Giddens Concepts Review (modules 3 and 4)

A nurse and a student nurse are talking about healthcare coordination. Which statement should the nurse make about the subject? A. "Patients have needs beyond the healthcare system." B. "Patients should coordinate their own care." C. "Physicians are the only ones who coordinate care." D. "Community health nurses coordinate care for the patient."

A RATIONALE: Many patients do have needs that go beyond what the healthcare system can offer, such as financial or social assistance. Patients do not have the healthcare knowledge to coordinate their care. Physicians and community health nurses are not the only ones involved in the coordination of health care.

Lack of mobility in a child may interfere with which developmental milestone? Physiological bonding and growth Speech and hearing development Intellectual and psychomotor function Correct Childhood play interaction

A child must experience mobility so he or she can explore and learn about the world. Immobility can cause intellectual and psychomotor deficits because children need to experience mobility to explore the world. Immobility does not have a direct effect on growth, speech, hearing, or play.

A patient does not make eye contact with the nurse and is folding his arms at his chest. Which aspect of communication has the nurse assessed? A. Nonverbal communication B. A message filter C. A cultural barrier D. Social skills

A. Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patient's social skills or whether a cultural barrier exists.

Which are consequences for a staff nurse related to the use of health informatics? A. Clinical decision support tools B. Confidentiality of health data C. Decreased cost of health care D. Personal health record

A. RATIONALE: The availability of clinical decision support tools at the point of care would be a consequence for a staff nurse. Confidentiality of health data affects patients; a nurse might be involved in ensuring the security and privacy of health information and exchange. A decreased cost of health care would affect a patient; a nurse's ability to reduce duplication of services will influence costs. Adopting a personal health record would be a consequence for a patient.

Which is the best description of the scope of the concept of functional ability? A. Continuum from complete independence to complete dependence B. Ability to perform the normal range of basic and advanced activities of daily living C. Capacity to perform specific self-care behaviors D. Levels of function within the family and the community

A. Rationale: On the broadest level, the scope of functional ability occurs along a continuum ranging from complete independence to complete dependence. An individual with full functional ability can independently meet all necessary life activities without any sort of assistance or use of assistive devices.

The nurse is assessing a patient's ability to perform basic activities of daily living (BADLs). Which of the following activities are considered in the BADLs assessment? (Select all that apply.) A. Brushing teeth or dentures B. Dressing oneself in the mornings C. Washing, drying, and folding laundry D. Counting own pulse and taking heart pill E. Taking the bus to the park F. Calling family members

A. B. Rationale: BADLs include actions related to self care and mobility and also includes eating, personal hygiene, and grooming activities. Instrumental activities of daily living (IADLs) include shopping, meal preparation, housekeeping, doing laundry, managing finances, using the telephone, taking medications, and using transportation.

Which concepts should a nurse consider to have the strongest links to technology and informatics? (Select all that apply.) A. Clinical judgment B. Ethics C. Leadership D. Professionalism E. Safety

A. B. C. E. RATIONALE: Professionalism refers to the attributes and behaviors of a nurse as a representative of the nursing profession and as a healthcare professional. There are many interrelated concepts that bear some relationship to health information technology and health informatics, including data, information, knowledge, wisdom, trust, health, health care, meaningful use, bandwidth, and interoperability. Others found in this book include clinical judgment, leadership, communication, collaboration, safety, evidence, care coordination, healthcare quality, ethics, health policy, and healthcare law.

The nurse is having a therapeutic conversation with a patient newly diagnosed with hypertension. Which communication techniques will most likely prove effective for this patient? (Select all that apply.) A. The nurse presents a laminated poster to the patient that depicts pictures of foods that would be on the low sodium diet. B. The nurse and patient engage in a humorous conversation about the top ten "what not to eat when you are being treated for hypertension." C. The nurse gives the patient a sheet full of information and asks the patient to read the information and let the nurse know if they have any questions. D. The nurse states the risk factors and statistics of patients who do not take their medications as prescribed. E. The nurse helps the patient identify weight loss goals that are reasonable. F. The nurse waits until the patient has been awake for a few hours before beginning the teaching plan.

A. B. E . F. Rationale: Effective communication has clarity and is goal-directed. Engaging techniques such as humor, visual props, and waiting for the patient to be more alert will increase the therapeutic interaction. Providing the patient with written materials is important; however, there is no way to gauge the effectiveness of the teaching and does not guarantee that the patient has read the information. It would be useful to implement the teaching plan and supplement the teaching with a handout at the end of the session to reinforce the teaching. Stating the consequences of not taking the medications is a scare tactic and may result in defensiveness or closed communication.

