N138 Exam 1 Study Material, Nursing 138 - Exam 1 Part 1, 00000 N138 Midterm

Developing sound clinical judgment is a professional responsibility of the nurse. Which statements indicate behaviors that improve clinical judgment?

"I believe that every patient deserves my very best efforts." "I always assess before acting and make changes as needed." "I look for research findings to support my nursing actions." "I have read the professional nursing standards."

The nurse is discussing the Nurse Licensure Compact (NLC) with a prospective employer. Which statement by the nurse indicates a need for further education?

"The NLC has been adopted by all states in the U.S." The Nurse Licensure Compact is a mutual recognition model of licensure that was developed to improve the mobility of nurses. As of mid-2015, 24 states have adopted the NLC, with 6 more states having pending legislation. NLC mobility occurs in travel nursing, telehealth and simply moving to another state to work.

Which statement by the nurse indicates that further teaching is needed, based on the Paul-Elder critical thinking framework?

"The critical thinker is closed minded." Paul and Elder (2015) describe the well-cultivated critical thinker as someone who: is open minded, raises questions and problems and formulates them clearly and precisely. The critical thinker gathers and assesses relevant information, using abstract ideas for interpretation. The critical thinker also communicates effectively with others as solutions to complex problems are formulated.

A nursing student is complaining about writing care plans. Which response by the faculty is best to help the student see the importance of this activity?

"The nursing process is a way to systematically think about and use patient data."

Which statement by the nursing student indicates that further teaching is needed on the nursing process?

"The nursing process is one area of nursing that has been without criticism." The nursing process has often been criticized, describe as rigid, linear and mechanistic. The nursing process as a method of addressing clinical problems is taught in schools of nursing across the United States, and many states refer to it in their nursing practice acts. It is a creative approach to thinking and decision making, and is the cornerstone of nursing standards.

The nurse professor is giving a lecture on statutory laws. Which statement by one of the nursing students indicates that the teaching has been effective?

"These laws are established through a formal legislative process." Statutory laws are established through a formal legislative process. Laws that are established by a judge's ruling are known as common law. Laws that are established by governmental authority are known as administrative law.

Pitfalls of ABSN

- 2nd degree students - various majors/life experiences - expectations - black & white answers to grey

How can the nurse avoid charges of malpractice?

- Administer medication using the 5 rights. - Obtain informed consent from the patient before a procedure.

Conflict (RTSS)

- Advise and support individual students. - Make appropriate referrals (e.g., mental health services, time management, study resources). - Provide periodic reminders of the stages to individual advisees or at informal student gatherings (e.g., lunch, student organization meetings).

ANA/C

- CA's version of ANA - any nurse can belong

Utley Smith

- Dr Donea Shane 1. Honeymoon (1st semester) • positive, glow, satisfaction, optimistic. • Few hours - months • Ended during 1st theory of nursing practice 2. Conflict (2nd semester - Spring - 1st highly intense clinical course) • Negative, feel inadequate • Cant apply previous knowledge from old jobs • Depression, anger, helpess, insecure, lethargy, no energy, exhausted 3. Reintegration (end of 2nd semester)>> positive resolution or maladaptation • Integration/positive resln • Angry, Blame teachers for bad grades • Integrate old work culture w nursing = biculturism • Recognize growth & know we'll function differently after graduation • Positive resolution • Maladaptation - resistance for growth & positive changes Put into practice - Assess critical transition points in assignments - Problem recognition is benefit to understand & apply this model - Go to professor & say ur in hostility phase - Use this model to anticipate and plan - Teachers can give us resources - Identify our transitions & get support thru them so we can improve our socialization

Joint Commission Sentinel Event Alert

- Healthcare is a high stakes, pressure packed environment that can test the limits of civility in the workplace - Rude, disruptive behavior among healthcare professionals can pose a serious threat to patient safety and overall quality of care

Reintegration (RTSS)

- Identify maladaptive students and plan appropriate strategies w students, advisors, & other faculty. - Help students focus on larger goal and benefits of reintegration.

Honeymoon (RTSS)

- Introduce the model to students in an introductory course, emphasizing the expected role change and strain and the normalcy of experiencing the stages. - Reinforce faculty commitment and faculty support. - Encourage peer support and recognition of symptoms. - Be alert to symptoms of early conflict. - Predict where in the curriculum students are likely to transition to the conflict stage and the beginning of the reintegration stage.

Invasion of Privacy

- Need to know basis only - Can't discuss patient with anyone who doesn't have a legitimate reason to know

Expanded Career Goals for Nursing

- Nurse Practitioner - Nurse administrator - Clinical nurse specialist - Nurse educator - Nurse anesthetist - Nurse midwife - Nurse scientist

Types of Transition according to Transition Theory

- Social/cultural - Life span - Vulnerable

Negligence

- actions fall below the standard of care - statute of limitations: 3 years - non-professional malpractice - must cause harm

Caregivers (balancing engagement & detachment of caregiving)

- affect outcomes w/o controlling them - pragmatic - conscious choices based on their emotional needs - set & maintain limits & boundaries - practice self-care more effectively - less burn out

Balancing engagement and detachment allows caregivers to...

- affect outcomes without controlling - be pragmatic - make conscious choices based on emotional needs - set/maintain boundaries - practice self-care - avoid burn out

Social changes in nursing

- aging population - change in reimbursement formula - diverse population - new diseases/environmental problems

Interdependent Actions

- allow nurse to alter prescribed treatment regimen after observing a client and determining their signs/symptoms, reaction, or condition doesn't exhibit normal characteristics or behaviors

Ways to stay current with changing laws

- become a member of a professional organization - board of RNs website - employer - continuing education - journals

Institute of Medicine (IOM) Report

- broadens the scope of nursing - All practitioners must be permitted to practice to the full extent of their knowledge and competence - Special impact for APRNs Nurses mandated to be team leaders in outcome research because they know the patients best

Duty of Care

- can prove through shift assignment/charting

New roles for RNs

- care coordinator - faculty team leader - informatics specialist - nurse/family cooperative facilitator - primary care provider

Traditional Roles/Functions of Nurses

- caregiver - communicator - teacher - client advocate - counselor - change agent - leader - manager - researcher

Critical values of Nursing

- code of ethics - standards - nursing practice act - NSNA's code of academic and clinical conduct

Recipients of Nursing Care

- consumer: purchaser - patient: already sick, passive acceptance of care - client: receiver of healthcare, active participant

Challenges to the Nursing Profession

- disconnect between education and practice - lack of professional identity - various occupations can be perceived as representing nursing - hierarchical structure of acute care

Independent Actions

- don't need a Dr's order. - direct and indirect patient care like observation, services that ensure hygiene, safety, comfort, and protection - immunization, drawing blood, skin test

Elements required to prove negligence

- duty of care - standard of care - failure to follow standard of care - patient was harmed - proximate cause

Stress reduction/ self care measures

- family/friends - ask for help - exercise/fresh air/ sunshine - healthy eating - sleep - time management - declutter life

Make a successful transition

- find mentors - make friends - study groups - ask for help - manage time by prioritizing and being organized - work with faculty - learn good study habits - meet all due dates

Standard of Care

- found in policy and procedure manuals, scope and standards documents, nursing practice act, textbooks, journals, expert witnesses, community standards

Shift in the image of RNs

- gender role - aging demographic - increased accountability/responsibility - shift from acute care to community

ANA Standards of Care

- guidelines, not laws, for safe nursing practice - establishes a minimum criteria for proficiency - enables judgement of quality nursing care provided (used by legal system)

scope of nursing practice

- health & wellness - Prevent illness - Restore health - Care for dying

HIPPA

- health insurance portability and accountability act - law that provides rights to patients and protects employees - In privacy section that are standards regarding accountability in health care settings

Advanced Directives

- include living wills, health care proxies, and durable power of attorney for health care

Ways to decrease liability

- know the law - practice within boundaries - positive nurse/client relationship - documentation

Practice within boundaries

- law: broadest - standards of practice: how to interact with patient/families. - policy: statement that has been written by a practitioner in a particular setting - your own ability: most narrow. If you do something you know you can't do, you are liable

HIPPA Rules create

- patient right to consent to use and disclosure of protected health info - inspect one's medical records - amend mistaken information - limits who can access patient's records

Contributory negligence

- patients portion of negligence - judgement can be reduced based on % patient was responsible

Recent transitions in nursing

- phase out diploma and aa - Offer BSN at community college - Increase number of masters - Accelerated programs - Increase doctorally prepared nurses

Harm that can be caused to a patient

- physical - emotional/pain and suffering: can't sue for emotional damage alone. Max $250k - monetary/financial loss: medical expenses, lost wages, hiring help, lifestyle adjustments. Jury must extrapolate over entire lifetime

Malpractice

- professional negligence - statute of limitations: 2 years

Criteria of a profession

- prolonged and specialized education - orientation towards service - code of ethics - autonomy - professional organization

Scope of nursing practice

- promotion of health and wellness - prevention of illness - restoration of health - care for the dying

Professional Nurse (ANA)

- protection, promotion, optimization of health & abilities - prevention of illness & injury -alleviation of suffering thru diagnosis & treatment of human response - advocacy in care of indivs, fams, communities, & pops

Defamation

- publication of false statements that result in damage to a person's reputation - slander = verbal - libel = written

florence nightingale pledge

- purity 2 practice faithfully - abstain from mischief, - wont give harmful drugs - elevate standards - aid Dr in his work & devote to welfare of pts

Dependent Actions

- require a Dr's order - administration of medication

Informed consent

- required for anything dangerous or invasive - based on full disclosure of risks, benefits, alternatives, and consequences of refusal -failure to obtain could result in a claim of battery

BRN Disciplinary Actions

- suspending judgement - probation - suspending license - revoking license

CNA

- union - membership is required if working at an institute that has a contract with CNA

Consent

- verbal, nonverbal, written, or understood - necessary before doing anything to a patient

ANA

- voluntary membership - fosters high standards of practice - promotes economic/general welfare for nursing - projects positive/realistic view of nursing - lobbies congress/regulatory agencies on health care issues

Good Samaritan Act

- when a nurse offers emergency help outside their place of work, they will not be liable for their actions if done in good faith. - only provide care consistent with your skill level

clinical nurse specialist

-CNS -adv practice nurses with masters, post-masters, or doctoral degrees in specialized areas of nursing (ie oncology)

challenges do foreign-educated nurses face:

-English as a second language -problems with peers who may not perceive them as knowledgeable -deep cultural differences -different views on gender, authority, power, and age that may effect their communication styles

What does a standardized procedure allow?

-Permits a nurse to do a "medical-physician job" usually dependently but sometimes independently -NP, Nurse midwife, Clinical Nurse Specialist, and Nurse Anesthetist can perform the tasks they do because there is a standard procedure that allows them to do it

What is the Magnet Recognition Program?

-an initiative of the American Nurses Credentialing Center (ANCC) -a credential demonstrating organizational recognition of nursing excellence -was established to recognize hospitals that attract and retain nurses, acknowledging that this achieves better pt outcomes

characteristics "To be A Professional"?

-be respectful -be ethical -be honest -be the bet -be consistent -be a communicator -be accountable -be collaborative -be forgiving -be current -be involved -be a model nurse -be responsible for your own learning -be prepared

how do nurses demonstrate collegiality?

-by sharing with -supporting -assisting -counseling other nurses and nursing students

wide range settings & roles

-hospitals -clinics -community-based facilities, medical offices -SNFs -long-term settings -homes -schools -workplaces -military -community and senior centers -children's camps -homeless shelters -retail clinics

Nursing Informatics

-intregration of science and practice nursing -information combined with knowledge

what is the code of ethics according to the ANA?

-is being answerable to someone for something one has done -nurses are accountable and responsible for the assignment or delegation of nursing activities -accountability is firmly rooted in the ethical principles of "fidelity (faithfulness), loyalty, veracity, beneficience, and respect for the dignity, worth, and self-determination of patients"

The ANA:

-is the official voice of nursing -primary advocate for nursing interests in general -is a federation of states nurses associations that all RNs are eligible to join -their purpose are to work for the improvement of health standards and the availability of health care services for all people, to foster high standards of nursing, and to stimulate and promote the professional development of nurses and advance their economic welfare

what is the function of Nightingale's pledge?

-it functions as nursing's first code of ethics -it has historical value -it established the roots for our current code

Hospice and Palliative Nurses Association (HPNA)

-largest and oldest professional nursing organization dedicated to the practice of hospice and palliative care

Explain the roles and education of advanced practice nurses

-nurse educator -clinical nurse leader -Advanced: NPs, clinical nurse specialists, certified nurse-midwives, CRNAs

What are some factors that pull nurses to emigrate?

-opportunities for better quality of life -personal safety -professional incentives (ie increased pay, better working conditions, and career development)

evolving practice opportunities for nurses

-palliative care/end-of-life care; terminally ill pts in their own homes/facilities -conducting research -teaching -managing -telehealth (through telecommunications) -faith community -informatics (combining information and knowledge in the management of pt care) -entrepreneur

What are independent functions of nursing according to the Nursing Practice Act?

-performance of skin tests, immunization techniques, and the withdrawal of human blood from veins and arteries. ensure the safety, comfort, personal hygiene, and protection of patients; and the performance of disease prevention and restorative measures. -Observation of signs and symptoms of illness, reactions to treatment, general behavior, or general physical condition

What are some factors that push nurses to migrate?

-poor compensation -poo working conditions -political stability -lack of career development opportunities

To prevent nursing shortages:

-recruit and educate younger nurses -recruitment of foreign-educated nurses to the US

Locate the regulation referring to emergency care (Good Samaritan) by nurses. What does it say? What does this mean to you?

-we are a nurse ALL the time -Once you offer care, you cannot leave. Even if they say that they are fine, are a doctor, do not want to be touched... -Don't assume just by title that you can hand off care. Must be equal or higher skill level -Does not apply if you are at work or on duty

A patient is admitted to the hospital for a routine surgery and held overnight for observation. In the middle of the night the patient suffers complications from the surgery and ends up dying. This death is determined to be a case of failure to rescue, according to Clarke and Aiken, the authors of the article "Failure to Rescue", what is the most effective way for hospitals to prevent this type of death?

