated to C. All patient care tasks that are being considered for delegation D. The condition and needs of the patient whose care is being delegated

D. The condition and needs of the patient whose care is being delegated The RN must then know the client whose care is being delegated. The client's condition and stability must be determined before tasks and outcomes can be determined or consideration be given to the skill level of the staff being delegated to.

What is the primary reason that an employer requests a nurse to provide nursing references? A. To determine whether a nurse is perceived as being professional B. To assess how well the nurse can work within a team setting C. To identify a nurse's strengths and weaknesses regarding interpersonal skills D. To confirm the nurse's ability to provide safe nursing care

D. To confirm the nurse's ability to provide safe nursing care The bottom line for any employer who provides health care services to the public is to ensure that its nursing staff practices safely. Recruiters are looking to uncover anything that would impair a nurse applicant's ability to provide safe nursing care, such as incompetence, unprofessional conduct, unreliability in attendance, chemical dependency, or a record of criminal activity. For screening, recruiters have four primary sources of information that include references. Although the reference may provide some insight into the other options, that is not its primary focus.

How does computerized provider order entry (CPOE) contribute to the prevention of medical errors? (Select all that apply.) A. Improving communication between members of the health care team B. Providing real time checks of intervention related activities C. Tracking of adverse patient focused events D. Providing support in the decision-making process E. Eliminating the need for human involvement in monitoring diagnostic results

A, B, C, D CPOE functions contribute to medical error prevention through improved communication, decision support, tracking and response to adverse events, and performance checks are done in real time. The CPOE may play a role in identifying appropriate diagnostic tests and preventing duplicate or contradictory orders for tests but it does not eliminate the human role associated with the monitoring results of such testing.

What is the most effective way to determine whether a position is a good match for an individual's strengths and goals? A. Prepare a list of questions to ask that will help provide information about the position. B. Talk with individuals who already work in similar positions. C. Self-reflect on one's strengths and goals prior to interviewing. D. Be willing and open to changing positions until a good match is arrived at.

A. Prepare a list of questions to ask that will help provide information about the position. The graduate's task is to enter the interview prepared to answer and ask questions that will help determine whether this organization, with its available job opportunities, is a good match. Although changing positions is an option, too many changes in a short period of time can be viewed as a negative by employers. The other options may prove helpful, but they are directed toward identifying personal strengths, weaknesses, and goals rather than identifying a good match in a position.

When considering nursing care what events are associated with the term "churning" and responsible for up to 70% of nursing care on a typical 20 bed medical-surgical unit? (Select all that apply.) A. Five patients will have initial visits from physical therapy staff. B. Two patients are in the ER department with orders to be admitted as soon as a bed is available. C. Five patients will be admitted for scheduled surgeries tomorrow between 7 and 8 am. D. Seven patients have been written discharge orders by their physicians. E. Twelve patients have needs that require assistance with bathing and elimination.

B, C, D Fast-paced patient turnover in acute care settings; the rapid discharge and admission cycle is now referred to as "churning" and is estimated to range from 25% to 70% on a typical medical-surgical unit. The remaining options reflect standard unit care.

What topic is appropriate for the nursing position interviewee to address during an interview with a recruiter? (Select all that apply.) A. "When can I expect to receive a pay raise?" B. "What will my salary be during the orientation period?" C. "What is the process for earning a pay increase?" D. "Is there a pay differential for shift work?" E. "How will my job performance be evaluated?"

B, C, D, E The recruiter will be prepared and qualified to provide information regarding pay differentials and salaries during the orientation period, as well as the evaluation processes for pay raises and position advancements. Exactly when pay raises will occur is dependent on specific institution policies and the results of the evaluation process and so is a question the recruiter is not prepared to answer.

What factors will be focal considerations when a facility begins developing its own set of clinical pathways? (Select all that apply.) A. Physician input as a primary source of decision making B. The facility's most commonly treated diagnoses C. Accepted standards of specialized nursing care D. Dietary and physical therapy are viewed as principal contributors E. The most costly diagnoses treated by the facility's staff

B, C, E Clinical pathways most often are developed for the health care facility's most common or costly diagnoses. Clinical pathways should also be based on accepted standards of practice as recommended by specialty nursing organizations. The success of clinical pathway development and implementation depends on input and support from all disciplines, including physicians, involved in using the pathway and caring for the patient.

