Complex Final Questions & Info

Which of the following statements provides the BEST understanding of a disaster reunification plan? +

"I placed matching labels in my 7-year-old daughter's 'go-bags' with important family phone numbers and my mother's address on it"

The Ask Me 3 model use three questions the pt can use to clarify understanding of the plan of care. Which of the following is an example of a question using this model that a patient may ask to clarify their information? +

"Why is it important for me to check my blood sugar throughout the day now that I am diabetic?"

START triage +

(will be given picture of protocol)

In complex nursing care environments, nursing clinical judgement is: SATA

-A process that nurses undertake daily when they make decisions about the care that they provide to patients -The result of critical thinking and clinical reasoning -Problem focused thinking that results in a decision after analyzing the data

Sexual Abuse S/S

-Children & adolescents often display few or no clear acute s/s -Most specific signs: age-inappropriate sexual behavior, age-inappropriate sexual knowledge & PTSD are considered to be the most specific signs of sexual abuse

An RN left the unit 30 minutes into the shift. You have 10 patients and only two nursing assistance. What actions should the nurse take? SATA +

-Contact the supervisor to request an additional nurse -Delegate all appropriate tasks to the nursing assistance -Perform a quick assessment of each client and form a plan -Invoke safe harbor collaborating with the supervisor

Out-of-Hospital Do-Not-Resuscitate Order +

-EMS CANNOT honor this order unless it is signed by both you and your physician. -ONLY in effect if complete -If pt is in ER= OOHDNR in effect (ER is an outpatient setting) -If patient is admitted inpatient= OOHDNR NOT in effect -DOES NOT need to be reviewed or signed by lawyer -Once complete, post the Out-of-Hospital DNR Order in your home. Keep a copy with you and gives copies to your health care providers -If you are unable to complete this document, your Medical Power of Attorney or a qualified relative may complete it on your behalf

Communication

-Improves the quality and safety of patient care -Helps nurses to manage competing priorities- and communication strategies can enhance effective management

Ultimate Goal of Communication

-Information exchange: ideas, get or give info., gain attention, & to persuade -Relationship building: encourage acceptance/responsibility, foster independance, & foster trust -Problem solving: provide info., to explain, motivate, & build understanding

Nursing Surveillance (definition) +

-Monitoring for dangerous situations (early s/s that indicate increasing problems) -interrupting & correcting error-prone situations -early correction of mistakes

When to call a Code Blue

-Person has stopped breathing -Person has no pulse -Unable to determine if the person has a pulse or if they are breathing, and is unresponsive -Unsure of what to do, and are very concerned for the life of the person

An adult special needs client is exhibiting decreased attention and mild confusion, which of the following interventions should the nurse do when engaging in conversation? Select all that apply +

-Rephrase the questions the client does not understand -Eliminate distracting stimuli including turning off the client radio (do not ask to walk, do not touch to center them)

Reporting Abuse

-Texas is a madated reporter -Nurses/HCP may not delegate reporting to anybody else -Identity of reporter is confidential unless needed in court -Failure to report child abuse is against the law -Report if you suspect a child is being abused/ neglected or an adult/ 65 y/o> is being abused neglected, financially exploited, or is in a state of self neglect -Need abuse-ees name, DOB, SS#, address (home, school, daycare, work), primary language, disability & other special needs

Medication Administration Communication +

-Used closed-loop communication (talking-back) -Communicate data (dose) and completed intervention to recorder or team leader "administering ___mg of ____"

How to read research article SATA question +

-You should be able to determine why the research was done -You should evaluate which research method was used for the study -You should read the method section to find out what setting was used -You should find information about how the data was collected for the study

SANE exam benefits

-allow the victim to have more control over the pace of the exam & treatment -remain unbiased -reveal the assailant -improved evidence collection -stronger cases for prosecution & decreased costs -does not put pt through unnecessary procedures

