RNSG 1413 Exam 1 Chapter REVIEW QUESTIONS
A nurse demonstrated caring by helping family members to: (Select all that apply.)
Become active participants in care. Have uninterrupted time for family and patient to be together. Have opportunities for the family to discuss their concerns.
A nurse is presenting a program to workers in a factory covering safety topics, including the wearing of hearing protectors when workers are in the factory. Which level of prevention is the nurse practicing?
Primary prevention
The nurse in a new community-based clinic is requested to complete a community assessment. Order the steps for completing this assessment.
Structure or locale Population Social systems
A community center is presenting a nurse-led program on the Patient Protection and Affordable Care Act. Which statement made by a participant indicates a need for further teaching?
"As long as my son is a full-time student in college, I will be able to keep him on my health insurance until he is 26 years old."
Which statement made by a nurse shows that the nurse is engaging in an activity to help cope with secondary traumatic stress and burnout?
"I am enjoying my quilting group that meets each week at my church."
Which of the following statements about evidence-based practice (EBP) made by a nursing student would require the nursing professor to correct the student's understanding?
"In evidence-based practice the patients are the subjects."
Which of the following are major public health problems commonly affecting older adults? (Select all that apply.)
Substance abuse Confusional states Financial limitations Acute and chronic physical illnesses
A nurse is educating parents to look for clues in teenagers for possible substance abuse. Which environmental and psychosocial clues should the nurse include? (Select all that apply.)
Blood spots on clothing Long-sleeved shirts in warm weather Changes in relationships Wearing dark glasses indoors
A nurse is reading a research article. The nurse just finished reading a brief summary of the research study that included the purpose of the study and its implications for nursing practice. Which part of the article did the nurse just read?
Abstract
What is the most effective way to control transmission of infection?
Hand hygiene practices
Fill-in-the-Blank. Swanson's caring process of ______ is demonstrated by a nurse helping a new mother through the birthing experience.
enabling
A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits?
Surgeon
You are admitting Mr. Jones, a 64-year-old patient who had a right hemisphere stroke and a recent fall. His wife stated that he has a history of high blood pressure, which is controlled by an antihypertensive and a diuretic. Currently he exhibits left-sided neglect and problems with spatial and perceptual abilities and is impulsive. He has moderate left-sided weakness that requires the assistance of two and the use of a gait belt to transfer to a chair. He currently has an intravenous (IV) line and a urinary catheter in place. Which factors increase his fall risk at this time? (Select all that apply.)
Takes antihypertensive and diuretics History of recent fall Neglect, spatial and perceptual abilities, impulsive Requires assistance with activity, unsteady gait IV line, urinary catheter
Based on the transtheoretical model of change, what is the most appropriate response to a patient who states: "Me, stop smoking? I've been smoking since I was 16!"
"I understand. Can you think of the greatest reason why stopping smoking would be challenging for you?"
After a class on Pender's health promotion model, students make the following statements. Which statement does the faculty member need to clarify?
"Perceived self-efficacy is not related to the model."
As part of a faith community nursing program in her church, a nurse is developing a health promotion program on breast self-examination for the women's group. Which statement made by one of the participants is related to the individual's perception of susceptibility to an illness?
"Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer."
A patient is fearful of upcoming surgery and a possible cancer diagnosis. He discusses his love for the Bible with his nurse, who recommends a favorite Bible verse. Another nurse tells the patient's nurse that there is no place in nursing for spiritual caring. The patient's nurse replies:
"Spiritual, mind, and body connections can affect health."
A nursing student is giving a presentation to a group of other nursing students about the needs of patients with mental illnesses in the community. The nursing professor needs to clarify the student's presentation when the student states:
"The majority of patients with mental illnesses live in long-term care settings."
A patient comes to the local health clinic and states: "I've noticed how many people are out walking in my neighborhood. Is walking good for you?" What is the best response to help the patient through the stages of change for exercise?
"Yes, walking is great exercise. Do you think you could go for a 5-minute walk next week?"
Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples? (Select all that apply.)
Caregiver Autonomy and accountability Patient advocate Health promotion
A hospice nurse sits at the bedside of a male patient in the final stages of cancer. He and his parents made the decision that he would move home and they would help him in the final stages of his disease. The family participates in his care, but lately the nurse has increased the amount of time she spends with the family. Whenever she enters the room or approaches the patient to give care, she touches his shoulder and tells him that she is present. This is an example of what type of touch?