What are the primary foci for nurses caring for patients currently being admitted to acute care facilities that make traditional nursing models less effective? (Select all that apply.) A. Rehabilitation B. Stabilization C. Rescue D. Prevention E. Transition

B, E Because acute care settings now admit only the most seriously ill or injured individuals with a focus on stabilization and transition, the traditional models of nursing care may no longer apply. In the past, nurses provided care based on comprehensive knowledge of the patients' needs, which were learned by caring for the patients over an extended period. Now nurses may have an entirely new group of patients to care for every shift or even more than once during a shift. The remaining options while concerns are not typically the focus of the acute care nurse.

What benefit is there to health care providers resulting from their effective efforts to help minimize reality shock among novice nurses? A. An increase in patient satisfaction B. A reduction in staff turnover C. A reduction in sentinel events D. An increase in advanced degree nurses

B. A reduction in staff turnover Reality shock leads to stress, which can threaten the well-being of new nurses and result in physical illness and mental exhaustion, leading to disillusionment with their career and ultimately to absenteeism and turnover. Although the remaining options are desirable, they are not generally related to reality shock.

What action demonstrates a nurse's correct understanding of patient-centered care? A. Referring to evidence-based practice when planning client care B. Discussing the client's wish to include herbal preparations to treat an illness C. Being careful to use costly dressing supplies appropriately but with their cost in mind D. Promptly medicating clients when they request their PRN analgesic

B. Discussing the client's wish to include herbal preparations to treat an illness Patient-centered care involves providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. Efficient care includes avoiding waste, effective care is based on scientific knowledge, and timely care focuses on reducing waits and delays in care delivery.

In order to best ensure that a novice nurse will transition well into the role of clinical care provider, the emphasis initially should be focused on what? A. Burnout prevention B. Socialization C. Time management skills D. Clinical nursing skills

B. Socialization The transition from student to professional nurse is difficult. Socialization of the novice nurse is key to his or her ability to transition or just "survive" at the clinical level. The other options are relevant, but not initially.

What is the ultimate goal of clinical reflection in supporting a nurse's professional practice? A. Developing the ability to empathize with patients B. Acquiring additional nursing knowledge C. Providing quality patient care D. Reviewing for personal biases on a regular basis

C. Providing quality patient care The nurse engaging in reflection evaluates the care outcomes of their patient and conducts a self-analysis. The nurse must have an underlying commitment to process and patient care improvement. The nurse transfers the learning and knowledge, gained through reflective practices, to the future care the nurse will provide ultimately improving patient care outcomes in future clinical care situations. Acquiring nursing knowledge is one of several components of effective nursing practice. The nurse does need to regularly review beliefs and values that may contribute to personal biases that can affect patient care. While these biases must never negatively affect the nurse's ability to provide quality nursing care, that requires self-reflection rather that clinical reflection. Empathy is a valuable nursing characteristic that contributes to effective nursing care but it is not necessarily fostered through clinical reflection.

Which statement made by an unlicensed assistive personnel (UAP) would cause the registered nurse team leader the most concern? A. "The nurse will follow up to make sure the client is well cared for." B. "I wonder who I can ask about how to use this new electronic thermometer." C. "I've only been working on this unit for a month and things are still new to me." D. "It's good to know that the nurse is really the one responsible for the client's care."

D. "It's good to know that the nurse is really the one responsible for the client's care." The UAP is responsible for his or her own actions. A belief that the nurse is fully responsible is a concern and needs immediate attention by the nurse. It is true that the nurse will follow up and evaluate the client's care. The statements concerning being new and asking for help are appropriate.

An __ includes activities that enhance one's ability to adjust to and function within a new environment.

Orientation An orientation involves activities that enhance adaptation to a new environment.

The active process of directing, guiding, and influencing the outcome of an individual's performance of an activity or task is referred to as __.

Supervision Supervision is the active process of directing, guiding, and influencing the outcome of an individual's performance of an activity or task.

What characteristics strongly suggests a nurse possesses the qualities required of sound clinical nursing judgement and reasoning skills? (Select all that apply.) A. Has ten years of experience working with post-surgical orthopedic patients. B. Regularly mentor's novice nurses on developing professional intuition. C. Has earned the Orthopaedic Nurse certification (ONC). D. Regularly volunteers at the hospital's health fairs. E. Advocates for the rights of the homeless population.