Hospice Modeling

-hospice is not a medical model -Hospices provide a holistic team approach to care with a focus on quality of life and patient/family goals Patients may choose to discharge from hospice care: -Improvement in condition -To undergo a treatment with curative intent -No longer desire services If discharged from hospice care, patients can be re-admitted at any time in the future

Trust & Teamwork

-improve thinking and performance through on-the-job partnerships -organizations assign preceptors or mentors to help students & novice nurses -opportunity to build trust and enhance communication -skilled communication and open, honest exchange of facts, thoughts, ideas, & feelings is key

List of SANE-related procedures that require patient consent/ refusal

-medical evaluation & treatment -photo documentation -performing a physical exam -reporting the crime -evidence collection (pt has the right to decline collection of any & all specimens) -transfer of evidence to law enforcement personnel -presence of advocate

Delegation

-stacking strategyauthorizing an unlicensed person to provide nursing services while the nurse retains accountability for how the unlicensed person performs the task -does not include situations in which an unlicensed person is directly assisting a RN by carrying out nursing tasks in the presence of a RN

Emotional Intelligence (EI-Emotional Quotient (EQ))

-the ability to recognize & manage your own emotions & help other do the same -emotions that are not properly managed can impact the ability to think critically through a scenario & come to an appropriate judgement

Principles of Delegation

1. Always assess the client before delegating. (Monitor) 2. Task should be routine for client. 3. Must be considered safe. 4. Must know UAP's work abilities. 5. Create atmosphere allowing comms. about concerns

The oncoming dayshift nurse has received the shift report for the night nurse. The dayshift nurse has done a quick check on all of the clients and has determined that all are stable and not in acute distress. Prioritize the order in which the dayshift nurse will care for the following clients: 1. Adolsecent who is alert and oriented. He was admitted 2 days ago for treatment of meningitis. He reports a continuous headache that is partially relieved by medication. 2. Older man who underwent a total knee replacement surgery 2 days ago. He is using the patient-controlled analgesia (PCA) pump frequently with good relief and occasionally asks for bolus doses. 3. Middle-aged woman who is demanding and frequently calls for assistance. She was admitted for investigation of functional abdominal pain and is scheduled for diagnostic testing this morning. 4. Older woman with advanced Alzheimer disease who requires total care for all activities of daily living. She struggles during any type of nursing care, and it is difficult to asess her subjective symptoms. 5. Young man who was admitted with chest pain secondary to a spontaneous pneumothorax. Today, the chest tube will be removed and the PCA pump will be discontinued.

5,3,1,2,4

Minimizing Interruptions in ACLS

<10 second interruptions

Sinus Bradycardia

<60 normal sinus rhythm

Which of the following are appropriate reasons for intervening with defribrillation during the early critical decision making period for individuals experiencing sudden cardiac arrest? Select all that apply. +

A common initial rhythm of ventricular fibrillation (VF) in out-of-hospital witnessed sudden cardiac arrest. Electrical defirillation is the most effective treatment for ventricular fibrillation (VF). The probability of successful defibrillation decreases quickly over time.

Which of the following are appropriate reasons for intervening with defibrillation during the early critical decision making period for individuals experiencing sudden cardiac arrest? SATA +

A common initial rhythm of ventricular fibrillation in out of hospital witnessed a sudden cardiac arrest Electrical defibrillation is the most effective treatment for ventricular fibrillation The probability of a successful defibrillation decreases quickly over time

Nurse Angela has arrived on shift and is beginning to plan her day and patient care activities. She will use cognitive stacking to help her manage the workload. Which of the following best describes the strategy of cognitive stacking?+

A continuous process of organization and prioritization

You arrive to the scene of a motor vehicle crash involving a 50 passenger bus. You are handed the following tags for patient triage. Which of the following motor vehicle crash victims should receive a yellow tag for using this triage system? +

A male teen on the bus sitting in his seat holding his right arm next to his body. He tells you he thinks it is broken. His vital signs are normal and he knows where he is