Which of the following interventions are priorities in a plan of care for a patient who had a stroke 30 days ago and is now in home care rehabilitation? (Select all that apply.) A. Promoting rest and sleep B. Promoting a diet rich in protein C. Promoting exercise and ambulation D. Assisting the patient with ADLs E. Limiting visitors and social contacts

A. C. Rationale: It is important to promote independence in ADLs early in the plan of care to increase independence in general. Promoting rest and sleep will promote well-being. Ambulation and exercise promote well-being and increase healing by circulating oxygen to the brain. Protein promotes healing in postsurgical patients but is not a main focus in stroke patients. Assisting the patient does not promote independence. Limiting visitors will isolate the patient, which can lead to depression.

Which older adult populations should have a comprehensive assessment of functional ability? Select all that apply. A. Those with multiple coexistent health problems B. Those older than age 75 C. Those with a change in mental status D. Those with a demonstrated loss of ability to perform one or more instrumental activities of daily living E. Those who live alone

A. C. D. Rationale: Comprehensive functional assessment, which is a time-intensive, interprofessional effort requiring use of multiple assessment tools, is indicated under specific circumstances. In older adults it is indicated when an individual has demonstrated a loss of functional ability, has experienced a change in mental status, has multiple health conditions, or is frail.

Coordination of healthcare services is complicated by which of the following? (Select all that apply.) A. Involving one or more services Too many community resources B. Poorly funded social programs C. Authority for managing services D. Too many nurses E. Lack of healthcare systems

A. C. D. F. RATIONALE: Coordination of services is complicated because it involves more than one service, poorly funded social programs, confusing chains of authority for managing services, and a lack of healthcare systems. Too many community resources and too many nurses are not complicating the healthcare system.

Which nutrients are critical for the musculoskeletal development during infancy, childhood, and adolescence? Vitamins and minerals Protein and calcium Correct Fats and carbohydrates Zinc and potassium

Adequate stores of protein and calcium allow the developing musculoskeletal system to grow properly. Without the proper vitamins, minerals, and protein, the bones would not develop as they should.

The nurse practitioner orders a wet-to-dry normal saline solution (NSS) dressing for a patient who has a stage III pressure ulcer on the sacral area. The patient's daughter will be dressing the wound at home. Which steps should the nurse include in the teaching plan? (Select all that apply.) Cleansing the wound Correct Managing pain Correct Applying a dry sterile dressing Using cold water in the bath Hand washing Correc

Administering pain medications will ensure that the patient is comfortable prior to a dressing change. Hands should be washed before and after performing a dressing change. The nurse should show the daughter how to cleanse the wound and then apply the sterile. The order calls for a wet-to-dry normal saline dressing. A cold water bath would be contraindicated for pressure ulcer treatment.

The nurse in the skilled nursing facility is very busy and unable to answer all the call lights. Which tasks related to skin care can the nurse delegate to the nursing assistant? (Select all that apply.) Applying over-the-counter lotions to skin that is not broken Correct Assisting the client with frequent turning to prevent pressure ulcers Correct Covering the client who complains of being cold with more blankets Correct Placing a sterile gauze pad over broken skin to contain drainage Correct Assessing a patient complaining of an itching rash

All the above options can be delegated to an unlicensed assistive personnel employee except assessing a patient complaining of an itching rash. Assessment of a rash should be done by the nurse so the appropriate referrals can be made if necessary. The nurse needs to investigate a new rash for the possibility of an allergic reaction.

The coordination and continuity of health care transferred between different locations or different levels of care within the same location is known as which type of care coordination? A. Healthcare doctrine B. Transitional care C. Transactional care D. Multilevel care

B RATIONALE: Transitional care transfers between different locations, as described in the chapter. Healthcare doctrine, transactional care, and multilevel care do not fit the definition of coordination and continuity of care.

When discussing the purposes of nursing healthcare informatics with a staff nurse during orientation, a nurse educator should be concerned if the nurse orientee stated that which is a primary purpose of informatics? A. Develop a data management system. B. Improve disease tracking. C. Improve a health provider's work flow. D. Increase administrative efficiencies.

B. RATIONALE: Data management is an exemplar of health informatics, but it would not be a primary purpose for a bedside nurse. The nurse educator would use this incorrect response to plan additional teaching about the primary purposes of healthcare informatics for the staff nurse. Purposes of information health technology include improving health provider work flow, improving healthcare quality, preventing medical errors, reducing healthcare costs, increasing administrative efficiencies, decreasing paper work, and improving disease tracking.

