Fundamentals ATI
Nurse reviewing hand hygiene techniques with group of assistive personnel. Which of the follwoing instructions should nurse include when discussing handwashing? Select all that apply A) Apply 3-5 mL or liquid soap to dry hands B) Wash hands with soap and water for at least 15 seconds C) Rinse hands with hot water D) Use clean paper towel to turn off hand faucets E) Allow hands to air dry after washing
B D
What is beneficence?
positive actions to help others
Chapter 8 Nurse caring for pt 24 hr postop inguinal hernia repair. Pt tolerates clear liquids, active bowel sounds, and is expressing a desire for real food, Nurse calls surgeon, gives report, surgeon prescribes full liquid diet. Nurse is using which of the following levels of critical thinking? A) Basic B) Commitment C) Complex D) Integrity
A At the basic level, thinking is concrete and based on a set of rules, such as obtaining the prescription for diet progression
Pt is about to undergo an elective surgical procedure. Which of the following actions are appropriate for the nurse who is providing preop care regarding informed consent? A) Make sure Dr. obtained pt's consent B) Witness pt signature on consent form C) Explain risks and benefits of the procedure D) Describe consequences of choosing not to have surgery E) Tell pt about alternatives to having surgery
A B
Nursing instructor is reviewing documentation with a group of students. Which of the following legal guidelines should they following when documenting? Select all that apply A) Cover errors with correction fluid and write in correct info B) Put date and time on all entries C) Document objective data, leaving out opinions D) Use as many abbreviations as possible E) Wait until the end of the shift to document
B C
Nurse is delegating the ambulation of a pt who had knee arthroplasty 5 days ago to an AP. Which of the following info should the nurse share with the AP. Select all that apply A) Roommate is up independently B) Pt ambulates with his slippers on over his anitembolic stockings C) Pt uses a front-wheeled walker when ambulating D) Pt had pain meds 30 min ago E) Pt is allergic to codeine F) Pt ate 50% of his breakfast
B C D
A nurse is explaining the differences among the various agencies that address health care. The nurse should note that which of the following are health care regulatory agencies? Select all that apply A) American Nurses Association (ANA) B) The Joint Commission C) State boards of nursing D) National League for Nursing (NLN) E) Food and Drug Administration (FDA)
B C E
Nurse caring for pt 24 hr postop abdominal surgery. Nurse suspects pt's pain is inadequate. Which of the following data reinforce this suspicion? Select all that apply A) Pt seems easily agitated B) Pt is nonadherent with coughing, deep breathing, dangling C) Pt may have pain meds q4-6hr but accepts it q6-7 hr D) Pt reports tenderness in r lower leg E) vitals are HR 110/min, resp 20/min, temp 98.6, and BP 136/80
B C E
Nurse is prepping an in-service program about delegation. Which of the following elements should she identify when presenting the five rights of delegation? A) Right client B) Right supervision/evaluation C) Right Direction/communication D) Right time E) Right circumstances
B C E
Nurse prepping discharge summary for pt who has had knee arthroplasty and is going home. Which should the nurse include in the discharge summary? Select all that apply A) Advance directives status B) Where to go for follow up care C) INstructions for diet and meds D) Most recent vitals E) COntact info for the home health care agency
B C E
A nurse is explaining the various types of health care coverage clients might have to a group of nursing students. The nurse should mention that which of the following health care financing mechanisms are federally funded? Select all that apply. A) Preferred provider organization B) Medicare C) Long-term insurance D) Exclusive provider organization (EPO) E) Medicaid
B E
Nurse is discussing protocol in event of tornado with the staff. Which of the following should nurse include? Select A) Open doors to pt rooms B) Place blankets over pt confined to beds C) Move beds away from windows D) Draw shades and close drapes E) Relocate ambulatory pt in hallways back into rooms
B C D
Nurse is wearing sterile gloves in prep for performing a sterile procedure. Which of the following objects may the nurse touch without breaching sterile technique? Select all that apply A) Bottle containing sterile solution B) Edge of sterile drape at base of field C) Inner wrapping of an item on sterile field D) Irrigation syringe on sterile field E) One gloved hand to other gloved hand
C D E
Which of the following interventions can be nurse-initiated? Select all that apply. A) Give morphine sulfate 1 to 2 mg IV q1hr as needed for pain B) Insert NG tube to relieve a pt's gastric distention C) Show pt how to use progressive muscle relaxation D) Perform a daily bath after the evening meal E) Reposition pt q2hr to reduce pressure ulcer risk
C D E
Nurse on med-surge unit informed of mass casualty in community and need to discharge pt to make beds available for victims. WHich can be safely discharged? Select all that apply A) Pt who is dehydrated and receiving IV fluid and electrolytes B) Pt who has NG tube to treat small bowel obstruction C) Pt who is scheduled for transurethral resection of the prostate D) Pt who is 24 hr postop following mastectomy E) Pt who is scheduled for appendectomy
C D
Chapter 12 Nurse is caring for pt who was just admitted to unit after falling at nursing home. A&O x3 and follows directions; Which are appropriate to decrease risk of fall, select all that apply A) Place a belt restraint on pt when he is sitting on beside commode B) Keep the bed in low position with full side rails up C) Ensure that the pt's call light is within reach D) Provide the pt with nonskid footwear E) Complete a fall-risk assessment
C D E
RN is making assignments for client care to a licensed practical nurse at the beginning of the shift. Which of the following assignments should the LPN question? A) Assisting pt who is 24 hr postop to use incentive spirometer B) Collecting clean catch urine from pt who was admitted on previous shift C) Providing nasopharyngeal suctioning for pt with pneumonia D) Replacing cartridge and tubing on pt-controlled analgesia pump
D
Security officer taking action in event of bomb threat by phone to group of nurses. Which of the following statements by a nurse indicates understanding of proper procedure? A) Get caller off phone as soon as possible so I can alert staff B) Use overhead paging to alert entire facility C) Not ask any questions and just let caller talk D) Listen for background noise
D
Nurse uses head-to-toe approach to conduct a physical assessment of a pt who will undergo surgery the following week. Which of the following critical thinking attitudes did the nurse demonstrate? A) Confidence B) Perserverance C) Integrity D) Discipline
D Systematic approach to thinking. Proceeding head to toe is a systematic approach to collecting the data a physical assessment yields
What is justice?
Fairness in care delivery and use of resources
What is safety?
Minimization of risk factors that could cause injury or harm while promoting high-quality care and maintaining a secure environment for clients, self, and others
What are the basic principles of ethics?
-Advocacy- support of the client's health, safety, and personal rights -Responsibility- Willingness to respect obligations and follow through on promises -Accountability- ability to answer for one's own actions -Confidentiality- protection of privacy without diminishing access to high-quality care
What is the nurse's role in ethical decision making?
-An agent for the client facing an ethical decision; Ex: caring for an adolescent client who has to decide whether to undergo an abortion even though her parents believe it is wrong; discussing options with a parent who has to decide whether to consent to a blood transfusion for a child when his religion prohibits such treatment -A decision maker for health care delivery; assigning staff nurses a higher client load than recommended because administration has cut the number of nurses per shift; witnessing a surgeon discuss only surgical options with a client without informing the client about more conservative measures available
What/Who are the components of the health care systems?