A.) Always have post-operative patients observed in the intensive care unit. B.) Have a low patient-nurse ratio on all hospital floors. C.) Assign one physician to stay on the patient care floors at all times. D.) Only hire register nurses to work on the patient care floors

A public health nurse is working with a young woman who is pregnant for the first time and has just found out she has HIV. During the clinic intake interview, what types of Transitions does the nurse identify? (Select all that apply.)

A.) Developmental Transition B.) Situational Transition C.) Health-Illness Transition D.) Organizational Transition

Laws are further broken down into what two categories?

1. Civil 2. Criminal

3 major types of laws that govern American society

1. Common law 2. statutory law 3. administrative law

A nurse notices that a large number of patients overconsume alcohol. The nurse designs a assistance program to change their lifestyle and prevent alcoholism. This is an example of which nursing role?

1. Counselor 2. Caregiver 3. Manager 4. Research consumer

4 objectives that each state has accomplished for the nursing practice Act?

1. Defines the practice of professional nursing 2. That's the minimum educational qualifications and other requirements for licensure 3. Determines the legal titles and abbreviations nurses may use 4. Provides for disciplinary action of licenses for certain causes

An elderly woman arrives at the Emergency Department with difficulty breathing. She is also extremely distressed due to having just witnessed her husband collapse from a heart attack. Patient is advised at hospital that her husband passed away. What type of transition(s) might apply to this patient:

1. Developmental 2. Situational 3. Health-Illness 4. All of the Above

A 72 year old patient was admitted to the hospital with a broken femur. After a lengthy stay in the hospital, the patient is discharged. What type of transition will the patient go through upon discharge?

1. Developmental transition 2. Situational transition 3. Health-Illness transition 4. Status Quo transition

A 35-year old patient is diagnosed with Multiple sclerosis. She recently moved to the United States with her two daughters. What types of transition will this patient undergo? Select all that apply.

1. Developmental transition 2. Situational transition 3. Health-illness transition 4. Organizational transition

criteria that Flexner's study stipulate in order to be considered a profession?

1. intellectual (as opposed to physical) and is accompanied by a high degree of individual responsibility 2. body of knowledge that can be learned and is developed and refined through research 3. is practical, & theoretical 4. can be taught thru a process of highly specialized professional education 5. strong internal organization of members well-developed group consciousness 6. motivated by altruism (the desire to help others) and who are responsive to public interests

the code of ethics serves as 3 distinct purposes:

1. it is a statement of the "ethical values, obligations, duties, and professional ideals of nurses individually and collectively" 2. it is nursing's "nonnegotiable ethical standard" 3. it expresses "nursing's own understands of its commitment to society"

what are the 2 main differences between a profession and occupation?

1. preparation 2. commitment

ANA Standards of Practice

1973 ANA Congress 4 nursing practice - not laws, but GUIDELINES 4 safe nursing prac - min criteria 4 proficiency - judgment of quality nursing (used by legal sys to estab what gd nurse wd do in similar circums)

Benner's Stages of Nursing Expertise

1: Novice 2: Advanced Beginner 3: Competent 4: Proficient 5: Expert NACPE

A nurse is educating a young female about the dangers of smoking tobacco. Which of the following suggestions, by the nurse, is the best example of Primary prevention?

A bone density exam for early detection of osteoporosis may be beneficial An outreach program may help with addiction to cigarettes Training for a marathon may help deter cigarette smoking This pamphlet offers various options to help quit smoking

The nurse is making phone calls to radiology and chiropractic department to schedule and coordinate a client's appointments for the day. This nurse is functioning as:

A case manager A manager A clinical nurse specialist A registered nurse

A patient is being treated for a panic attack. The nurse contemplates using mindful meditation techniques he/she recently read about in a research article. What should the nurse do first?

A) Consider whether the demographics of the study's sample population is similar to the patient. B) Ask the patient about his/her spiritual and cultural background. C) Consider the patient's interpretation of why the panic attack occurred. D) Inform the patient of the benefits of mindful meditation.

A nurse who works at a research hospital has learned that a colleague has been recruiting patients for a research study with out informing them of the risks. This is a clear violation of the patient's Right Not to Be Harmed, how should the nurse react?

A.) The nurse should report their colleague to the Charge Nurse. B.) The nurse should report their colleague to the head of the hospital. C.) The nurse should report their colleague to the police. D.) The nurse should report their colleague to the Institutional Review Board (IRB) for that study.

What following characteristics of a profession were listed in Flexnor's work on professions?

Activities of professions are based on their own body of knowledge

Analysis of cases of reported negligence from 1995 to 2001 demonstrated that the majority of cases occurred in which patient care setting?

Acute care

Joint Commission Standards

All accredited health care organizations need to create behavioral codes of conduct and establish a formal process for managing unacceptable behavior

In an effort to redefine the image of Nursing what can Nurse leaders do to facilitate this process? (check all that apply)

Allow Nurses to do whatever they want off the job because it is really their time. Define unacceptable workplace behaviors and hold the staff accountable Hire only female nurses Have more potlucks on the unit to create more social interaction

A nursing student midway through an accelerated BSN program is feeling overwhelmed by the workload and disagrees with faculty about their teaching methods. What should the student do?

Arrange a meeting with the faculty to point out problems in the teaching method. Seek help in understanding how to study for the exams. Find out what the professors are looking for and study that. Drop out and try a program with a slower pacing.

Preparation of the components of professions separates occupations from professions. Which of the following is the best way that a nurse demonstrates preparation for the profession?

Articulation of our use of caring and compassionate patient-centered care

A nurse is caring for a patient who has just received a diagnosis of breast cancer. What should the nurse do to help this patient prepare for her transition?

Assure the patient that there are several options for treatment. Assemble information for the patient on healthy diet and exercise. Encourage the patient to join a support group during her treatment. Inform the patient's family that she will need their help throughout her treatment.

Which action can the nurse take to demonstrate critical thinking skills?

Communicate effectively as solutions are being formulated. Critical thinking is crucial to providing quality care to patients with complex medical diagnoses. The nurse demonstrates critical thinking skills by communicating effectively with others as solutions are being formulated.

Which of the following nursing roles is not considered an advanced practice role?

Community health nurse

The nurse manager has hired a nurse from another country. What action should the nurse manager take, in order to make the new nurse's transition easier?

Educate the current staff about the new nurse's background.

Which best defines nursing practice?

Formalized experiences designed to enhance the knowledge or skills of a practicing professional. Process of helping a client to recognize and cope with stressful psychological or social problems. Activity that assist the client physically and psychologically while preserving the client's dignity. The protection, promotion, and optimization of health and abilities, preventions of illness and injury, alleviation of human response, and the advocacy in the care of individuals, families, and populations.

1800-1900 phase of the US Health System

Health concerns relating to social and public health issues

Which of the following is true about bachelor's of science in nursing (BSN) education?

It is recommended by professional organizations as preparation for entry into practice

A recent graduate from an ABSN program was just hired as an RN. The first few weeks on the job the new nurse lacks "experienced intuition" when it comes to making clinical judgments. The beginning nurse should help increase their clinical intuition by focusing on (select the best answer):

Reading and studying additional textbooks and research studies Learning to recognize situations in order to develop a practical knowledge Speaking with co-workers about their past experiences Staying within the same unit for an extended period of time

The RN asked a nursing assistant to monitor several postoperative patients. Which of the following instructions to the nursing assistant demonstrate appropriate delegation?

Record the urine output, and report to me if they have not voided within 4 hours.

________ are the largest group of health care providers in the US.

Registered Nurses (RNs)

Schumacher & Meleis Types of Transitions

Transitions relevant to nursing - Developmental - Situational - Health/illness - Organizational - Individual/dyad/family - Environmental - Well-being

Transition Theory

Universal experiences occur over time.

what was the first university-based nursing program?

University of Minnesota in 1909

For a nursing malpractice action, essential characteristics of negligence must be present. Which of the following constitute these essential characteristics?

a. The nurse assumed the responsibility for the patients care. b. The nurse is found to have failed to meet the standard of care. c. The harm to the patient must be shown to have been caused by the failure to meet the standard of care. d. Harm to an individual has occurred.

The American Nurses Association (ANA) serves as the

Professional organization for all nurses regardless of practice setting or level of practice.

An English-speaking nurse, is assigned to a patient who only speaks and understands French. To get past this communication barrier, the nurse should:

Provide a pen and paper to the patient so they can communicate with illustrations. Notify the charge nurse that he or she cannot communicate with the patient and request for a switch to be made. Bring in the hospital's interpreter to translate between the nurse and the client. Bring in one of the patient's family members who understands French and English to provide translations.

The hospice nurse is caring for a patient who is actively dying. Which actions are supported by the Hospice Standards of Practice?

Provide culturally sensitive care to the patient and family.

healer (nurse)

healing vs curing hurt ppl hurt. healed ppl heal

Several methods have been developed to assist nurses in organizing patient data. they include?

hendersons 14 nursing problems gordons 11 functional health patterns abdellahs 21 nursing problems

Which of the following patient problems is given the highest priority by the nurse?

impaired tissue perfusion, cerebral, related to hypoxia as manifested by decreased level of consciousness

Which of the following patient problems is given highest priority by the nurse using Maslow's hierarchy of needs?

ineffective airway clearance related to retained secretions

One important advantage of the evolution of nursing informatics is that

informatics nurses are best able to design systems with the needs and skills of nurses who use them.

Which of the following is a characteristic of an accomplished critical thinker?

inquisitiveness

Battery

intentional touching without consent

ending

moving from what you were doing before to something different (disengagement, disidentification, disenchantment)

Bridges' Transition Theory (3 phases)

must achieve change through the internal process people go through (the personal stuff)

new beginnings

new role begins, acceptance of new values, behaviors, knowledge, and attitudes (ie. starting nursing school, finding new meaning and future, experiencing control and challenge)

Defenses against negligence

one of the elements was not met

ANA Definition of a Nurse

protection, promotion, optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations

consumer

prsn who purchases healthcare

A nurse reviewing a patient's care plan notes a goal of "patient will ambulate 50 ft. three times in the hallway today." According to Bloom, what taxonomic category is this goal?

psychomotor domain

criminal law

public concerns regarding an individual's unlawful behavior that threaten Society, such as murder, robbery, kidnapping, or domestic violence

client

receiver active participant collars w provider

civil law

recognises and enforces the rights of individuals and disputes over legal rights or duties of individuals and relation to one another

A child is tested for genetic abnormalities. After the test results are delivered from the laboratory, a representative of the parents medical insurance company calls the nurse's station and asks for the results of the tests. The nurse's best response to this request is to

refuse to give the information.

state boards of nursing (SBN) job?

regulatory bodies by which nursing practice acts are administered and enforced. They ultimately regulate nursing to protect the public from harm but I'm prepared or incompetent practitioners.

The use of standardized plans of care for different patient populations has...?

required the nurse to individualize the plan of care to the patient

accountability

responsibility for one's behvior

A patient is admitted with the diagnosis of bronchitis, congestive heart failure and fever. The nurse's assessment finds a temperature of 101 F, peripheral edema and rhonchi. Which of the following is the best etiology to support the nursing diagnosis of ineffective airway clearance?

retained secretions

autonomy

self-determination. control over one's own professional practice

profession criteria

specialized education service oriented ongoing research ethics autonomy organization ex: law, clergy, medicine

patient

suffer or bear sick when seek med help passive acceptance of healthcare decisions

Which of the following is an independent nursing intervention?

teaching a patient with congestive heart failure to weigh herself daily

collective identity

the connection and feeling of similarity individuals in a particular group feel with one another; group identification

The Nursing: Scope and Standards of Practice outlines what?

the expectations of the professional role within which all RNs must practice and delineates the standards of care and associated competencies for professional nursing

The major benefit of serving as a military nurse is

the financial support to seek advanced degrees

The racial and ethnic composition of the nursing profession will change to more accurately reflect the population as a whole when

the increased numbers of racial and ethnic minorities enrolled in educational programs graduate and begin to practice.

define evidence-based practice

the use of research findings as a basis for practice rather than trial and error, intuition or traditional methods, such as problem solving

Which of the following is an example of civil law?

Child custody case

The parents of a young patient newly diagnosed with Type I diabetes would benefit most from which of the following?

Instruction on how to read nutrition labels. Instruction on how to test blood sugar and inject insulin. Referrals to schools that have a lower student to teacher ratio. Referrals to therapists to help the parents cope with having a child with diabetes.

A major challenge to full autonomy for nurses is/are

Lobbyist for the American Medical Association in hospital associations

A nurse is confronted with a patient who suddenly stops breathing after hip replacement surgery. Which of the following is not an example of a measure used to prevent the measure of hospital performance known as "failure to rescue"?

Lowering the patient-to-nurse ratio Recognizing complications Teaching illness-prevention-techniques to patients Anticipating possible complications

A patient is being held at a psychiatric ward on a 5250 hold. Before his evaluation on whether or not he is ready to be released he tells the nurse that he likes his mania and does not plan to take the medication that reduces the manic effect. What stage of health behavior change is the patient exhibiting?

Maintenance Stage Contemplation Stage Preparation Stage Precontemplation Stage

Which of the following could eventually change the historical status of nursing as a female-dominated profession?

More male graduates of basic nursing programs entering the workplace

expanded career roles

NP admin CNP clinical nur spec educator CRNA midwife scientist ("nurse" in front of each word"

How many people are on the Board of Nursing (BRN) and who do they represent? How are they appointed: What are the implications of this process?

Nine, but four of them are not Nurses so it only takes ONE RN to change a vote if all four community members are in agreement

A nursing student got a thank-you card from a patient's family and had another student take a photo of the student with the family. The student asks the nursing instructor if it would be alright to post the photo on Facebook. Which response by the instructor is best?

No, posting pictures of patients and families on social media sites is not acceptable.

Which of the following statements explains why the school nurse of today is truly a community health nurse?

The school nurse may be called on to care for a student's family members in underserved areas.

CNSs may

a. Manage an inpatient nursing unit. b. Develop educational programs for nursing staff. c. Conduct practice outcomes research.