A, B, C Professional nurses must have continued and increasing competence to engage and work in complex care environments. In these complex care environments, nurses will use clinical reasoning skills to decide upon a clinical judgment. The ability to make a clinical judgment is influenced by the nurse's knowledge, intuition, and experiences. The nurse's ten years of working with orthopedic patients supports the acquisition of experience. Earning the ONC certification demonstrates knowledge in the field of orthopedic nursing. Mentoring novice nurses on intuition development serves to shows his/her view of its importance to effective nursing care. Advocacy and caring are qualities known to be important to professional nursing but they are not directly associated with the characteristics needed to support sound clinical nursing judgement.

Which situations demonstrate effective delegation by the RN to the LPN? (Select all that apply.) A. RN assumes responsibility for ambulating a patient when he reports, "I'm feeling dizzy." B. RN adjusts the LPN's assignments when a patient's condition becomes unstable. C. RN asks the LPN, "Do you have any concerns about your assignment for today?" D. LPN asks, "Where will you be if I need help with the dressing I've been assigned?" E. LPN states, "I'll do whatever is necessary to keep my patients free of pain."

A, B, C, D The RN is responsible for communicating effectively with the LPN concerning responsibilities and accountability regarding patient care. Asking the LPN if she/he has any concerns demonstrates effective communication. Appropriate supervision is demonstrated by the LPN's when a question about support is asked. Evaluation and reassessment are demonstrated by the RN adjusting assignments and assuming a responsibility when the patients' conditions change. The LPN's statement about doing whatever is necessary demonstrates a possible risk for actions outside the established job description, competency, and standard of care on the part of the LPN.

According to the national Patient Safety goals, how can nursing reduce the risk of patients developing associated infections? (Select all that apply.) A. Striving to remove indwelling urinary catheters as soon as possible B. Creating mandatory competencies associated with the care of surgical incisions C. Instituting sterile technique policies related to the care of central lines D. Ambulating postsurgical patients as soon as their physical condition allows E. Implementing current WHO hand washing guidelines

A, B, C, E Safety goals to reduce the risk of health care-associated infections include complying with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines; implementing evidence-based practices to prevent health care-associated infections caused by multidrug-resistant organisms in acute care hospitals; implementing evidence-based practices to prevent central line-associated blood stream infections; implementing evidence-based practices for preventing surgical site infections; and implementing evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTIs). Early ambulation is not a current goal related to infection risk management.

What characteristics are generally possessed by effective mentors who work with novice nurses? (Select all that apply.) A. Welcomes change B. Sensitive to the needs of others C. Possesses moral and ethical integrity D. Has good management skills E. Is nonjudgmental

A, B, C, E The characteristics that are demonstrated by effective mentors include sensitivity to others, flexibility, demonstrate moral and ethical integrity, and is nonjudgmental. Management skills would be important only if you were seeking to develop management skills.

Which statements reflect common nurse practice acts policies? (Select all that apply.) A. Only nursing tasks can be delegated, not nursing practice. B. The RN must evaluate patient outcomes resulting from the delegated activity. C. The LPN works under the supervision and direction of the RN. D. The LPN practices professional nursing. E. The RN can delegate only what is within the scope of nursing practice.

A, B, C, E The common policies reflected in nurse practice acts include: only nursing tasks can be delegated, not nursing practice, the RN can delegate only what is within the scope of nursing practice, the LPN or LVN works under the direction and supervision of the RN, the RN must evaluate patient outcomes resulting from the delegated activity. The LPN or LVN and UAP do not practice professional nursing.

Which documents are appropriately included in a professional nursing portfolio? (Select all that apply.) A. Copies of poster presentations B. Proof of an advanced cardiac life support (ACLS) certification C. Summary of future professional goals D. Continuing education certificates E. Letters of recommendations

A, B, D, E A portfolio appropriately can contain proof of professional certifications; educational credentials that include earned CEUs; scholarly activities like poster presentations; letters of recommendations. The focus of a portfolio is past and current accomplishments not the plans for future ones.

What guidelines should a novice nurse consider when selecting a mentor? (Select all that apply.) A. Someone you can easily establish regular contact with B. Has experience in your nursing specialty C. Similar age and educational background D. Someone you've known for a long time E. Possesses characteristics you view yourself being weak in

A, B, E A mentor who lives nearby or works in the same facility will make interaction easy to arrange. Having experience in the field of nursing you share will help with clinical situations. By having the strengths you lack, the mentor can certainly be a role model. Similar age and educational background are not necessarily advantages nor is having known the person for a length of time.