-Consumers (clients) -Providers -Licensed providers (RN, LPN, Advanced practice nurses, medical doctors, pharmacists, dentists, dietitians, PT, Resp, OT, unlicensed providers such as assistive personnel
What are qualities of documentation?
-Factual- subjective and objective data -Accurate and concise- facts and info precisely- what the nurse sees, hears, feels, smells- without any interpretation of the situation. Only those abbreviations and symbols The Joint Commission and the facility approve are acceptable -Complete and current- Document info that is comprehensive and timely. Never Pre-chart an assessment, intervention, or evaluation -Organized- communicate info in a logical sequence
Types of Documentation formats
-Flow charts- trends in vitals, blood glucose levels, pain levels, other frequent assessments -Narrative documentation records info as a sequence of events in a storylike manner -Charting by exception uses standardized forms that identify norms and allows selective documentation of deviations from those norms -Problem-oriented medical records consist of a database, problem list, care plan, and progress notes (SOAP- Subjective Data, Objective Data, Assessment including nursing diagnosis based on assessment, and Plan); PIE (Problem, Intervention, Evaluation); DAR focus charting (Data, Action, Response)
What is preventive health care?
-Focuses on educating and equipping clients to reduce and control risk factors for disease -Immunization, stress management, seat belt use
What are the five elements necessary to prove negligence?
1. Duty to provide care as defined by a standard 2. Breach of duty by failure to meet standard 3. Foreseeability of harm 4. Breach of duty has potential to cause harm 5. Harm occurs
Nurse manager of a med-surg unit is assigning care responsibilities for the oncoming shift. Pt is awaiting transfer back to the unit from the PACU following thoracic surgery, To which staff member should the nurse assign this pt? A) Charge nurse B) RN C) LPN D) AP
B
Nurse manager reviews care of pt who has had seizure with nurses on the unit. Which one requres further instruction? A) I will place pt on side B) I will go to nurses' station for assistance C) I will admin meds as prescribed D) I will be prepared to insert airway
B
Nurse offers pain medication to pt who is postop prior to ambulation. Nurse understands that this aspect of care delivery is an example of which of the following ethical principles? A) Fidelity B) Autonomy C) Justice D) Beneficence
D
A client with heatstroke will have which of the following? A) Hypotension B) Bradycardia C) Clammy skin D) Bradypnea
A
A nurse observes an assistive personnel reprimanding a client for not using the urinal properly. The AP tells him she will put a diaper on him if he does not use the urinal more carefully next time. Which is this? A) Assault B) Battery C) False Imprisonment D) Invasion of privacy
A
By the second postop day, a pt has not achieved satisfactory pain relief. Based on this evaluation, what should the nurse do next according to the nursing process A) Reassess the pt to determine the reasons for unsatisfactory pain relief B) See whether the pain lessens during next 24 hours C) Change the plan to ensure that the pt achieves adequate pain relief D) Teach the pt about the plan of care for managing pain
A
Nurse questions med prescription as too extreme in light of the pt's advanced age and unstable status. Nurse understands that this action is an example of: A) Fidelity B) Autonomy C) Justice D) Nonmaleficence
D
During eval, nurse must gather info about pt to A) Identify whether pt outcomes have been met B) Organize resources to proceed with implementing interventions C) Establish client-centered outcomes that are measurable and realistic D) Determine the priority of care and appropriate interventions
A
Nurse caring for newly admitted pt who has documented history of falls. Which is priority action of nurse? A) Complete fall=risk assessment B) Educate pt and family on fall risks C) Complete physical assessment D) Survey the pt's belongings
A
Nurse educator is teaching about proper body mechanics during employee orientation. Which of the following statements by a newly hired nurse indicates the need for further teaching? A) My line of gravity should fall outside my base of support B) Lower my center of gravity- more stability C) To broaden my base of support, I should spread my feet apart D) When I lift an object, I should hold it as close to my body as possible
A
Student reports to clinical instructor about the care she gave to a pt. She states "Pt said his leg pain was back, so I checked his medical record, and he last received his pain medication 6 hr ago. Prescription reads q4hr PRN for pain, so I decided he needs it. I asked the unit nurse to observe me preparing and administering it. I checked with the pt 40 min later, and he said his pain is going away." Instructor should inform student that she left out which of the following steps? A) Assessment B) Planning C) Intervention D) Evaluation
A
Nurse is receiving a provider's prescription by telephone for morphine for a pt who is reporting moderate to severe pain. Which of the following nursing actions are appropriate? Select all that apply. A) Repeat the details of the prescription back to the provider B) Have another nurse listen to telephone prescription C) Obtain prescriber's signature on prescription within 24 hours D) Decline verbal prescription because it is not an emergency situation E) Tell charge nurse that provider has prescribed morphine by telephone
A B C
Nurse is admitting pt to med surg unit. Which of te following are essential steps of admission procedure? Select all that apply A) Explain the roles of other care delivery staff B) Begin discharge planning C) Provide info about advance directives D) Document pt's wishes about organ donation E) Introduce the pt to his roommate
A B C E
What are examples of the types of tasks a CNA may perform? Select all that apply A) Bathing B) Ambulating C) Toileting D) Determining Pain level E) Measuring vitals
A B C E
A nursing instructor is explaining the various levels of health care services to a group of nursing students. Which of the following examples of care or care settings should the nurse classify as tertiary care? Select all that apply. A) Intensive Care unit B) Oncology treatment center C) Burn center D) Cardiac rehabilitation E) Home health care
A B C Tertiary care involves the provision of specialized and highly technical care, such as the care nurses deliver in ICU, oncology treatment centers, and burn centers
The skin barrier covering intestinal fistula keeps falling off when she stands to ambulate. Nurse has reapplied twice during current shift, but remains intact only when supine in bed. Nurse telephones PT about difficulties containing drainage with an absorbent pad over the fistula. Pt ate all food on tray. Wound care nurse confirmed she would see pt later today. Pt states she feels frustrated at not having PT, but nurse thinks the pt welcomed having a day to rest. Which should nurse include in change-of-shift report? Select all that apply. A) PT did not abulate pt today B) Skin barrier's seal stays on in bed but loosens when pt stands C) Pt seemed to welcome having a day off from PT D) Wound care nurse will see pt later today E) Pt ate all food on lunch tray
A B D
A client who is postop after a knee arthroplasty is concerned about the adverse effects of the med he is receiving for pain management. Which of the following members of the interprofessional care team may assist the client in understanding the med's effects? Select all that apply. A) Provider B) CNA C) Pharmacist D) RN E) Resp therapist
A C D
Nurse transferring pt from acute-care to rehab. Which of the following is important to transfer report? Select all that apply A) Alert and Oriented B) Refuses to eat spinach C) Has shelfish allergy D) Requests morphine q4hr E) Misses two cats at home
A C D
Nurse caring for pt who has new prescription for anithypertensive meds. Before admin, nurse uses electronic database to gather info about the med and the effects it might have on pt. Which component of critical thinking is the nurse using when he reviews the med info? A) Knowledge B) Experience C) Intuition D) Competence
A Competence involves making judgments and no one can make a judgment about how the nurse handles researching and administering this med to this client until he performs those tasks
Nursing instructor is reviewing the steps of the nursing process with a group of students. Students should Identify which of the following data as objective? Select all that apply. A) Resp rate of 22/min with even, unlabored resp B) "I can only walk three blocks before my legs start to hurt" C) Pain level 3 on scale of 0 to 10 D) Skin pink, warm, and dry E) Urine output of 300 mL/8hr F) Dressing clean, dry, intact
A D E F
Chapter 9 Nurse is performing an admission assessment for an older adult client. After gathering the assessment data and performing the review of systems, which of the following actions is a priority for the nurse? A) Orient pt to his room B) Conduct a client care conference C) Review the pt's medical orders D) Develop a plan of care
A Risk for injury from unfamiliar surroundings
Chapter 11 Nurse caring for pt with severe acute resp syndrome (SARS). Nurse is aware that health care professionals are required to report communicable and infectious diseases. Which of the following illustrate the rationale for reporting? Select all that apply A) Planning and evaluating control and prevention strategies B) Determining public health priorities C) Ensuring proper medical tx D) Identify endemic disease E) Monitor common-source outbreaks
A B C E
Nurse reviewing guidelines to prevent injury which should manager include in teaching? Select A) Request assistance when repositioning a pt B) Avoid twisting the spine or bending at the waist C) Keep the knees slightly lower than hips when sitting for long periods D) Use smooth movements when lifting and moving pt E) Take a break from repetitive movements ever 2-3hr to flex and stretch joints and muscles
A B D
Nurse removed sterile pack from outside cover and placed on clean work surface in prep for invasive procedure. Which of the following flaps should the nurse unfold first? A) Closest to body B) R side C) L side D) Farthest from body
D
What is a medical record?
