RNSG 1137 Final Exam

What are the four teachable-learnable team skills per TeamSTEPPS? Example?

-communication -leadership -situation monitoring -mutual support -using SBAR

What are the Registered Nurse's responsibilities for the Standards of Practice for Evaluation?

-evaluate the effectiveness of planned strategies in relation to consumer's response ("E" in ADPIE).

Reflection IN action

-happens in real time while care is occurring -refers to nurses' ability to "read" the patient—how he or she is responding to the nursing intervention and adjust the interventions based on that assessment.

The increasing emphasis of health care delivery is placed on___________, ___________, ____________, and _____________.

-health, health promotion, wellness, and self-care

A clinical nurse leader is a certified nurse generalist with a master's degree in nursing and a special background in clinical leadership. In what way is her title able to help patients?

-help patients navigate the complex health care system.

Technical skills focus on _________________.

-manipulating equipment skillfully to produce a desired outcome.

What are the four basic components of the RAI?

-minimum data set -triggers -resident assessment protocols -utilization guidelines

A nurse is caring for a client with quadriplegia who is fully conscious and able to communicate. What skills of the nurse would be the most important for this client? A) Comforting B) Assessment C) Counseling D) Caring

D) Caring

What effect does DVT prophylaxis have on preventing VAP?

-The exact relationship is unclear. However, when appropriate, evidence-based methods to ensure DVT prophylaxis are applied (see Chapter 30), then the rates of VAP also drop.

Critical thinking in nursing practice results in_______________.

-a comprehensive plan of care with maximized potential for success

Signs and symptoms of BLOODSTREAM INFECTIONS

-abrupt temp elevation shortly after infusion is started -backache -headache -increased pulse and respiratory rate -nausea and vomiting -diarrhea -chills and shaking -general malaise

What does a NURSE NAVIGATOR do?

-advocate for patients by helping translate complex medical information into language that the client can understand and apply and making the overwhelming more manageable.

How can the nurse establish a good nurse-patient relationship upon admission of the client to the clinical facility?

-ask the client if he/she have any FINANCIAL NEEDS

Which of the following is a characteristic of a mentor?

-assists protege in professional development

Five conclusions of the CLINICAL JUDGEMENT MODEL

(1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand; (2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns; (3) Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit; (4) Nurses use a variety of reasoning patterns alone or in combination; and (5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning.

When should central lines be discontinued?

-Assessment for removal of central lines should be included as part of the nurse's daily goal sheets. -The time and date of central line placement should be recorded and evaluated by staff to aid in decision making. -The need for the central line access should be reviewed as part of multidisciplinary rounds. -During these rounds, the "line day" should be stated to remind everyone how long the central line has been in place (e.g., "Today is line day 6"). -An appropriate time frame for regular review of the necessity for a central line should be identified, such as weekly, when central lines are placed for long-term use (e.g., chemotherapy, extended antibiotic administration).

Mental Age of a 12 y/o: What is the greatest concern for the Nurse?

-During pre-entry phase of home visit, the nurse can determine whether the patient's caregiver can answer questions related to patient's family needs and can also learn about the PATIENT'S COGNITIVE ABILITIES, orientation, and caregiver status.

Which of the following is an evidence-based documentation tool?

-clinical pathway

In providing patient-centered care, nurse navigators may do any or all of the following:

-Educate patients about their disease, prescribed treatment, and side effects of treatment and how to manage them -Provide clinical resources -- where to seek a second opinion, treatment or testing that may not be available locally, and how to access reliable sources of information -Assess patients for psychosocial distress and referral to a medical social worker or counselor if more intensive support is needed -Answer questions as appropriate and serve as liaison to the physician for additional questions and concerns -Address tangible barriers to care such as finances, housing, transportation, childcare, prescription costs, and much more. They refer patients to the appropriate contact, such as a social worker -Ensure any health information provided is accessible: this may include securing documents printed in the patient's own language or arranging for certified medical interpretation, either in-person or by phone/video conference -Function as a member of an interdisciplinary team to assess, secure, and coordinate appropriate services through the continuum of care -Empower patients, families, and caregivers to assume as much responsibility for their care as possible, within the constraints of age, illness, and other factors -In consultation with other members of the healthcare team, promote awareness of clinical trials as appropriate -Support the timely scheduling of appointments, diagnostic testing, and procedures -Educate/identify patients for genetic counseling or fertility preservation, and facilitate appropriate referrals

What are the five key elements of the VAP bundle?

-Elevation of the head of the bed (30° to 45°) -Daily "sedation vacations" and assessment of readiness to extubate (see below) -Peptic ulcer disease prophylaxis -Deep venous thrombosis (DVT) prophylaxis (see below) -Daily oral care with chlorhexidine (0.12% oral rinses)

A mentor is assisting a new graduate nurse....

-Evaluates a growth by comparing progress with peers

Which of the following is a component of biculturalism?

-Evaluation of personal values

Which of the following is a characteristic associated with Kramer's honeymoon?

-Excitement

What are the five key elements of the central line bundle?

-Hand hygiene -Maximal sterile barrier precautions during line insertion (see later discussion) -Chlorhexidine skin antisepsis -Optimal catheter site selection with avoidance of using the femoral vein for central venous access in adult patients -Daily review of line necessity, with prompt removal of unnecessary lines

National Patient Safety Goals include........

-IDENTIFYING PATIENT'S CORRECTLY -IMPROVING STAFF COMMUNICATION -Using medications safely -PREVENTING INFECTION -Identifying patient safety risks -Preventing surgery-related mistakes

What are the INTERPROFESSIONAL collaboration core skills a team member must possess? Select all that apply.

-Interpersonal skills (tolerance, patience, understanding) -Humanity (warmth, acceptance, empathy, genuineness, and nonjudgmental attitude) -Knowledge about disorders, symptoms, and behavior -Communication skills -Personal qualities (consistency, assertiveness, and problem-solving abilities) -Teamwork skills (collaborating, sharing, integrating) -Risk assessment and risk management skills

What is a factor to consider during discharge planning?

-LANGUAGE PREFERENCE Other Factors to consider: -Age or Gender -Medical Dx -Functional Limitations (Impaired Sight or hearing, amputation, use of wheelchair) -Emotional Support -Caregiver's age and relationship to patient as well as feelings and living status -Home Environment -Financial Resources

What EBP interventions to prevent VAP (ventilator-associated pneumonia), would the nurse apply? Select all that apply.

-Peptic ulcer prophylaxis -sedation interruptions -daily readiness to extubate the patient off the ventilator -oral care with chlorhexdine

Testing Changes

-Plan-Do-Study-Act (PDSA) -is shorthand for testing a change in the real work setting-by planning it, trying it, observing the results, and acting on what is learned. -this is the scientific method adapted for action-oriented learning

What is meant by daily "sedation vacations," and how does this tie into assessing readiness to extubate?

-Protocols should be developed so that sedative doses are purposely decreased at a time of the day when it is possible to assess the patient's neurologic readiness for extubation. -Vigilance must be employed during the time that sedative doses are lower to ensure that the patient does not self-extubate.

What are the components of thoughtful person-centered practice? Select all that apply.

-THE PERSON, -THE PROFESSIONAL NURSE, -REFLECTIVE PRACTICE LEADING TO PERSONAL LEARNING -clinical reasoning, judgement, and decision making -person-centered nursing process (ADPIE) -nurse's action in response to individual clinical need.

Reflection ON action

-occurs after the fact and involves thinking through a situation that has occurred in the past -showing what nurses gain from their experience contributes to their ongoing clinical knowledge development and their capacity for clinical judgment in future situations.