Which self-assessment questions would be helpful when evaluating one's personal sense of self-esteem? (Select all that apply.) A. Do you struggle with feelings of inferiority? B. Do you believe luck has played a big role in your career success? C. What gives you the greatest sense of accomplishment? D. When did you know you wanted to be a nurse? E. Do your good points seem ordinary and your failings all important?

A, B, E The nurse with high self-esteem will possess a positive attitude; have pride in his or her accomplishments; have a balanced view of personal strengths and weaknesses; are not overly critical of oneself. Feeling that one has earned the rewards of life is an indicator of high self-esteem. The incorrect options are not related to feelings of self-esteem.

What topics are not appropriate for discussion during an initial employment interview? (Select all that apply.) A. Nationality B. Credit status C. Reasons for leaving previous jobs D. Criminal convictions E. Sexual preference

A, B, E Topics neither legal nor appropriate for discussion during an initial job interview include nationality, sexual preference, and credit status while discussing reasons for leaving previous jobs and any criminal convictions are appropriate and legal.

What elements are considered when addressing workforce advocacy? (Select all that apply.) A. Physical environment B. Support of health care policies C. Social factors D. Staffing E. Workflow design

A, C, D, E Elements of workforce advocacy include staffing, workflow design, personal and social factors, physical environment, and organizational factors. Supporting health care policies is the role of the patient advocate.

Which characteristics are associated with patient advocacy? (Select all that apply.) A. Promotion of safe patient care B. Promotion of an optimal nursing working environment C. Cornerstone of the nursing profession D. Enhancement of health care systems' accountability E. Delivery of quality nursing care

A, C, D, E Patient advocacy: The nurse and the nursing profession's powerful voice at the local, state, and national levels in supporting policies that protect consumers and enhance accountability for quality by promoting safer health care systems. Patient advocacy is a cornerstone of the nursing profession, and patients depend on nurses to ensure that they receive quality care. Workforce advocacy promotes an optimal professional work environment.

What is the best example of a situation where a nurse could demonstrate workforce advocacy? A. A client feels pressured by a health care provider into agreeing to a specific medical procedure. B. A nurse volunteers time to participate in a fund raiser to provide toys for a hospital's pediatric unit. C. A client wishes to become an organ donor in spite of family opposition. D. Staff on a particular unit feel that the nurse manager is showing favoritism when granting vacation time.

A. A client feels pressured by a health care provider into agreeing to a specific medical procedure. Nurses' strong concern and commitment to patient care and their role as patient advocates often place them in direct conflict with those who have more control, such as physicians and health care administrators. How a nurse reacts to such conflicts within the workplace and continues to advocate to improve patient care is a necessary focus for the profession—a focus called workforce advocacy. Volunteering time to provide funds for toys shows an interest in the client's welfare but is not as strongly related to client care. Advocacy for a client wishing to become an organ donor is an example of patient advocacy. The issue of fair management in this situation does not involve client care.

The novice nurse should prepare a résumé that focuses primarily on being what? A. A one-page summary of education and work experience B. A detailed description of one's educational and work history C. Attracting the interviewer's attention D. The basis of scheduling an interview

A. A one-page summary of education and work experience The résumé is the most appropriate format for the new graduate and will complement the cover letter by filling in important details about educational and work experiences. An effective résumé should compress education and employment history into an attractive, easy-to-read one-page summary. The cover letter serves to attract the interviewer and is a basis for scheduling an interview, while the curriculum vitae (CV) is a detailed document that describes education and work history.

Which nursing activity best demonstrates the quality management principle of "all one team"? A. Asking a wound care team nurse how to best educate a client on wound prevention B. Doing a search of the literature regarding prevention of postoperative bleeding in smokers C. Encouraging clients to determine when they want their daily bath D. Attending a seminar on the latest recommended therapy to reinforce cognitive function in the elderly

A. Asking a wound care team nurse how to best educate a client on wound prevention Demonstrating faith in the people who comprise the health care team and recognizing the expertise of particular team members reflects the "all one team" principle. Quality is demonstrated by considering clients as those who define whether their care is appropriate and of high value. Knowledge, especially when evidence based, demonstrates the scientific approach to client care.

What important change have nurses implemented regarding their clinical care of patients was required by the use of point-of-care technology? A. Becoming proficient users of the electronic tools B. Knowing where to access necessary information needed for client care C. Being skilled proficiently while allowing technology to provide the knowledge D. Relying more on memorization of client data

A. Becoming proficient users of the electronic tools Nursing today requires understanding and skill related to the variety of technological resources available to the nurse. Point-of-care technology is an essential component of nursing practice as it moves from practice that relies on memory to one that emphasizes continuous use of resources as they are needed. This means that nurses must transform from being technical experts to knowledge workers and rely on the ever-increasing and reliable computer memory versus the overburdened and fallible human memory.