Instruments such as the Functional Activities Questionnaire (FAQ) for postoperative patients who are at home, the Minimum Data Set for Nursing Facility Resident Assessment and Care Screening (MDS) for nursing home patients, the Functional Status Scale (FSS) for children, and the Edmonton Functional Assessment Tool for cancer patients are used to assess activities of daily living (ADLs). The nurse needs to remember that a disadvantage of these instruments includes: A. the measurement of efficacy and reliability of the instruments used to assess activities of daily living (ADLs). B. the variations in assessments and responses may be subjective because of self-reporting of functional activities. C. the instruments do not show a true measure of ability because of a lack of interactivity during the assessments. D.the information contained in the instruments is insufficient to make a determination about functional status in these populations.

B. Rationale: A disadvantage of many of the ADLs and instrumental activities of daily living (IADLs) instruments is the self-reporting of functional activities. Efficacy and reliability are not measured when assessing ADLs and IADLs. Interaction with the patient is necessary to complete the ADL and IADL assessments. The FAQ and FSS are comprehensive tools that can help the nurse determine functional status.

Which communication term can be applied to this statement: How messages are received and interpreted would include personal states such as mood disturbance, environmental stimuli related to the setting of the communication, and contextual variables? A. Therapeutic communication B. Metacommunication C. Vigor communication D. Internal noise

B. Rationale: Metacommunication is a term which means how messages are received and interpreted would include personal states such as mood disturbance, environment stimuli related to the setting of the communication, and contextual variable. Therapeutic communication is consciously influencing communication to help patient understand plan of care. Vigor communication is used by advertisers for products such as soaps and foods are colorful, humorous and often quite memorable. Internal noise inhibits the ability to accurately receive and interpret messages.

The nurse is assessing a patient's ability to perform instrumental activities of daily living (IADLs). Which of the following activities are considered in the IADLs assessment? (Select all that apply.) A. Feeding oneself B. Preparing a meal C. Balancing a checkbook D. Walking E. Toileting F. Grocery shopping

B. C. F. Rationale: IADLs include shopping, meal preparation, housekeeping, doing laundry, managing finances, taking medications, and using transportation. The other activities listed are activities of daily living (ADLs) related to self-care. IADLs are more complex skills that are essential to living in a community.

Two nurses are discussing the important attributes of care coordination. Which attribute of care coordination should be included in the discussion? A. Community based B. Hospital based C. Team based D. Health insurance based

C RATIONALE: Care coordination should be team based, or interdisciplinary. This allows the care to extend over several disciplines for a broader approach. Care that is community based, hospital based, or health insurance based would be too broad and might not serve the patient well.

To address a goal of improving the health of populations, a nurse is most likely to use which domain of informatics? A. Certified clinical information systems B. Clinical healthcare informatics C. Public health/population informatics D. Translocational bioinformatics

C. RATIONALE: Public health/population informatics is the domain that relates information, computer science, and technology to public health science to improve the health of populations; this domain would provide data for a nurse working with communities. Certified clinical information systems (CISs) refers to the tools used for achieving quality outcomes, including electronic health records, clinical data repositories, decision support programs, and handheld devices, not to the data. Clinical healthcare informatics and the subset nursing informatics provide for the development of direct approaches to patients and their families that can be used by a staff nurse to promote quality patient care. Translational bioinformatics refers to the research science domain where biomedical and genomic data are combined; it is a new term that describes the domain where bioinformatics meets clinical medicine and generally applies to healthcare research rather than direct patient care.

The nurse is admitting a new patient to the psychiatric unit. Which factors will most likely contribute to a positive outcome of the interaction? (Select all that apply.) A.The patient is in a bad mood. B. The patient states that he or she is in pain. C. The unit is quiet. D. The patient has been admitted to the facility in the past. E. The patient is awake, alert, and oriented to person, place, and time. F. There are various interactive sessions going on in the unit today.

C. D. E. Rationale: Positive outcomes for interactions include factors such as the relationship between participants, internal mood states, mental and physical condition, experience and education, and external noise emanating from the environment. Noisy environments increase stress, as does pain. If the patient is in a bad mood, it may be best to address this issue prior to completing the admission because the patient will be more receptive.