What are the attributes of "The professional nurse?"

-openmindedness -profound sense of the value of the person -self-awareness and knowledge of own beliefs and values -sense of personal responsibility for actions -motivation to do what you do to the best of your ability because you care about the well-being of those entrusted to your care -leadership skills -bravery to question the "system"

According to Patricia Benner, which of the following is a characteristic of the advanced beginner nurse? Select all that apply.

-performs at an acceptable level -bases actions on principles

Which of the following will assist the new graduate nurse with professional development?

-preceptor

Tanner's Clinical Judgement Model (INTERPRETING)

-reasoning pattern, analytical, intuitive, narrative, developing a sufficient understanding of the situation

Tanner's Clinical Judgement Model (NOTICING)

-recognizing a potential issue, perceptually grasping the situation

A nurse is engaged as a mentor for a new graduate nurse....

-shares ideas and provides feedback

What Are Desired Qualities in a Nurse Navigator?

-strong communication skills -cultural openness -respect for others -commitment to patient confidentiality

Interpersonal skills are used______________.

-to establish and maintain a caring relationship

A nurse is working as a member of a interprofessional team. Which of the following actions...

-use assertive communication

Wellness involves being proactive and being involved in self-care activities aimed toward a state of physical, psychological, and spiritual well-being. What are the 4 concepts of wellness?

1) The capacity to perform to the best of one's ability, (2) The ability to adjust and adapt to varying situations (3) A reported feeling of well-being, and (4) A feeling that "everything is together" and harmonious. (Hinkle6)

What are the hallmarks of Effective Quality Control Programs?

1. support from top-level administration 2. commitment by the organization in terms of fiscal and human resources 3. quality goals reflect search for excellence rather than minimums 4. PROCESS IS ONGOING (continuous) EVALUATING FOR IMPROVEMENT

What are the leadership roles associated with QC?

1. Encourages followers to be actively involved with process 2. Communicates expected standards of care clearly 3. Encourages setting of high standards to maximize quality instead of setting minimize safety standards 4. Embraces and champions quality improvement as an ongoing process 5. Uses control as method determining why goals were not met 6. Active in communicating quality control findings and their implications to other health professionals and consumers 7. Acts as a role model for followers in accepting responsibility and accountability for nursing actions 8. Uses established professional standards and ethical codes as a guide for practice excellence 9. Distinguishes between clinical standards and resource utilization standards, ensuring that patients receive at least minimally acceptable levels of quality care 10. SUPPORTS/PARTICIPATES IN RESEARCH EFFORTS TO IDENTIFY AND MEASURE NURSING-SENSITIVE PATIENT OUTCOMES.

What are the 3 steps of the QC process?

1. criterion or standard is determined 2. information is collected to determine if standards have been met. 3. Educational or corrective action is taken if criterion has not been met.

The nurse managers of a home health care office wish to maximize nurses' freedom to characterize and record client conditions and situations in the nurses' own terms. Which of the following documentation formats is most likely to promote this goal? A) Narrative notes B) SOAP notes C) Focus charting D) Charting by exception

A) Narrative notes

Which of the following phrases best describes continuity of care? A) Focusing on acute care in the hospital B) Serving the needs of children C) Facilitating transition between settings D) Providing single-episode care services

C) Facilitating transition between settings

What guidelines do nurses follow to identify the patient's health care needs and strengths, to establish and carry out a plan of care to meet those needs, and to evaluate the effectiveness of the plan to meet established outcomes? A) Nursing process B) ANA Standards of Professional Performance C) Evidence-based practice guidelines D) Nurse Practice Acts

A) Nursing process

Minimum data set

A core set of screening, clinical, and functional status elements that forms the foundation of the comprehensive assessment of all residents in long-term care facilities certified to participate in Medicare or Medicaid. The items in the minimum data set standardize communication about resident problems and condition.

What is a Prospective Payment System?

A payment system for care given based upon the DRG classification system (predetermined payment for services based on medical diagnosis)

Which of the following are examples of common factors in a client that may influence assessment priorities? Select all that apply. A) Diet and exercise program B) Standing in the community C) Ability to pay for services D) Developmental stage E) Need for nursing

A) Diet and exercise program D) Developmental stage E) Need for nursing

Which of the following roles of the nurse is most important in providing continuity of care to clients? Select all that apply. A) Educator B) Collaborator C) Mentor D) Advocate E) Role model

A) Educator B) Collaborator D) Advocate

A client being prepared for discharge to his home will require several interventions in the home environment. The nurse informs the discharge planning team, consisting of a home health care nurse, physical therapist, and speech therapist, of the client's discharge needs. This interaction is an example of which professional nursing relationship? A) Nurse-health care team B) Nurse-patient C) Nurse-patient-family D) Nurse-nurse

A) Nurse-health care team

Nurses have identified the following outcome in the care of a client who is recovering from a stroke: "Client will ambulate 100 feet without the use of mobility aids by 12/12/2011." Several nurses have evaluated the client's progression towards this outcome at various points during her care. Which of the following evaluative statements is most appropriate? A) "12/12/2011 - Outcome partially met. Patient ambulated 75 feet without the use of mobility aids" B) "12/12/2011 - Outcome unmet. Patient's ambulation remains inadequate." C) "12/10/2011 Outcome met, but with the use of a quad cane to assist ambulation." D) "12/14/2011 Outcome met."

A) "12/12/2011 - Outcome partially met. Patient ambulated 75 feet without the use of mobility aids"

A hospital utilizes the SOAP method of charting. Within this model, which of the nurse's following statements would appear at the beginning of a charting entry? A) "Client complaining of abdominal pain rated at 8/10." B) "Client is guarding her abdomen and occasionally moaning." C) "Client has a history of recent abdominal pain." D) "2 mg Dilaudid PO administered with good effect"

A) "Client complaining of abdominal pain rated at 8/10."

An adolescent comes to a community health clinic with complaints of vaginal itching and discharge. She believes it is from having sex with her boyfriend. Which response should the nurse use during the health history to elicit information? A) "Tell me about the sexual activity with your boyfriend." B) "Why did you ever have sex with someone you don't know?" C) "You are old enough to know to use condoms." D) "I don't understand how you could be so careless."

A) "Tell me about the sexual activity with your boyfriend."

A nurse uses critical thinking every day when going through the nursing process. Which of the following is an outcome of critical thinking in nursing practice? A) A comprehensive plan of care with a high potential for success B) Identification of the nurse's preferred goals for the patient C) A collaborative basis for assigning care D) Increased cost efficiency in health care

A) A comprehensive plan of care with a high potential for success

A nurse has drafted an SBAR communication before contacting the primary care provider of a client whose condition has worsened suddenly. How should the nurse best conclude this communication? A) Ask the care provider to come and assess the client. B) Provide the client's most recent vital signs. C) Ask the care provider if he or she is familiar with this client. D) Provide the most likely diagnosis of the problem.

A) Ask the care provider to come and assess the client.

All of the following are factors to consider when caring for clients with limited income. Which one is the most important? A) Basic human needs may go unmet B) Limited access to reliable transportation C) Decreased access to health care services D) Risk for increased incidence of disease

A) Basic human needs may go unmet

A client has suddenly become very ill, and a nurse is transferring him to the intensive care unit (ICU). How does the nurse provide information to ensure continuity of care? A) By giving a verbal report to nurses in the ICU B) By ensuring that the chart and all belongings are moved C) By delegating a nursing assistant to provide information D) By asking the family to provide the information

A) By giving a verbal report to nurses in the ICU

The nursing student uses evidence-based practice findings in the development of a care plan. This is an example of which type of nursing skill? A) Cognitive skill B) Technical skill C) Interpersonal skill D) Ethical/legal skill

A) Cognitive skill

Which activity does the nurse engage in during evaluation? Select all that apply. A) Collect data to determine whether desired outcomes are met. B) Assess the effectiveness of planned strategies. C) Adjust the time frame to achieve the desired outcomes. D) Involve the client and family in formulating desired outcomes. E) Initiate activities to achieve the desired outcomes.