Nursing care has shifted from a diagnose and treat model to what kind of approach? +

A predictive approach

Advanced Care Planning

A process of communication between healthcare providers, patients and their families/medical power of attorney or healthcare proxy, with a purpose of identifying individualized goals of care that will shape future clinical care, through informed decision-making based on what fits the patient's personal values and preferences.- is NOT about making immediate decisions

Mr. Frank is an auditor who has come to evaluate whether or not your hospital has met the joint commission standards for nursing care. He is currently on your unit and asking you where your policy and procedure manual is located. You respond that you are not sure. Mr. Frank gets up very close to you, pointing his index finger in your face and states in a raised voice, "well maybe you should know... You are risking patient care! "He stormed off and you are left there dazed and confused. This is an example of:

Aggressive communication

During a mass casualty, which patient would be triaged as green using START Triage? a. Fractured wrist b. Shock c. Conscious with head injuries d. Expired from cardiac arrest

Answer is A. Green coding using the START algorithm is designated for those with minor injuries where the status is unlikely to deteriorate- these are the walking wounded that can await further assessment. Week 6 Lecture Part 2 .

Using the ESI Triage System, categorize the following patient: Police escort a disheveled 43-year-old handcuffed male into the triage area. The police report that the patient had been standing on the railing of a bridge on the local highway screaming about the extra-terrestrial invasion. He refuses to answer questions or allow you to take vital signs. a. ESI Level 1 b. ESI Level 2 c. ESI Level 3 d. ESI Level 4 e. ESI Level 5

Answer is B. ESI level 2: High risk. This patient is experiencing delusions and may have a past medical history of schizophrenia or other mental illness, or he may be under the influence of drugs. Regardless, the major concern is patient and staff safety. He needs to be taken to a safe, secure area and monitored closely. Week 6 lecture Part 2 ; AHRQ video case studies; ESI Practice case studies.

A nurse is working with a 15-year-old victim of abuse. The nurse tells this patient:"I just want you to know that everything we talk about today is confidential, except by law I must report if I am concerned that you might hurt yourself or someone else, or if someone might be hurting you." This is an example of the nurse disclosing: a. The limits of the nurse-patient relationship b. The limits of confidentiality under mandatory reporting laws c. Situations where there is a breach of trust d. Situations when child protective laws must be enacted

Answer is B. When a patient is threatens to harm themselves or others, the nurse is required to report.

The nurse is caring for a client who is on the cardiac monitor because of these symptoms: syncope, dizziness, and intermittent episodes of palpitations. Below is a display of what the nurse sees on the cardiac monitor. What should the nurse do FIRST? a. Call the Rapid Response Team (RRT) b. Obtain the automated external defibrillator (AED) c. Assess the client and take vital signs d. Check the adherence of the gel pads on the chest

Answer is C. The nurse recognizes that the monitor is showing sinus rhythm with occasional premature ventricular contractions (PVCs). The client is likely to be alert and in no distress.

Nurse Jane is observing 8-year-old Anna during a home visit. Which of the following findings would lead Nurse Jane to suspect that Anna is a victim of sexual abuse? a. The child is fearful of the caregiver and other adults b. The child has a lack of peer relationships c. The child has self-injurious behavior d. The child has interest in things of a sexual nature

Answer is D. Interest in things of a sexual nature in the prepubescent child can be indicative of sexual abuse.

The purpose of Advanced Care Planning is: a. To identify individualized goals that will shape future clinical care through informed decision-making. b. To select the right Hospice provider. c. To ensure that your financial estate is properly administered. d. None of these.

Answer is a. A process of communication between healthcare providers, patients and their families/medical power of attorney or healthcare proxy, with a purpose of identifying individualized goals of care that will shape future clinical care, through informed decision-making based on what fits the patient's personal values and preferences.