Caring touch
Which of the following nursing activities is provided in a secondary health care environment?
Changing the postoperative dressing for a patient on a medical-surgical unit Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit
A nurse is evaluating a patient who is in soft wrist restraints. Which of the following activities does the nurse perform? (Select all that apply.)
Check the patient's peripheral pulse in the restrained extremity Evaluate the patient's need for toileting Offer the patient fluids if appropriate
Match the advanced practice nurse specialty with the statement about the role.
Clinical nurse specialist - Expert clinician in a specialized area of practice such as adult diabetes care Nurse anesthetist - Provides care and services under the supervision of an anesthesiologist Nurse practitioner - Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients who are healthy or have chronic conditions Nurse-midwife - Provides independent care, including pregnancy and gynecological services
Which of the following family assessments are most important for successful family caregiving? (Select all that apply.)
Collaboration between family members Social support Conflict resolution practices
A family has decided to care for a grandparent with terminal cancer in the daughter's home. Family caregiving is new to the family. When helping this family as they begin to plan for their caregiving roles, what are the two top priority assessments to best learn about family functioning? (Select all that apply.)
Communication Decision making
Using Healthy People 2020 as a guide, which of the following would improve delivery of care to a community? (Select all that apply.)
Community assessment Implementation of public health policies Increased access to care Determining rates of specific illnesses
A nurse researcher is collecting data following approval from the institutional review board (IRB). In which part of the research process is this nurse?
Conducting the study
When recruiting subjects to participate in a study about the effects of an educational program to help patients at home take their medications as ordered, the researcher tells the subjects that their names will not be used and no one but the research team will have access to their information and responses. This is an example of:
Confidentiality
A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take?
Contact a child abuse hotline
Presence involves a person-to-person encounter that:
Conveys a closeness and a sense of caring.
A nurse researcher wants to know which factors are associated with a person's decision to exercise. The nurse distributes a survey to people who recently joined an exercise wellness program and analyzes the data to determine which factors and characteristics are most significantly linked to the decision to start exercising. Which type of a research study is this?
Correlational
Following a community assessment that focused on adolescent health behaviors, a nurse determines that a large number of adolescents smoke and designs a smoking cessation program at the youth community center. This is an example of which nursing role:
Counselor
Arrange the following steps of evidence-based practice (EBP) in the appropriate order.
Create a spirit of inquiry. Ask the burning clinical question. Collect the most relevant and best evidence. Critically evaluate the evidence you gather. Integrate the evidence. Evaluate the practice decision or change. Share the results with others.
A group of nurses have identified that the elderly patients on their unit have a high incidence of pressure ulcers after they have a stroke. During a unit meeting they discuss different interventions that they think may reduce the development of pressure ulcers. What is the nurses' next step to investigate this clinical problem further?
Create a well-defined PICOT question
A woman has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse's responsibility?
More information is needed about the wife's preference and if the husband has her medical power of attorney
A patient is isolated for pulmonary tuberculosis. The nurse notes that the patient seems to be angry, but he knows that this is a normal response to isolation. Which is the best intervention?
Explain the reasons for isolation procedures and provide meaningful stimulation.
A patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.)
Failure to document a change in assessment data Failure to notify a health care provider about a change in the patient's condition
A hospice nurse is caring for a family that is providing end-of-life care for their grandmother, who has terminal breast cancer. When the nurse visits, the focus is on symptom management for the grandmother and helping the family with coping skills. This approach is an example of which of the following?
Family as patient
Which of the following are possible outcomes with clear family communication? (Select all that apply.)
Family goals Decision making Methods of discipline
A family is facing job loss of the father, who is the major wage earner, and relocation to a new city where there is a new job. The children will have to switch schools, and his wife will have to resign from the job she likes. Which of the following contribute to this family's hardiness? (Select all that apply.)
Family meetings Established family roles Willingness to change in time of stress
A Muslim woman enters the clinic to have a woman's health examination for the first time. Which nursing behavior applies Swanson's caring process of "knowing the patient?"
Gaining an understanding of what a woman's health examination means to the patient
How does knowledge of genomics affect patient treatment decisions?
Genomics describes the study of all the genes in a person, as well as interactions of those genes with each other and with that person's environment. Genomic information allows health care providers to determine how genomic changes contribute to patient conditions and influence treatment decisions.