A) Collect data to determine whether desired outcomes are met. B) Assess the effectiveness of planned strategies. C) Adjust the time frame to achieve the desired outcomes.

An obstetrical nurse wishes to identify whether clients' perceptions of a high level of support from their partner is associated with a decreased length of the second stage of labor. Which type of quantitative research is most appropriate for this research question? A) Correlational research B) Descriptive research C) Quasi-experimental research D) Experimental research

A) Correlation reasearch

An obstetrical nurse wishes to identify whether clients' perceptions of a high level of support from their partner is associated with a decreased length of the second stage of labor. Which type of quantitative research is most appropriate for this research question? A) Correlational research B) Descriptive research C) Quasi-experimental research D) Experimental research

A) Correlational research

What is a systematic way to form and shape one's thinking? A) Critical thinking B) Intuitive thinking C) Trial-and-error D) Interpersonal values

A) Critical Thinking

Achieving adequate pain management for a postoperative patient will require sophisticated critical thinking skills by the nurse. What are the potential benefits of critical thinking in nursing? Select all that apply. A) Enhancing the nurse's clinical decision making B) Identifying the patient's individual preferences C) Planning the best nursing actions to assist the patient D) Increasing the accuracy of the nurse's judgments E) Helping identify the patient's priority needs

A) Enhancing the nurse's clinical decision making C) Planning the best nursing actions to assist the patient D) Increasing the accuracy of the nurse's judgments E) Helping identify the patient's priority needs

A nurse has come on day shift and is assessing the client's intravenous setup. The nurse notes that there is a mini-bag of the client's antibiotic hanging as a piggyback, but that the bag is still full. The nurse examines the patient's medication administration record (MAR) and concludes that the night nurse likely hung the antibiotic but failed to start the infusion. As a result, the antibiotic is three hours late and the nurse has consequently filled out an incident report. In doing so, the nurse has exhibited which of the following? A) Ethical/legal skills B) Technical skills C) Interpersonal skills D) Cognitive skills

A) Ethical/legal skills

The nurse is caring for a client with a diagnosis of end-stage renal disease. The client has expressed the desire to be kept comfortable and to not continue further treatment. The daughter arrives from out of town and is demanding to have further testing done to determine the best treatment option for the client. What is the best action for the nurse to take at this time? A) Explain to the daughter the wishes of the client. B) Arrange a meeting between the physician and daughter. C) Contact the imaging center to schedule the testing. D) Persuade the client to agree to the daughter's request.

A) Explain to the daughter the wishes of the client.

Who is involved in quality control measurement functions? Select all that apply. A) Facility staff B) Consumers C) All levels management D) Health-care professionals

A) Facility staff B) Consumers C) All levels management D) Health-care professionals

The nurse working in the hospital understands the changes that have resulted in shorter hospital stays, with a focus on acute care needs of the client. Which of the following factors influence shorter hospital stays? Select all that apply. A) Federal regulations for health care reimbursement policies. B) Increased emphasis on preventive care. C) Improvement in treatment of illness. D) Patients realize that longer stays result in infections and other problems.

A) Federal regulations for health care reimbursement policies. B) Increased emphasis on preventive care. C) Improvement in treatment of illness.

The nurse is trying to determine factors influencing a client who is not following the plan of care. Which client statement identifies a potential factor interfering with following the plan of care? Select all that apply. A) I don't drive so I was unable to fill my prescription. B) I consult the list of low sodium foods when preparing meals. C) My social security check does not come until next week. D) I dropped the strips for my finger-stick blood glucose testing in the bath water. E) "My daughter helps me with my range of motion exercises every morning and afternoon."

A) I don't drive so I was unable to fill my prescription. C) My social security check does not come until next week. D) I dropped the strips for my finger-stick blood glucose testing in the bath water.

The nurse notes that the blood glucose level of a client has increased and is planning to notify the health care provider by telephone. Which of the following techniques would be most appropriate for the nurse to use when communicating with the health care provider? A) ISBAR B) EMAR C) SOAP D) CBE

A) ISBAR

The nurse notes that the blood glucose level of a client has increased and is planning to notify the health care provider by telephone. Which of the following techniques would be most appropriate for the nurse to use when communicating with the health care provider? A) ISBAR B) EMAR C) SOAP D) CBE

A) ISBAR -The nurse should use ISBAR to communicate verbally to the health care provider. Identify/Introduction, Situation, Background, Assessment, and Recommendation (ISBAR) is the communication tool to provide critical client information to the health care provider. EMAR is Electronic Medication Administration Record, which documents medication administration. SOAP is Subjective, Objective, Assessment, and Plan, which is a progress note that relates to only one health problem. CBE is Charting by Exception and permits the nurse to document only those findings that fall outside the standard of care and norms that have been developed by the institution.

Which intervention is associated with the nursing leadership role? A) Inspiring staff to establish and maintain high standards regarding patient care B) Being aware of the changes in quality control regulations C) Reviewing research results upon which to base changes D) Identifying outcomes that support quality nursing care

A) Inspiring staff to establish and maintain high standards regarding patient care

Which of the following are core skill areas that are needed of any effective team member of an interdisciplinary team? Select all that apply. A) Interpersonal skills B) Teamwork skills C) Communication skills D) The ability to work independently E) Risk assessment and risk management skills

A) Interpersonal skills B) Teamwork skills C) Communication skills E) risk assessment and risk management skills

Which of the following are examples of characteristics of evidence-based practice? Select all that apply. A) It is a problem-solving approach. B) It uses the best evidence available. C) It is generally accepted in clinical practice. D) It is based on current institutional protocols. E) It blends the science and art of nursing.

A) It is a problem-solving approach. B) It uses the best evidence available. C) It blends the science and art of nursing.

Nurses apply critical thinking to clinical reasoning and judgment in their nursing practice every day. Which of the following are characteristics of this practice? Select all that apply. A) It is guided by standards, policies and procedures, ethics codes, and laws. B) It is based on principles of nursing process, problem solving, and the scientific method. C) It carefully identifies the key problems, issues, and risks involved. D) It is driven by the nurse's need to document competent, efficient care. E) It calls for strategies that make the most of human potential.

A) It is guided by standards, policies and procedures, ethics codes, and laws. B) It is based on principles of nursing process, problem solving, and the scientific method. C) It carefully identifies the key problems, issues, and risks involved. E) It calls for strategies that make the most of human potential.

A hospital's emergency operations plan has been enacted following an industrial accident. While one nurse performs the initial triage, what should other emergency medical services personnel do? A) Perform life-saving measures. B) Classify patients according to acuity. C) Provide health promotion education. D) Modify the emergency operations plan.

A) Perform life-saving measures. -In an emergency, patients are immediately tagged and transported or given life-saving interventions. One person performs the initial triage while other emergency medical services (EMS) personnel perform life-saving measures and transport patients. Health promotion is not a priority during the acute stage of the crisis. Classifying patients is the task of the triage nurse. EMS personnel prioritize life-saving measures; they do not modify the operations plan.