The nurse responsible for unit staffing must recognize that client care is most affected positively by what factor? A. Nurses who report high levels of job satisfaction B. Units that implement the job-sharing model C. Nursing staff that hold advanced nursing degrees D. A mix of high- and low-acuity client needs

A. Nurses who report high levels of job satisfaction Nurses who are satisfied with their work generally provide higher-quality, more cost-effective care. Staffing systems should consider the quality of work life for the nursing staff as important as the quality of patient outcomes. Although the other options are factors to be considered, they are all influenced by whether the staff is satisfied with their work environment.

Which nursing care model is most likely to support the novice nurse's familiarity with providing holistic nursing care? A. Primary B. Functional C. Team D. Task

A. Primary Most novice nurses are more comfortable with the whole-task system because it is more consistent with what they were taught in school. The whole-task system requires complete knowledge and encourages loyalty to the profession. The model of nursing care consistent with the whole-task system is primary nursing, in which the nurse is responsible for all the needs of the patient. The other options tend to fragment the care and divide it among many other providers.

A nursing student is discussing their patient's emotional reaction to a new diagnosis of congested heart failure at a post-clinical briefing. By engaging in this learning activity, the student is developing what clinical aspect of "thinking like a nurse"? A. Reasoning B. Responding C. Assessing D. Evaluating

A. Reasoning Clinical reasoning includes the thinking process related to patient situations and experiences. Nursing students can practice the skill of clinical reasoning to make clinical judgments through various learning modalities such as nursing theory, clinical case studies, clinical simulations with pre- and post-briefings, and hands-on clinical experiences. Using a combination of theoretical and practical learning experiences, students will begin their transition from novice to expert nurse clinicians. Assessing requires collecting, analyzing, and interpreting data related to a patient's condition. This information is used to formulate one or more potential patient problems. During this evaluation, the nurse examines, evaluates, and modifies the patient's plan of care. The nurse decides on a suitable action or no action at all which is referred to as responding. While assessing, evaluating, and responding are components of clinical judgment, reasoning is associated with the student activity described.

In the clinical setting which example of the meaningful use of electronic health records has the greatest impact on the delivery of care by the nurse? A. Reviewing physical therapy notes before attending a patient's interprofessional care team meeting B. Logging off the computer when called to help another nurse with a patient's wound change C. Stressing the importance of not sharing login passwords with new staff members D. Explaining to a client's family that all client information is kept confidential

A. Reviewing physical therapy notes before attending a patient's interprofessional care team meeting Improved care coordination is one of the five priorities established as meaningful use standards. Sharing information between interprofessional health care team members would demonstrate that priority. The other options focus on confidentiality, which, while important, is not restricted for the clinical setting.

Novice nurses can find it most helpful to discuss nursing positions with their clinical instructor, especially when the discussion is related to what? A. Their strengths and weaknesses regarding nursing skills. B. Their level of nursing professionalism and leadership potential. C. The courses they have taken and grades earned. D. The expectation nursing administrators have on novice nurses.

A. Their strengths and weaknesses regarding nursing skills. Although the clinical instructor may be able to provide information on all the options, he/she is best suited to help the novice nurse evaluate his or her clinical skills so they can be aligned with the needs of a particular nursing position.

Which actions demonstrate a nurse's understanding and implementation of QSEN's competencies? (Select all that apply.) A. Deviates from facility's hand hygiene practice policy only when caring for noninfectious patients B. Shares a patient's religious food preferences with members of the health care team C. Attends an in-service on a piece of equipment new to the unit D. Asks for assistance when transferring a large patient onto a stretcher E. Encourages a patient newly diagnosed with terminal cancer to talk about their end-of-life concerns

B, C, D, E QSEN competencies are demonstrated in the sharing of patient preferences and encouraging the patient to express their needs and values (patient-centered care); asking for assistance from team members (teamwork and collaboration); learning to use equipment properly (safety). Deviating from policies and practices based on evidence-based practice without first consulting clinical experts on the subject is clearly not demonstrating EBP.

In order to best ensure client safety, which of the following questions should a staff nurse ask first when determining whether to accept a client assignment that is made when several staff members have reported off sick? A. "How long will it be before I get additional help?" B. "Do I have the experience and knowledge to care for these patients?" C. "Is this a staffing crisis or a result of typical staffing patterns?" D. "Can I expect to be mandated to stay an additional shift?"