A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nurse manager because this action is a violation of which act?
Health Insurance Portability and Accountability Act (HIPAA)
In viewing the family as context, what is the primary focus?
Health needs of an individual member
During a visit to a family clinic, a nurse teaches a mother about immunizations, car-seat use, and home safety for an infant and toddler. Which type of nursing interventions are these?
Health promotion activities
What is your role as a nurse during a fire? (Select all that apply.)
Help to evacuate patients Shut off medical gases Use a fire extinguisher Direct ambulatory patients
When taking care of patients, a nurse routinely asks if they take any vitamins or herbal medications, encourages family members to bring in music that the patient likes to help the patient relax, and frequently prays with her patients if that is important to them. The nurse is practicing which model?
Holistic
Which of the following Internet resources can help consumers compare quality care measures? (Select all that apply.)
Hospital Compare, Hospital Consumer Assessment of Healthcare
A nursing student is preparing to read the methods section of a research article. Which type of information will the student expect to find in this section? (Select all that apply.)
How the researcher conducted the study The number and type of subjects who participated in the study
Which of the following statements indicate that the new nursing graduate understands ways to remain involved professionally? (Select all that apply.)
I am thinking about joining the health committee at my church." "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing."
The nurse assesses the following risk factors for coronary artery disease (CAD) in a female patient. Which factors are classified as genetic and physiological? (Select all that apply.)
Mother died from CAD at age 48 History of hypertension Elevated cholesterol level
A nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline that the nurse will follow?
A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state.
Which activity shows a nurse engaged in primary prevention?
A school health nurse provides a program to the first-year students on healthy eating.
A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with them. The nurse is acting as the patient's:
Advocate
Two single mothers are active professionals and have teenage daughters. They also have busy social lives and date occasionally. Three years ago they decided to share a house and housing costs, living expenses, and child care responsibilities. The children consider one another as their family. What type of family form does this represent?
Alternative family relationship
A nurse who works on a pediatric unit asks, "I wonder if children who interact with therapy dogs have reduced anxiety when they are in the hospital." In this example of a PICOT question, which of the following is the O?
Anxiety
The family of a patient who is confused and ambulatory insists that all four side rails be up when the patient is alone. What is the best action to take in this situation? (Select all that apply.)
Ask the family to stay with the patient if possible. Inform the family of the risks associated with side-rail use.
An example of a nurse caring behavior that families of acutely ill patients perceive as important to patients' well-being is:
Asking permission before performing a procedure on a patient.
The public health nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2020. In the immigrant community most of the population does not have a primary care provider, nor do they participate in health promotion activities; the unemployment rate in the community is 25%. How does the nurse determine which goals need to be included or updated? (Select all that apply.)
Assess the health care resources within the community. Assess the existing health care programs offered by the county health department. Compare existing resources and programs with Healthy People 2020 goals.
An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, listens to her lung and heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed?
Assessment
Which activity performed by a nurse is related to maintaining competency in nursing practice?
Attending a review course in preparation for a certification examination
The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the Plan-Do-Study-Act (PDSA) model. Which of the following is an example of "Do" from that model?
Based on findings from patients who developed ulcers, implementing an evidence-based skin care protocol
You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. Which is the best nursing action to take first?
Call the nursing supervisor to discuss the situation
A new immigrant family consisting of a grandparent, two adults, and three school-age children has decided to receive their health promotion care at the Community Wellness Center. This is their first visit, and a family assessment, a health history, and a physical of each family member are needed. Which of the following are included in a family function assessment? (Select all that apply.)
Cultural practices Decision making Rituals and celebrations
Health care reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform?
Moving from an acute illness to a health promotion, illness prevention model
A nursing student in the last semester of a baccalaureate nursing program is beginning the community health practicum and will be working in a clinic with a focus on asthma and allergies. What is the primary focus of the community health nurse in this clinic setting? (Select all that apply.)
Decrease the incidence of asthma attacks in the community Increase patients' ability to self-manage their asthma Provide asthma education programs for the teachers in the local schools
You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient with terminal cancer. As part of the preparation you have your classmates read the Nursing Code of Ethics for Professional Registered Nurses. Your instructor asks the class why this document is important. Which of the following statements best describes this code?
Defines the principles of right and wrong to provide patient care
You are the night shift nurse caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the priority nursing action?