Which task is a management function associated with quality control? A) Periodic evaluation of unit mission and philosophy B) Making out the daily patient care assignments C) Creating a yearly budget D) Distributing holiday staffing policies

A) Periodic evaluation of unit mission and philosophy

A client is diagnosed with mild dementia while in the hospital. In preparing for discharge, what should the nurse should discuss with the family? A) Possible need for home care B) Legal responsibility for the future C) Need for transfer to a long-term care facility D) Lack of free resources of care

A) Possible need for home care

Which one of the following methods of documentation is organized around client diagnoses rather than around patient information? A) Problem-oriented medical record (POMR) B) Source-oriented record C) PIE charting system D) focus charting

A) Problem-oriented medical record (POMR)

A nursing instructor is teaching a class about ethical principles to a group of nursing students. The instructor determines that the teaching was successful when the students give which of the following as an example of nonmaleficence? A) Protecting clients from a chemically impaired practitioner B) Performing dressing changes to promote wound healing C) Providing emotional support to clients who are anxious D) Administering pain medications to a client in pain

A) Protecting clients from a chemically impaired practitioner

Which of the following is an essential feature of professional nursing? Select all that apply. A) Providing a caring relationship to facilitate health and healing B) Attention to a range of human experiences and responses to health and illness C) Use of objective data to negate the client's subjective experience D) Use of judgment and critical thinking to form a medical diagnosis E) Advancement of professional nursing knowledge through scholarly inquiry

A) Providing a caring relationship to facilitate health and healing B) Attention to a range of human experiences and responses to health and illness E) Advancement of professional nursing knowledge through scholarly inquiry

A student is asked to perform a skill for which he is not prepared. When using the method of critical thinking, what would be the first step to resolve the situation? A) Purpose of thinking B) Adequacy of knowledge C) Potential problems D) Helpful resources

A) Purpose of thinking

The nurse is caring for a client who has been newly diagnosed with diabetes. One of the outcomes the nurse read on the client's plan of care this morning was: "Client will demonstrate correct technique for self-injecting insulin." The client required insulin prior to his lunch and successfully drew up and administered his insulin while the nurse observed. How should the nurse follow up this observation? A) Record an evaluative statement in the client's plan of care. B) Remove the outcome from the client's care plan. C) Ask the nurse who wrote the plan of care to document this development. D) Reassess the client's psychomotor skills at dinner time.

A) Record an evaluative statement in the client's plan of care.

After completing an assessment of a client, the nurse uses critical thinking and clinical reasoning to prioritize the client's problems. Which of the following would the nurse determine is the highest priority? A) Severe bleeding from a wound B) History of asthma C) Diabetes D) Lack of family support

A) Severe bleeding from a wound

Upon evaluation of the client's plan of care, the nurse determines that the expected outcomes have been achieved. Based upon this response, the nurse will do what? A) Terminate the plan of care. B) Modify the plan of care. C) Continue the plan of care. D) Re-evaluate the plan of care.

A) Terminate the plan of care.

The nurse recognizes that the goals established for a client's discharge are more likely to be accomplished when ... A) the client assists in developing the goals. B) the physician develops the goals. C) the nurse develops the goals. D) the multidisciplinary team develops the goals.

A) The client assists in developing the goals.

Which example reflects client variables that influence outcome achievement? Select all that apply. A) The client was born with cystic fibrosis. B) The nurse works at a hospital in a diverse community. C) Nursing interventions are consistent with standards of care. D) The client is a college graduate and is employed. E) The client engages in activities associated with Ramadan.

A) The client was born with cystic fibrosis. D) The client is a college graduate and is employed. E) The client engages in activities associated with Ramadan.

A group of students have been challenged to prioritize ethical practice when working with a marginalized population. How should the students best understand the concept of ethics? A) The formal, systematic study of moral beliefs B) The informal study of patterns of ideal behavior C) The adherence to culturally rooted, behavioral norms D) The adherence to informal personal values

A) The formal, systematic study of moral beliefs

Nursing continues to recognize and participate in collaboration with other health care disciplines to meet the complex needs of the patient. Which of the following is the best example of a collaborative practice model? A) The nurse and the physician jointly making clinical decisions. B) The nurse accompanying the physician on rounds. C) The nurse making a referral on behalf of the patient. D) The nurse attending an appointment with the patient.

A) The nurse and the physician jointly making clinical decisions. -The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public. The other answers are incorrect because they are not examples of a collaborative practice model.

Which of the following are examples of a nurse demonstrating the professional value of altruism? Select all that apply. A) The nurse arranges for an interpreter for a client whose primary language is Spanish. B) The nurse calls the physician of a client whose pain medication is not strong enough. C) The nurse provides information for a client so he is capable of participating in planning his care. D) The nurse reviews a client chart to determine who may be informed of the patient's condition. E) The nurse documents client care accurately and honestly and reviews the entry to ensure there are no errors.

A) The nurse arranges for an interpreter for a client whose primary language is Spanish. B) The nurse calls the physician of a client whose pain medication is not strong enough.

A client age 50 years reports to a primary care unit with an open wound due to a fall in the bathroom. Which of the following nursing actions represents caring skills? A) The nurse cleans the wound and applies a dressing to it. B) The nurse inspects and examines the wound for swelling. C) The nurse tells the client to use caution while on slippery surfaces. D) The nurse informs the client that the wound is small and will heal easily.

A) The nurse cleans the wound and applies a dressing to it.

Nursing continues to recognize and participate in providing appropriate, uninterrupted care and facilitate clients' transitions between different settings and levels of care. What would be an example of this continuity of care? A) The nurse collaborating with other members of the health care team B) The nurse accompanying the physician on rounds C) The nurse taking detailed notes on how each client wants to continue care D) The nurse attending an appointment with the client in some place other than where the nurse works

A) The nurse collaborating with other members of the health care team

At what point during hospital-based care does planning for discharge begin? A) Upon admission to the hospital B) After the patient is settled in a room C) Immediately before discharge D) After leaving the hospital

A) Upon admission to the hospital

The nurses who provide care in a large, long-term care facility utilize charting by exception (CBE) as the preferred method of documentation. This documentation method may have which of the following drawbacks? A) Vulnerability to legal liability since nurse's safe, routine care is not recorded B) Increased workload for nurses in order to complete necessary documentation C) Failure to identify and record client problems and associated interventions D) Significant differences in the charting between nurses due to lack of standardization

A) Vulnerability to legal liability since nurse's safe, routine care is not recorded

The nurse should utilize ISBARR communication (Introduction, Situation, Background, Assessment, Recommendation, Read Back) during which of the following clinical situations? A) When communicating a client's change in condition to the client's physician B) When providing a change-of-shift report to a colleague C) When documenting the care that was provided to a client whose condition recently deteriorated D) When reporting to a client's family member or significant other

A) When communicating a client's change in condition to the client's physician

Many of the homeless clients who are supposed to receive care for HIV/AIDS miss their appointments at a clinic because it is located in a high-rise building on a university campus. Several of the clients state that the clinic is difficult to find and in an intimidating environment. This demonstrates that which of the following variables influencing outcome achievement is being inadequately addressed? A) Psychosocial background of clients B) Developmental stage of clients C) Ethical and legal considerations D) Resources

A) psychosocial background of clients

Ethics versus Morals

ETHICS- formal, systematic study of moral beliefs to understand, analyze, and evaluate matters of right and wrong. MORALS- includes specific values, characters, or actions whose outcomes are often examined through systematic ethical analysis.

Utilitarian approach:

Predict the consequences of the alternatives; assign a positive or negative value to each consequence; choose the consequence that predicts the highest positive value or "the greatest good for the greatest number."