A Confidential, permanent, and legal document that is admissible in court. Nurses are legally and ethically responsible for ensuring confidentiality. Only those health care providers who are involved directly in a client's care may access that client's medical record. -Electronic medical records create problems with protecting the privacy and safety of health information -Information documented: assessments, med admin, tx and responses, client education -Documentation is standard for The Joint Commission- JCAHO mandates the use of computerized databases to expedite the accreditation process. Health care facilities use the computerized data for budget management, quality improvement programs, research, and many other endeavors -Purposes: communication, legal documentation, financial billing, education, research, and auditing -Reporting allows continuity of care among all team members who provide care to the same clients -Reporting should be confidential
What is the nursing process?
A cyclical, critical thinking process that consists of five steps to follow in a purposeful, goal-directed, systematic way to achieve optimal client outcomes. Variation of scientific reasoning that helps nurses organize nursing care and apply the optimal available evidence to care delivery -Dynamic, continuous, client-centered, problem-solving, and decision-making framework that is foundational to nursing practice; allows framework to apply knowledge, experience, judgment, and skills, as well as established standards of nursing practice to the formulation of a plan of nursing care -Goal is a comprehensive, individualized, client-centered plan of nursing care that nurses can deliver in a timely and reasonable manner; helps integrate critical thinking creatively to base nursing judgments on reason
What is ethical decision making?
A process that requires striking a balance between science and morality 1. Identify whether the issue is indeed an ethical dilemma 2. State the ethical dilemma, including all surrounding issues and individuals involved 3 List and analyze all possible options for resolving the dilemma, and review implications of each option 4 Select the option that is in concert with the ethical principle that applies to this situation, the decision maker's values and beliefs, and the profession's values for client care. Justify selecting that one option in light of the relevant variables 5 Apply this decision to the dilemma, and evaluate the outcomes
A nurse enters a pt's room and finds him sitting in his chair. He states I fell in the shower, but I got myself back up and into my chair. How should the nurse document this in the chart? A) Client fell in the shower B) Client states he fell in the shower and was able to get himself back into his chair C) Nurse should not document this info in the chart because she did not witness it D) Pt fell in shower but is now resting comfortably
B
A nurse is caring for pt who decides not to have surgery despite significant blockages in his coronary arteries. The nurse understands this is the client's choice. This is: A) Fidelity B) Autonomy C) Justice D) Nonmaleficence
B
Nurse educator reviewing with newly hired nurse the difference in clinical manifestations of a localized versus a systemic infection. Which of the following are clinical manifestations of systemic infection? Select all that apply A) Fever B) Malaise C) Edema D) Pain or tenderness E) Increase in pulse and resp rate
ABE
What is continuing health care?
Addresses long-term or chronic health care needs -End-of-life care, palliative care, hospice, adult day care, and in-home respite care
What is implied consent?
Adhering to the instructions the nurse provides -This is adequate for most aspects of nursing care -Written consent is required for an invasive procedure or surgery
What is fidelity?
Agreement to keep promises
What is nonmaleficence?
Avoidance of harm or injury
A hospital is conducting a community blood pressure screening in its lobby. This is an example of which of the following levels of care? A) Preventive B) Primary C) Secondary D) Tertiary
B
Adult pt who is competent tells nurse that he is thinking about leaving the hospital against medical advice. Nurse believes this is not in pt's best interest so she asministers a PRN sedative the pt has not requested along with his usual medication. Which is this?
B
Chapter 14 Nurse caring for pt receiving enteral tube feedins due to dysphagia. Which is the best position? A) Supine B) Semi-Fowler's C) Semi-prone D) Trendelenberg
B
Nurse educator conducting parenting class for new parents. Which indicates a need for further instruction? A) I will begin swimming lessons as soon as baby can close mouth under water B) Once my baby can sit up, he should be safe in the tub C) I will test temp of water before placing baby in bath D) Once my infant starts to push up, I will remove mobile from over bed
B
Nurse gets rx for an antibiotic for a pt who has cellulitis. Nurse checks medical record, discovers that she is allergic to the antibiotic and calls provider to request different antibiotic. Which of the following critical thinking attitudes did the nurse demonstrate? A) Fairness B) Responsibility C) Risk taking D) Creativity
B
What are standard precautions?
Apply to all body fluids, nonintact skin, and mucous membranes. Nurses should implement for all pt -Hand hygiene, clean gloves and PPE, gloves for body fluids, nonintact skin, mucous membranes, contaminated equipment and articles
What is the role of the physical therapist?
Assesses and plans for clients to increase musculoskeletal function, especially of the lower extremities, to maintain mobility -Refer if: Following hip arthroplasty, a client requires assistance learning to ambulate and regain strength
What is the role of the occupational therapist?
Assesses and plans for clients to regain activities of daily living skills, especially motor skills of the upper extremities -Refer if: client has difficulties using an eating utensil with her dominant hand following a stroke
What is the role of the provider?
Assesses, diagnoses, and treats disease and injury. Providers include medical doctors, doctors of osteopathy, advanced practice nurses, and physician assistants. State regulations vary in their requirements for supervision of APNs and PAs by a physician -Refer if: Client has temp of 102.2 F, is achy, shaking, and reports feeling cold
What is the role of the registered dietitian?