Determine from the medical record if the family has been granted permission by the patient to access his or her medical information
A male patient has been laid off from his construction job and has many unpaid bills. He is going through a divorce from his marriage of 15 years and has been seeing his pastor to help him through this difficult time. He does not have a primary health care provider because he has never really been sick and his parents never took him to a physician when he was a child. Which external variables influence the patient's health practices? (Select all that apply.)
Difficulty paying his bills Family practice of not routinely seeing a health care provider
Which type of personal protective equipment are staff required to wear when caring for a pediatric patient who is placed into airborne precautions for confirmed chickenpox/herpes zoster? (Select all that apply.)
Disposable gown N 95 respirator mask Gloves
You are conducting an education class at a local senior center on safe-driving tips for seniors. Which of the following should you include? (Select all that apply.)
Drive shorter distances Drive only during daylight hours Use the side and rearview mirrors carefully Keep a window rolled down while driving if has trouble hearing Look behind toward the blind spot
A patient is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Which type of isolation precaution is most appropriate for this patient?
Droplet precautions
Which of the following most greatly affects a family's access to adequate health care, opportunity for education, and sound nutrition?
Economic stability
You are caring for a family that consists of a father and 3-year-old boy who has well-managed asthma but misses care infrequently. They live in state-supported housing. The father is in school studying to be an information technology professional. His income and time are limited, and he admits to going to fast-food restaurants frequently for dinner. However, he and his son spend a lot of time together. The family receives state-supported health care for his son, but he does not have health insurance or a personal physician. He has his son enrolled in a government-assisted day care program. Which of the following are risks to this family's level of health? (Select all that apply.)
Economic status Underinsured Frequency of fast-food dinners
The nurse spends time with the patient and family reviewing the dressing change procedure for the patient's wound. The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role?
Educator
A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws?
Emergency Medical Treatment and Active Labor Act (EMTALA) without triage completed
A nurse in a community health clinic noticed an increase in the number of positive tuberculosis (TB) skin tests from students in a local high school during the most recent academic year. After comparing these numbers to the previous years, 10% increase in positive tests was found. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community nurse was acting in which nursing role(s)? (Select all that apply.)
Epidemiologist Collaborator
Of the five caring processes described by Swanson, which describes "knowing the patient?"
Establishing an understanding of a specific patient
Vulnerable populations of patients are those who are more likely to develop health problems as a result of:
Excess risks, limits in access to health care services, and dependency on others for care
A nurse researcher studies the effectiveness of a new program designed to educate parents to promote the immunization of children. The nurse divides the parents randomly into two groups. One group receives the typical educational program and the other group receives the new program. This is an example of which type of study?
Experimental
You are caring for a patient who frequently tries to remove his intravenous catheter and feeding tube. You have an order from the health care provider to apply a wrist restraint. Place the steps for applying a wrist restraint in the correct order.
Identify patient using two identifiers. Introduce self and ask patient about his feelings of being restrained. Be sure that patient is comfortable with arm in anatomic alignment. Assess condition of skin where restraint will be placed. Wrap wrist with soft part of restraint toward skin and secure snugly.
On the basis of an assessment, the nurse identifies an increase in the immigrant population group in the community. How would the nurse determine the health needs of this population? (Select all that apply.)
Identify what the immigrant population views as the two most important health needs. Apply information from Healthy People 2020. Determine how the population uses available health care resources. Identify perceived barriers for health care.
A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed?
Implementation
Nurses in an acute care hospital are attending a unit-based education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education?
In-service education
A couple who is caring for their aging parents are concerned about factors that put them at risk for falls. Which factors are most likely to contribute to an increase in falls in the elderly? (Select all that apply.)
Inadequate lighting Throw rugs Multiple medications Doorway thresholds Cords covered by carpets
Some nurses are collecting data to determine how many adolescents attempt suicide in a community. This is an example of what type of community assessment data?
Incident rates
A community nurse in a diverse community is working with health care professionals to provide prenatal care for underemployed and underinsured South African women. Which overall goal of Healthy People 2020 does this represent?
Increase life expectancy and quality of life and to eliminate health disparities.
Which of the following is a strategy for creating work environments that enable nurses to demonstrate more caring behaviors? (Select all that apply.)
Increasing the number of nurses who work each shift to decrease the nurse-patient ratio Providing nursing staff an opportunity to discuss practice changes they can implement to enhance opportunities for patient caring
A critical care nurse is using a computerized decision support system to correctly position her ventilated patients to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which QSEN competency?