Common barriers for families to initiating conversations about advanced care planning include: [select all that apply]: a. Feeling it is too late b. Poor communication between patients and family c. Health literacy d. Cultural, racial, and historical influences

Answer: b, c, d. Some families feel that the discussion timing may be an issue, and that it may be too soon to have this discussion. This can stem from a general fear of the subject. Also, poor communication between the patient and family members, Health literacy, and Cultural, racial, and historical influences can impact the ability to have the discussion.

The charge nurse discovers that two nurses have switched patients because Nurse Jane does "not like to take care of patients with prostate cancer". Which action should the charge nurse take FIRST? +

Ask Nurse Jane to explain her position regarding prostate cancer patients and seek alternatives to prevent future issues

Unexperienced nurse has worked on the same unit for many years. Over the last 10 years the patient population residing in the area the hospital serves have shifted ethnically and culturally. What is the best first step in building rapport with patients as the nurse becomes accustomed to some of the new cultural norms? +

Ask how they prefer to be addressed during their stay

Duty of a nurse +

BON POSITION STATEMENT 15.14-emphasizes the nurse's responsibility and duty to the client/patient to provide safe, effective nursing care -Duty of a nurse cannot be superseded by a doctor, hospital policy or administrator LUNSFORD V. BOARD OF EXAMINERS CASE

ESI triage (will be given picture)

Based on the acuity of patients' health care problems and the number of resources their care is anticipated to require

Parental vs. Empowered Partnership Models

Breastfeeding question +

Collaborating & Communicating

Collaborate with charge nurse when you are asked to float somewhere but you don't have experience

Which of the following pieces of patient information received during handoff and exclude your patient from brain doctor termination testing? SATA +

Core body temperature of 93.6 F spinal surgery that required anesthesia that completed 35 minutes ago patient being treated for active Guillen-barre episode

CURE hierarchy

Critical patient needs: -Immediate intervention is necessary Urgent patient needs: -High potential for harm if not addressed Routine patient needs: -Routine ordered care Extras: -Activities that promote patient comfort

Which of the following is an identified role of the acute care RN during a disaster response? SATA +

Crowd control to ensure that those entering the ED have been seen and accounted for set up the emergency treatment area using the waiting room outside of the main entrance assist with patient decontamination in the parking lot outside of the main entrance

How does surveillance relate to nursing responsibilities?

Detects signs & symptoms that deviate from the norm is a key nursing responsibility

"I'm here to make sure you know how to take care of yourself when I'm not here" demonstrates what kind of partnership?

Empowered partnership between the nurse & the patient

End of life tasks include +

Estate planning, relationship closure, searching for meaning, forgiveness (NOT revenge)

7 steps of triage in order +

First look, screening for infectious disease, assessment, triage decision, assign patient, symptom relief, reassessment

Dual wave phenomenon

First wave of patients: first 15-30 minutes after a disaster -Walking Wounded patients Second wave of patients: next 30-60 minutes after disaster -Non-ambulatory patents.

Normative Hierarchy

Follows the CURE hierarchy but included additional core nursing management responsibilities: -relationship management -documenting -care team collaboration- patient teaching -system improvements -nurses personal care -breaks, social relationships with peers, etc.

An emergency room nurse is performing an assessment on a child suspected of being assaulted. Which assessment data obtained by the nurse most likely support the suspicion? +

Guarding of their abdomen and reluctant to lift their shirt

Common barriers to discussing advance care planning

Healthcare Providers -Time -Skill -Clarity For ourselves & loved ones -Feeling it's "too soon"/fear of the subject -Poor communication between patients and family -Health literacy -Cultural, racial, and historical influences

Phases of emotional reaction during a disaster

Heroic - intense excitement and concern for survival. Rush for assistance. Honeymoon- affected individuals begin to bond and relive their experiences. Disillusionment - responders may experience depression and exhaustion. Delays in receiving aid. Reconstruction- involves adjusting to a new reality and continued rebuilding of the area. Counseling may be needed.