Assesses, plans for, and educates regarding nutrition needs; designs special diets, and supervises meal prep -Refer if: Client has low albumin level and recently had an unexplained weight loss
Chapter 13 Nurse is providing discharge to pt who has precription for oxygen at home. What should she teach the pt for safely using oxygen? Select all that apply A) Fam who smoke must be 10 ft from pt B) Nail polish should not be used near pt receiving oxygen C) No smoking sign on door D) Cotton bedding to be replaced with wool E) Fire extinguisher readily available in house
B C E
Home health care nurse discusses dangers of food poisoning with pt, Which of the following should be included? Select A) Most food poisoning is caused by a virus B) Immunocompromised pt are at risk for complications of food poisoning C) Pt especially at risk are to eat or drink only pasteurized milk, yogurt, cheese, or other dairy products D) Healthy individuals usually recover from the illness in a few weeks E) Handling raw and fresh food separately to avoid cross contamination may prevent food poisoning
B C E
Nurse contributing to plan of care for pt who is admitted to facilty with a suspected dx of pertussis. Which should nurse include in plan of care (Select all that apply) A) Place pt in a room with negative air pressure of at least 6 exchanges per hour B) Wear a mask when providing care within 3 ft of pt C) Place surgical mask on pt if transporting D) Use sterile gloves when handling soiled linens E) Wear gown when performing care that may result in contamintion from secretion
B C E
Nurse prepared a sterile field for assisting a provider with a chest tube insertion. Which of the following events should the nurse recognize as contaminating the sterile field? Select all that apply A) Drops sterile instrument onto near side of sterile field B) Nurse moistens a cotton ball with sterile normal saline and places it on sterile field C) Procedure delayed 1 hr because provider receives an emergency call D) Nurse turns to speak to someone who enters through a door behind her E) Pt's hand brushes against the outer edge of the sterile field
B- Fluid permeation of sterile drape or barrier contaminates C- Prolonged exposure to air D- Turning back on field
Pt who will undergo neurosurgery the following week tells nurse in Dr's office that he will prep his advance directives before he goes to hospital. Which statement= understanding of advance directives? A) I'd rather have my brother make the decisions for me, but I know it has to be my wife B) I know they won't go ahead with the surgery unless I prep these forms C) I plan to write that I don't want them to keep me on a breathing machine D) I will get my regular Dr to approve my plan before I hand it in to the hospital
C
Nurse instructing a group of nursing students about how to know and what to expect when ethical dilemmas arise. Which of the following sits should the student identify as an ethical dilemma? A) Nurse on med-surg demonstrates signs of chemical impairment B) Nurse overhears another nurse tell an older adult client that if he doesn't stay in bed, she will have to apply restraints C) Family has conflicting feelings about the initiation of enteral tube feedings for their father, who is ill D) Client who is terminally ill hesitates to name her spouse on her durable power of attorney form
C A review of scientific data cannot solve the issue, and it is not easy to resolve. The decision will have a profound effect on the situation and on the client
What are legal guidelines of documentation?
Begin each entry with the date and time -Record entries legibly, in nonerasable black ink, and do not leave blank spaces in the nurse's notes -Do not use correction fluid, erase, scratch out, or blacken out errors in the medical record. Make corrections promptly, following the facility's procedure for error correction -Sign all documentation as the facility requires, generally with name and title -Documentation should reflect assessments, interventions, and evaluations, not personal opinions or criticism of others' care
A nurse is preparing info for change-of-shift report. Which of the following info should the nurse include? A) I&O for shift B) PT's BP of previous day C) Bone scan scheduled for today D) Med routine from the med admin record
C
Chapter 10 Pt is coughing and sneezing. When preparing sterile field nurse should: A) Keep sterile field 6ft away from bedside B) Instruct pt to refrain from coughing and sneezing during dressing change C) Place mask on pt to limit spread of micro-organisms into the surgical wound D) Keep box of facial tissues nearby for pt to use during dressing change
C
Nurse has noticed several occasions in past week when another nurse on the unit seemed drowsy and unable to focus on the issue at hand. Today, she found the nurse asleep in a chair in the break room when she was not on break. Which of the following actions should the nurse take? A) Remind nurse that safe pt care is priority on unit B) Ask others on the team whether they have observed the same behaviors C) Report her observations to the nurse managed on the unit D) Conclude that her coworker's fatigue is not her problem to solve
C
Nurse is completing discharge teaching to COPD. Pt understands orthopneic position when he says A) Lie on my back with my head and shoulders elevated on pillow B) lie flat on stomach with head to one side C) sit on side of bed and rest arms over pillows on top of my raised bedside table D) Lie on side with my weight on my hips and should and with my arms flexed in front of me
C
Nurse is instructing a group of nursing students about the responsibilities involved with organ donation and procurement. When the nurse explains that all clients waiting for a kidney have to meet the same qualifications, the students should understand that this aspect of care delivery is an example of: A) Fidelity B) Autonomy C) Justice D) Nonmaleficence
C
Nurse observes smoke coming from under door of staff lounge. Which action is the priority of nurse? A) Extinguish the fire B) Pull the alarm C) Evacuate pts D) Close all open doors on unit
C
Nurse on med-surg has received change-of-shift report and will care for four clients. Which of the following pts needs may the nurse assign to assistive personnel? A) Feeding pt who was admitted 24 hours ago with aspiration pneumonia B) Reinforcing teaching with a pt who is learning to walk using a quad cane C) Reapplying a condom catheter for a pt who has urinary incontinence D) Applying a sterile dressing to a pressure ulcer
C
OT nurse caring for employee who was eposed to unknown dry chemical, resulting in chemical burn. WHich should nurse include in plan of care? A) Irrigate affected area with running water B) Wash area with antibacterial soap C) Brush chemical off skin and clothing D) APply neurtralizing agent
C
A Client in a managed care organization (MCO) requires hospitalization. Which of the following parties must first approve the admission? A) Emergency department physician B) Utilization review committee C) Provider D) Managed care administrator
C, The provider oversees all of the client's care including hospitalizations; therefore, the provider must approve the admission
Home health care nurse is discussing dangers of carbon monoxide poisoning with a pt. Which of the following info should be included? A) Carbon monoxide has distinct odor B) Water heaters should be inspected every 5 years C) Lungs are damaged from carbon monoxide inhalation D) Carbon monoxide binds with hemoglobin in the body
D
Nurse caring for pt who is sitting in chair and asks to return to bed. Which is the priority action for the nurse to take at this time? A) Obtain a walker for the pt to use to transfer back to bed B) Call for additional personnel to assist with transfer C) Use transfer belt and assist pt to bed D) Assess pt's ability to help with transfer
D
Nurse caring for pt with linear clusters of fluid-containing vesicles with some crustings. Which one should the nurse expect? A) Allergic reaction B) Ringworm C) Systemic lupus erythematosus D) Herpes zoster
D
What is quality improvement?
Care-related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients' needs
What is the role of a nurse researcher?