Informatics
When a nurse helps a patient find the meaning of cancer by supporting beliefs about life, this is an example of:
Instilling hope and faith.
Listening is not only "taking in" what a patient says, but it also includes:
Interpreting and understanding what the patient means.
A researcher is studying the effectiveness of an individualized evidence-based teaching plan on young women's intention to wear sunscreen to prevent skin cancer. In this study which of the following research terms best describes the individualized evidence-based teaching plan?
Intervention
A patient has an indwelling urinary catheter. Why does an indwelling urinary catheter present a risk for urinary tract infection? (Select all that apply.)
It allows migration of organisms into the bladder. It obstructs the normal flushing action of urine flow.
Which of the following actions by the nurse comply with core principles of surgical asepsis? (Select all that apply.)
Keep the sterile field in view at all times. Consider the outer 2.5 cm (1 inch) of the sterile field as contaminated.
Match the following caring behaviors with their definitions.
Knowing - Striving to understand an event as meaning for another person Being with - Being emotionally there for another person Doing for - Providing for another as he or she would do for themselves Maintaining belief - Sustaining faith in one's capacity to get through a situation
Which of the following are symptoms of secondary traumatic stress and burnout that commonly affect nurses? (Select all that apply.)
Lack of interest in exercise Difficulty falling asleep Lack of desire to go to work Anxiety while working
What is the most common reason for calling on grandparents to raise their grandchildren?
Legal interventions
A patient is worried about her 76-year-old grandmother who is in very good health and wants to live at home. The patient's concerns are related to her grandmother's safety. The neighborhood does not have a lot of crime. Using this scenario, which of the following are the most relevant to assess for safety?
Lighting, locks, clutter, medications
Which of the following statements is true regarding Magnet status recognition for a hospital? Magnet is a special designation for hospitals that achieve excellence in nursing practice.
Magnet is a special designation for hospitals that achieve excellence in nursing practice.
A group of nurses on the research council of a local hospital are measuring nursing-sensitive outcomes. Which of the following is a nursing-sensitive outcome that the nurses need to consider measuring? (Select all that apply.)
Number of patients who develop a urinary tract infection from a Foley catheter Number of patients who fall and experience subsequent injury on the evening shift
The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career?
Nurse researcher
Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the healthcare system?
Patient safety
A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an appropriate goal for restorative care?
Patient will be able to walk 200 feet without shortness of breath.
A nurse is presenting information to a management class of nursing students on the topic of financial reimbursement for achievement of established, measurable patient outcomes. The nurse is presenting information to the class on which topic?
Pay for performance
A nurse knows that the people most at risk for accidental hypothermia are: (Select all that apply.)
People who are homeless. People with cardiovascular conditions. The very old.
A family member is providing care to a loved one who has an infected leg wound. What should the nurse instruct the family member to do after providing care and handling contaminated equipment or organic material?
Perform hand hygiene after care and/or handling contaminated equipment or material.
Many older homes in a neighborhood are undergoing a lot of restoration. Lead paint was used. The community clinic in the neighborhood is initiating a lead screening program. This activity is based on which social determinant of health?
Physical environment
A nurse is conducting a home visit with an older-adult couple. While in the home the nurse weighs each individual and reviews the 3-day food diary with them. She also checks their blood pressure and encourages them to increase their fluids and activity levels to help with their voiced concern about constipation. The nurse is addressing which level of need according to Maslow?
Physiological
The nursing assessment of an 80-year-old patient who demonstrates some confusion but no anxiety reveals that the patient is a fall risk because she continues to get out of bed without help despite frequent reminders. The initial nursing intervention to prevent falls for this patient is to:
Place a bed alarm device on the bed.
A nurse is caring for a patient who recently had coronary bypass surgery and now is on the postoperative unit. Which are legal sources of standards of care that the nurse uses to deliver safe health care? (Select all that apply.)
Policies and procedures of the employing hospital State Nurse Practice Act Regulations identified in The Joint Commission manual The American Nurses Association standards of nursing practice
The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the 314patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)?
Posting medical information about the patient on a message board in the patient's room
A patient registered at the local fitness center and purchased a pair of exercise shoes. The patient is in what stage of behavioral change?
Preparation
At 12 noon the emergency department nurse hears that an explosion has occurred in a local manufacturing plant. Which action does the nurse take first?