The nurse is caring for an elderly patient and notices that the patient is growing weaker and may need a walker to prevent a fall. The doctor the nurse is working with is condescending and continues to point out the nurse's mistakes so the nurse is afraid to be wrong with an assessment. The nurse would be advised to do which of the following?

a. Observe the patient for a few more days to see if the patient's condition worsens. b. Tell one of the other nurses the care plan change you are considering. c. Immediately change the care plan for the patient and provide a walker. d. Present your observations to the charge nurse and/or doctor and suggest the patient use assistance when walking.

A first-time mother has been trying to nurse her baby at every feeding since giving birth two days ago. It has been a very painful process. The nurses have all tried coaching the patient to make sure the baby is latching on properly. The baby continues to have a hard time latching on, unlatches every few seconds and cries. The patient is in obvious distress as she is teary-eyed, tensed and shaking because of all the pain. Upon physical examination, the nurse notices bleeding and cracked nipples. The patient is very determined and wants to continue nursing but doesn't know how she will be able to given all the pain she is in. How should the nurse support this patient?

a. Recommend that she have a consultation with the lactation specialist b. Continue to work with the patient on the latching technique c. Encourage the patient to give the baby formula so that her breasts can take a break d. Advise her to stop nursing and pump

In what stage of the returning-to-school model are false acceptance and chronic hostility both maladaptive responses?

a. Reintegration b. Conflict c. Recovery d. Shock

One important advantage of clinical ladder programs for hospital-based RNs is that they

allow career advancement for nurses who choose to remain at the bedside.

Bridges Transition Model

always moving forward Stages: - Ending - Neutral Zone - New Beginnings - Disengagement, disenchantment, disidentification, disorientation - acceptance of new values, behaviors, knowledge, and attitudes

although criteria for professions vary, all professions have on criterion in common:

an obligation to the recipients of their services

association

an organization of members with common interest

what characteristic is the core of professional nursing through which nurses intervene for their patients?

caring

Top of the most clinical ladders are _______ (3 wrds)

clinical nurse specialist

the promotion of a supportive and health work environment, cooperation, and recognition of interdependence amount members of the nursing profession is the essence of ______

collegiality

A competent resident in a long-term care facility refuses an ordered antidepressant medication. The nurse believes the patient needs the medication because he is clearly showing signs of depression and dissolves the medication in juice without telling the patient. This illustrates negligence by failure to

communicate with a patient.

Critical thinking in nursing needs to include which of the following important variables?

consideration of ethics and responsible decision making

recipients of nursing care

consumer patient client

Respondeat Superior

Holds employer legally responsible for wrongful act of an employee if it occurs withing the scope of employment

Proximate Cause

harm was directly related to the failure to follow standards

possible sources of vulnerability in our own transitions

misapplication of previous work/ education new relationships time constraint for socialization

Which of the following statements describes the purpose of the nursing process?

process used to identify and solve patient problems

professionalism

professional behavior, appearance, and conduct

purpose of Licensing certain professions is to what?

protect the public health, safety, and Welfare.

Older nurses are more likely to remain in the workforce because:

protected from layoffs & downsizing

profession

work requiring advanced training and usually involving mental rather than manual effort. usually has a code of ethics and professional organization

Developing clinical judgment is a professional responsibility of the nurse. which statements indicate behaviors that improve clinical judgment? (Select all that apply)

"I always assess before acting and make changes as needed," "I look for research findings to support my nursing actions," "I believe that every patient deserves my very best efforts," "I have read the professional nursing standards"

The student nurse is preparing to take the NCLEX RN examination. Which statement by the student indicates that further education is needed?

"I am allowed 3 hours to take the exam." Each student taking the NCLEX RN examination is allowed 6 hours, including breaks, to complete the examination. The exam is administered through computerized adaptive testing. The minimum number of questions is 75 and the maximum is 265.

The nurse professor has just given a lecture on the process of professionalization. Which statement by one of the students indicates that the teaching has been effective? A. "Practitioners performed part-time work in their discipline." B. "A code of ethics was established first and foremost." C. "After determining work standards, legal protection was established." D. "Licensure was obtained after all other steps have been met."

"After determining work standards, legal protection was established." [The earliest learned professions generally followed a sequential development. First, licensed practitioners performed full-time work in their discipline. They determined work standards, created a body of knowledge and sought legal protection. Finally, they established a code of ethics.]

The nurse professor is giving a lecture on autonomy. Which statement indicates that the teaching has been effective?

"Autonomy means that the nurse has control over his/her own practice." Autonomy means that nurses have control over their own practice, and are responsible for their practice. Altruism means to be motivated by service to others, and to consider work an important part of one's life. The code of conduct guides nurses in ethical decision making.

The nurse professor has just provided a lecture on the influence of Esther Lucille Brown. Which statement by means teaching has been effective?

"Brown called for nursing education to be based in colleges and universities." [Esther Lucille Brown (1948) wrote Nursing for the Future, which called for nursing education to be based in colleges in universities. Brown did not call for nursing education to be shortened, or for student nurses to work as hospital staff during their education.]

The nursing student is discussing criminal law with the nursing professor. Which statement indicates that the nursing student needs further education?

"Criminal law recognizes and enforces the rights of individuals." Criminal law involves public concerns regarding an individual's unlawful behavior. These behaviors include: murder, kidnapping, robbery, and domestic violence. Civil law recognizes and enforces the rights of individuals.

The nurse educator is providing a lecture on practice settings for nurses. Which statement from a new nurse indicates that the teaching has been effective?

"Hospitals remain the primary worksite for RNs."

The student nurse is listening to a lecture on methods of collecting patient data. Which statement indicates that more teaching is needed?

"Internal factors related to the patient's condition rarely influence the type and amount of data obtained." Internal factors related to the patient's condition may influence the amount and the type of data obtained. For example, when interviewing a patient who is experiencing shortness of breath, the verbal data obtained in the interview may be limited. Other factors that can affect the quality of the interview include: the physical environment, the presence of family members or other patients.

The nurse is listening to a lecture about The Magnet Recognition Program. Which statement indicates that the teaching has been effective?

"Magnet status recognizes nursing excellence." [The Magnet Recognition Program is a credentialing demonstrating organizational recognition of nursing excellence. The Magnet credential was established to recognize hospitals that attract and retain nurses, acknowledging that this achieves better patient outcomes. Approximately 7% of registered US hospitals have obtained Magnet status.]

The nurse educator is giving a presentation on military nursing. Which statement by one of the attendees indicates that the teaching has been effective?

"Military nurses have great opportunities for advanced education."

The student nurse is discussing consultation as a means of gathering patient data with a clinical instructor. Which statement by the nurse indicates that teaching has been effective?

"Nurses can use consultation to obtain patient data from other healthcare providers." Consultation is discussing patient needs with health care providers who are directly involve in the care of the patient. Nurses also consult with patients' families to obtain background information and their perceptions about the patients' needs; however it is necessary for the nurse to remember that the patient's family may be unaware of certain concerns or situations of the patient.

A professor is presenting a lecture on the age of nurses in the work force today. Which statement by one of the student nurses indicates that the teaching has been effective?

"Older nurses are likely to remain in the workforce because the nursing field is reasonably protected from layoffs experienced by other professions." [The increasing number of older nurses who are in the workforce is possibly due to the recent economic downturn, which resulted in high unemployment rates. The nursing field is reasonably protected from layoffs that other professions often experience. In the past decade, the rate of aging nurses has decreased. The average age of graduating nurses from all nursing programs is 31 years old. One-third of the current workforce is older than 50 years of age.]

A nursing student asks a faculty member how to improve critical thinking. Which response by the faculty is best?

"Pay close attention to how you solve problems; assess your own style of thinking."

Which statement by the nursing student regarding permissive law indicates that teaching has been effective?

"Permissive law states that a person can practice nursing if they do not refer to themselves as a nurse." Licensure laws are either mandatory or permissive. Permissive laws protect and limit the use of the title granted in the law, but does not prohibit persons from practicing the profession, if they do not use the title. This means, that a person can practice nursing, as long as they do not refer to themselves as a nurse. A mandatory law requires that any person who practices a profession be licensed. All states now have a mandatory law in order to safe guard the public.

The nurse case manager is discussing the difference between a profession and an occupation with a nursing student. Which statement should the nurse case manager make, to accurately define a profession?

"Professionals often feel that they are called to their profession." [Professionals often feel that their profession is their calling. They often do not change career paths, they are not motivated by reward, and they feel as though their profession is an integral part of their lives.]

The student is listening to a lecture on nursing standards of practice. Which statement by the student indicates that the teaching has been effective?

"Standards of practice determine responsibilities to which nurses are held accountable." [The nursing scope and standards of practice establish standards to improve the health and well-being of all recipients of nursing care, and to establish the responsibilities to which nurses are held accountable. The standards of practice do not determine appropriate pay rates, hours of work or holiday rotations.]

The nurse is attending a lecture on the advancements in telehealth. Which statement from a colleague indicates that the teaching has been effective?

"Telehealth expands healthcare access to underserved populations."

what is interprofessionality?

"process by which professionals reflect on and develop ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population...[involving] continuous interaction and knowledge sharing between professionals"

Differentiate Direct vs Indirect Nursing

-DIRECT: anything the nurse did it -INDIRECT: things the nurse delegated to the LVN, UAP, other RNs -CANNOT delegate to someone who is not in the "nursing profession" i.e. med tech

What are dependent functions of nursing according to the Nursing Practice Act?

-DOES require an order -Dependent: The administration of medications and therapeutic agents, necessary to implement a treatment, disease prevention, or rehabilitative regimen ordered by and within the scope of licensure of a physician, dentist, podiatrist, or clinical psychologist

uniquely nursing?

-Uniquely Nursing: Scientific knowledge, coping, potential health (prevention) -Lots of different pathways to get to your RN

Issues in Advanced Practice Nursing (APN)

-against recognizing them as independent health care providers and therefore receiving direct reimbursement for their services -However, numerous published studies validated the safety, cost-efficiency, and high pt acceptance of APN care

A student with a business degree background is pursuing a second degree in nursing, which statement reflects conflict according to the Returning-to-School Syndrome Model?

1. "I'm going to do so well!" 2. "The instructor grades unfairly." 3. "I've never gotten a B before." 4. "This class is a waste of my time!"

A patient in an urgent care unit complains to a novice nurse that he is still in pain after an initial dose of hydrocodone. An experienced nurse hears this and says "He is always asking for more pain meds. Probably an addict." The novice nurse's first action is to:

1) Ask the physician on call to evaluate the patient because the nurse is inexperienced in recognizing drug users. 2) Trust in the intuition of the experienced nurse and discount the patient's complaint 3) Immediately evaluate the patient for pain and alert physician of possible need for more pain medication. 4) Ask another nurse on the floor to evaluate the patient because the experienced nurse has shown bias.

3 programs you can take in order to qualify in taking the NCLEX?

1) BSN 2) ADN 3) diploma in nursing form a hospital-based program

A client interrupts a nurse introducing himself to ask "Are you my doctor? I don't understand all these tests they are running and what's wrong with me." The nurse should answer:

1) I am not your doctor. Would you like me to get him for you? He can answer your questions. 2) I am your nurse. I will explain why these tests are necessary and explain more about your condition. 3) I am a nurse, not a doctor. I cannot make diagnoses. 4) I will ask the doctor about your condition and why he is running those tests.

A patient has just been diagnosed with Type II diabetes. Her nurses gives her information on prescribed medications, a diet plan, and places where she can find support groups.

1) Implementation 2) Planning 3) Evaluation 4) Resource Counseling

A patient has just been diagnosed with Type II diabetes. Her nurses gives her information on prescribed medications, a diet plan, and places where she can find support groups. What step of the nursing process is being addressed in this scenario?

1) Implementation 2) Planning 3) Evaluation 4) Resource Counseling

A patient is admitted to the hospital after her water breaks. After several hours of regular contractions, her labor slows and she reports pain under her ribs that is making it hard to breathe. The nurse suspects that the baby may be presenting in a transverse or breech position and suggests that a check be performed.

1) Skilled Know How 2) Pattern Recognition 3) Sense of Salience 4) Expert Instinct

Three major concepts foundational to end-of-life care

1) persons are living until the moment of death 2)coordinated care should be offered by a variety of professional, with attention to the physical, psychological, social, and spiritual needs of pts and their families 3) Care should be sensitive to pt/fam diversity

A patient about to undergo surgery expresses to his nurse that he is fearful of being put under via anesthesia. Which of the following actions exhibit the nurses role as a client advocate?

1) relaying the clients concern to associated health care staff 2) educating the client in regards to what to expect when the anesthesiologist arrives. 3) asking questions regarding the clients anxiety to ascertain it's potential origins 4) ask the patient if he is interested in medication to treat the anxiety

The nurse is caring for a patient with an undiagnosed illness with neuropsychiatric symptoms. The patient asks the nurse, "When do you think I will get better?" What is an appropriate response?

1. "I am sure you will get better soon." 2. "God only knows." 3. "I do not know." 4. "I cannot answer that."

A law office representative is brought in to a hospital respond to a complaint on the professionalism of nurses in addressing health care recipients. According to the textbook, what term should the nurses adopt when referring to health care recipients?

1. "Patient" because it implies they are suffering and need help 2. "Consumer" because they are rendering services from the nurse 3. "Client" because it implies a collaboration in professional relationship 4. The nurse should call the patient by their first name only 5. "Patient" because it implies they will wait patiently for care

A culturally sensitive nurse's first interaction with a patient of Asian descent would

1. Address the patient by their first and last name 2. Introduce your full name and explain your role 3. Seek for an interpreter then introduce yourself 4. Speak directly to family members only

A patient arrives at the hospital due to a fall down the stairs. Patient assessment reveals contradictory information about the accident and the nurse notices fear in patient's body language. Final nursing diagnosis points at a case of abuse from her partner. The nurse's next step is:

1. Advice the patient to seek couple's therapy 2. Ask the hospital social worker to meet the patient 3. Nurse informs the charge nurse that they should take action 4. Nurse tells the patient to stay at his or her place for a week until patient is fully recovered

There are four areas that fall under the scope of nursing practice, which of these is not one of them.