Conducts research primarily to improve the quality of client care
A client who has has cerebrovascular accident has persistent problems with dysphagia. Nurse caring for him should initiate a referral with which of the following members? A) Social worker B) CNA C) OT D) Speech-language pathologist
D
A goal for a client who has trouble with self-feeding due to Rheumatoid arthirtis is to use adaptive devices. Nurse caring for him should initiate a referral with which of the following members of the interprofessional care team? A) Social worker B) CNA C) Registered Dietitian D) OT
D
A nurse is caring for an older adult client who lives along and is to be discharged in 3 days. He states it's hard to prepare good meals at home for just one person. Who should he talk to; who should the nurse refer him to? A) Registered Dietitian B) OT C) PT D) Social worker
D
As part of admission, nurse at long-term care facility is gathering a nutrition history for pt who has dementia. Which part of the nutrition evaluation is the priority for the nurse to determine from the client' family? A) Body mass index B) Usual meal times and snack times C) Favorite foods D) Any difficulty swallowing
D
Chapter 15 Nurse caring for multp pt during mass casualty, Which has highest priority? A) Pt who received crash injuries to chest and abdomen and is expected to die B) Pt who has 4 inch laceration to head C) Pt who has partial-thickness and full-thickness burns to face, neck, chest D) Pt has has fractured fibula and tibia
D
Charge nurse is designating room assignments for pts who will be admitted to the unit. Based on nurse's knowledge of fall prevention, which pt should be assigned to the room closest to nurses' station? A) 43-year ols pt who is postop following cholecystectomy B) 61 pt being admitted for telemetry to rule out myocardial infarction C) 50 Who is postop after open reduction internal fixation of ankle D) 79 Post op following below-the-knee amputation
D
What are teamwork and collaboration?
Deliver of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes
What is Secondary Health care?
Diagnosis and tx of acute illness and injury -Care in hospital settings (inpatient and emergency departments), diagnostic centers, and emergent care centers
What agents are spread via GU?
E coli Hep A Herpes simplex virus (type 1) HIV
What are the roles and responsibilities of LPNs? Also educational requirements
Educational requirements vary- must meet the state board of nursing's requirements -Requires vocational or community college education prior to taking the licensure exam -Work under the supervision of the RN -Collaboration within the nursing process, coordinate the plan of care, consult with other team members, and recognize the need for referrals to assist with actual or potential problems -Participate in the delivery of nursing care, using the nursing process as a framework
What are the roles and responsibilities of an RN? Also educational requirements
Educational requirements vary- must meet the state board of nursing's requirements for licensure; requires completion of a diploma program, an associate degree, or a baccalaureate degree in nursing prior to taking the licensure exam -Function legally under state nurse practice acts -Perform assessments, establish nursing dx, goals, and interventions; and conduct ongoing client evaluations -Participate in developing interprofessional plans for client care -Share appropriate information among team members; initiate referrals for client assistance, including health education; and identify community resources
Planning
Establish priorities and optimal outcomes of care they can readily measure and evaluate; these priorities and outcomes then direct nurses in selecting interventions to include in a plan of care to promote, maintain, or restore health 1. Develop comprehensive plan of care 2. Ongoing planning throughout provision of care; modify 3. Discharge planning; begins as soon as clients are admitted
What is the role of the speech-language pathologist?
Evaluates and makes recommendations regarding the impact of disorders or injuries on speech, language, and swallowing. Teaches techniques and exercises to improve function -Refer if: Client is having difficulty swallowing a regular diet after trauma to the head and neck
What is the role of respiratory therapist?
Evaluates resp status and provides resp treatments including oxygen therapy, chest physiotherapy, inhalation therapy, and mechanical ventilation Refer if: Client who has respiratory disease is short of breath and requests a nebulizer treatment
What is ethical theory?
Examines principles, ideas, systems, and philosophies that affect judgments about what is right and wrong, and good and bad. Two common types of ethical theories are utilitarianism and deontology -Utilitarianism- actions are right if they are useful or for the benefit of a majority -Deontology- judges the morality of an action based on the action's adherence to a rule or rules
What is subjective data? Objective?
Subjective- Direct quotes, within quotation marks, or summarize and identify the info as the client's statement -Objective- Descriptive and should include what the nurse sees, hears, feels, and smells. Document without derogatory words, judgments, or opinions. Document pt's behavior. Instead of client is agitated, write "client pacing back and forth in his room, yelling loudly."
What are task factors?
Factors to consider before delegating client care: -Predictability of outcome -Potential for harm -Complexity of care -Need for problem solving and innovation -Level of interaction with the client -Consider delegatee's education, training, experience, knowledge to perform skill, level of critical thinking, ability to communicate with others, competence, facility policies and procedures, licensing legislation -Tasks to delegate include repetitive, requiring little supervision, relatively noninvasive for a certain client
What is professional negligence?
Failure of a person who has professional training to act in a reasonable and prudent manner= average judgment, intelligence, foresight, and skill that a person with similar training and experience would have -Common negligence issues that prompt malpractice suits: Follow professional and facility-established standards of care, use equipment in a responsible and knowledgeable manner, communicate effectively and thoroughly with clients, document care the nurse provided
What is Primary heath care?
First level of health care -Emphasizes health promotion, and includes prenatal and well-baby care, nutrition counseling, and disease control. -Sustained partnership between clients and providers. -Office or clinic visits and scheduled school or work-centered screenings (vision, hearing, obesity)
How can nurses avoid liability for negligence?
Follow standards of care Give competent care Communicate with other health team members Develop a caring rapport with clients Fully document assessments, interventions, and evaluations
Goals vs Outcomes
Goals- identify optimal status Outcomes- identify the observable criterion that will determine success or failure of the goal -Always client-centered, singular, observable, measurable, time-limited, mutually agreeable, and reasonable
What agents are spread through blood/body fluids
HIV Hep B and C
What federal laws affect nursing practice?
Health Insurance Portability and Accountability Act Americans with Disabilities Act Mental Health Parity Act Patient Self-Determination Act
What is mandatory reporting?
Health care providers have a legal obligation to report their finding in accordance with state law in the following situations: Abuse Communicable Diseases
How do regulatory agencies affect the level of care?
Help ensure the quality and quantity of health care and the protection of health care consumers
What agents are spread through skin/mucous membrane?
Herpes simplex virus Varicella
What are impaired coworkers?
Impaired healthcare providers pose a significant risk to pt -Nurse who suspects a coworker of any behavior that jeopardizes client care or could indicate a substance use disorder has duty to report to assistance programs that facilitate entry into a treatment program -Each state has laws and regulations that govern the disposition of nurses who have substance use disorders. Criminal charges may apply
What are incident reports?
Incident/variance reports are an important part of a facility's quality improvement plan -An incident is the occurrence of an accident or an unusual event. Medication errors, falls, needlesticks -Nurses must document the facts without judgment or opinion -Nurses must not refer to an incident report in the client's medical record -Incident reports contribute to changes that help improve health care quality
What are transfer reports?
Include demographic info, medical diagnosis, providers, an overview of health status (physical, psychosocial), plan of care, recent progress, any alterations that might become an urgent or emergent situation, directives for any assessments or client care essential within the next few hours, most recent vitals, meds and last doses, allergies, diet, activity, special equipment or adaptive devices (oxygen, suction, wheelchair), advance directives and resuscitation status, and family involvement in care and health care proxy
How does health care finance affect the level of care?
Influences the quality and type of care by setting parameters for cost containment and reimbursement
What is Assault?
Intentional tort -Conduct of one person makes another person fearful and apprehensive -Nurse threatens to place an NG tube in a client who is refusing to eat
What is Battery?
Intentional tort -Intentional and wrongful physical contact with a person that involves an injury or offensive contact -Nurse restrains a client and administers an injection against her wishes
What is false imprisonment?