B. "Do I have the experience and knowledge to care for these patients?" Although all these questions can help the staff nurse think critically about accepting the assignment, initially the important question is whether the nurse possesses the experience, skills, and knowledge necessary to safely provide appropriate care for the clients she is asked to care for.

Nursing educational programs attempt to prepare the novice nurse to enter into clinical practice at what practice level? A. Beginner nurse B. Advanced beginner nurse C. Proficient nurse D. Competent nurse

B. Advanced beginner nurse Advanced beginners are able to perform adequately and make some judgment calls based on experience; most novice nurses enter the workforce during this stage. Beginners are nursing students, while competent and proficient nurses usually emerge after a period of independent nursing practice.

How can a nurse manager best foster high-quality and safe nursing care among the nursing staff? A. Praise the staff's efforts to provide care that is both safe and of high quality. B. Create a unit culture where asking questions about health care interventions is encouraged. C. Place great emphasis on how important safe, high-quality nursing care is to the client's health. D. Offer incentives to those providing specific interventions that are safety and quality focused.

B. Create a unit culture where asking questions about health care interventions is encouraged. Health care organizations focusing on quality and safety encourage inquiry, making it okay to ask questions and providing resources to access information needed through various means, including informatics. Although praise and incentives are appropriate, they are not effective if the unit culture is not accepting. Placing emphasis on such interventions alone will not be successful if not supported by nursing managers and leaders.

The implementation of a "Medication Nurse" is an example of what nursing care delivery model? A. Primary B. Functional C. Total patient care D. Team

B. Functional In the functional nursing method of patient care delivery, staff members are assigned to complete certain tasks for a group of patients rather than care for specific patients. In total patient care, nurses are responsible for planning, organizing, and performing all care for specific clients. In team nursing, the RN functions as a team leader and coordinates a small group (generally no more than four or five) of ancillary personnel to provide care to a small group of patients. In primary nursing, the RN, or "primary" nurse, assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge.

What is the most effective way to assess the accuracy of information obtained from the Internet? A. Checking that the website is frequently updated and the information is less than 5 years old B. Research several different sources while comparing the information for similarities C. Relying on just a few sites that you are familiar with and well known D. Concentrating on .org and .com sites when searching for objective information

B. Research several different sources while comparing the information for similarities Determine whether the information is accurate by looking for documentation and referencing. Compare information on the website with information from other sources. Review links that go from the website to other Internet resources. Ensure that the links are going to high-quality resources. Currency is better ensured on websites that are frequently updated with information that is less than 5 years old. It is restrictive to rely on only a few familiar sites, especially if they are related to commercial (.com) organizations.

When considering staffing needs, what is the registered nurse's (RN) primary concern? A. The history of staff absenteeism B. The client acuity levels C. The availability of support staff D. The number of available licensed staff

B. The client acuity levels The primary considerations for staffing a specific nursing unit are the number of patients followed by the level of intensity of care required by those patients (commonly referred to as patient acuity). Knowing only the number of patients that require care is an ineffective way to plan staffing because of the wide range of care requirements needed by individual patients. The other options may in some degree affect the delivery of care but not to the degree that client acuity does.

When considering supervisory responsibilities, what statement is accurate? A. Supervision is required only when staff is new to the unit, the patient, or the task. B. When two RNs work together to move a client, neither nurse is in a supervisory position. C. A charge nurse is actually supervising only the LPNs and UAPs on the unit. D. All supervision is done with the RN being immediately available to the staff.

B. When two RNs work together to move a client, neither nurse is in a supervisory position. One RN is working with another RN in a collegial relationship, and neither RN is in the position of supervising the other. Each RN is responsible and accountable for his or her own practice. However, the RN in a supervisory or management position (e.g., team leader, charge nurse, nurse manager), as defined by the health care organization, will be in a position to supervise other RNs. Appropriate supervision is a responsibility of any delegation of task, not just when the staff is unfamiliar with the patient, the task, or the unit. Supervision may be categorized as on-site, in which the nurse is physically present or immediately available while the activity is being performed, or off-site, in which the nurse has the ability to provide direction through various means of written, verbal, and electronic communication.

Being able to introduce ideas or values brought from nursing school and integrate them into the work environment is referred to as __.