A nurse, preparing for a client's discharge after surgery, is teaching the client's wife to change the dressing. How can the nurse be certain the wife knows the procedure? A) Tell the wife exactly how to do it. B) Give the wife information about supplies. C) Have the wife demonstrate the procedure. D) Ask another nurse to reinforce teaching.

C) Have the wife demonstrate the procedure.

According to Patricia Benner, a novice nurse demonstrates which of the following behavior? A) Improved decision making B) Intuition C) Inflexibility D) Flexibility

Ans C Feedback: The proficient nurse demonstrates improved decision-making skills, due in part to an ability to see the big picture. The expert nurse demonstrates flexibility and an intuitive grasp of clinical situations. The novice, or beginner with no experience, applies general rules learned in school to all situations and demonstrates inflexible behavior.

One step in implementing evidence-based practice is to ask a question about a clinical area of interest or an intervention. The most common method is the PICO format. Which of the following accurately defines the letters in the PICO acronym? A) P = population B) I = institution C) C = compromise D) O = output

Ans: A Feedback: P = patient, population, or problem of interest, I = intervention of interest, C = comparison of interest, and O = outcome of interest

What is the primary focus of health care today? A) Care of acute illnesses B) Care of chronic illnesses C) Health promotion D) Health restoration

C) Health promotion

If there is no order for restraints and there is not an availability for a sitter, what can the nurse use an an appropriate option?

Ask a family member of patient if they can come sit.

The models of nursing care delivery have been many and varied throughout the history of nursing. Which of the following best describes the idea of the continuity of care? A) Money focused B) Client focused C) Primary nursing D) Functional nursing

B) Client focused

A nurse is unsure how best to respond to a patient's vague complaint of "feeling off." The nurse is attempting to apply the principles of critical thinking, including metacognition. How can the nurse best foster metacognition? A) By eliciting input from a variety of trusted colleagues B) By examining the way that she thinks and applies reason C) By evaluating her responses to similar situations in the past D) By thinking about the way that an "ideal" nurse would respond in this situation

B) By examining the way that she thinks and applies reason

A group of students is reviewing information about evidence-based practice in preparation for an exam. The students demonstrate understanding of the information when they identify which of the following as associated with evidence-based practice? A) It emphasizes personal experience over science. B) Clinical expertise is integrated with external evidence. C) It involves gaining solutions to problems. D) The purpose is to learn about a specific problem.

B) Clinical expertise is integrated with external evidence.

Nurses have different educational backgrounds and function under many titles in their practice setting. If a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by influencing the patient, the nurse, and the health care system, what would most accurately describe this nurse's title? A) Nursing care expert B) Clinical nurse specialist C) Nurse manager D) Staff nurse

B) Clinical nurse specialist

Which activity does the nurse perform during the evaluating stage? Select all that apply. A) Validates with the client the problem of constipation. B) Collects data to determine the number of catheter-associated infections on the nursing unit. C) Increases the frequency of re-positioning from every two hours to every one hour. D) Sets a goal of ambulating from bed to room door and back to bed. E) Identifies smoking and sedentary lifestyle as risk factors for hypertension.

B) Collects data to determine the number of catheter-associated infections on the nursing unit. C) Increases the frequency of re-positioning from every two hours to every one hour.

A nurse is undergoing debriefing with the critical incident stress management (CISM) team after participating in the response to a disaster. During this process, the nurse will do which of the following? A) Evaluate the care that he or she provided during the disaster. B) Discuss own emotional responses to the disaster. C) Explore the ethics of the care provided during the disaster. D) Provide suggestions for improving the emergency operations plan.

B) Discuss own emotional responses to the disaster. -Ans: B Feedback: In DEBRIEFING, participants are asked about their emotional reactions to the incident, what symptoms they may be experiencing (e.g., flashbacks, difficulty sleeping, intrusive thoughts), and other psychological ramifications. The EOP and the care the nurse provided are not evaluated.

A nurse is triaging patients after a chemical leak at a nearby fertilizer factory. The guiding principle of this activity is what? A) Assigning a high priority to the most critical injuries B) Doing the greatest good for the greatest number of people C) Allocating resources to the youngest and most critical D) Allocating resources on a first come, first served basis

B) Doing the greatest good for the greatest number of people

An industrial site has experienced a radiation leak and workers who have been potentially affected are en route to the hospital. To minimize the risks of contaminating the hospital, managers should perform what action? A) Place all potential victims on reverse isolation. B) Establish a triage outside the hospital. C) Have hospital staff put on personal protective equipment. D) Place hospital staff on abbreviated shifts of no more than 4 hours.

B) Establish a triage outside the hospital.

The nurse is planning the discharge of a client who had surgery for a left hip replacement. The client is being discharged from the hospital to the home and requires a walker and high-rise toilet seat. Which type of home health care service does the client require? A) Custodial services B) Home medical services C) High-technology pharmacology services D) Hospice services

B) Home medical services

Health care costs are increasing as technology and related services increase. Patients interact with many health care providers, such as RNs, LPNs, physicians, physical therapists, medical technologists, radiation technologists, specialists, and others employed in health care. As a result of the complexity of care and multiple providers, health care is becoming fragmented. What are the major results of fragmented care? Select all that apply. A) Less confusion for clients regarding treatment. B) Increased medication errors. C) Clients receive more specialized care. D) Lack of continuity of care.

B) Increased medication errors. C) Clients receive more specialized care. D) Lack of continuity of care.

A nurse asks a multidisciplinary team to collaborate in developing the most appropriate plan of care to meet the needs of an adolescent with a severe head injury. Which of the blended skills essential to nursing practice is the nurse using? A) Cognitive skills B) Interpersonal skills C) Technical skills D) Ethical/legal skills

B) Interpersonal skills

A nurse has developed a plan of care with nursing interventions designed to meet specific client outcomes. The outcomes are not met by the time specified in the plan. What should the nurse do now in terms of evaluation? A) Continue to follow the written plan of care. B) Make recommendations for revising the plan of care. C) Ask another health care professional to design a plan of care. D) State "goal will be met at a later date."

B) Make recommendations for revising the plan of care.

A nurse uses the SBAR method to hand off the communication to the health care team. Which of the following might be listed under the "B" of the acronym? A) Vital signs B) Mental status C) Client request D) Further testing

B) Mental status -SBAR stands for Situation, Background, Assessment, and Recommendations, and provides a consistent method for hand-off communication that is clear, structured, and easy to use. Vital signs would fall under the category of situation; mental status: background; client request: assessment; further testing: recommendations.

A nurse is documenting information about a client in a long-term care facility. What is used in a Medicare-certified facility as a comprehensive assessment and as the foundation for the Resident Assessment Instrument (RAI)? A) PIE system B) Minimum data set C) OASIS D) Charting by exception

B) Minimum data set

The nurse is caring for a patient who is withdrawing from heavy alcohol use and who is consequently combative and confused, despite the administration of benzodiazepines. The patient has a fractured hip that he suffered in a traumatic accident and is trying to get out of bed. What is the most appropriate action for the nurse to take? A) Leave the patient and get help. B) Obtain a physician's order to restrain the patient. C) Read the facility's policy on restraints. D) Order soft restraints from the storeroom.

B) Obtain a physician's order to restrain the patient. -Before restraints are used, other strategies, such as asking family members to sit with the patient, or utilizing a specially trained sitter, should be tried

The home health nurse receives a referral from the hospital for a client who needs a home visit. After reading the referral, what would be the first action the nurse should take? A) Identify community services initially for the client B) Obtain client information from the discharge planner C) Call the client to obtain permission to visit D) Schedule a home health aide to visit the client

B) Obtain client information from the discharge planner.