Intentional tort -Person is confined or restrained against his will -Nurse uses restraints on a competent client to prevent his leaving the health care facility
What is restorative health care?
Intermediate follow-up care for restoring health -Home health care, rehabilitation centers, and skilled nursing facilities
What are collaborative interventions?
Intervention nurses carry out in collab with other health care team professionals such as ensuring pt receives and eats his evening snack
What is provided-initiated/dependent intervention?
Interventions nurses initiate as a result of a provider's prescription (written, standing, or verbal) or the facility's protocol, such as blood admin procedures
What are telephone or verbal prescriptions?
It is best to avoid these, but they are sometimes necessary during emergencies and at unusual times -Have a second nurse listen to a telephone prescription -Repeat it back, making sure to include the med's name (spell if necessary), dosage, time, and route -Question any prescription that may seem appropriate for the pt -Make sure the provider signs the prescription in person within the time frame the facility specifies, typically 24 hours
What are Criminal laws?
Subsection of public law and relates to the relationship of an individual with the government. A nurse who falsifies a record to cover up a serious mistake may be guilty of breaking a criminal law
What are client rights?
Legal privileges or powers clients have when they receive health care services -Clients using the services of health care institution retain their rights as individuals and citizens -Nursing facilities that participate in Medicare programs also follow "Resident Rights" statutes that govern their operation -Nurses must ensure that clients understand their rights and protect their clients' rights -Regardless of age of pt, the pt's nursing needs, or the health care setting, the basic tenets are the same: -Right to Understand the aspects of care to be active in the decision-making process -Right to Accept, refuse, or request modification of the plan of care -Right to receive care from competent individuals who treat the client with RESPECT
What is informed consent?
Legal process by which a client has given written permission for a procedure or treatment -Consent is informed when provider explains and the client understands: -The reason the client needs the treatment or procedure, how the tx or procedure will benefit the client, the risks involved if the client chooses to receive the tx or procedure, other options to treat the problem, including not treating the problem -Nurse's role is to witness the client's signature on the informed consent form and to ensure that the provider obtained informed consent appropriately -State laws prescribe who can give informed consent -Competent adult must sign the form for informed consent; the person who signs must be capable of understanding the information from the health care professional who will perform the service and the person must be able to communicate with the health care professional; when that person is unable to communicate due to a language barrier or hearing impairment, a trained medical interpreter must intervene. Many health care facilities contract with professional interpreters who have additional skills in medical terminology to assist with providing information -Nurse must verify consent is informed and witness the client signing the consent form
What are the roles of Advanced Practice nurses (APN)?
Lots of autonomy -Minimum of a master's degree in nursing or related field, advanced education in pharmacology and physical assessment, and certification in a specialized area of practice -Ex: Clinical nurse specialist (specializes in a practice setting or clinical field), Nurse Practitioner (collaborates with one or more providers to deliver nonemergency primary health care in a variety of settings), Certified registered nurse anesthetist (administers anesthesia and provides care during procedures under the supervision of an anesthesiologist), Certified nurse-midwife (collaborates with one or more providers to deliver care to maternal-newborn clients and their families)
What is information security?
Mandatory adherence with the Health Insurance Portability and Accountability Act of 1996 began in 2003 to help ensure the confidentiality of health information -Major component of HIPPA, the Privacy Rule, promotes the use of standard methods of maintaining the privacy of protected health information among health care agencies -Nurses must be aware of pt's rights to privacy and confidentiality; facility policy and procedures help ensure adherence with HIPPA regulations -The Privacy Rule requires that nurses protect all written and verbal communication about clients -Only health care team members directly responsible for pts care may access the record. Nurses may not share info with other clients or staff not caring for the client -Clients have a right to read and obtain a copy of their medical record -Nurses may not photocopy any part of a medical record except for authorized exchange of documents between facilities and providers -Staff must keep medical records in a secure area to prevent inappropriate access to the info. They may not use public display boards to list client names and dx -Electronic records are password protected. Public may not view them -Staff must use only their own passwords -Nurses must not disclose pt info to unauthorized individuals or family members who request it in person or by telephone or email -Many hospital use a code system to identify those who may receive info about a client -Nurses should ask any pt inquiring about a client's status for the code and disclose info only when the individual can give the code -Communication about a pt should only take place in private settings -Each health care facility has specific policies and procedures to monitor staff adherence, technical protocol, computer privacy, and data safety to HIPPA -Security protocols: Log off from the computer before leaving the workstation to ensure that others cannot view protected health info on the monitor; never share a user ID or password with anyone; never leave a medical record or other printed or written PHI where others can access it; shred any printed or written client info for reporting or client care after use -Know the implications of HIPPA before using social networking sites for school or work-related communication -Become familiar with your facility's or school's policies or about using social networking -Do not use or view social networking media in clinical settings -Do not post info about your school, clinical sites, clinical experiences, clients, and other health care staff on social networking sites
What agents are spread via droplet/airborne?
Mycobacterium tuberculosis Streptococcus pneumoniae Measles, varicalla, pulmonary or layngeal tuberculosis, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, sepsis N95 Mask, negative airflow exchange with 6-12 exchanges per hour, depending on age of structure -Precautions protect against droplets larger than 5 mcg and travel 3-6 ft from the pt
Restraints
Never interfere with treatment -Restrict movement as little as is necessary to ensure safety -Fit properly and be as discreet as possible -Be easily removed or changed to decrease the chance of injury to provide for the greatest level of dignity -Must be prescibed by provider in writing, based on face-to-face assessment of the pt -In emergent situation where there is immediate risk to pt or others= nurse may place pt in restraints; must obtain a prescription from provider as soon as possible usually within 1 hr= must include reason,, type, location of restraint, how long may be used, and type of behaviors that led to restraint -Renewal= 4 hr for adult, 2 hr for 9-17, 1 hr for under 9yr; max of 24 consecutive hours -PRN prescriptions for restraints are not allowed =Assess skin integrity q2hr
What are standards of care (Practice)?
Nurses base practice on established standards of care or legal guidelines for care, such as: -Nurse practice act for each state, published standards of nursing practice from professional organizations and specialty groups, including the American Nurses Association, the American Association of Critical Care Nurses, and the American Association of Occupational Health Nurses, health care facilities' policies and procedures, which establish the standard of practice for employees of that facility. They provide detailed info about how the nurse should respond to or provide care in specific situations and while performing client care procedures -Standards define and direct the level of care nurses should give, and they implicate nurses who did not follow these standards in malpractice lawsuits -Nurses should refuse to practice beyond the legal scope of practice or outside of their areas of competence regardless of reason -Nurses should use the formal chain of command to verbalize concerns related to assignment in light of current legal scope of practice, job description, and area of competence
Implemetation
Nurses base the care they provide on assessment data, analysis, and the plan of care they developed in the previous steps of the nursing process -Use problem-solving, clinical judgment, and critical thinking to select and implement appropriate therapeutic interventions using nursing knowledge, priorities of care, and planned goals or outcomes to promote, maintain, or restore health -Therapeutic interventions- include measures nurses take to minimize risk and to respond to unplanned events, such as an observation of unsafe practice, a change in a status, or the emergence of a life-threatening situation
Evaluation
Nurses evaluate pts' responses to nursing interventions and form a clinical judgment about the extent to which pts have met the goals and outcomes -Progress toward achievement of client outcomes is what determines whether or not to modify the plan of care -Determine effectiveness of plan of care
What is a change-of-shift report?