1. Promoting Health and Wellness 2. Curing Disease 3. Preventing Illness 4. Caring for the Dying

An advice nurse is counseling a person who is trying to decide which type of health care plan to choose. What information about health maintenance organizations (HMOs) given below is accurate:

1. An HMO provides a client with a group of providers or a hospital with health services at a discounted rate. 2. Options for HMOs include Kaiser Permanente, United Healthcare and Aetna. 3. An HMO client can sign contracts with individual health care providers. 4. In an HMO, a patient sees a primary care provider but is limited in the specialists the can be referred to within the agency.

A charge nurse wishes to improve the image of the nurses on her unit, according to the article by Cohen, all the following except what would be seen as acceptable actions to take:

1. Ask her nurse who wears cartoons on her scrubs to wear plain scrubs while working with her critical patients. 2. Tells the nurses to introduce themselves as Registered Nurses when first meeting their patients. 3. Tell the nurses to follow scripts regarding common situations found on the unit. 4. Post and circulate around the unit stories about what they're nurses have accomplished recently.

A Hispanic woman in labor is surrounded by her family and is told that a cesarean delivery needs to be performed. Labor and delivery is extremely busy and the nurse brings in the standard consent form with a pen and insists that the patient sign it. The nurse notices that the patient and her family are clearly uncomfortable. What could the nurse have done to alleviate the discomfort.

1. Ask the doctor to explain the reason a cesarean delivery is needed and then have the patient sign the form. 2. Find a nurse of Hispanic heritage to explain the reason a cesarean delivery is needed and then have the patient sign the form. 3. Explain to the entire family the reason that a cesarean delivery is needed and after they understand have the patient sign the form. 4. Immediately call in a Spanish speaking interpreter to explain the reason a cesarean delivery is needed and then have the patient sign the form.

A patient experiencing gastroparesis refuses to take a medication in pill form because it is too large and hard to digest. The nurse demonstrates critical thinking by:

1. Asking how the patient normally swallows a large pill. 2. Accepting the patients legal right to refuse treatment and documenting it. 3. Asking the nurse manager what to do. 4. Checking the pharmacy to see if the medication comes in liquid form.

After explaining that the cause of her injuries was an accidental fall, an older patient now tells the emergency nurse privately that she is afraid of her current caregiver. What should the nurse do? Select all that apply.

1. Assume that the original explanation of the injuries is correct. 2. Privately question the patient further regarding the caregiver. 3. Disregard the comment due to probable senior memory loss. 4. Document this information and relay to the attending physician.

A researcher is formulating a specific research problem. Which of the following would not be a feasible problem to conduct a study?

1. Does reduced noise levels at times of patient sleep increase successful patient healing? 2. Should parents be allowed to deny blood transfusions for their child based on religious beliefs? 3. Does having a greater proportion of nurses in respiratory care associate with fewer infections and increase successful ventilator weaning? 4. Do women who receive continuous support during labor have less risk of a caesarean compared to usual care?

According to nursing practice, to prevent illness a nurse would advise the patient to

1. Exercise on a regular basis 2. Receive updated immunizations 3. Eat a well balance diet 4. Obtain yearly checkups

A 25-year old patient has undergone a spinal column break and has lost the use his legs. During this time in the patient's life what should the nurse do to prepare the patient to make a healthy transition into his new life?

1. Focus on helping the patient learn how to do everyday tasks in a new way. 2. Focus on the process of transitioning to a new lifestyle. 3. Make sure the patient is a good state of mind. 4. Focus on the patient staying positive in the face of tragedy.

Doctor. A. prescribes a new intravenous drug to a patient. His/her nurse administers the prescribed dosage. Minutes later patient shows a toxic reaction to the drug. Charge nurse is not able to locate doctor A. and neither the floor resident. Charge nurse next step is to:

1. Give patient a lot of fluid to decrease the toxic level 2. Keep trying to locate doctor A. 3. Contact doctor at nearby hospital 4. Give patient the antidote to this drug

An elderly, introverted patient has difficulty determining who his nurse might be among the staff. He is not the only patient experiencing this frustration. How might this issue be resolved?

1. Have nurses wear name tags with large print. 2. Enact a policy requiring distinct uniforms for nurses. 3. Ensure that the nurse is introduced to the patient right away. 4. Advise patients to read the nurse's name on the board.

A patient is admitted to the emergency department and is showing signs of confusion, agitation, and combativeness. How should the nurse first respond to this patient's behavior?

1. Have the patient transferred to another nurse colleague that can better deal with the behavior. 2. Administer a sedative to help alleviate the patient's confusion and agitation. 3. Attempt to soothe the patient and keep them as calm as possible without sedation. 4. Refer the patient to a psychiatric nurse to perform a psychiatric evaluation for the erratic behavior

A nurse starts their shift on a medical/surgical floor, and an elderly patient describes being confused by the number of staff visiting his room. He doesn't understand whose role is what. Which of the following could help alleviate this patient's confusion? Choose all correct answers.

1. Introducing yourself and your position upon entering the room. 2. Check the patients chart to see if they have a diagnosis of dementia or Alzheimer's disease. This could explain the confusion. 3. Standardized uniforms could be worn, with one color for nurses, one color for support personnel like nursing assistants, and one color for technicians like x-ray techs, etc. 4. Explain to the patient that the staff dress the way they do for the benefit of the patient. A hospital can be a difficult place to spend time and wearing cartoons on uniforms helps lighten the mood for everyone.

What are the three branches of the government?

1. Judicial 2. executive 3. legislative

A new patient arrives and speaks a little English. What is the first step the nurse should take to ensure culturally responsive care is given?

1. Look for non-verbal communication to enhance communication. 2. Ask a family member who speaks both languages to help translate. 3. Use the LEARN model to assess the patient. 4. Determine language spoken and engage an interpreter.

The head of the emergency department is holding a meeting and is suggesting that all the nurses wear white uniforms to look more professional and to better distinguish themselves from other hospital employees. Which of these statements would be the best argument against wearing white uniforms?

1. Nurses have been wearing scrubs for so long now patients no longer associate white uniforms with nurses. 2. Nurses would have to buy new uniforms all the time because white gets so dirty. 3. All white uniforms could scare children and make a difficult time even more difficult. 4. Scrubs are way more comfortable and allow nurses to express their own personality better, making them more comfortable in a stressful environment.

A nurse is caring for a postpartum patient who underwent a successful cesarean section, and is also a first time parent. During the nursing assessment, what key transition(s) is/are identified. Also, what transition condition should be paid special attention to with regard to her surgery?

1. Organizational and Health-Illness transitions, environment 2. Developmental transition, level of planning 3. Developmental and Health-Illness transitions, expectations 4. Situational transition, environment

In the article, An Experiment in White, Jeri Burn makes the argument that the nursing staff in hospitals should return to the all-white uniform. She makes several arguments as to why returning to white would benefit hospitals. Choose the answer that was not one of her arguments:

1. Patients get confused by all of the different scrub colors in a hospital. 2. White is a symbol of cleanliness 3. White uniforms are more comfortable than scrubs 4. The white uniform looks more professional than scrubs

After administering a medication to a patient in the emergency department, the nurse notices that this routinely administered medication doesn't elicit the usual response in the patient. What key intuitive process does the nurse use to help this patient?

1. Pattern recognition 2. Similarity recognition 3. Commonsense understanding 4. Intuitive analysis

A nurse manager is looking to write a letter of recommendation for one of the nurses in their department. The nurse has 3 ½ years of experience and has demonstrated improved decision-making skills relying on theories and rules. When thinking of patient care they take into account the entire health history and anticipate the long-term needs of the patient. Which stage of nursing expertise should the nurse manager rank them in?

1. Proficient 2. Competent 3. Excellent 4. Advanced beginner 5. Expert

A returning-to-school accelerated BSN student has depression, has academic difficulties and bursts of anger, feels helpless, insecure, sad and lethargic. This are the signs of which stage of Shane's returning-to -school model?

1. Reintegration 2. Conflict 3. Shock or Rejection 4. Honeymoon

A charge nurse over-seeing several new graduates performs research on the incidence of infection in the daily care of patients at the hospital in which he or she works and realizes there is a very high rate. According to Gawande's article entitled, "The Checklist", what can the nurse do to decrease the incidence of infection among patients?

1. Require all new graduates receive additional monthly training. 2. Fire the new graduates and hire only nurses with five years of experience. 3. Implement a checklist to ensure all nurses are following the same protocol. 4. Show the research to the staff and hope that they perform their tasks correctly in the future.

An RN's advise to a teenager to use condoms on a regular basis correlates with which level of disease prevention?

1. Secondary Prevention 2. Basic Prevention 3. Tertiary Prevention 4. Primary Prevention

A patient backs away when approached by a nurse who needs to assess the lungs with a stethoscope. In this situation, the nurse should do which of the following?

1. Since the assessment needs to be done, the nurse should continue with the assessment making sure to not get any closer than is needed. 2. Forgo doing the assessment to make the patient as comfortable as possible. 3. The nurse should explain the procedure and when possible wait for permission to proceed. 4. The nurse should always obtain the permission of the patient before starting any assessment.

A nurse is assigned a patient who is recovering very well from a cerebrovascular accident. The patient is recovering speech, movement and strength. However, she notices the patient is a less talkative than the day before. The experienced nurse recognizes that there might be a problem underlying the patient's new behavior by using:

1. Skilled Know-How 2. Similarity Recognition 3. Sense of Silence 4. Deliberative Rationality

A critical care nurse who has ten years of experience in the intensive care unit has a different approach to decision making than a new graduate nurse. Much of the decision making of the experienced nurse is influenced by:

1. Texts and manuals that provide a cookbook like approach to medicine. 2. Primarily from gut instinct, doing what they feel is right for the patient which comes from their years of experience. 3. Knowledge gained from education, clinical experience, and from information gained by treating that individual patient and working with their family. 4. The evidence that is being given by the patient, family members, lab results and other datasets.

A nurse is trying to give pre-operative directions to a 45-year-old female Spanish speaking client awaiting an emergency hysterectomy. The nurse does not speak Spanish and an interpreter is not available. According to our textbook, who would be the best choice of interpreter?

1. The 7-year-old daughter 2. The 44 year-old brother 3. One of the Spanish-speaking male nurses on shift 4. Wait at least an hour for the interpreter

What should the nurse do first to help alleviate the stress of a worried patient only just diagnosed with Crohn's disease?

1. The nurse should provide the patient statistics about the survival rate of other patients with Crohn's disease. 2. The nurse should give the patient further information about the treatments that the gastroenterologist has just recommended. 3. The nurse should find out what social support the patient has to encourage and support the patient at this time. 4. The nurse should ask the patient what immediate concerns and worries the patient has at the present time.

Which of the following transitions is considered a Health-Illness transition?

1. The introduction of restraint-free care in a nursing home 2. Hospitals transitioning from paper to electronic patient charting 3. The transition of a patient from the hospital to a rehabilitation center 4. The transition of a woman into parenthood.

A nurse practitioner at a residential treatment center for adolescent girls transitioning out of juvenile detention wants to facilitate a series of interactive health education seminars for her clients. The nurse knows that many of the young clients are sexually active and is concerned about birth control and disease prevention in this community. What should be the initial focus of the health seminars?

1. The major health concern that the clients have for themselves, which is weight loss. 2. The major health concern that the guardians have for the clients, which is gang violence. 3. The major health concern that the residential counselors have for the clients, which is personal hygiene. 4. The major health concern that the nurse has for the clients, which is sex education.

The nurse is caring for a patient who is showing signs of depression and lethargy while in the hospital recovering from surgery. Which action(s) suggest the nurse follows Florence Nightengale's Environmental Theory Model?

1. The nurse allows the patient to watch television for two hours each day. 2. The nurse opens the blinds to allow bright light into the room. 3. The nurse attempts to tell the patient a joke to lighten his/her mood. 4. The nurse takes the patient outside in a wheelchair for fresh air.

According to "An Experiment in White" by Jeri Burn, by wearing all white as a floor nurse, how does the patient benefit.

1. The nurse embodies a more professional role and provides improved care. 2. The nurse is able to focus only on higher level needs rather than those involving blood, bodily fluids and excrement. 3. The patient is able to more easily distinguish their nurses from other hospital staff. 4. The nurse provides care with increased hygiene and sterility.

A nurse is attempting to take a patient health history, but the client is having difficulty remembering her medications and is distracted by her two young children. What should the nurse do to take as accurate a health assessment as possible?

1. The nurse should complete as many questions as possible and base his/her assessment off of those answers. 2.The nurse should ask the client to come back later with a list of medications and without her children. 3. The nurse should ask the client to call the clinic back later with a list of medications. 4. The nurse should get toys for the client's children and ask the client more specific questions to finish the health history.

A new graduate nurse working in a community clinic has been reminded by their mentor to refer to the people they see as clients instead of patients. When the nurse asks the mentor why, the mentor states:

1. This is part of the Affordable Care Act of 2010 and the updated language is mandated by federal law. 2. This is a very diverse area and you need to get accustomed to using politically correct and modern medical language. 3. Some of the people we see are from lower economic levels and referring to them as clients gives them a morale boost. 4. In the community health setting, goals include actively participating in health promotion and illness prevention rather than receiving only direct medical treatment or care.

A hospital administrator mandates that all nurses wear white uniforms while caring for patients in the hospital. According to Burn in an article titled, "An Experiment in White", what is the best rationale for this requirement?

1. To distinguish nurses from other hospital staff 2. To maintain a certain level of professionalism 3. To show respect for the traditional portrayal of nurses 4. To demonstrate prestige and honor for the profession

A Japanese patient who has limited knowledge of English is admitted to the hospital. Which of the following is the most appropriate action for the nurse to take?

1. Use medical terminology in order to accurately describe the patient's condition 2. Speak slowly and loudly to help the patient understand. 3. Choose an interpreter who speaks the same language and shares same cultural background. 4. Do not observe the patient's facial expressions because it can be offensive.

After taking Flexner's criteria into consideration, what was Hall's 5 attributes to a profession?

1. Use of a professional organization as a primary point of reference 2. belief in the value of public service 3. belief in self-regulation 4. commitment to a profession that goes beyond economic incentives 5. a sense of autonomy in practice

A nurse is caring for a patient in the ICU that needs a central line placed. All of the following are key issues. Which of the following is the most important?