Biculturalism Biculturalism is the joining of two contradictory value systems, in this context, those of school values with those of the workplace. Biculturalism is designed to enhance a positive self-image and help novice nurses set realistic goals for practice.

An emergency department nurse will likely provide care according to which care delivery model? A. Team B. Total care C. Functional D. Primary

C. Functional Emergency departments often use functional approaches to care because emphasis is on efficient assessment and immediate treatment. The team model is often used in medical-surgical units while the primary care model can be used in long-term care facilities. Some aspects of home health nursing function under the total care model.

Health care institutions are automatically approved by The Centers for Medicare & Medicaid Services (CMS) under what circumstance? A. The institution has provided care to a substantial number of Medicare and Medicaid clients. B. The institution has demonstrated their commitment to quality improvement. C. The institution has earned The Joint Commission (TJC) accreditation. D. The institution has incorporated ORYX® performance measurements into their goals.

C. The institution has earned The Joint Commission (TJC) accreditation. Health care organizations that are accredited by TJC automatically meet foundational approval from the CMS. The other options are not true regarding CMS approval.

What is the most basic factor contributing to the effective supervision of unlicensed assistive personnel (UAP) by the nurse? A. The nurse's ability to communicate effectively with others B. The nurse's experience managing other members of the health care team C. The nurse's confidence in his or her ability to delegate appropriately D. The nurse's ability to teach UAPs the necessary skills for their assigned tasks

C. The nurse's confidence in his or her ability to delegate appropriately Because RNs are becoming increasingly responsible for delegation and supervision in today's health care system, it is imperative that they have confidence in their delegation skills and understand the legal responsibility that they assume when delegating to and supervising licensed personnel and UAP. RNs must know what aspects of nursing and health care can be delegated. Although the other options support their supervision of UAP, the basic component is appropriate delegation.

A __ is an individual or group who seek a product or service and whose needs and expectations to determine the quality of the service.

Customer A customer is an individual or group who relies on an organization to provide a product or service to meet some need or expectation. It is these customer needs and expectations that determine quality.

Which statement made by the RN demonstrates a lack of effective delegation to a LPN? (Select all that apply.) A. "Which mandatory competency testing session are you planning to attend?" B. "Have you ever cared for a postoperative patient who experienced a total mastectomy?" C. "Don't change the patient's catheter until you are sure the correct one has arrived on the unit." D. "Remember the patient is depressed so don't say anything to make her more sad." E. "If you begin that complex dressing change while I'm off the floor, get someone to help you."

D, E Not being available to provide effective supervision and addressing the issue in such a general manner is not a demonstration of effective delegation. Assigning a patient whose emotional state is unstable is not reflective of effective delegation. Evaluating the staff member's competency to perform a task or care for a patient with a particular set of needs and the requirement of mandatory competency testing is a factor in effective delegation. It is necessary to assure that the staff member has the resources including supplies to accomplish the assigned task.

When considering clinical pathways, the nurse recognizes what definition of an outcome as appropriate? A. It is an event that can prevent or help a patient reach wellness. B. It is an unexpected event that determines a need to change the plan of care. C. It is the result of a collaborative intervention of the health care team. D. It is the end result of interventions provided by the health care team.

D. It is the end result of interventions provided by the health care team. Patient outcomes are the end result of interventions by the health care team. Interprofessional intervention is the collaborative effort by all disciplines. Variance is any event that may alter the patient's progress through the clinical pathway. Triggers alert the caregiver that an unexpected event has occurred and a change in the plan of care may be indicated.

Which hospital-wide policy would best address the nurse's negative view of job satisfaction? A. Instituting biannual staff recognition days that include a free meal in the cafeteria B. Providing security backup when there is a perceived sense of workplace violence C. Providing a dedicated parking area close to the hospital for nursing staff D. Making it possible to earn additional personal leave time based on their absentee records

D. Making it possible to earn additional personal leave time based on their absentee records RNs are generally satisfied with their jobs when hospital administrators emphasize quality of patient care; recognize the importance of their personal and family lives; and provide nurses with satisfying salary and benefits, high job security, and positive relationships with other nurses and with management. The other policies may appeal to groups of nurses, but they are not directed toward any of the major job satisfaction indicators.

A personal decision to withhold information is considered to be associated with which patient right? A. Security B. Informed consent C. Confidentiality D. Privacy

D. Privacy Privacy refers to the right of an individual to keep information about himself or herself from being disclosed to anyone else. Confidentiality refers to the act of limiting disclosure of private matters. Informed consent is the right to have all pertinent information before making a decision. Security refers to the means to control access and protect information from accidental or intentional disclosure to unauthorized persons and from alteration, destruction, or loss.