With the changing population of health care consumers, it has become necessary for nurses to work more closely with other nurses, as when acute care nurses collaborate with public health and home health nurses. What nursing function has increased in importance because of this phenomenon? A) Prescribing medication B) Performing discharge planning C) Promoting family involvement D) Forming collegial relationships

B) Performing discharge planning

What step in the nursing process is most closely associated with cognitively skilled nurses? A) Assessing B) Planning C) Implementing D) Evaluating

B) Planning

What results from the development of plan of correction associated with health-care delivery errors? A) Sentinel event B) Root cause analysis C) Quality assessment (QA) program D) Failure mode and effects analysis (FMEA)

B) Root cause analysis -Another Joint Commission priority is the development of root cause analysis with a plan of correction for the errors that do occur. A sentinel event is likely the trigger of the root cause analysis. FMEA examines all possible failures in a design - including sequencing of events, actual and potential risk, points of vulnerability, and areas for improvement. QA IS AN ONGOING PROCESS THAT FOCUSES ON CONTINUED DELIVERY IMPROVEMENT.

A nurse is collecting data from a home care client. In addition to information about the client's health status, what is another observation the nurse should make? A) Number of rooms in the house B) Safety of the immediate environment C) Frequency of home visits to be made D) Friendliness of the client and family

B) Safety of the immediate environment

The nursing instructor cites a list of skills that support critical thinking in clinical situations. The nurse should describe skills in which of the following domains? Select all that apply. A) Self-esteem B) Self-regulation C) Inference D) Autonomy E) Interpretation

B) Self-regulation C) Inference E) Interpretation

In what type of documentation method would a nurse document narrative notes in a nursing section? A) Problem-oriented medical record B) Source-oriented record C) PIE charting system D) Focus charting

B) Source-oriented record

The staff in a long-term care facility often plays loud rock music on the radio and designs children's games as exercise. What is the staff doing in this situation? A) Considering the hearing level of older adults B) Failing to consider visual deficits that occur with aging C) Ignoring the developmental needs of older adults D) Meeting needs for sensory input and exercise

C) Ignoring the developmental needs of older adults

A nurse is conducting a health assessment for an African American client. What should the nurse consider in terms of cultural sensitivity? A) All individuals, regardless of culture, have the same anatomy and physiology. B) Asking specific questions about race during the health history C) Cultural risk factors for alterations in health and normal racial variations D) Differences in emotional, social, and spiritual basic human needs

C) Cultural risk factors for alterations in health and normal racial variations

A client, unsure of the need for surgery, asks the nurse, "What should I do?" What answer by the nurse is based on advocacy? A) "If I were you, I sure would not have this surgical procedure." B) "Gosh, I don't know what I would do if I were you." C) "Tell me more about what makes you think you don't want surgery." D) "Let me talk to your doctor and I will get back to you as soon as I can."

C) "Tell me more about what makes you think you don't want surgery."

Which statement is true regarding criteria for assuring that a quality control program will be effective? A) The primary purpose of the program is to satisfy various federal and state standards B) Developed standards should reflect minimally acceptable levels so the organization will score well on self-assessment audits C) A belief in the importance of quality control must be integrated through all levels of the organizational hierarchy D) The process should be reactive; in other words, quality improvement efforts should be initiated after problems are identified

C) A belief in the importance of quality control must be integrated through all levels of the organizational hierarchy

An audit of a large, university medical center reveals that four patients in the hospital have current orders for restraints. You know that restraints are an intervention of last resort, and that it is inappropriate to apply restraints to which of the following patients? A) A postlaryngectomy patient who is attempting to pull out his tracheostomy tube B) A patient in hypovolemic shock trying to remove the dressing over his central venous catheter C) A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode D) A patient with depression who has just tried to commit suicide and whose medications are not achieving adequate symptom control

C) A patient with urosepsis who is ringing the call bell incessantly to use the bedside commode

A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse provides care. This nurse's compliance with the nurse practice act demonstrates adherence to which of the following? A) National Council of Nursing's guidelines for care B) National League for Nursing's Code of Conduct C) American Nurses Association's Social Policy Statement D) Department of Health and Human Service's White Paper on Nursing

C) American Nurses Association's Social Policy Statement

What is the nurse's best defense if a client alleges nursing negligence? A) Testimony of other nurses B) Testimony of expert witnesses C) Client's record D) Client's family

C) Client's record

A class of nursing students is in their first semester of nursing school. The instructor explains that one of the changes they will undergo while in nursing school is learning to "think like a nurse." What is the most current model of this thinking process? A) Critical-thinking Model B) Nursing Process Model C) Clinical Judgment Model D) Active Practice Model

C) Clinical Judgment Model

While developing an emergency operations plan (EOP), the committee is discussing the components of the EOP. During the post-incident response of an emergency operations plan, what activity will take place? A) Deciding when the facility will go from disaster response to daily activities B) Conducting practice drills for the community and facility C) Conducting a critique and debriefing for all involved in the incident D) Replacing the resources in the facility

C) Conducting a critique and debriefing for all involved in the incident

Which of the following is one example of a client benefit of using the nursing process? A) Greater personal satisfaction B) Decreased reliance on the nursing staff C) Continuity of care D) Decreased incidence of medical errors

C) Continuity of care

Which of the following statements is true of factors that influence communication? A) Nurses provide the same information to all clients, regardless of age. B) Men and women have similar communication styles. C) Culture and lifestyle influence the communication process. D) Distance from a client has little effect on a nurse's message.

C) Culture and lifestyle influence the communication process.

The IOM Report Health Professions Education: A Bridge to Quality issued a number of challenges to the educational programs that teach nurses and members of other health professions. According to this report, what activity should educational institutions prioritize? A) More clearly delineate each profession's scope of practice during education B) Move toward developing a single health curriculum that can be adapted for any health profession C) Include interdisciplinary core competencies into curricula D) Elicit input from patients and families into health care curricula

C) Include interdisciplinary core competencies into curricula

A nurse has access to computerized standardized plans of care. After printing one for a client, what must be done next? A) Date it and put it in the client's record. B) Sign it and put it in the Kardex. C) Individualize it to the specific client. D) Use it as printed, based on common needs.

C) Individualize it to the specific client.

The care team has deemed the occasional use of restraints necessary in the care of a patient with Alzheimer's disease. What ethical violation is most often posed when using restraints in a long-term care setting? A) It limits the patient's personal safety. B) It exacerbates the patient's disease process. C) It threatens the patient's autonomy. D) It is not normally legal.

C) It threatens the patient's autonomy.

A nurse in a nursing home is writing a note that addresses the care a resident has received during the day and the resident's response to care. What type of note does this represent? A) PIE note B) Flow sheet C) Narrative note D) SOAP note

C) Narrative note

A nurse is documenting information about a client in a long-term care facility. What is used in the home health industry for the Resident Assessment Instrument (RAI)? A) PIE system B) Minimum data set C) OASIS D) Charting by exception

C) OASIS

Medicare uses a prospective payment plan based on diagnosis-related groups (DRGs). What are DRGs? A) Locally supported health care financing, usually by donations B) A public assistance program for low-income individuals C) Predetermined payment for services based on medical diagnoses D) A private insurance plan for subscribers who pay a copayment

C) Predetermined payment for services based on medical diagnoses -Medicare, based on DRGs, pays a hospital a fixed amount that is predetermined by the medical diagnosis or specific treatment rather than by the actual cost of hospitalization and care. This plan was put into effect in an effort to control rising health care costs. It is not supported by donations; it is not a public assistance program or a private insurance plan.