The nurse is caring for an 85-year-old woman 6 weeks following a hysterectomy secondary to ovarian cancer. The patient will need chemotherapy and irradiation on an outpatient basis. The nurse should identify and address which barriers to healing? (Select all that apply.) A. Can feed herself and prepare meals but cannot drive to the store B. Lives on a fixed income and can balance her checkbook C. Experiences stress incontinence D. Cannot participate in activities at the senior center E. Lives alone and has no nearby relatives F. Has no transportation to the oncology clinic

C. E. F. Rationale: The patient will not be able to get treatment if she has no transportation or no relatives that live nearby who can help her with recovery. Stress incontinence increases the risk of falls because of urgency and rushing to get to the bathroom. Income and social abilities are lower priorities during this phase of recovery.

Which term is the conglomerate of morals, values, beliefs, norms, and meanings that a group of people share and communicate from one generation to the next? Language Religion Culture Correct Customs

Culture is a blend of everything an individual experiences throughout the lifespan. Norms, values, beliefs, meanings, and morals are shared and taught to young persons. As an individual grows, he or she reflects on the teachings and molds them to fit his or her personal development.

A student nurse asks why care coordination is now a top priority for health system redesign. What is the nursing instructor's best response? A. "Patients like to be cared for by more than one service agency." B. "Care coordination increases confusion about who is responsible for the patient." C. "Community services are lacking, and care coordination helps to fill the void." D. "Every patient will need coordinated care services at some time in life."

D RATIONALE: Care coordination is more prominent in healthcare design today because patients will need coordination of services to promote optimal healthcare outcomes. Community services are not always lacking but may be restricted by financial resources. Care coordination should not increase confusion but should rather lessen it. Patients are usually knowledgeable about the service agencies that are available to care for them.

On which basis is an alteration in functional ability categorized as a primary problem? A. Age at onset B. Sudden versus gradual onset C. Duration of the problem D. Absence as opposed to loss of function

D. Alterations in functional ability are categorized as a primary problem when the ability to perform a particular function never developed. They are categorized as secondary problems when the functional ability developed and was subsequently lost.

The specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice is known as which specialty? A. Computer science B. Health informatics C. Health information technology D. Nursing informatics

D. RATIONALE: The specialty is nursing informatics. Computer science is a branch of engineering that studies computation and computer technology, hardware, software, and the theoretical foundations of information and computation techniques. Health informatics is a discipline in which health data are stored, analyzed, and disseminated through the application of information and communication technology. Health information technology is an application of information processing that deals with the storage, retrieval sharing, and use of healthcare data, information, and knowledge for communication and decision making.

In which way is the relationship between sexuality and functional ability most similar to or most different from that between culture and functional ability? A. Functional ability is a significant determinant of sexuality. B. There is a strong reciprocal relationship between sexuality and functional ability. C. Neither sexuality nor culture influences functional ability but rather are affected by it. D. Both sexuality and culture are major determinants of functional ability.

D. Rationale: Sexuality has a primarily unidirectional relationship with functional ability in that functional ability is a significant determinant of sexuality. Culture also has a unidirectional relationship with functional ability but it is in the opposite direction, with culture being a major determinant of functional ability.

Mr. Walker is caring for his ailing wife, who was diagnosed with a terminal illness. Mr. Walker is talking with a nurse, and states, "I miss my old life. I don't see any of my friends anymore. Caring for my wife is much more difficult than I thought. I want things to be the way they used to be." Which emotional strain should the nurse realize that Mr. Walker is experiencing? Caregiver stress Correct Remorse over being healthy Anger that his children are not helping Grief over losing his friends

Mr. Walker is showing signs of caregiver stress because he expresses that he wants his situation to change. He is not remorseful about being healthy. No children are mentioned in the question. He has not lost his friends; he just does not see them any more.

The nurse should explain to a patient that which are effective treatments for atopic pruritus? (Select all that apply.) Oral steroids Correct Topical steroids Correct Oral antihistamines Topical antihistamines Topical petroleum ointment

Oral and topical steroids may be given for acute cases of atopic pruritus. Oral and topical antihistamines are not usually given, because they are ineffective and may cause further irritation. Petroleum ointment is also ineffective.

Patients who are immobile often experience which emotions? (Select all that apply.) Helplessness Correct Hunger Anger Correct Anxiety Correct Increased communication Improved self-worth

Patients who experience immobility often have psychological issues such as helplessness, anger, and anxiety. Hunger, increased communication, and improved self-worth are usually the opposite of what is experienced.