As an established ED RN working in Florida, you have worked through your share of Hurricanes.....You and several other veteran nurses work throught the duration of the storm for a total of 8 days. Within the few days following the storm, you and a unit clerk design and order T-shirts to commemorate your successful 8 days of work. This is BEST described as which phase of emotional response to a disaster?

Honeymoon

which of the following reflective questions best helps the nurse to evaluate their own critical thinking potential? SATA +

How open I am I to new ideas and viewpoints? How secure am I in asking for clarification? How well do I communicate and get along with others?

As a registered nurse, you have decided to sign up to be a member of your unit's newly formed disaster preparedness committee. Which of the following best identifies the FIRST step needed to develop an effective plan for your unit?

Identify natural threats that are common to your region to identify what areas of need your unit needs to anticipate.

Research has shown that which of the following is/are a benefit of allowing family to remain present during a Rapid Response or Code?

Increased communication to the family about the current status of the patient.

The client admitted to the critical care unit tells the nurse, "I have an advance directive (AD) and I do not want to have cardiopulmonary resuscitation (CPR)." Which intervention should the nurse implement FIRST?

Inform the physician of the client's request as soon as possible.

Jeff is a new nurse on the telemetry unit. This week he started working independently of his preceptor. Today the shift has been unusually busy with very complex high acuity patients. Beth, the charge nurse, has assigned Kim yet another admission, skipping over Jeff. Kim explodes and confronts Jeff stating, "you are useless to this team! You can't even pull your weight around here!" Jeff, even though he feels personally attacked, remains calm and responds start "I understand how you might feel that way. You have taken so many admissions today to accommodate my learning curve. What can I do to help you?" Jeff's approach demonstrates which principle of emotional intelligence?

Managing emotions and behavior to reach goals

Upon completion of a windshield survey of a smaller town in Ohio, it is identified that there is one main road that leads from the largest residential part of town to the nearest hospital. This information is best utilized during which phase of disaster management?

Mitigation

Pain Management at the end of life +

Nurses must advocate for humane & dignified care, promoting ethical, effective pain & symptom management without exception -Question: Pts family worried about pt in hospice getting addicted to opioids, doesnt want to give pt pain med (or pt is afraid of getting addicted), important for nurse to give medication & explain that comfort is more important, physiologically would not get addicted

For cognitively impaired client who cannot accurately report pain what is the first action that the nurse should take? +

Obtain baseline behavioral indicators from family members

Which of the following is required in order to prove that any sexual act between a geriatric patient and their caregiver is consensual and not abuse? +

Patient's ability to understand the act and its outcome

Phases of Disaster Management

Prevention: mitigation Preparedness Response Recovery: evaluation

Activation of a Code Blue +

Question: Nurse enters patient room with a UAP, pt goes into code blue, what are the steps? -Nurse will immediately press code buttons and start CPR -UAP will exit the room and grab the crash cart & emergency equipment to bedside, secures backboard, ambu bag

Jiang Lin is a first generation American working on your unit. She confides in you that "in my culture asking questions is discouraged and a sign of weakness. I've been working on becoming more confident and capable of asking questions to improve my practice and critical thinking." You understand that Jiang Lin is: +

Reflecting on her self awareness of cultural influences

Which of the following is a decision making strategy that facilitates triage? +

Repetitive hypothesizing

Which of the following is an example of a value or attitude necessary to prepare ourselves to be globally competent citizens? +

Respect for the diversity seen within your community and commitment to providing equal care to all

Stacked Tasks

Routinization -Habits that have become repeated- An integrated approach: Considering both the sequencing of expected activities and the duration of each; List making of expected tasks for the shift Prioritization -Includes CURE & Normative hierarchy Delegation

The family member of the client experiencing a cardiac arrest refuses to leave the client's room. Which intervention should the administrative supervisor implement? +

Stay with the family member and explain what the team is doing.