A newly hired nurse is participating in the orientation program for the health care facility. Part of the orientation focuses on the use of the SOAP (subjective, objective, assessment, and plan) method for documentation, which the facility uses. The nurse demonstrates understanding of this method by identifying which of the following as the first step? A) Plan of care B) Data, action, and response C) Problem selected D) Nursing activities during a shift

C) Problem selected -The SOAP method begins by selecting a problem from a list. PIE (problems, interventions, and evaluation) notes incorporate the plan of care into the progress notes. Focus DAR notes organizes entries by data, action, and response. The narrative notes are used to record relevant client and nursing activities throughout a shift.

A man 75 years of age is being discharged to his home following a fall in his kitchen that resulted in a fractured pelvis. The home health nurse makes a home assessment that will be used to design interventions to meet which priority need? A) Sleep and rest B) Support from family members C) Protection from potential harm D) Feeling a sense of accomplishment

C) Protection from potential harm

A group of disaster survivors is working with the critical incident stress management (CISM) team. Members of this team should be guided by what goal? A) Determining whether the incident was managed effectively B) Educating survivors on potential coping strategies for future disasters C) Providing individuals with education about recognizing stress reactions D) Determining if individuals responded appropriately during the incident

C) Providing individuals with education about recognizing stress reactions Ans: C Feedback: In DEFUSING, patients are given information about recognizing stress reactions and how to deal with handling the stress they may experience. Debriefing involves asking patients about their current emotional coping and symptoms, following up, and identifying patients who require further assessment and assistance in dealing with the stress experienced. The CISM team does not focus primarily on the management of the incident or on providing skills for future incidents.

What is the first step in quality control? A) To take corrective action when standards have not been met B) To collect data to determine whether standards have been met C) To determine criteria and standards D) To determine who will measure the standard

C) To determine criteria and standards

Which of the following group of terms best describes the nursing process? A) nursing goals, medical terminology, linear B) nurse-centered, single focus, blended skills C) patient-centered, systematic, outcomes-oriented D) family-centered, single point in time, intuitive

C) patient-centered, systematic, outcomes-oriented

A workplace explosion has left a 40-year-old man burned over 65% of his body. His burns are second- and third-degree burns, but he is conscious. How would this person be triaged? A) Green B) Yellow C) Red D) Black

D Feedback: The purpose of triaging in a disaster is to do the greatest good for the greatest number of people. The patient would be triaged as black due to the unlikelihood of survival. Persons triaged as green, yellow, or red have a higher chance of recovery.

A nurse sees a patient with a diagnosis of anorexia nervosa and orders a diet/nutrition consult. What clinical reasoning skill is used?

CLINICAL JUDGEMENT

Supports the idea that nurses engage in a complex process of clinical reasoning when caring for patients. Nurses draw on personal knowledge and experience from various situations and consider the contextual background of the clinical culture.

CLINICAL JUDGEMENT MODEL

During report, a nurse finds that she has been assigned to care for a patient admitted with an opportunistic infection secondary to AIDS. The nurse informs the clinical nurse leader that she is refusing to care for him because he has AIDS. The nurse has an obligation to this patient under which legal premise? A) Good Samaritan Act B) Nursing Interventions Classification (NIC) C) Patient Self-Determination Act D) ANA Code of Ethics

D) ANA Code of Ethics

Critical thinking concepts, when used in the Nursing Process, will result in________________.

Clinical judgement

A client is having problems with insurance reimbursement. The home health care nurse discusses the client's need for home health services with the insurance company. What role is the nurse demonstrating? A) Direct care provider B) Coordinator of services C) Educator D) Advocate

D) Advocate

The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) are evaluating a large, university medical center according to core measures. Evaluators should perform this evaluation in what way? A) By auditing the medical center's electronic health records B) By performing focus groups and interviews with care providers from numerous disciplines C) By performing statistical analysis of patient satisfaction surveys D) By comparing the center's patient outcomes to best practice indicators

D) By comparing the center's patient outcomes to best practice indicators

A nurse is manually documenting information related to a client's condition. When documenting this information, the nurse makes an error on the manual record sheet. Which is the best technique for recording the error made in documentation? A) Erase the incorrect statement and write the correct one. B) Cross out the wrong statement in a way that is not readable. C) Use correction fluid to obliterate what has been written. D) Cross out the incorrect statement with a single line.

D) Cross out the incorrect statement with a single line.

The nursing instructor is explaining critical thinking to a class of first-semester nursing students. When promoting critical thinking skills in these students, the instructor should encourage them to do which of the following actions? A) Disregard input from people who do not have to make the particular decision. B) Set aside all prejudices and personal experiences when making decisions. C) Weigh each of the potential negative outcomes in a situation. D) Examine and analyze all available information.

D) Examine and analyze all available information.

A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched within the past decade. In this role, the nurse should prioritize which of the following activities? A) Acting as a spokesperson for the nursing profession B) Generating and disseminating new nursing knowledge C) Diagnosing and treating health problems that have a predictable course D) Helping patients to navigate the health care system

D) Helping patients to navigate the health care system.

A case manager has been hired at a rural hospital that has a combined medical-surgical unit. When defining this new role, which of the following outcomes should be prioritized by the hospital's leadership? A) Decreased need for physician services B) Improved patient and family education C) Increased adherence to the principles of EBP D) Increased coordination of health services

D) Increased coordination of health services Case management is a system of coordinating health care services to ensure cost effectiveness, accountability, and quality care. The case manager coordinates the care of a caseload of patients through facilitating communication between nurses, other health care personnel who provide care, and insurance companies.

The nurse is providing care for a patient with chronic obstructive pulmonary disease (COPD). The nurse's most recent assessment reveals an SaO2 of 89%. The nurse is aware that part of critical thinking is determining the significance of data that have been gathered. What characteristic of critical thinking is used in determining the best response to this assessment finding? A) Extrapolation B) Inference C) Characterization D) Interpretation

D) Interpretation

An RN is a supervisor in an organization that has total quality management (TQM) as the backbone of its organizational goals and objectives for quality control. How does the RN practice TQM on the unit? A) Encouraging employees to think of a unit slogan B) Developing a quota system for number of patients cared for C) Explaining to the staff that "if it's not broke, don't fix it" D) Promoting teamwork rather than individual accomplishments

D) Promoting teamwork rather than individual accomplishments

Which of the following interpersonal skills is essential to the practice of nursing? A) Performing technical skills knowledgeably and safely B) Maintaining emotional distance from clients and families C) Keeping personal information among shared clients confidential D) Promoting the dignity and respect of patients as people

D) Promoting the dignity and respect of patients as people

Members of the staff on a hospital unit are critical of a client's family, who has different cultural beliefs about health and illness. A student assigned to the patient does not agree, based on her care of the client and family. What critical thinking attitude is the student demonstrating? A) Being curious and persevering B) Being creative C) Demonstrating confidence D) Thinking independently

D) Thinking independently

Nursing is a profession in a rapidly changing health care environment. What is the most important reason for the nurse to develop critical thinking and clinical reasoning? A) To be able to employ the nursing process in client care. B) The licensing examination requires nurses to be adept at critical thinking. C) Because clients deserve experts who know how to care for them. D) To provide quality care with nursing ability and knowledge.

D) To provide quality care with nursing ability and knowledge.