1. Using a checklist ensure the physicians followed protocol 2. Check the patients identity against the order 3. Provide the patient and the patients family with information regarding the reason the central line is being placed and the importance of cleanliness. 4. Drape the patient from head to toe to ensure a sterile environment.

A 67-year-old patient is seen in the emergency department after falling and breaking his pelvis. After his recovery, he is sent home with a bag full of medications as well as a referral for physical therapy. He is enrolled in Medicare plan part A and D. Which services and/or items will he have to pay for out of pocket in addition to his monthly premium?

1. Visit to the emergency department 2. Medications 3. Radiologist reading and interpreting the x-ray of his pelvis 4. Physical therapy

What are the eight spokes of Miller's Wheel of professionalism in Nursing?

1. competence and continuing education 2. adherence to the code of ethics 3. participation in the primary and referent professional organization (ANA and state constituent member org.) 4. publication and communication 5. orientation toward community services 6. theory development and utilization 7. research development and utilization 8. self-regulation and autonomy

A charge nurse is working in coronary care on a step down telemetry unit. The nurse informs the cardiologist that a patient is not responding to dopamine and nitroglycerin as most patients have in the past and could be experiencing some other condition that doesn't respond to vasodilators. What type of reasoning did the nurse use in this situation ?

1. deductive 2. intuitive 3. inductive 4. adductive

Bridges' 3 phases

1. endings (dealing with loss) 2. neutral zone (transitional period) 3. beginnings (setting new goals)

What are the characteristics that each member of a profession share?

1. prolonged specialized training 2. a service orientation 3. an ideology based on the original faith professed by members 4. an ethic that is binding on the practitioners 5. a body of knowledge unique to the members 6. a set of skills that forms the technique of the profession 7. a guild of those entitled to practice the profession 8. an authority granted by society in the form of licensure or certification 9. a recognized setting in which the profession is practiced 10. a theory of societal benefits derived from the ideology

What are the 3 characteristics that seem to be agreed on across the board in all professions?

1. service/altruism 2. specialized knowledge 3. autonomy/ethics

What were the 8 characteristics created by Dr Lucie Kelly about the nursing profession?

1. the services provided are vital to humanity and the welfare of society 2. there is a special body of knowledge that is continuously enlarged through research 3. the services involve intellectual activities; individual responsibility (accountability) is a strong feature 4. practitioners are educated in institutions of higher learning 5. practitioners are relatively independent and control their own policies and activities (autonomy) 6. Practitioners are motivated by service (altruism) and consider their work an important component of their lives 7. There is a code of ethics to guide the decisions and conduct of practitioners 8. there is an organization (association) that encourages and supports high standards of practice

what are the four components of the interprofessional collaborative practice competencies?

1. values/ethics for interprofessional practice 2. roles/responsibilities 3. interprofessional communication 4. teams and teamwork

The authors of Avoiding Socialization Pitfalls in Accelerated Second-Degree Nursing Education: The Returning-to-School Syndrome Model state that there are three stages of the returning-to school syndrome model. At what stage, is there an initial strong rejection of the new culture?

1.) Honeymoon 2.) Resolution 3.) Conflict 4.) Reintegration

4 historical phases of the US Health System

1800-1900: Health concerns relating to social and public health issues 1900-1945: Focus on controlling acute infectious diseases (doing a lot in the home) 1945-1984: Shift away from acute infectious health problems toward chronic health problems 1984-present: Emphasis on controlling costs, restricting growth in health care industry, and reorganizing care delivery

Board of Registered Nurses

9 members, 4 non RNs

A 7 year old patient was admitted for multiple grand mal seizures, of which they had no previous history. After a having a seizure in the hospital, the nurse notices that the child seems more withdrawn than earlier in their stay. The nurse asks the patient why they seem to be a bit more quiet and the patient responds that they are scared and miss their mommy and daddy. What intuitive process did the nurse utilize to assist this patient?

A Commonsense understanding B Pattern recognition C Intuitive analysis D Similarity recognition

A patient recovering from triple bypass surgery received a urinary tract infection (UTI) from their catheter. The treatment of the UTI will need to be paid for by:

A Private insurance B Medicaid C Medicare D Hospital

Which of the following best describes the difference between occupation and a profession?

A profession requires a duty to serve

What are the "Standards of Competent Performance"? What does this mean for you and your practice?

A registered nurse shall be considered to be competent when he/she consistently demonstrates the ability to transfer scientific knowledge from social, biological and physical sciences in applying the nursing process

You attempt to begin a general survey with a new patient by saying hello and offering your hand only to find they do not understand your greeting and shy away from your gesture. After calling for a translator how might you begin your interview again to avoid possible cultural offenses:

A) Ask the interpreter to rely your exact words in their language to avoid misunderstandings B) Ask the interpreter if there are any cultural taboos your exam might violate C) Instruct the interpreter to translate only when asked if the patient cannot answer a question D) Instruct the interpreter how to perform tasks that require touching the patient so you don't offend them

You are with a patient waiting for a central line insertion. When the doctor enters he introduces himself, and begins to prepare the materials without washing his hands. Which option is the best course of action in protecting the patient from healthcare harm:

A) Bring a bottle of alcohol sanitizer to the prep table and hope the doctor notices B) Say nothing to avoid embarrassing the physician C) Make a mental note to request the charge nurse talk to the doctor D) Ask the doctor if he forgot to wash his hands

A patient suffering from dyspnea is admitted to the Emergency Room. The attending nurse has treated the patient before and remembers that he/she is allergic to cats. The nurse compiles an emergency database and asks the patient if he/she has come in contact with any cats. What part of clinical judgment is this nurse demonstrating?

A) Interpreting B) comparing C) noticing D) reflecting

You notice that a patient in your care has had no visitors during their one week stay. In addition, because of the unusually high volume of patients, the nursing staff have been unable to spend any significant time with individual patients aside from providing treatment. As you enter, the patient does not greet you or meet your eyes as you check their vitals. This patient is most likely failing to meet which of Maslow's human needs:

A) Physiological needs B) Love and Belonging needs C) Self-actualization needs D) Safety and Security needs

A novice registered nurse is caring for a patient. The patient's vital signs show elevated heart rate, elevated respiration rate and low oxygen saturation. The novice calls a more experienced nurse for help. What does the competent nurse do?

A) Rechecks vital signs and performs an electrocardiogram test. B) Considers each of the vital signs and determines low oxygen saturation to be most important. C) Asks a mentor for assistance D) Immediately focuses on increasing oxygen saturation

While prepping a nervous patient for surgery the nurse should tell the patient which of the following ?

A. "The surgery will be over in no time" B. "The doctor has performed many of these surgeries" C. "I would like to explain your procedure so you what to expect" D. "I have had the same surgery and I recovered in no time"

Which of the following is not an example of the functions and roles of a nurse.

A. A nurse offering instruction on the proper ways to check blood sugar levels in diabetic patients B. A nurse easing patient's worries by agreeing to lie to the patient's family about prior drug use C. A nurse counseling a patient on smoking cessation resources and discussing research regarding the benefits of quitting D. A nurse asking family members to leave the room during the insertion of a catheter

Which of the following is an example of a situational transition that a patient may go through?

A. A woman transitioning to the role of a mother after giving birth to her first child. B. An adolescent going through changes in their physical appearance. C. A family adjusting to their father being moved from his home of 50 years to an assisted living facility. D. A patient adjusting to their limited mobility because of a spinal cord injury.

A nursing student is having a hard time adjusting to being back in school. What should the student do to help with this transition?

A. Consider dropping out of the program because it may not be a good fit C. Seek advise from the dean of the school and an advisor B. Find students to commiserate with in the same situation D. Seek advise from tutors and counselors

Hospice and palliative care nursing is a rapidly developing specialty in nursing. Which facts have contributed to this growth?

A. End-of-life care is largely the responsibility of nurses. b. End-of-life needs are expected to increase with the aging population. E. Hospice and palliative care nurses work in a variety of settings.

A young working professional is tired of their career and decides to enroll in an accelerated Nursing program. A few months into the program, they begin to feel frustrated, lost, and are constantly saying how unprepared and scared they are to be entering the career after graduation. Which stage in the returning-to-school syndrome model identifies this particular student?

A. Honeymoon B. Conflict C. Tension D. Reintegration

A post-operative patient complains about pain to a nurse, but refuses prescribed medication stating concerns about becoming addicted. The nurse should:

A. Ignore the patient's concerns and administer the physician prescribed medications B. Immediately inform the physician of the patient's concerns C. Do not administer the prescribed medications and adhere to the patient's wishes D. Ask the patient the reasons for their concerns and offer pertinent information regarding the prescribed medication

It is a nurses responsibility to act professional at work and away from work in order to further improve the image of nursing. When a family friend asks about a nurse's career, which of the following responses would be most appropriate?

A. Look the family member right in the eye and say, "I am a registered Nurse at a hospital." B. Look at the family member right in the eye and say, "I 'm just a Nurse at a hospital." C. Avoid eye contact and say, "I am a registered Nurse." D. Roll your eyes and say, "I'm just a Nurse."

A client in a coma with respiratory problems is put into an upright position by a nurse, Upon a routine check the nurse notices the patient has not moved, but is still experiencing labored breathing. The nurse decides to re-position the client to achieve better breathing. According to the clinical judgment model this is an example of:

A. Noticing B. Interpreting and responding C. Reflection-in-action D. Reflection-on-action

Nursing's metaparadigm focuses on which four concepts central to nursing?

A. Person, Knowledge, health, nursing B. Family, environment, health, and nursing C. Person, environment, health, and nursing D. Patient, vital signs, care plan, rehabilitation

A patient recently had hip replacement surgery and is receiving physical therapy care in the hospital. This type of care is an example of:

A. Secondary Prevention B. Health Promotion C. Tertiary Prevention D. Treatment and Prevention

A nurse is caring for a client who has been having abdominal pain. Which of the following is an example of trial and error that the nurse may use in this situation?

A. The nurse asks the patient questions about the nature of the abdominal pain and from there suggests possible solutions. B. The nurse tries a number of approaches to alleviate the pain until a solution is found. C. The nurse attempts to understand the patient's abdominal pain by using feeling and suspicion rather than reasoning. D. The nurse monitors the situation over time to ensure its initial and continued effectiveness.

A nurse came across a research article, which stated a new drug had been found to cure cancer. What steps should the nurse take to determine if the research is reliable?

A. The nurse should not question the research since it was printed in a medical journal B. The nurse should look at other sources to determine if the information is reliable C. The nurse will know the study is reliable if it was conducted with a large population group D. The nurse should look to the opinion of an oncologist as a conclusive source

Which of the following is a characteristic of a nursing student in the reintegration phase? Select all that apply.

A. The student is strongly rejecting the new culture. B. The student is blaming faculty and the institution for their poor performance. C. The student becomes aware of the similarities between their past work life and their current experience. D. The student integrates previous work culture with the new culture of nursing.

Members of the health care team share some common goals when it comes to their client's health. What is the most important goal?

A. To ensure that the clients receive fiscally sound, appropriate care B. To restore the client's health and promote wellness C. To find and implement the best treatment plan for the client D. To assist clients to gain the skills to perform activities of daily living

national & international nursing organizations

ANA - amer nurs assoc CNA - canadian nurses assoc NLN - natnl league 4 nursing ICN - internation council NSNA - nations student nurses' assoc sigma that tau honor soc

According to the nurses could've ethics the hallmark of nursing practice is?

Accountability

Which of the following nursing responsibilities can never be delegated?

Accountability

All levels of nursing educational programs can be accredited by which organization?

Accreditation Commission for Education in Nursing (ACEN)

Negligence - don't act the way a normal responsible person would in the same situation Autonomy - self determination Control over ur own space Beneficence - do good Nonmaleficence - speak no hear no see no evil - don't do any harm or evil Justice - equals should be treated equally and nonequals should be treated non-equally Fidelity - faithful to ur responsibilities Veracity - be truthful Accountability - responsible for ur behavior

Altruism - unselfish concern for welfare of others Caring - relating to, attending to, providing for needs of others, theoretical framework Evidence-based practice - research is basis NOT trial & error or intuition or problem solving ANA - voice Advocate Helps hold high nursing standards Help increase development of nurses 2 b more professional

Which of the following falls under the jurisdiction of the state board of nursing?Approving or rejecting applications for new nursing education programs

Approving or rejecting applications for new nursing education programs

A nurse has a 12 year old oncology patient whose doctor has recommended to the parents that the child take part in a new research study. The young patient tells the nurse he/she doesn't want to participate in the study. The patient's parents enroll him/her anyway. Ethically, what should the nurse do?

Ask questions of both the patient and his/her parents to ascertain their feelings. Utilize a concept map to illustrate to the patient why he/she is doing the study. Listen to and address the patient's concerns to the best of his/her ability. Inform the patient they are under the age of 18, and his/her parents are his legal guardians. Ask the charge nurse to intervene with the patient's doctor, reiterating the patient's request to not participate in the study. Inform the parents that the Code of Federal Regulations requires researchers "solicit the assent of children."

The RN has asked the nurse aid to obtain vital signs on a post-operative patient. Which delegation to the nurse aid would be inappropriate for the RN to make?

Ask the nurse aid to interpret the vital signs for the RN. The RN is legally liable for all nursing acts that are delegated to others. The RN may ask the nurse aid to repeat vital signs, document the vital signs and directly report them to the RN. It would be inappropriate for the RN to ask the nurse aide to interpret the vital signs, as this is a nursing specific duty.

The nurse plans to obtain subjective data from the patient. Which action should the nurse take to obtain this information?

Ask the patient to rate pain. Subjective data is obtained from patients as they describe their needs, feelings, strengths, and perceptions of the problem. Subjective data are often referred to as symptoms. The nurse would obtain subjective data in this scenario by asking the patient to rate pain. Objective data is data in which the nurse collects through observation, examination or consultation with other health care providers. Objective data can be obtained by taking a blood pressure, checking blood glucose, and observing the patient walking.

Which type of basic nursing education program graduates the largest number of RNs in the U.S. today?

Associate degree programs

The nurse educator has given a lecture on the difference between the term "profession" and "occupation." Which statement(s) by one of the students indicates that the teaching has been effective?