The nurse is reviewing skin care for immobilized patients with an unlicensed assistive employee. The nurse knows the employee understands the importance of skin care when making which statement? "Proper care of the skin is important because the immobilized patient does not want to smell bad." "Proper care of the skin is important because the immobilized patient is at high risk for breakdown." Correct "Proper care of the skin is important because the immobilized patient will have many visitors." "Proper care of the skin is important because the immobilized patient will be incontinent."

Skin care is important for an immobilized patient because the patient is prone to skin breakdown from pressure and body fluids. Body odor (smell) is embarrassing to the patient, but it does not pose a risk to the skin. Not every immobilized patient is incontinent. Having visitors does not pose a risk to the skin.

A nursing instructor and a student nurse are talking about caregivers and their role in the caring process. What are some of the emotions and obstacles that caregivers experience that the nursing instructor should include in the discussion? (Select all that apply.) Financial prosperity Anxiety Correct Denial Correct Social isolation Correct Euphoria Understanding of the disease

The caregiver experiences emotions such as anxiety and denial of the disease process and faces obstacles such as social isolation when caring for someone else. Financial prosperity is usually not occurring; quite the opposite is likely because a caregiver may be drained of his or her savings. A caregiver does not feel euphoria, because the caregiver is not happy about the situation. The caregiver may not understand the disease process and may not know what to expect as he or she assumes the caregiver role.

A nurse is talking with a woman who is caring for her elderly father. The woman states that she has very little time for herself or any of the activities she used to enjoy. What process is the nurse using to assess this situation? Understanding the father's wishes Cognitive ability of appraisal* Diagnosing the father's health Understanding the woman's wishes

The cognitive ability of appraisal allows the nurse to assess the woman's feelings and her ability to care for her father. Understanding the woman's or the father's wishes is good, but it is not a process of appraisal of the situation. Diagnosing the father's health is outside of the nursing realm.

A family is talking with a nurse because a family member is experiencing a chronic illness. The family asks the nurse how they should cope with their changing roles. What is the nurse's best response? "Don't worry about the role changes; everyone will know what to do." "I know you are worried about this, so you should talk with the physician." "The family should discuss the changing roles and what is needed for everyone." Correct "As the nurse, I can decide about the role changes and what would be best for the family."

The nurse should encourage the family to discuss the changes and what everyone needs and wants with this new situation. This approach will allow every family member to recognize their own needs in addition to the changing needs of the family. Everyone may not know what to do, so answer A is incorrect. Talking to the physician is fine, but he or she will not take on the role of problem solver for the family. The nurse does not have the right to decide for the family; decisions about role changes have to be made by the family members.

A nurse is instructing a nursing assistant on how to prevent pressure ulcers for frail elderly clients. The action by the nursing assistant indicates understanding of the instructions? (Select all that apply.) Bathes and dries the skin vigorously to stimulate circulation Keeps the head of the bed elevated 45 degrees Offers nutritional supplements and frequent snacks Correct Turns the patient at least every 2 hours Correct Maintains a cooler environment when bathing

The patient should be turned at least every 2 hours because permanent damage to the tissues can occur at pressure points in 2 hours or less. If skin assessment reveals a stage I ulcer while the patient is on a 2-hour turning schedule, the patient must be turned more frequently. Protein-calorie malnutrition is another major risk factor for developing pressure ulcers. Additional supplements boost nutritional status, which is essential to healthy skin. Elevation of the head of the bed more than 30 degrees and overstimulation of the skin may stimulate, if not actually encourage, dermal decline. Older adults are more prone to hypothermia if bathed in a cooler environment.

To help decrease the threat of melanoma in a blonde-haired, fair-skinned patient at risk, which recommendations should the nurse provide? (Select all that apply.) Wear sunglasses. Correct Drink plenty of water. Eat plenty of foods high in vitamin K. Apply sunscreen 30 minutes prior to exposure. Correct Consume fish oil and vitamin E.

Wearing sunglasses and using sunscreen are recommended by the National Cancer Institute. Drinking water will help with heat exhaustion but will not prevent melanoma. Green tea, fish oil, soy products, and vitamin E are thought to be helpful in minimizing the risk of developing melanoma; however, vitamin K can cause the blood to clot and is not in a recommendation for the prevention of melanoma.

A nurse observes a patient walking in the hall. Which assessment is the nurse able to complete? Gait and balance Correct Speech and hearing Mental alertness Ability to follow directions

When the patient is walking, the nurse is assessing for gait and balance (mobility). Speech, hearing, mental alertness, and the ability to follow directions do not have a bearing on mobility.