Which nursing action best demonstrates clinical nursing judgement? A. Adding additional interventions to a patient's plan of care B. Engages in the process of debriefing after engaging in physically restraining a violent patient C. Reviewing the patient's medication history for possible causes of dizziness D. Providing a PRN analgesic to a restless, cognitively impaired patient recovering from surgery

D. Providing a PRN analgesic to a restless, cognitively impaired patient recovering from surgery Clinical judgment is defined as an interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not) deemed appropriate by the patient's actions and/or responses. The nurse has recognized the cognitively impaired patient's restlessness in the likely presence of post-surgical pain as a likely need for pain medication; this conclusion was arrived at through the process of decision making called clinical reasoning. Reflecting is the process that requires the nurse to think about what they learned from a patient situation that may be applied to a future patient situation. Debriefing is a form of reflection. By reviewing a patient's medication history for possible causes of reported dizziness the nurse is implementing the process of interpreting or analyzing data to arrive at the cause of a patient's problem. Adding to a patient's plan of care is an action associated with the planning stage of the nursing process.

What is a widely used approach of encouraging cooperation between the health care professions? A. Quality and Safety Education for Nurses (QSEN) B. SBAR (Situation; Background; Assessment; Recommendation) C. The Robert Wood Johnson Pilot School Collaboration D. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)

D. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) A widely used team training approach for health care teams is TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety). TeamSTEPPS acknowledges that team training and enhanced communication are among the essential components of a comprehensive patient safety system. The SBAR technique provides a succinct, structured framework for communication among members of the health care team about a patient's condition. QSEN is a national program with the goal of preparing future nurses with the knowledge, skills, and attitudes (KSA) necessary to continually improve the quality and safety of the health care systems in which they work. The Robert Wood Johnson Foundation supported the Pilot School Collaborative to model how faculty could include the six competencies in prelicensure programs.

Compassion fatigue is most likely among nurses working with what patient population? A. The culturally diverse B. The homeless C. The elderly D. The mentally ill

D. The mentally ill Nurses who work in emotionally charged environments, such as hospice, emergency departments, and mental health settings, are likely to experience this reaction. Intensive ongoing losses such as those in oncology care make nurses vulnerable to burnout and compassion fatigue.

In order to best address workplace satisfaction among its nursing staff, a hospital's administration should consider implementing what intervention? A. A yearly salary raise B. An extra 15-minute break per shift C. Additional vacation time D. Tuition reimbursement

D. Tuition reimbursement Areas that have been identified as affecting nursing satisfaction include: (1) opportunities to influence decisions about workplace organization; (2) recognition of accomplishments and work well done; (3) opportunities for professional development and advancement; and (4) opportunities to influence decisions about patient care. Tuition reimbursement would meet the interest in professional development of many nurses. Although the other options are considered favorable gestures, they do not address the identified factors.

Information is stored, retrieved, communicated, and managed using hardware and software that is collectively referred to as __.

Information technology Information technology is the term used to identify the hardware and software that enable information to be stored, retrieved, communicated, and managed.

__ is the term used to define the capabilities and standards that an electronic health records system must be capable of utilizing in order to qualify for financial incentives provided by Medicare.

Meaningful use Meaningful use is a defined set of EHR capabilities and standards that EHR systems must meet to ensure that their full capacity is realized and for the users (hospitals and physician/provider practices) to qualify for financial incentives from Medicare.

The American Nurses Association (ANA)'s Principles for Delegation provides nurses with guidance when delegating patient care to __.

Nursing Assistive Personnel ANA's Principles for Delegation provides the principles and guidelines for delegation of tasks to others. Its purpose is to define relevant principles and provide RNs with practice strategies when delegating patient care to nursing assistive personnel. It also covers needed definitions and the essentials of care provision and related nurse education.

A __ is a measurable condition that results from interventions that can be either positive or negative in nature.

Patient outcome Patient outcome is a measurable condition that results from interventions by the health care team; a change in a person's health after treatment; outcomes may be positive such as improved mobility or improved lab values or negative such as infections, falls, or death.

__ focuses on managing the increasingly complex requirements of documenting patient care activities.

Principles for Nursing Documentation Principles for Nursing Documentation focuses on managing the increasingly complex requirements of documenting patient care activities in both paper and electronic formats.