RNSG 1137 PNC III final exam possible questions for final part 1
14.Evidence Based Practice #1,2,3,4 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)
16 Evidence Based Practice #1,3,4EBP/Interventions to Prevent Central Venous Line Associated Bloodstream Infections 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
What changes can be made to improve hand hygiene? Implement a central line procedure checklist that requires that clinicians perform hand hygiene as an essential step in care.
Post signage stating the importance of hand hygiene. Have soap and alcohol-based hand sanitizers prominently placed to facilitate hand hygiene practices. Model hand hygiene practices. Provide patient and family education and engage family in hand hygiene practices during visitation.
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?
"Client complaining of abdominal pain rated at 8/10."(Subjective data, Objective data, Assessment, Plan)
25 Safety #1, Safety/Establishing an effective nurse-patient relationship on admission 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?
"Tell me about the sexual activity with your boyfriend."
client, unsure of the need for surgery, asks the nurse, "What should I do?" What answer by the nurse is based on advocacy?
"Tell me more about what makes you think you don't want surgery."
Deontology
"sense of duty"
utilitarianism
"the greatest good for the greatest number."
increasing emphasis is placed on health, health promotion, wellness, and selfcare. Wellness involves being proactive and being involved in self-care activities aimed toward a state of physical, psychological, and spiritual well-being. wellness has four components:
(1) The capacity to perform to the best of one's ability, 2) (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.
Nurse Navigator?
A clinically trained nurse responsible for the identification and removal of barriers to timely and appropriate treatment.
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.
ADE
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?
Clinical nurse specialists
S - Situation:
Complaint, diagnosis, treatment plan, and patient's want and needs
Which of the following is one example of a client benefit of using the nursing process?
Continuity of care
15.Evidence Based Practice #1,2,4EBP/Steps to Quantitative Research Process 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?
Correlational research
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?
Independent thinking - do not let the status quo or a persuasive individual control their thinking.
12.HIT #1,2,5 A nurse has access to computerized standardized plans of care. After printing one for a client, what must be done next?
Individualize it to the specific client.
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?
Nursing process
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?
Purpose of thinking
Which type of quantitative research is often conducted to examine the effects of nursing interventions on patient outcomes?
Quasi-experimental research is often conducted in clinical settings
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?
Record an evaluative statement in the client's plan of care.
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?
cleans the wound and applies a dressing
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?
cognitive skills : which is characterized by identifying rationales for plan of care and selecting nursing interventions
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?
cognitive skills, - plan
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?
comprehensive plan of care with maximized potential for success.
Which of the following roles of the nurse is most important in providing continuity of care to clients? Select all that apply.
educator, collaborator , advocate
on admission.
financial needs addressed
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?
interpretation
Which of the following group of terms best describes the nursing process?
patient-centered, systematic, outcomes-oriented
Which of the following interpersonal skills is essential to the practice of nursing?
promoting the dignity and respect of clients as people
Professionalis m #1 ,2 Taylor 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?
safety of the immediate environment.
Resident Assessment Instrument (RAI),
tracks resident's strengths and needs and addresses these in an individualized plan of care by evaluating resident goal achievement and making appropriate revisions in the plan of care - Minimum data set is part of RAI and required in all facilities certified to participate in Medicare or Medicaid
What are maximal sterile barrier precautions? These are implemented during central line insertion:
wearing a cap, mask, sterile gown, and sterile gloves. The cap should cover all hair, and the mask should cover the nose and the mouth tightly. The nurse should also wear a cap and a mask. For the patient, this means covering the patient from head to toe with a sterile drape, enforce use of a central line checklist
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 evidencebased practice?
Clinical expertise is integrated with external evidence.
No restraints, no availability if sitter: Always Obtain Orders from the Physician
Ask family if they can come sit with patients
17 When should hand hygiene be performed in the care of a patient with a central line?
Before and after palpating the catheter insertion site With all dressing changes to the intravascular catheter access site When hands are visibly soiled or contamination of hands is suspected Before donning and after removing gloves
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, B Feedback: The altruistic nurse demonstrates understanding of cultures, beliefs, and perspectives of others; advocates for clients; and takes risks on behalf of clients and colleagues
??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, B, C, E
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, B, E
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, B, E
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, C, D
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, C, D, E
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, D, E
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?
Advocate
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?
American Nurses Association's Social Policy Statement
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?
Ask the care provider to come and assess the client.
When should central lines be discontinued?
Assessment for removal of central lines should be included as part of the nurse's daily goal sheets
As a result of the complexity of care and multiple providers, health care is becoming fragmented. What are the major results of fragmented care
B) Increased medication errors. C) Clients receive more specialized care. D) Lack of continuity of care.
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, C, E
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?
Client focused
What is the nurse's best defense if a client alleges nursing negligence?
Client's record
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?