Prepare for an influx of patients
Nurses in a community clinic have seen an increase in the numbers of obese children. The nurses who care for children are discussing ways to reduce childhood obesity. One nurse asks a colleague, "I wonder what the most effective ways are to help school-age children maintain a healthy weight?" This question is an example of a/an:
Problem-focused trigger.
Which of these statements are true regarding disinfection and cleaning? (Select all that apply.)
Proper cleaning requires mechanical removal of all soil from an object or area. General environmental cleaning is an example of medical asepsis. Cleaning in a direction from the least to the most contaminated area helps reduce infections.
Which of the following are characteristics of managed care systems? (Select all that apply.)
Provider receives a predetermined payment for each patient in the program. System tries to reduce costs while keeping patients healthy. Focus of care is on prevention and early intervention.
The examination for registered nurse (RN) licensure is exactly the same in every state in the United States. This examination:
Provides a minimal standard of knowledge for an RN in practice.
The nurse caring for a Bosnian community identifies that the children are undervaccinated and the community is unaware of resources. The nurse assesses the community and determines that there is a health clinic within a 5-mile radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources. Which of the following practices is the nurse providing? (Select all that apply.)
Providing community resources for the children Teaching the community about health promotion and illness prevention Improving the health care of the community's children
A family has decided to care for their father who is in the last stages of a debilitating neurological illness. Although he is alert, he cannot speak clearly or carry out self-care activities; he indicates that he wants to remain involved in family life as long as possible and loves spending time with his wife and two teenage children. Which best defines family caregiving? (Select all that apply.)
Providing physical and emotional care for a family member Establishing a safe physical environment for a family Monitoring for side effects of illness and treatments
Which of the following are examples of a nurse participating in primary care activities? (Select all that apply.)
Providing prenatal teaching on nutrition to a pregnant woman during the first trimester Assessing the nutritional status of older adults who come to the community center for lunch Teaching a class to parents at the local grade school about the importance of immunizations
The nurses on a medical unit have seen an increase in the number of medication errors on their unit. They decide to evaluate the medication administration process on the basis of data gained from chart reviews and direct observation of nurses administering medications. Which process are the nurses using?
Quality improvement
A nurse is using data collected from the unit to monitor the incidence of falls after the unit implemented a new fall protocol. The nurse is working in which area?
Quality improvement (QI)
A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient 29correctly. A change is needed quickly. What type of quality improvement method would be most appropriate?
Rapid-improvement event (RIE)
Put the following steps for removal of protective barriers after leaving an isolation room in order.
Remove gloves. Remove eyewear or goggles. Untie waist and neck strings of gown. Remove gown, rolling it onto itself without touching the contaminated side. Untie top and then bottom mask strings and remove from face. Perform hand hygiene.
Your assigned patient has a leg ulcer that has a dressing on it. During your assessment you find that the dressing is saturated with purulent drainage. Which action would be best on your part?
Remove saturated dressing with gloves, remove gloves, then perform hand hygiene and apply new gloves before putting on a clean dressing.
The Collins family includes a mother; stepfather, two teenage biological daughters of the mother; and a 25-year-old biological daughter of the father. The father's daughter just moved home following the loss of her job in another city. The family is converting a study into Stacey's bedroom and is in the process of distributing household chores. When you talk to members of the family, they all think that their family can adjust to lifestyle changes. This is an example of family:
Resiliency
A family is undergoing a major change. Just as twins graduate from college and leave home to begin their careers, the husband loses his executive well-paying job. Because the family had two children in college at the same time, they did not save for retirement. They planned to save aggressively after the children left college. In this situation, which of the following demonstrate family resiliency? (Select all that apply.)
Resuming full-time work when spouse loses job Developing hobbies when children leave home Consulting a financial planner
The nursing assessment of a 78-year-old woman reveals orthostatic hypotension, weakness on the left side, and fear of falling. On the basis of the patient's data, which one of the following nursing diagnoses indicates an understanding of the assessment findings?
Risk for Falls
Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply.)
Taking or selling controlled substances Applying physical restraints without a written physician's order
A nurse enters a patient's room, arranges the supplies for a Foley catheter insertion, and explains the procedure to the patient. She tells the patient what to expect; just before inserting the catheter, she tells the patient to relax and that, once the catheter is in place, she will not feel the bladder pressure. The nurse then proceeds to skillfully insert the Foley catheter. This is an example of what type of touch?