A newly graduated nurse overhears a senior emergency department nurse making sarcastic remarks toward a medical student and refusing to help the student find equipment for a non-emergent procedure. What should the new nurse do first? +

Step in and offer to assist the medical student because the other nurse is unwilling

An individual that is designated as the medical power of attorney for an incapacitated individual may make decisions regarding: SATA +

Surgical interventions, initiating two feedings, initiation of experimental treatments, removal of the ventilator

Line-ups

The goal is to triage patients within 10 to 15 minutes of arrival. If a line-up forms at triage, scan the line for critically ill or injured patients and prioritize them accordingly. Stay calm, and request help when needed.

Which of the following statements best captures the concept of a hot zone or cold zone in a bio terrorism emergency treatment area? +

The hot zone is the first point of entry as the contaminated patient enter the hospital

The nurse manager on the cardiac unit is counseling a staff nurse because the nurse has clocked in late multiple times for the 7 AM to 7 PM shift. Which conflict resolution action uses the win-win strategy?

The nurse manager discovers that the staff nurse is having problems with childcare so the manager allows a change to the staff nurses schedule, allowing her to work a 9 AM to 9 PM shift

Whenever possible it is good practice to conduct the interview of the forensic patient within approximately 36 hours from the time of the incident in the effort to maintain which of the following? +

The physical evidence

Whenever possible, it is good practice to conduct the interview of the forensic patient within approximately 36 hours from the time of the incident in the effort to maintain which of the following? +

The physical evidence

How do victims of sexual assaults access Sexual Assault Nurse Examiners? Select all that apply +

Through law enforcement Presentation to a hospital for care From Child Protective Services

The first step to building trust on a team is: +

To agree to follow to a defined code of contact (that defined roles & responsibilities)

What is the purpose of a rapid response team? +

To improve patient outcomes by identifying and treating early clinical deterioration

For which of the following situations would it be essential to obtain an accurate assessment of the patient's health literacy? Select all that apply

While responding to questions regarding establishing an end-of-life plan. During assessment of a 13-year-old patient admitted for tonsillectomy. When presenting post-operative discharge instructions with antibiotic use.

When designating a Medical Power of Attorney for Healthcare (MPOA), it is a good idea to pick an individual: Select all that apply +

With the same ethical and moral views as you. That is able to make hard decisions about your life when you are unable. That completely understands your wishes for your end of life care.

Critical thinking is+

an umbrella term that includes reasoning inside and outside the clinical context used interchangeably with clinical reasoning, clinical judgement, problem solving, and decision making a skill that includes communication, interpersonal skills, collaboration, and conflict resolution thinking ahead, thinking in action, and thinking back

Ted works in the ED with Shawna. Shawna habitually calls upon Ted for much of the "heavy work" including patient lifting and intervening with aggressive patients. At first had felt like he had a good partnership with Shawna but he discovered that whenever he needed help Shawna was unwilling to give him a hand. Ted began to resent this but did not want to talk to Shawna about it. This is an example of which style of conflict management? +

avoiding

Application of ethics in the end of life

helping patient explore what they believe -ethical reasoning & ______+

Clinical Judgement

is an iterative (happens over & over) decision-making process that uses nursing knowledge to: -observe & assess presenting situations -identify a prioritized client concern -generate the best possible evidence-based solutions in order to deliver safe client care additive process: critical thinking and clinical reasoning-> clinical judgement NOT a linear process

Two ethical principles most closely associated with the failure to assess and intervene are: +

justice and nonmaleficence

While discussing discharge instructions for your 88-year-old patient with her granddaughter, the granddaughter repeatedly asks if the patient's prescription medications can be sent to her residence instead of the patient's home. She states that she "prefers to organize them before taking them to her grandmother's house". This strikes you as odd based on your knowledge of financial abuse and which of the related concepts below?

misappropriation

Failure of the nurse to assess a patient and provide life-saving interventions can result in: SATA +

negligence malpractice loss of licensure

Internal factors that can influence thinking and communication with others include: SATA+

values stress personality