B. "The word profession means a calling or vocation." D. "The word occupation is defined as a person's regular work." E. "An occupation is a calling to work that possess characteristics of expertise." [According to Collins English Dictionary, the word "occupation" is defined as a person's regular work. "Profession" is defined as a calling or vocation. A profession is a calling to work that possess characteristics of expertise.]

Using Flexner's criteria of professionalism, which attributes make nursing a profession?

B. Is practical, in addition to being theoretical. C. Has practitioners who are motivated by altruism. D. Has practitioners who are responsive to public interest. E. Has a strong internal organization of members. [Flexner's criterion stipulates that a profession is practical, in addition to being theoretical. A profession also has practitioners who are motivated by altruism, are responsive to public interest and has a strong internal organization of members. A profession is basically intellectual, as opposed to physical, and is accompanied by a high level of personal responsibility.]

Which actions can the nurse take to demonstrate collegiality?

B. Share the latest nursing research with colleagues. C. Become an active member of professional organizations. D. Assist researchers with data gathering. E. Publish in professional literature. [Collegiality is an important aspect of professionalism in nursing. Acts of collegiality include, but are not limited to: sharing the latest research with colleagues, become an active member of professional organizations, assist researchers with data gathering and publish in professional literature. Refusing to mentor a nursing student does not demonstrate collegiality.]

empirical evidence shows that improved patient outcomes of hospitals are due to the employment of _______ degrees

BSN or higher (Box 1-1, p7)

The rise in the number of nurses under age 30 is attributed to the increased number of graduates from _______ programs, who tend to be ___(younger/older)?___ than graduates from other types of programs.

BSN; younger

A chief nursing manager institutes a new dress code for registered nurses: all white uniform only. The main purpose of this dress code policy according to the article, "An Experiment in white", can be summarized to:

Because all white uniform is a symbol of hygiene and sterility. Because all white uniform motivates people to become a nurse. Because all white uniform distinguishes nurse from other staffs and defines nurse's spot in the hierarchy among staffs. Because all white uniform increases nurse's visibility and identifies nurses as a professional

Which of the following is considered objective data obtained from the patient?

Blood pressure is 110/70 at 8 pm

Recent transitions affecting the practice of nursing in the USA

Broadening the scope of nursing (AUTONOMY, RESPONSIBILITY, and ACCOUNTABILITY) Increased education mandated Aging population, new diseases shifts in what a "nurse" is stereotyped as (gender etc.)

Interdependent

By law, RNs do not need an order to immunization, techniques, withdrawal of huan blood, and perform skin tests. Can change and evolve

executive branch

Charge to implement law, including the office of the president at its highest level. Implements laws through governmental agencies.

judicial branch

Charged to interpret the law, which includes the Supreme Court and federal court system. Stop They resolve disputes. Amend the common law. Interprets statutory law.

legislative branch

Charge to create law, including the US Congress and other Regulatory Agencies. Makes statutory law. Delegate authority to governmental agencies to create rules and regulations to meet the intent of statutes (administrative law)

document that provides professional standards and framework for professional decision-making that ensures decisions are made with the highest integrity is the

Code of Ethics

critical values of nursing

Code of ethics standards nurse practice acts in legal system NSNA's Code of Academic and Clinical Conduct

The nurse observes a patient lying rigidly in bed and taking shallow breaths. The patient reports a pain score of 4 out of 5 and says "my leg hurts." The nurse determines that the objective and subjective data are?

Congruent and support that the patient is in pain

A novice nurse begins his or her shift and notices that one of his or her clients, who is recovering from surgery, has an elevated pulse and respiratory rate and low blood pressure. The nurse is very busy and has many clients to attend to. What is the best course of action for the nurse to take?

Consult with the charge nurse about whether the client's vitals are cause for concern. Record the client's vitals as "stable" and continue rounds. Note the client's vitals on his or her chart and continue to monitor the client for changes. Immediately alert the client's doctor to his or her condition.

A charge nurse witnesses one of the floor nurses rolling her eyes when asked by another nurse asks about his/her first week of employment. The nurse also appears disheveled and unkept. What can the charge nurse do to implement an image of professionalism and value in the nursing profession, within the workplace ? Check all that apply.

Define appropriate dress in the workplace Define inappropriate behavior in the workplace Post nursing accomplishments in the workplace Encourage staff to contribute to research and the community Require staff to address all nurses formally with title and last name Have staff contribute to the development of unacceptable behaviors and dress code

The quality of nursing care is judged by whether nursing actions meet the standard of care. Which of the following is an example of meeting the standard of care?

Demonstrating the use of the nursing process when charting

Which of the following is an important step in preventing legal action against the nurse?

Develop caring, therapeutic relationships with patients.

What is the primary function of the National Council of State Boards of Nursing (NCSBN)?

Developing the NCLEX-RN and NCLEX-PN licensing examinations

independent functions

Does NOT require an ORDER from the doctor. Means you MUST do them, not that you CAN do them. NO excuse you need to take care of the patient

1984- present phase of the US Health System

Emphasis on controlling costs, restricting growth in health care industry, and reorganizing care delivery

2. A charge nurse notices at the beginning of a shift the nurse enters a client's room, completes necessary tasks, and leaves the client's room without speaking to either the client or the client's family. What should the charge nurse recommend the nurse do first upon entering a client's room for the first time?

Encourage the nurse to greet the client and the client's family. Advise the nurse to practice proper hand hygiene. Advise the nurse to introduce his/herself by name and as a registered nurse. Indicate that the nurse should ask the client if they have any needs or concerns.

A nursing student tells a classmate "These NCLEX questions we have to write are impossible. I'm just going to write some garbage questions and hope no one notices- I'm not a test author and I don't have time for this!" How should the classmate respond? Select all that apply.

Encourage the nursing student to visit the student counseling office for options in stress management. Offer to assist the nursing student to with the assignment by providing examples from textbooks and online. Recommend that the nursing student speak with the instructor and ask to be excused from the assignment. Recommend that the nursing student speak with the instructor and ask for further assistance

statutory law

Established through formal legislative process

Who wrote Nursing for the Future, calling for nursing education to be based in universities and colleges?

Esther Lucille Brown in 1948

Which of the following is most essential for the nurse entrepreneur to be successful?

Excellent time-management skills

A single father of two is ending his first month as a nursing student. He is excited to learn and eager to complete his assignments, often going home and practicing his new skills on his children. What phase of the RN-BSN educational process is he experiencing?

Excitement Honeymoon Reintegration Anticipation

A patient who was in a motorcycle accident is brought to the Emergency Department with multiple injuries: severe head trauma, a broken leg, and a punctured lung. The nurse acts quickly and efficiently, using intuition and analytic skills to determine the best course of action to treat all of the patient's needs. How would you describe this nurse?

Expert Advanced Beginner Novice Proficient

A barrier to professionalism attributed to nursing's roots in altruism is illustrated when the nurse

Feels guilty for expecting to be paid well for work

Which of the following is a correctly stated nursing diagnosis?

Fluid volume deficit is related to vomiting as evidenced by increased heart rate and decreased urine output

1900-1945 phase of US Health System

Focus on controlling acute infection diseases (doing a lot in the home)

During an assessment a Nurse discovers that a 17 year old patient is having unprotected sex with multiple partners and has contracted an STD in the past. What action by the nurse is an example of Primary prevention?

Giving the patient information on all options available for protection from STDs Advising the patient to get checked frequently for STDs Giving the patient a handful of condoms Calling the patient's parents and letting them know they have a sexually active teenager

An 87-year old woman in the intensive care unit contracts a urinary tract infection from her urinary catheter. The novice nurse assigned to the patient over night observes normal vitals but notes the patient is confused and agitated. The nurse is unable to find an available physician or experienced nurse with whom to relay the patient's mental status. Over the next few hours the patient develops urosepsis, goes into multi-organ failure and dies. Which unit-wide interventions could have prevented failure to rescue in this case? Select all that apply.

Having experienced nurses in this unit serve as "safety checks" in order to consult and observe novice nurses. Monthly team-building trainings in which nurse leaders role model communication techniques for other team members. Avoiding the use of urinary catheters in elderly patients due to the high incidence of urinary tract infection contraction. Hiring more nurses and increasing the number of nurses scheduled for each shift.

Bloom's Taxonomy

Higher order thinking - creating - evaluating - analyzing - applying - understanding - remembering Lower order thinking

Returning-to-school syndrome (model) RTSS Donea Shane 1970

Honeymoon Conflict Reintegration

3 stages of nursing school

Honeymoon Conflict Reintegration- starting to fight against the teacher culminuates when we integrate our old work culture into new

Reality Shock Kramer 1974

Honeymoon Shock/rejection Recovery Resolution

_____ remained the primary work site for RNs, with 63.2% of nurses employed

Hospitals

How can the nurse manager take the first step to reduce the barriers to professionalism in nursing?

Identify the barriers to professionalism in nursing. [1st step=identify what those barriers are. Once the barriers have been identified, the nurse manager can begin taking steps to reduce them.]

What does the process of analysis of patient data directly result in?

Identifying actual or potential problems amendable to nursing intervention

Why is the etiology of the nursing diagnosis statement important?

If the etiology is incorrect, the nursing interventions are likely to be ineffective

A hospital is attempting to reduce the rate of hospital-acquired infections. Health care providers at the hospital have been given a list of steps to follow when they enter patient's rooms. A nurse notices that a doctor skips one of the steps as she or he attends to a patient/client. The nurse should do which of the following?

Ignore the misstep and assume the doctor's hands are clean. Replace each of the client's dressings with sterile dressings and clean each of the client's wounds after the doctor leaves. Quietly inform the doctor of the misstep after they leave the client's room. Gently remind the doctor that she or he may have forgotten a step before she or he begins to exam the patient/client.

The nurse instructs the patient about incentive spirometry as preoperative teaching. Which phase of the nursing process does this illustrate?

Implementation

nursing roles in various practice settings

In office practices: -routine tasks or more challenging roles (ie dialysis nurse) In workplace: -provide basic health care, health education, screenings, and emergency tx to employees

During the Maternity/Obstetric rotation in clinicals, one of the male nurses is assigned to a female patient. Upon entering the patient's room and introducing himself the female patient becomes uncomfortable and asks to be reassigned to a female nurse. The nurse becomes upset and storms out of the patient's room. What is one way the nurse could have better handled the situation?

Inform the patient that he needs the experience and that he will make her feel as comfortable as possible Inform the patient that he will report to the charge nurse and have a female nurse reassigned to her case Inform the patient that he is uncomfortable as well and reassure her a female nurse will be assigned Inform his other nursing colleagues that this is unfair treatment and he feels only female nurses will get the opportunity to achieve preceptorship in the maternity/obstetric field.

Which of the following is a legitimate defense to a charge of assault and battery?

Informed consent

what if you became a nurse video

Language connects us Words matter U are safe, I am here Adrienne rich - insight is only 1 dimentional until u hold it and examine it from diff angles and various light. Our insight is what insights our humanity.

The process of professionalization of an occupation typically follows a pattern of developmental stages. One of the stages is collective identity. Which of the following is an example of collective identity?

Legal right to practice profession to protect unique skills from outsiders

___________ is credited with initiating community health nursing when she established the Henry Street Settlement in NYC in 1895

Lilian Wald

What are some of the activities that the RN cannot delegate to unlicensed assistive personnel?

Med admin, Tube feedings, invasive procedures, assessment, education, moderate complexity lab tests

Similarities exist between various ideas about what constitutes a profession. Which of the following is believed to be a characteristic of a profession?

Members have autonomy

A component that separates occupations from professions is commitment. Which of the following is the best way that nurses can show commitment to each other?

Mentoring nursing students and novice nurses

Which recommendation made by the 1965 American Nurses Association (ANA) position paper and other position papers of national nursing organizations is still an issue today?

Minimum preparation for professional nursing practice should be the BSN degree

Which of the following was recognize earliest as a true profession?

Ministry

Which of the following puts the nurse at increased risk for legal action?

Not assessing a patient who is complaining of pain

The charge nurse witnessed a nursing staff discussing a patient's alcohol abuse problem with another staff in front of elevator where other people are present. The charge nurse should do the following:

Not taking any action because a patient's substance abuse is not confidential health information. Educating the nurse that a patient's privacy and confidential health information should only be accessible or shared with those who "need to know". Reporting it to the supervisor to hold the nursing staff accountable. Holding a quick meeting to educate personal consequences for inappropriate sharing of patient's confidential health information.

The nurse is caring for a patient with chest pain. Which action should the nurse take to obtain objective data?

Note that the patient is diaphoretic. Subjective data are the other types of data that the nurse will collect through observation, examination, or consultation with other health care providers. These data are measurable, such as pulse rate and blood pressure, and include observable patient behaviors. Objective data are often called signs.

A nurse has cared for a patient diagnosed with Chronic Obstructive Pulmonary Disease and pneumonia for three days. The patient who has just been discharged comments to the nurse, he is sick of her lectures and is going outside for a cigarette. What is the appropriate action for the nurse to take?

Nothing. The patient is no longer under his/her care and has the right to smoke once off of the hospital's property. Reavaluate the patient's care plan for personal bias, and determine appropriate future adjustments. Practice "self preservation" through a series of deep inhalations and the self affirmation - I did all that I could. Inform the charge nurse the patient has tobacco products on hospital grounds and ask him/her to alert security.

The nurse giving medications to a pediatric patient notes that an order for a medication is considerably larger than the usual dose. She looks up the medication in a pharmacology book and finds she is correct about the dosage. Which action should the nurse take?

Notifying the physician of her findings before giving the medication

Benner's Role Transition Model

Novice --> Advanced beginner --> competent --> proficient --> expert Its a continuum

Which of the following best describes trends in nursing education?

Numbers of RNs with bachelor's and higher degrees are increasing.

The nurse professor is giving a lecture on the origin of nursing practice and care. Which statement by one of the students indicates that the teaching has been effective?

Nursing care originated in the home and community settings." [Nursing care originated and was practiced informally in the home and community settings. Over the last 150 years, nursing care moved into the hospital settings. In more modern times, nursing care became available in medical offices.]

Which of the following describes the primary difference between nursing diagnosis and medical diagnosis?

Nursing diagnosis identifies problems that can be treated with independent nursing actions.

statute that defines and controls nursing

Nursing practice Act

What action should the nurse recruiter take to successfully recruit (pull) a nurse from a foreign country?