Nurses give this at conclusion of each shift to the nurse assuming responsibility for the clients -Formats include face to face, audiotaping, or presentation during walking rounds in each pt's room -Includes significant objective info about the pt's health problems -Proceeds in logical sequence -Includes no gossip of personal opinion -Relates recent changes in meds, tx, procedures, and the discharge plan
What is licensure?
Nurses must have a current license in every state in which they practice. -The nurse licensure compact allows licensed nurses who reside in a compact state to practice in other compact states under a multistate license. Within the compact, nurses must practice in accordance with the statutes and rules of the state in which they provide care
Abuse Mandatory Reporting
Nurses must report any suspicion of abuse (child or elder abuse, domestic violence) following facility policy
Communicable Diseases Mandatory Reporting
Nurses must report communicable disease dx to the local or state health department -Reporting allows officials to ensure appropriate medical tx of diseases (TB), monitor for common-source outbreaks (foodborne, Hep A), Plan and evaluate control and prevention plans (immunization), identify outbreaks and epidemics, determine public health priorities based on trends
Analysis (RN)/ Data Collection (PN)
Nurses use critical thinking skills (diagnostic reasoning process) to identify clients' health status or problems, interpret or monitor the collected database, reach an appropriate nursing judgment about health status and coping mechanisms, and provide direction for nursing care
What are nurse-initiated/independent interventions?
Nurses use evidence and scientific rationale to take autonomous actions to benefit clients. They base these actions on identified problems and health care needs, and make sure they are within their scope of practice; nurses perform or delegate the interventions and are accountable for them. Ex: repositioning a pt at lest q2hr to prevent skin breakdown
What is the role of the Lab Tech?
Obtains specimens of body fluids, and performs diagnostic tests -Refer if: provider needs to see a client's complete blood count results immediately
Who may grant consent for another person?
Parent of a minor Legal guardian Court-specified representative An individual who has durable power or attorney authority for health care -Emancipated minors (minor who are independent from their parents, such as a married minor) for themselves
What is refusal of treatment?
Patient Self-Determination Act stipulates that staff must inform clients they admit to a health care facility of their right to accept or refuse care; competent adults have the right to refuse treatment, including the right to leave a health care facility without discharge prescription from the provider -If tx is refused, client signs a document indicating that he understands the risk involved with refusing the tx or procedure and that he has chosen to refuse it -When pt decides to leave against medical advice, the nurse notifies the provider and discusses with the client the risks to expect when leaving the facility prior to discharge -Nurse asks client to sign an "Against Medical Advice" form and documents the incident
What is the role of the radiologic technologist?
Positions clients and performs x-rays and other imaging procedures for providers to review for diagnosis of disorders of various body parts -Refer if: Client reports severe pain in his hip after a fall, and the provider prescribes an x-ray of the client's hip
What are ethical dilemmas?
Problems that involve more than one choice and stem from the different values and beliefs of the decision makers. Common in health care, and nurses must be prepared to apply ethical theory and decision making to ethical problems
What are civil laws?
Protect individual rights -One type relates to the provision of nursing care is tort law
What are the roles of the spiritual support staff?
Provide spiritual care (pastors, rabbis, priests) -Refer if: Client requests communion or the family asks for prayer prior to the client undergoing a procedure
What is the role of the pharmacist?
Provides and monitors medication. Supervises pharmacy technicians in states that allow this practice -Refer if: client is concerned about a new medication's interactions with any of the other medications he is taking
What is the role of nurse administrator?
Provides leadership to nursing departments within a health care facility
What is Patient-centered care?
Provision of caring and compassionate, culturally sensitive care that addresses clients' physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values
What is Tertiary Health care?
Provision of specialized and highly technical care. -Intensive care, oncology centers, burn centers
What are Health care financing mechanisms?
Public federally funded programs: -Medicare- for clients 65 years of age or older and for those with permanent disabilities -Medicaid- clients with low incomes (federally funded, individual states determine eligibility requirements) Private Plans: -Traditional insurance reimburses for services on a fee-for-service basis -Managed care organizations- primary care providers oversee comprehensive care for enrolled clients and focus on prevention and health promotion -Preferred provider organizations- clients choose from list of contracted providers. Using noncontracted providers increases the out-of-pocket costs -Exclusive provider organizations- clients choose from a list of providers within a contracted organization -Long-term care insurance- this provides for long term care expenses Medicare does not cover
What are advance directives?
Purpose: communicate a client's wishes regarding end-of-life care should the client become unable to do so -Patient Self-Determination Act- requires asking all clients on admission to a health care facility whether they have advance directives -Give pt without advance directives written info that outlines their rights related to health care decisions and how to formulate advance directives -Health care representative should be available to help with this process -Nurse's role: provide written info about advance directives, document the pt's advance directives status, ensure that the advance directives reflect the client's current decisions, inform all members and the health care team of the client's advance directives
What is breach of confidentiality?
Quasi-intentional tort -Nurse releases client's medical diagnosis to a member of the press
What is defamation of character?
Quasi-intentional tort -Nurse tells a coworker that she believes the client has been unfaithful to her spouse
Fire response: RACE
R-Rescue- rescue and protect clients in close proximity to the fire by evacuating them to a safer location; ambulatory pt can walk unattended to a safe location -A- Alarm- Activate the facility alarm system, and then report fire details and location per facility protocol -C- Contain: contain the fire by closing doors and windows as well as turning off any sources of oxygen and electrical devices. Clients who are on life support are ventilated with a bag-valve mask -E- Extinguish the fire if possible using an appropriate fire extinguisher (Class A= Paper, wood upholstry, rags, or other types of trash fires; B for flammable liquids and gas fires; C- electrical fires)
What is a primary survey?
Rapid assessment of life-threatening conditions -ABCDE principle: -A- Airway/Cervical spine- patent airway is established -B- Breathing- presence and effectiveness of breathing -C- Circulation -D- Disability- determine pt's level of consciousness -E- Exposure- quick physical assessment should be performed to determine the pt's expsure to adverse elements such as heat or cold
What is autonomy?
Right to make one's own personal decisions, even when those decisions might not be in that person's own best interest
What agents are spread through GI?
Shigella Salmonella enteritiditis Salmonella typhi Hep A
What are advantages of electronic health records? Challenges? Rules?
Standardization, accuracy, confidentiality, easy access for multiple users, and rapid acquisition and transfer of client's info -Challenges- learning the system, knowing how to correct errors, and maintaining security -Rules and formats are similar to those for paper charting
What are ethical principles?
Standards of what is right or wrong with regard to important social values and norms. Pertain to the treatment of clients and include: -Autonomy -Beneficence -Fidelity -Justice -Nonmaleficence
What are state laws?
Statues enacted by each state that define the parameters of nursing practice and give the authority to regulate the practice of nursing to its state board of nursing -Boards of nursing have the authority to adopt rules and regulations that further regulate nursing practice. Although the practice of nursing is similar among states, it is critical that nurses know the laws and rules governing nursing in the state in which they practice -Boards of nursing have the authority to issue and revoke a nursing license -Boards also set standards for nursing programs and further delineate the scope of practice for RNs, licensed practical nurses, and advanced practice nurses
What do nurses supervise?