By examining the way that she thinks and applies reason
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?
By giving a verbal report to nurses in the ICU
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?
Clinical Judgement Model : To depict the process of "thinking like a nurse," Tanner (2006) developed a model known as the clinical judgment model.
A nurse sees a patient with a diagnosis of anorexia and orders a diet/nutrition consult what clinical reasoning skill is used?
Clinical Judgment
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?
Caring - The client needs assistance in performing activities of daily life.
Which antiseptic should be used to prepare the patient's skin for central line insertion?
Chlorhexidine skin antisepsis
What is a systematic way to form and shape one's thinking?
Critical thinking is defined as "a systematic way to form and shape one's thinking.
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?
Cross out the incorrect statement with a single line.
A nurse is conducting a health assessment for an African American client. What should the nurse consider in terms of cultural sensitivity?
Cultural risk factors for alterations in health and normal racial variations
Which of the following statements is true of factors that influence communication?
Culture and lifestyle influence the communication process.
When conducting quantitative research, the researcher collects information to support a hypothesis. This information would be identified as:
Data
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?
Ethical and Legal skills Reporting problems and unacceptable practices is an aspect of 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?
Explain to the daughter the wishes of the client.
Which of the following phrases best describes continuity of care?
Facilitating transition between settings
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.
Federal regulations for health care reimbursement policies. B) Increased emphasis on preventive care. C) Improvement in treatment of illness.
What is the primary focus of health care today?
Health promotion
24 Safety #1,2,3,4 Safety/SBAR Application Safe & Effective Care Environment: Management of Care Which of the following techniques would be most appropriate for the nurse to use when communicating with the health care provider?
ISBAR
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?
Ignoring the developmental needs of older adults
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?
Interpersonally skilled nurses establish and maintain caring relationships that facilitate the achievement of valued goals, and simultaneously affirm the worth of those in the relationship.
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?
It threatens the patient's autonomy.
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?
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?
Mental status
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)?
Minimum data set
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?
Narrative note
10.Ethics/Legal precepts #2,3,6, 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?
Obtain a physician's order to restrain the patient.
2. Clinical Judgement #1,2,3,4 Brunner 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?
Openness to various viewpoints : inherent in critical thinking;
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
P = patient, population, or problem of interest, I = intervention of interest, C = comparison of interest, O= outcome of interest
What step in the nursing process is most closely associated with cognitively skilled nurses?
Planning _ Cognitively skilled nurses are critical thinkers and are able to plan those nursing interventions that are most likely to yield the desired outcomes.
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?
Problem selected - The SOAP method begins by selecting a problem from a list.
Which one of the following methods of documentation is organized around client diagnoses rather than around patient information
Problem-oriented medical record (POMR)
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?
Requiring clients to attend a clinic that is difficult to access, lack of consideration for clients' psychosocial backgrounds.
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?
Restraints should never be applied for staff convenience.
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?
Severe bleeding from a wound
In what type of documentation method would a nurse document narrative notes in a nursing section?
Source-oriented record - health care group keeps data on its own separate form
18 EBP/Steps in Implementing EBP
Step 1: Ask a question about a clinical area of interest Step 2: Collect the most relevant and best evidence.
To develop the critical thinking skills essential to quality nursing practice, nurses find it helpful when posed with a challenge to work methodically through a set of five types of considerations : the purpose of thinking, adequacy of knowledge, potential problems, helpful resources, and critique of judgment/decision ;
The first step: identify the purpose or goal of your thinking. Adequacy of Knowledge : you need to judge whether the knowledge you have is accurate, complete, factual, timely, and relevant. Potential Problems : learn to "flag" and remedy pitfalls to sound reasoning. Helpful Resources : Wise professionals are quick to recognize their limits and seek help to remedy their deficiencies. Critique of Judgment/Decision: Ultimately, you must identify alternative judgments or decisions, weigh the merits of each, and reach a conclusion.
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?
The formal, systematic study of moral beliefs
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?
The nurse collaborating with other members of the health care team
Dependent variable:
The variable being studied, determined as a result of a study
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?
To provide quality care with nursing ability and knowledge.
B - Background:
Vital signs, mental and code status, list of medications, and lab results
11.Using Informatics #1,2,5 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?
Vulnerability to legal liability since nurse's safe, routine care is not recorded
Admission Assessment
ask about culture
Essential components of discharge planning include
assessing the strengths and limitations of the patient, the family or support person, the environment; implementing and coordinating the plan of care; considering individual, family, and community resources; and evaluating the effectiveness of care. Uninterrupted care.
Moral distress,
aware of the correct course of action, but constraints stand in the way of pursuing the correct action.
5. Professionalism Influences on Health Care Delivery All of the following are factors to consider when caring for clients with limited income. Which one is the most important?
basic human needs may go unmet
Moral dilemmas,
choose the lesser of two evils.