Offer personal incentives such as increased pay. [Factors that pull nurses to emigrate include: personal incentives such as better pay, safer working conditions and career development. Factors that push nurses to seek employment in other countries include poor working conditions, poor compensation, political instability and lack of opportunities for career development.]

The nurse is caring for a patient who is well-known in the community. Which action should the nurse take to protect the patient's privacy?

Only share information with health care providers directly involved in the care of the patient. Nurses are entrusted to protect the privacy of their patients. The nurse should only share information with health care providers directly involved in the care of the patient. The nurse should only share information with the patient's family if consent has been given by the patient. The nurse should never share private information on social media, and should never have conversations about private information in public places.

A nurse is caring for a client recovering from a severe infection following an injury to the client's leg. The nurse changes the client's dressings and linens, gives the client water, and opens the blinds on the window to the client's room. The nurse is practicing according to which theory of nursing?

Orem's General Theory of Nursing Nightingale's Environmental Theory Henderson's Definition of Nursing Roy's Adaptation Model

A pregnant woman learns that she has gestational diabetes. What type(s) of transitions is she undergoing? Select all that apply.

Organizational Health-Illness Developmental Situational

A nursing student has just recently graduated and is entering a new grad program at a nearby hospital. She is nervous about leaving the role of "nursing student" to a professional nurse. What type of transition is this new graduate going to focus specifically on?

Organizational transitions Situational transitions Developmental transitions Health-illness Transitions

What has been found about the outcomes of patients cared for in hospitals with a higher percentage of BSN-prepared nurses as compared to patients in hospitals with a lower percentage of BSN-prepared nurses?

Outcomes were better in hospitals with more BSN-prepared nurses.

The clinical nurse leader (CNL) is a recently proposed role. The responsibilities of the person in this role include which of the following?

Oversee and manage care delivery in specific settings.

considered subjective data in information gathering from the patient?

Pain

Which of the following represents an interdependent nursing action?

Participating in a "code" (cardiac arrest response)The use of standardized plans of care for different patient populations has...?

Which of the following chart entries represents a pitfall in documentation?

Patient demanding and difficult to please

Which patient rights are guaranteed by HIPAA?

Patients are protected against medical records being indiscriminately shared.

The nurse manager wants to encourage staff nurses to enroll in an RN-BSN program. Which patient centered outcomes are likely to encourage the staff nurses to obtain a higher degree level?

Patients cared for by BSN (or higher) prepared nurses have more positive outcomes.

A patient in respiratory distress is placed on oxygen. Which is the most appropriate short-term goal?

Patient maintains an oxygen saturation of 90% during the shift

In which of the following situations should the legality of an informed consent be questioned?

Patient who received a preoperative dose of Demerol before giving consent

Which of the following is an appropriate long term goal to measure diabetes control for a patient whom diabetes has been newly diagnosed?

Patient's A1C will be 5% at year 1 post-diagnosis

A patient declines a medical procedure because it is painful and opts for a less painful, but also less effective procedure. Evidence-based practice in nursing suggests that the nurse should do the following:

Perform the more effective procedure anyhow because it is in the best interest of the patient. Perform the less effective procedure on the patient but advise them that they are making the wrong decision based on evidence that the procedure is less effective. Provide the patient with information regarding both procedures and the risks and benefits, but perform the less effective procedure at the patient's request. Provide information to the patient as well as their clinical expertise based opinion and persuade them to accept the more effective procedure.

3 interrelated functions nurses perform according to the O'Rourke model

Practitioner Role (standards of care), Scientist Role (evidence based led practice) Leader Role (Self direction and decision making authority) There is knowledge transfer between all three roles that cultivates a profession

Which of the following actions by the nurse constitutes professional malpractice?

Placing the head of the bed flat when a patient is receiving a tube feeding, causing the patient to aspirate the mixture

Factors that make a population vulnerable

Poor and homeless persons Abused clients substance abusers severely mentally ill persons older adults children/ immigrants

An international nurse recruiter is looking at factors that would push nurses to seek employment in another country. What should the recruiter expect to push nurses towards migration?

Poor working conditions [Factors that push nurses to seek employment in other countries include: poor working conditions, poor compensation, political instability and lack of opportunities for career development. Personal safety, professional incentives and better quality of life are factors that pull nurses emigrate.]

Which of these behaviors best describes a nursing student in the conflict phase of the Returning-to-School Syndrome Model?

Prepares for classes by doing all the readings and assignments a week before they are due. Becomes depressed after getting a C+ in the Introduction to Nursing class. Rejects the advice of a preceptor because the preceptor is younger than himself/herself. Adapts to skills learned in his or her previous job as a waitress to cope with difficult patients and staff.

Which of the following statements is correct about community health nursing (CHN)?

Prevention and community education are the cornerstones of CHN.

A nurse is assessing a 16 year old Latino patient in his/her free clinic. The patient is being evaluated for gestational diabetes with her current pregnancy, has 2 other children, and a Body Mass Index of 35. The patient is having difficulty comprehending the dietary instructions the nurse is giving. The nurse is concerned the patient has not previously received adequate education regarding diet and weight gain during pregnancy. What could be the cause for the patient's lack of understanding?

Previous nurses in the clinic were not knowledgeable about the risk of gestational diabetes in obese patients and did not provide the patient with adequate information. The patient does not know that having 2 children can lead to weight gain. Hispanics were 1.7 times as likely as Whites to report poor provider-client communication. Previous nurses in the clinic gave this patient a substandard quality of care because she is a minority.

The nurse forgets to give the patient a dose of antibiotic. Later in the shift, the patient goes into cardiac arrest and dies. What element is lacking to support malpractice?

Proximate cause

A nurse works with a patient to develop a weight loss plan that is within the patient's limited financial means and time constraints. The nurse clearly and thoroughly documents the plan in the patient's electronic health record. The nurse is demonstrating knowledge and skills from which two Institute of Medicine pre-licensure competencies?

Quality Improvement and Safety Patient Centered Care and Informatics Teamwork and Collaboration and Quality Improvement Creativity and Organization

A "well-cultivated critical thinker" is an individual who does which of the following?

Raises questions, Recognizes alternative ways to see problems

Which of the following actions is acceptable as an exception to a nurse's obligation regarding confidentiality?Reporting certain diseases to public health authority

Reporting certain diseases to public health authority

Which of the following is a nursing responsibility regarding informed consent?

Serving as a witness, ensuring that the patient does not feel coerced into a decision

A female nurse was overheard speaking inappropriately to a male nurse. She has since had to work on redefining her professional image in the hospital in which she works. What is her best course of action to regain the respect of her colleagues?

She should go to work and only do her job, refraining for social activities. She should wear an all white uniform in an attempt to be taken seriously. She should apply for a nursing job in a different unit within the hospital. She should value nursing as a profession, and project that image daily.

1945-1984 phase of the US Health System

Shift away from acute infectious health problems toward chronic health problems

A nurse has been working in the acute care setting for three years and notices that one of his/her patients who has congestive heart failure is exhibiting early signs and symptoms that have historically been detrimental to this illness. What aspect of intuitive judgment is the nurse exhibiting?

Similarity Recognition Commonsense Understanding Pattern Recognition Sense of Salience

An 82 year old male patient has recently been diagnosed with Cancer. His family and the patient has decided it would be best for him to move in with his Daughter & her family as he begins chemotherapy treatments. What type of transition(s) would best describe what the family & patient will experience according to the Schumacer and Meleis article?

Situational Transition Developmental & Organizational Transitions Health-Illness & Situational Transitions Health-Illness Transition

A seasoned nurse with 20 years of experience gets frustrated when trying to adapt to the Electronic Medical Records system the hospital has just implemented. The nurse is experiencing difficulty with which type of transition?

Situational Transition Developmental Transition Health-Illness Transition Organizational Transition

The nurse is planning short term goals for a patient. Which goal should be included?

Sleep 8 hours per night. Establishing a time frame for patient goals to be met is important. Short-term goals may be attainable within hours or days. They are usually specific and are small steps leading to the achievement of broader, long-term goals. Sleeping 8 hours per night is a short-term goal that the patient can accomplish right away. The other goals are likely to take a considerable amount of time to achieve.

When communicating with a patient whose native language is not the same as the nurse's; the nurse should:

Speak slower and louder to gain the patient's attention and focus Use non verbal gestures and pictures to aid the verbal conversation Wait until you receive an affirmative head nod and/or smile from the patient Ask a family member who speaks both languages to help interpret

Faith community nursing (FCN) was founded on which of the following premises?

Spiritual health is central to a person's well-being.

Stages in Benner's model of nursing expertise

Stage 1: novice Stage 2: advanced beginner Stage 3: competent (2-3 years in the same clinical setting) Stage 4: proficient: more than 2-3 years, autonomy Stage 5: expert: synthesize all data learned, apply it individually to patients. Creative individual solutions

Holmes and Rahe

Stressful life events scale. Top 3: death of spouse, divorce, marital separation - Score of: >300: high risk of illness 150-299: moderate risk of illness <150: low risk of illness

A nurse is examining an Asian female adult patient and notices large red bruises covering her back. The patient denies pain in this location and says her husband does that when she is sick. What should the nurse do?

Submit a domestic abuse report to the hospital administrators. Do nothing and continue with the physical examination. Ask another Asian nurse on the floor if she/he has encountered this before. Assess the patient for other potential signs of domestic abuse while addressing the chief complaint.

For which information is the nurse expected to break confidentiality?

Suspected abuse of a child Nurses are mandatory reporters, which means that suspected or witnessed child abuse must be reported immediately. It would be inappropriate for the nurse to break confidentiality for patients with positive STD tests, patients who are well known in the community or patients who are family members.

A 43-year old patient has recently been diagnosed with thyroid cancer. During a clinical visit to discuss treatment, the patient exclaims to the nurse, "I do not know what I have done to offend the spirits so that they cursed me with this illness! I must appease them by performing a cleansing ritual each morning and they will cure me of this darkness. I do not need radiation." The nurse understands the patient's magico-religious health belief, so their most likely response is:

That is ridiculous. Cancers are caused by cell mutations, not spirits! I completely understand your concern. We will wait for your rituals to work before proceeding with treatment options. I completely understand your concern. We should discuss your treatment options that can coincide with your cleansing rituals. I completely understand your concerns, but you should always do what your doctor says when battling cancer.

The RN delegates changing a sterile dressing over a central line to a licensed practical/vocational nurse (LPN/LVN). The LPN/LVN contaminated the site during the dressing change, and an infection developed in the patient. Which of the following statements is true?

The RN is ultimately responsible for acts he or she delegates.

How can the BRN discipline?

The board shall discipline the holder of any license, whose default has been entered or who has been heard by the board and found guilty, by any of the following methods: (a) Suspending judgment. (b) Placing him upon probation. (required to work still) (c) Suspending his right to practice nursing for a period not exceeding one year. (d) Revoking his license. (e) Taking such other action in relation to disciplining him as the board in its discretion may deem proper.

The BRN can take disciplinary action for what types of offenses?

The disciplinary penalty is determined based on a number of factors including but not limited to: severity and recency of offense, rehabilitation evidence, current ability to practice safely, mitigating factors, and past disciplinary history.

Which of the following is a correct statement about the registered nurse (RN) population?

The rate of aging of RNs has slowed for the first time in the past 30 years.

How is the practice of nursing defined?

The practice of nursing within the meaning of this chapter means those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill

A nurse is trying to educate his/her patient's wife on how to use a glucose monitor at home. The patient's wife states, "I'm going to wait for the doctor to come in and explain this. I'm sure HE will be able to answer my questions better." What are some possible reasons for this person's bias against nurses' medical/diagnostic knowledge? Select all that apply.

The image of nursing has been under scrutiny in the past and it is necessary to redefine nurses as skilled, knowledgeable professionals. Nurses have less medical/diagnostic knowledge than physicians and are unable to educate patients accurately. Nurses have historically been recognized as caregivers and physician's helpers, not medical professionals. This patient's wife was treated poorly by a nurse in the past.

How do interdependent functions relate to Standardized Procedures?

The means designated to authorize performance of a medical function by a registered nurse is a standardized procedure developed through collaboration among registered nurses, physicians and administrators

One of the characteristics of a profession by Kelly was "there is an organization (association) that encourages and supports high standards of practice." Which of the following illustrates a concern for nursing meeting this characteristic?

The membership of the ANA is less than 10% of all nurses

Which of the following conveys cultural sensitivity by the nurse to the patient?

The nurse addresses the patient about decisions regarding their care, preventing the patient's family from interrupting or interfering with decisions regarding their care. The nurse frequently asks the patient if there is anything that they do not understand throughout their interaction. The nurse is unfamiliar with the patient's culture but makes sure to appear knowledgeable to the patient. The nurse addresses the patient by their first name to express friendliness and a level of acquaintance with the patient.

A nurse is caring for a patient with hypertension. The patient questions the nurse about dietary restrictions and wants to know what foods to avoid. The nurse offers the patient examples of foods that the patient should avoid, foods that are recommended, and general information about hypertension. In this scenario, the nurse is assuming which nursing role?

The nurse is acting as a change agent. The nurse is acting as a counselor. The nurse is acting as a teacher. The nurse is actin as a patient advocate.

A nurse caring for a client with recently diagnosed diabetes mellitus instructs the client how to use a device to monitor blood glucose. The nurse is demonstrating which nursing role?

The nurse is functioning as a counselor. The nurse is functioning as a teacher. The nurse is functioning as a change agent. The nurse is functioning as a communicator.

A nurse has applied for a job and during the interview was told that the health care facility is a "closed shop." What does that phrase mean to the nurse?

The nurse must join a union to be employed there.

Florence Nightingale established a school of nursing based on which of the following innovative principles? (

The nursing school should be affiliated with a teaching hospital but independent of it. Professional nurses should be paid for their instruction in the school. The curriculum should include theory and practical experience.

The nurse is working in a busy emergency department, and is preparing to perform an interview and assessment on a patient with COPD exacerbation. Which factor(s) should the nurse expect to affect the patient interview?

The patient's shortness of breath. The presence of family members. The nurse's phone ringing. The physician walking into the room.