Supervision of client care tasks delegated to assistive personnel and licensed practical nurses -Responsible for providing clear directions when delegating a task initially and for periodic reassessment and evaluation of the outcome of the task -May delegate to other RNs, LPNs, and AP -RNs delegate so that they can complete higher-level tasks that only RNs can perform allowing more efficient use of all members of the health care team -Delegate only tasks appropriate for the skill and education level of the nurse who is receiving the assignment -Do not delegate the nursing process, client education, or tasks that require nursing judgment to LPNs or AP
Assessment (RN)/Data Collection (PN)
Systematic collection of info about pt's present health status to identify needs and additional data to collect based on findings; collect data through initial assessment, focused assessment, and ongoing assessment -Methods of data collection- observation, interviews with clients and families, medical history, a comprehensive or focused physical examination, diagnostic and lab reports, and collaboration -Ask appropriate questions, listen carefully to responses, and have excellent head-to-toe physical assessment skills, employ clinical judgment and critical thinking in accurately recognizing when to collect assessment data; recognize the need to collect assessment data prior to interventions -Collect subjective data (sx) during a nursing history including feelings, perceptions, and descriptions of health status. Pts are the only ones who can describe and verify their own sx -Nurses observe and measure objective data (signs) during a physical examination. They feel, see, hear, and smell objective data through observation or physical assessment of pt
What is the role of a nurse educator?
Teaches in schools of nursing, staff development departments in health care facilities, or client education departments
Where are the ethical guidelines for nurses located?
The American Nurses Association's Code of Ethics for Nurses with Interpretive Statements -The International Council of Nurses' The ICN Code of Ethics for Nurses
What assists nursing programs in preparing nurses to provide safe, high quality care?
The Quality and Safety Education for Nurses (QSEN)
Who is the lead team member of the interdisciplinary team?
The RN; solicits input from all nursing team members, setting priorities, sharing information with other disciplines, and coordinating client care
What is bioethics?
The field that addresses dilemmas that arise from advancing science and technology, such as stem cell research, organ transplantation, gender reassignment, and reproductive technologies (in vitro fertilization, surrogate parenting)
How do the people affect the level of care?
The level of care depends on the needs of the client. Licensed and unlicensed health care personnel work in every level of care
What are Provider's Orders?
Type of advance directive -Unless a provider writes DNR or Allow natural death (AND) prescription in the client's medical record, the nurse initiates cardiopulmonary resuscitation when the client has no pulse or respirations. The provider consults the client and the fam prior to admin a DNR or AND
How does the setting affect the level of care?
The settings for secondary and tertiary care are usually within a hospital or specific facility and settings for other levels may vary
What is ethics?
The study of conduct and character
What is the ultimate issue of health care?
The ultimate issue in designing an delivering health care is ensuring the health and welfare of the population
What are morals?
The values and beliefs that guide behavior and decision making
What is the job of ethics committees?
To address unusual or complex ethical issues
What is a durable power of attorney for health care?
Type of advance directive -Document where clients designate a health care proxy to make health care decisions for them if they are unable to do so. The proxy may be any competent adult the client chooses
What is a living will?
Type of advance directive -Legal document that expresses the client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues -Most state laws include provisions that protect health care providers who follow a living will from liability
What are regulatory agencies of the health care system?
US Department of Health and Human Services US Food and Drug Administration State and local public health agencies -State licensing boards- to ensure that health care providers and agencies comply with state regulations -The Joint Commission (JCAHO) to set quality standards for accreditation of health care facilities -Professional Standards Review Organizations (PSROs) -Utilization review committees- to monitor for appropriate diagnosis and tx of hospitalized clients
What is malpractice (professional negligence)?
Unintentional tort -Nurse administers a large dose of medication due to a calculation error. Client has a cardiac arrest and dies
What is negligence?
Unintentional tort -Nurse fails to implement safety measures for a client at risk for falls
What is Evidence based practice?
Use of current knowledge from research and other credible sources on which to base clinical judgment and client care
What are informatics?
Use of information technology as a communication and information-gathering tool that supports clinical decision making and scientifically based nursing practice
What is surgical asepsis?
Use of precise practices to eliminate all micro-organisms from an object or area and prevent contamination "sterile technique." Applies to parenteral med admin, insertion of urinary catheters, surgical procedures, sterile dressing changes, and many other common nursing procedures
What is medical asepsis?
Use of precise practices to reduce the number, growth, and spread of micro-organisms ("Clean technique"). Applies to administering oral meds, managing NG tubes, providing personal hygiene, and performing many other common nursing tasks -Hand hygiene, soap, running water, friction; wash for 15 seconds to remove transient flora and up to 2 min when hands are more soiled
What are telephone Reports?
Useful when contacting provider of other members of interprofessional team -Important to: have all the data ready prior to contacting any member of the interprofessional team -Use a professional demeanor -Use exact, relevant, and accurate info -Document the name of the person, the time, content of the message, and the instructions or info received during the report
What are the roles of unlicensed assistive personnel? CNAsa, CMAs, non-nursing personnel -Educational requirements
Varies- must meet the state's formal or informal training requirements -Requirement by most states for training and examination to attain CNA status -Work under the direct supervision of an RN or LPN -Position description in the employing facility outlies specific tasks -Tasks may include feeding, preparing nutritional supplements, lifting, basic care, hygiene, measuring and recording vitals, and ambulating pts
Herpes Zoster (Shingles)
Viral infection; initially produces chicken pox after which the virus lies dormant in the dorsal root ganglia of the sensory cranial and spinal nerves, then reactivates as shingles later in life -Preceded by a prodromal period of several days, pain and tingling or burning may occur along with the involved dermatome; can be painful and debilitating -Prodromal-interval from onset of general sx to more distinct sx; during this time, the pathogen is multiplying -Risk factors: concurrent illness, stress, compromise to immune system, fatigue, poor nutritional status, older adults are more susceptible -Paresthesia, pain that is unilateral and extends horizontally along a dermatome -Vesicular, unilateral rash, erythematous, pustular, crusting depending on the stage, resolves in 14-21 days, low-grade fever -Cultures= definitive dx, but virus grows so slowly; immunofluorescence assay sometimes used -Isolate until vesicles have crusted over -Acyclovir (Zovirax) may shorten clinical course -Postherpetic neuralgia= characterized by pain that persists for longer than 1 month following resolution of the vesicular rash, tricyclic antidepressants may be prescribed, postherpetic neuralgia is common in adults older than 60 years of age
When is a problem an ethical dilemma?
When a review of scientific data is not enough to solve it -It involves a conflict between two moral principles -The answer will have a profound effect on the situation and the client
What is the role of the social worker?
Works with clients and families by coordinating inpatient and community resources to meet psychosocial and environmental needs that are necessary for recovery and discharge -Refer if: Client who has terminal cancer wishes to go home but is no longer able to perform many activities of daily living. The spouse needs medical equipment in the home to care for the client
Nurse caring for pt who reports a severe sore throat, pain when swallowing, and swollen lymph nodes. Pt is experiencing which of the following stages of infection? A) Prodromal B) Incubation C) Convalescence D) Illness
d