A care conference has been organized for a patient with complex medical and psychosocial needs. When applying the principles of critical thinking to this patient's care planning, the nurse should most exemplify what characteristic? A) Willingness to observe behaviors B) A desire to utilize the nursing scope of practice fully C) An ability to base decisions on what has happened in the past D) Openness to various viewpoints

D) openness to various veiwpoints

When a team is handling a CODE- what is done post the code?

DEBRIEFING -Debriefing typically occurs 1 to 10 days after the critical incident. Debriefing sessions follow a format similar to the initial defusing session; however, during these sessions, participating staff are encouraged to discuss their feelings about the incident and are reassured that their negative reactions and feelings are normal and that their negative feelings will diminish over time.

ISBARQ

I-Introduction: People involved in the handoff identify themselves, their roles, and their jobs S-Situation: COMPLAINT, DIAGNOSIS, TREATMENT PLAN, PATIENT'S WANTS AND NEEDS B-Background: Vital signs, mental health and codes status, list of medications, and lab results A-Assessment: Current provider's assessment of the situation R-Recommendation: Identify pending lab results and what needs to be done over the next few hours and other recommendations for care Q-Questions and answer: An opportunity for questions and answers

What is QUANTITATIVE RESEARCH?

It involves the concepts of basic and applied research. Is a method of research conducted to gain insight by discovering meanings? At its core is the idea that reality is based on perceptions, which differ for each person and change over time.

Definition of Safety KSA

K—Examine human factors and other basic safety design principles as well as commonly used unsafe practices (e.g., workarounds, dangerous abbreviations). S—Demonstrate effective use of strategies to reduce risk of harm to self or others. A—Value the contributions of standardization and reliability to safety.

Collaborative practice to prevent:

Need to get an order to change the dressing

A clinically trained nurse responsible for the IDENTIFICATION AND REMOVAL OF BARRIERS to timely and appropriate cancer treatment.

Nurse navigator

Tanner's Clinical Judgement Model (REFLECTING)

SAME AS REMEMBERING: attending to patient's responses to nursing action while in the process of acting

What does SBAR stand for?

S - Situation: Complaint, diagnosis, treatment plan, and patient's wants and needs B - Background: Vital signs, mental and code status, list of medications, and lab results A - Assessment: Current provider's assessment of the situation R - Recommendation: Identify pending lab results and what needs to be done over the next few hours and other recommendations for care

What Core Measures does the nurse need to value/have?

Show INITIATIVE -Interprofessional teamwork and team-based practice -Values/ethics for interprofessional practice -Roles and responsibilities for collaborative practice -Interprofessional communication practices

Triggers

Specific resident responses for one or a combination of minimum data set elements that identify residents who either have or are at risk for developing specific functional problems and who require further evaluation using resident assessment protocols.

Utilization guidelines

Specified in state operation manuals that direct when and how to use the RAI.

Resident assessment protocols

Structured, problem-oriented frameworks for organizing minimum data set information and examining additional clinically relevant information about a resident. Resident assessment protocols help identify social, medical, nursing, and psychological problems and form the basis for individualized care planning.

Team STEPPS

Team Strategies and Tools to Enhance Performance and Patient Safety -evidence-based curriculum that trains health care professionals to achieve improved teamwork skills and communication, based upon the assumption that if teamwork improves, quality and safety will also improve.

Purpose of Thinking

The first step: identify the purpose or goal of your thinking. This directing your thoughts toward the goal. The purpose of critical thinking might be to make a judgment about a particular patient or situation or to make a decision about how best to intervene.

Critique of Judgment/Decision

Ultimately, you must identify alternative judgments or decisions, weigh the merits of each, and reach a conclusion. It helps to try to predict the consequences of your major options before concluding your reasoning. You will also want to evaluate the alternative you selected as your decision begins to influence your actions.

Helpful Resources

Wise professionals are quick to recognize their limits and seek help to remedy their deficiencies. Experienced clinicians know that learning is continuous and expect their practice to involve challenges that demand new knowledge. Critical thinkers know what help they need to assist their reasoning and what resources to tap. Key resources include experienced clinicians, texts and journals, institutional policies and procedures, and professional groups and writings.

Moral dilemmas

are situations in which a clear conflict exists between two or more moral principles or competing moral claims, and nurses must choose the lesser of two evils. (report nurses findings concern to provider

National Patient Safety Goals (NPSGs)

areas of patient safety concern identified annually by the Joint Commission that, if rectified, may have the most positive impact on improving patient care and outcomes

Deontologic or Formalist theory:

argues that ethical standards or principles exist independently of the ends or consequences. In a given situation, one or more ethical principles may apply. Nurses have a duty to act based on the one relevant principle, or the most relevant of several ethical principles. Problems arise with this theory when personal and cultural biases influence the choice of the most primary ethical principle

Core measures

benchmark standards of best practices used to gauge how well a hospital gives care to its patients who are admitted to seek treatment for a specific disease (e.g., heart failure) or who need a specific treatment (e.g., an immunization)

When conducting quantitative research, the researcher collects information to support a hypothesis. This information would be identified as: a. The subject b. Variables c. Data d. The instrument

c. Data

Which type of quantitative research is often conducted to examine the effects of nursing interventions on patient outcomes? a. Descriptive research b. Correlational research c. Quasi-experimental research d. Experimental research

c. Quasi-experimental research -Quasi-experimental research is often conducted in clinical settings to examine the effects of nursing interventions on patient outcomes. Descriptive research is often used to generate new knowledge about topics with little or no prior research. Correlational research examines the type and degree of relationships between two or more variables. Experimental research examines cause-and-effect relationships between variables under highly controlled conditions.

Tanner's Clinical Judgement Model (RESPONDING)

deciding on the court of action deemed appropriate for the situation, which may include, NO IMMEDIATE ACTION

Teamwork Collaboration Collaborative practice involves.....

employing multiple health professionals to work together with patients, families, and communities to deliver best practices, which assures best patient outcomes. -INTERPROFESSIONAL TEAMWORK is central to the model

Teleologic theory or consequentialism:

focuses on the ends or consequences of actions. The best-known form of this theory, UTILITARIANISM, is based on the concept of "the greatest good for the greatest number." The choice of action is clear under this theory, because the action that MAXIMIZES GOOD OVER BAD IS THE CORRECT ONE. The theory poses difficulty when one must judge intrinsic values and determine whose good is the greatest. In addition, it is important to ask whether good consequences can justify any amoral actions that might be used to achieve them.

Tanner's Clinical Judgement Model (OBSERVATION & INTERPRETATION)

hallmarks of trained nursing practice

Moral distress

in which one is aware of the correct course of action, but constraints stand in the way of pursuing the correct action.

Potential Problems

learn to "flag" and remedy pitfalls to sound reasoning. Common problems include working with untested or faulty assumptions, accepting an unproven claim or line of argument, allowing bias to color your thinking, and reasoning illogically, such as making a generalization on the basis of a single experience or case or allowing emotion to rule reason. The more familiar you are with these common blocks to critical thinking, the easier it is to detect them in your own thinking.

clinical judgement

refers to the nurse's interpretation and inferences that influence his/her actions in a care-giving setting.

clinical judgement are influenced by....

the context in which the situation occurs and the culture of the nursing care unit

Continuity of care

to ensure that patient and family needs are consistently met as the patient moves from a care setting to home.

Adequacy of Knowledge

you need to judge whether the knowledge you have is accurate, complete, factual, timely, and relevant. If you reason with false information or a lack of important data, it is impossible to draw a sound conclusion. You also want to be sure that you understand all the details relevant to the issue. What is at stake? How much time do you have to make a decision? How much room is there for error?