The nurse practice act of a state defines the scope and responsibilities of nursing practice in that state. Which of the following is true regarding nurse practice acts?

They determine the educational requirements for licensure.

What best describes the competency, "Evidence - based Practice?"

This competency is universally accepted within the medical field as the gold standard set by the American Nurses Association. This competency acknowledges current medical studies, advanced clinical knowledge and the individual patient/family's values for delivering health care. This competency is defined by Patient Centered Care through teamwork and collaboration. This competency is opposed by the organisation, Quality and Safety Education for Nurses due to unsubstantiated claims regarding Knowledge, Skills, and Attitudes.

administrative law

This is as a result of legislative branch of a government delegating authority to governmental agencies to create laws that meet the intent of a statute

The nurse is preparing to obtain informed consent. Which action is expected of the nurse?

To determine if the elements for a valid consent are in place The nurse is not responsible for giving an explanation of the procedure to the patient, evaluating whether the physician has truly explained risks and benefits or offering the patient alternative treatment options. The nurse is responsible for, and expected to, determine if the elements for a valid consent are in place

What is the purpose of the law in the United States?

To ensure order, protect the individual person, resolve disputes, and promote the general welfare.

Tom, the Emergency Department charge nurse, is concerned about a recent increase in readmission of patients for improper wound care. He asks staff to track the number of return patients who are being seen for errors in following discharge instructions and/or prescription labels. After he receives the requested data from staff, what is the next step in the Evidence Based Practice?

Tom needs to implement a department wide policy. Tom needs to critically analyze the evidence. Tom should design a change to ensure that proper teaching is completed prior to discharge. Tom should assess the need for change in the Emergency Department.

The nursing profession has experienced barriers to professionalism. Which of the following is the primary current barrier to nursing professionalism?

Variability of educational backgrounds of nurses

The RN is working on a busy surgical floor, with a team including an LPN and a Nurse Aid. Which duty can the RN delegate to the Nurse Aid?

Vitals signs every hour The RN can delegate vital signs to the nurse aid. The nurse should follow up with the nurse aid to ensure that the vital signs have been obtained and documented in the clinical record, because the nurse is legally liable for the patient. Assessing patients, providing wound care and administering medications cannot be delegated to the nurse aid.

ANA

Wash DC, 1896 Amer. Journal of Nursing purpose: - high standards - economic & gr8r welfare 4 nursing - positive & realistic - lobbies congress & regulatory agencies on issues

A student nurse who read "An Experiment in White" by Jeri Burn, would use their critical thinking skills to conclude that an RN should wear all white while at work due to/because:

Wearing white may look clean and sterile This was/is an industry standard for RNs Nursing schools' requirements prevent students from wearing all white Standard white uniforms makes it easier to identify an RN

example of administrative case?

When a nurse practices without a valid license or beyond the scope of nursing practice

Participants were asked this question: What single change would have the least impact on the image of emergency nurses?

Whether or not we introduce ourselves as nurses. How we act around nursing station. How easily patient and family can read our name tags. Whether or not we belong to the Emergency Nurses Association (ENA)

The Patient Self-Determination Act of 1991, as implemented today, is known as providing

advance directives.

Which American university opened the first nursing school as a separate department within the university?

Yale

Community Standards

a group of nurses come together and confirm they perform a procedure a certain way

occupation

a person's principal work or business

professionalization

a process thru which an occupation evolves to professional status

caring

a theoretical framework central to nursing that results in a professional form of relating to, attending to, and providing for the needs of others

A client who was diagnosed with asthma says to the nurse, "I don't want to quit smoking. It is hard, and my grandmother smoked every day of her life, and she was fine." What is the most appropriate response of the nurse?

a) "If you don't quit, you will die of lung cancer." b) "I will call a respiratory therapist to talk to you about this soon." c) "Why do you think quitting will be so difficult?" d) "Your grandmother probably had lots of problems"

The patient is complaining of sharp chest pain and so the nurse immediately gets the EKG and reports it to the doctor, forgetting to check other conditions of the patient. According to Benner & Tanner, which type of nurse is best described?

a) Advanced Novice b) Competent c) Proficient d) Expert

The doctor walks into a patient's room to explain that they have discovered cancer in his/her body. The patient begins to tear up. Which role as a nurse would initially be recommended with this patient?

a) Caregiver b) Counselor c) Teacher d) Communicator

The nurse finds the pre-operative duties with a surgical patient hindered by the presence of the patient's family. The patient exhibited high levels of stress and anxiety prior to his family members' arrival, and is now calm and collected. The nurse should:

a. Inform the charge nurse of the problem b. Ask for the family's cooperation in helping prepare the patient for surgery c. Ask the family to leave d. Do the best job possible given the circumstances

A vasospastic patient in intensive care is prescribed a variety of medications by the attending physician. The nurse notices that the painkiller regimen included in the drug treatment is interfering with their ability to assess whether or not the vasospasm is ameliorating. The patient is in severe pain, has become unruly, and the physician is unavailable for assistance. What is the proper course of action.

a) Discontinue the painkiller treatment prescribed by the attending physician. b) Increase the painkiller medication due to the subjective needs of the patient. c) Explain to the patient the gravity of the situation and that you are doing everything you can for them. d) Modify the Rx of meds without physician assistance to find a suitable balance of pain mediation and vasospastic amelioration.

What type of knowledge is a pediatric nurse who utilizes toys and puppets to communicate with clients using?

a) Ethical b) Empirical c) Aesthetic d) Personal

A person just got hired at a huge successful company that provides unlimited healthcare benefits. Which type of healthcare plan most likely covers this person?

a) HMO b) PPO c) PPA d) IPA

According to a survey in 2006 of 331 registered nurses, what is the quality that they considered to be the most important as far as having the greatest effect on the professional image as a nurse?

a) How skilled they appeared to be at their jobs. b) How nurses presented themselves to the patient and their family. c) Whether or not the patient felt they cared about them. d) How many professional nursing organizations that they presented.

A pediatric nurse has just finished the difficult task of drawing blood from a fearful male child of Asian decent. What is the least appropriate action the nurse can exhibit to the child?

a) Offer a small toy and candy to the child in congratulations of overcoming a scary procedure. b) Offer mild praise to the child for being tough. c) Offer a congratulatory pat on the head rewarding the braveness of the child. d) Progress to taking the child's rectal temperature after the fearful procedure of drawing blood.

A nurse sees a client who has lost forty pounds and quit smoking since the nurse last saw them one year ago. Which stage of health behavior change is the client presently in?

a) therapy stage b) contemplation stage c) maintenance stage d) action stage

The nurse receives reports on the following patients at the beginning of the shift. Which of the following care activities could be delegated to a nursing assistant?

a. Ambulating a patient who had an emergency appendectomy 8 hours ago, has stable vital signs, and needs to ambulate for the second time b. Assisting a patient who was in an automobile accident and whose right arm and leg are in traction with bathing c. Feeding a patient recovering from a stroke resulting in difficulty holding a spoon d. Taking vital signs, including blood pressure, for a patient with newly diagnosed diabetes and a history of hypertension

A patient comes in with a chief complaint of a sprained ankle. The patient is limping, but is showing no signs of struggle on their face and does not appear to be in serious pain. When the nurse asks the patient to rate his or her pain, they respond with 8/10. The nurse should do which of the following?

a. Ask the patient to re-evaluate their own pain assessment because it does not seem accurate. b. Create own empirical pain assessment of the patient and record. c. Value the patient's expertise with own health and symptoms and record the pain assessment. d. Record the pain assessment but make a note that the patient can be dramatic.

The central question in any charge of malpractice is whether the prevailing standard of care was met. Which of the following are considered part of the standard of nursing care?

a. Basic prudent nursing care is a standard. d. Standards are based on the ethical principle of nonmaleficence. e. National standards of nursing practice are standards for all nurses.

Your coworker, David, decides to wear all white scrubs to work to mimic Jeri Burn's, "An Experiment in White". While you choose not to follow suit, you remain neutral in his encounters to bring back the tradition of nurses in all white uniforms. While doing rounds on the medical-surgical floor, you overhear one of your coworkers make a snide remark, "David looks ridiculous. He's always so desperate for attention. I'm going to see what I can do to get him fired". How would you respond?

a. Confront the nurse who made this remark and tell him/her this behavior is unacceptable b. Immediately go to the charge nurse to let him/her know what you heard c. Tell David if he doesn't stop this ridiculous behavior, he will not have any friends at work d. Ignore the situation, keep the comment to yourself and stay out of it as much as possible

The American Nurses Association (ANA) published a guide for state nurses associations seeking to revise their nurse practice acts. According the ANA, which of the following should be included in these revisions?

a. Differentiation between advanced and generalist nursing practice b. Authority for boards of nursing to oversee UAP d. Authority for boards of nursing to regulate prescription writing by advanced practice nurses e. Nurses responsibility for delegating to LPN/LVNs

Nursing care involves making serious judgment calls on what is right or wrong. This is an example of:

a. Empirical Knowing b. Ethical Knowing c. Personal Knowing d. Aesthetic Knowing

The nurse detects a potentially serious complication developing with a patient. It is most important that the nurse:

a. Ensures there is a problem before calling for a physician b. Not allow one patient's non life-threatening needs to monopolize the nurse's time c. Communicates clearly to mobilize hospital resources d. Begins by documenting the findings clearly in the patient's chart

A premature infant born at 28 weeks to parents of two other children that were carried to term is being discharged from the hospital. The nurse helping prepare the family for the infant's discharge should focus on:

a. Ensuring the parents understand the proper care of their new baby b. Ensuring the paperwork is all in order c. Ensuring the couple's two other children aren't neglected in the process d. Communicating with other staff to ensure the transition goes smoothly

A patient comes in for an annual physical examination. He/she has recently been diagnosed with orthostatic hypotension after reporting dizziness and lightheadedness upon waking out of bed. The nurse comes into the room, lays the patient down on the examination bed, takes his/her vitals and records the blood pressure as 118/78. The nurse then calls the patient to stand and step outside the room briefly to have his/her weight taken. The nurse leads the way with the patient trailing behind. Suddenly, the nurse hears a big thump. The patient has fainted. How could the nurse have demonstrated better clinical judgment to prevent the patient from fainting?

a. The nurse should have requested the patient sit up for a few minutes before standing b. The nurse should have provided the patient with a walker to prevent a fall c. The nurse should have walked behind the patient to catch him/her if he/she fell d. The nurse should have brought in a portable scale

It is vital for nurses to be culturally sensitive and to convey this sensitivity to clients, support people, and other health care personnel. Which of the following actions supports this cultural sensitivity? Select all that apply.

a.) Always address clients by their first name, unless otherwise requested b.) Introduce yourself by your full name, and then explain your role c.) Avoid culturally sensitive language, such as "gay", "lesbian", or "bisexual" d.) Always ask when you do not understand to avoid making assumptions

Autonomy

ability or tendency to function independently

Despite the variety of work settings available to the RN, data from 2008 indicate that the primary work site for RNs is

acute care hospitals.

nursing is a cognitive (mental) activity that requires what?

both critical and creative thinking and serves as the basis for providing nursing care

NPs are advanced practice nurses who

can diagnose and treat common and chronic conditions

top new RN roles (ACA)

care coordinator faculty team leader informatics specialist nurse/fam cooperative faciilitator primary care provider

Roles & Functions

caregiver communicator teacher advocate counselor change agent leader manager researcher

common law

decisional, meaning that judge's rulings become law.

In the nursing process, the evaluation phase is used to determine the?

degree of outcome achievement.

nurse challenges

diploma, assoc, bach, master - disconnect btw educ & prac - lack prof identity - job vs career -varied occupations in health care may look like prof nursing - hierarchical struc dos acute care setting

3 phases of bridges transition theory

ending, neutral zone, new beginnings

neutral zones

free fall, disorientation, disintegration, discovery

What is the primary method of obtaining patient data?

interview with patient

A nurse is admitting a non-English speaking patient to the hospital unit. Which is the best method of obtaining data from the patient?

interviewing the patient using a professional interpreter

RN demographics

majority women, but increasing men avg age: 32 y/o [BSN grads is 28 y/0] Race and Ethnicity: 19% of pop

The identification of nursing diagnosis and goal setting should ideally be a collaborative process between the nurse and which other party?

patient

Which of the following statements has all the necessary criteria for a well-written outcome?

patient will consume 50% of meals with no nausea and vomiting by 24 hours post surgery

most common reason that nurses are disciplined by the state board of nursing is

practicing while impaired.

O'Rourke Model of Professional Role (generic professional role)

practitioner - role-based standards of care scientist - role & evidence-based pray leader - role-based self-direction & decision-making authority

primary care

prenatal and well baby care, nutrition counseling, family planning, exercise classes

altruism

unselfish concern for the welfare of others

Assault

verbal action that places a person in apprehension of a harmful or offensive contract without consent

scope of prac is professional model basis 4 power & authority?

we r given powerful decision authority over health & welfare cuz we use a lot of scientific knowl & tech skill 2 guide prac & commit 2 monitor our standards

Direct

what the RN does

Indirect

what the RN orders

A patient is admitted with asthma. The nurse's assessment finds a temperature of 99 F, wheezing, speaking in 3-word phrases, and respiratory rate of 16 breaths/minute. Which are the best defining characteristics to support diagnosis of ineffective airway clearance related to inflammation and constriction of bronchial tree?

wheezing and speaking in three-word phrases

reflection

why do u want 2 bcom whats impact ur actions impacts of words image presenting fit stereotype of nurse or change it

Intentional Torts

willful acts that violate another's rights

nursing remains a profession dominated by ______

women

Transitions Meleis

• Transitions - moving from a state to another which is associated with big changes in goals, roles, & responsibilities • 2 parts: 1.) Intervention 2.) Understanding transition experience itself Nurses prepare people for developmental, situational, & health illness transitions & to care for them during the transition & try to enhance their quality of lives Goal - make sure they can cope w changes in their health & still be able to cope w changes & fully function • Meleis studied what nurses did to help people thru their transitions cuz some weren't transitioning well Mothers who had babies were traumatized There is a process that's triggered by illness or event Families need care Before an event (chemo abt to start) or after an event (accident) Hopes theory & research evidence will lead to policies to make people transition better & have better outcomes