Task-oriented touch
The infection control nurse has asked the staff to work on reducing the number of iatrogenic infections on the unit. Which of the following actions on your part would contribute to reducing health care-acquired infections? (Select all that apply.)
Teaching correct handwashing to assigned patients Using correct procedures in starting and caring for an intravenous infusion Providing perineal care to a patient with an indwelling urinary catheter
A nurse meets with the registered dietitian and physical therapist to develop a plan of care that focuses on improving nutrition and mobility for a patient. This is an example of which QSEN competency?
Teamwork and collaboration
A patient has been newly admitted to a medicine unit with a history of diabetes and advanced heart failure. The nurse is assessing the patient's fall risks. Place the following steps for measuring the "Timed Get-up and Go Test" (TUG) in the correct order:
Tell patient to walk 10 feet as quickly and safely as possible to a line you marked on the floor, turn around, walk back, and sit down. Have patient rise from straight-back chair without using arms for support. Begin timing. Look for unsteadiness in patient's gait. Have patient return to chair and sit down without using arms for support. Check time elapsed.
A patient had surgery for a total knee replacement a week ago and is currently participating in daily physical rehabilitation sessions at the surgeon's office. In what level of prevention is the patient participating?
Tertiary prevention
A nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. What would probably cover the nurse in this situation?
The Good Samaritan law, which grants immunity from suit if there is no gross negligence
What does it mean when a patient is diagnosed with a multidrug-resistant organism in his or her surgical wound? (Select all that apply.)
The antibiotics the patient has received are not strong enough to kill the organism. The organism has developed a resistance to one or more broad-spectrum antibiotics, indicating that the organism will be hard to treat effectively.
Using the Transtheoretical Model of Change, order the steps that a patient goes through to make a lifestyle change related to physical activity.
The individual becomes angry when the physician tells him that he needs to increase his activity to lose 30 lbs. The individual recognizes that he is out of shape when his daughter asks him to walk with her after school. The individual visits the local running store to purchase walking shoes and obtain advice on a walking plan. The individual walks 2 to 3 miles, 5 nights a week, with his wife. Eight months after beginning walking, the individual participates with his wife in a local 5K race.
When should a nurse wear a mask? (Select all that apply.)
The nurse is assisting with an aerosolizing respiratory procedure such as suctioning. The patient is in droplet precautions. The nurse is assisting a health care provider in the insertion of a central line catheter.
A nurse is caring for an older adult who needs to enter an assisted-living facility following discharge from the hospital. Which of the following is an example of listening that displays caring?
The nurse listens to the patient's story while sitting on the side of the bed and then summarizes the story.
A nurse is using the Plan-Do-Study-Act (PDSA) strategy to do a quality improvement project to decrease patient falls on a nursing unit. Place the steps in the correct sequence for PDSA.
The nursing council develops a strategy for bedside change of shift report. Bedside change of shift report is piloted on two medical-surgical units. Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change. After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units.
A patient who has been isolated for Clostridium difficile (C. difficile) asks you to explain what he should know about this organism. What is the most appropriate information to include in patient teaching? (Select all that apply.)
The organism is usually transmitted through the fecal-oral route. Hands should always be cleaned with soap and water versus alcohol-based hand sanitizer. Everyone coming into the room must be wearing a gown and gloves.
A nurse is sued for negligence due to failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.)
The patient must prove injury, damage, or loss occurred. The person filing the lawsuit has to show a compensable damage, such as lost wages, occurred. The patient must prove that a breach in the prevailing standard of care caused an injury.
A patient tells a nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO?
This health plan gives you a list of physicians and hospitals from which you can choose.
A parent calls the pediatrician's office to ask about directions for using a car seat. Which of the following is the most correct set of instructions the nurse gives to this parent?
Toddlers must reach age 2 or the height or weight requirement before they ride forward facing.
A nurse hears a colleague tell a nursing student that she never touches a patient unless she is performing a procedure or doing an assessment. The nurse tells the student that from a caring perspective:
Touch forms a connection between nurse and patient.
A nurse researcher wants to conduct historical research. Which of the following ideas for a study could the nurses conduct? (Select all that apply.)
Understanding how Clara Barton shaped nursing in America Evaluating the effect of the Vietnam War on nursing leadership and practice Analyzing the evolution of nursing and patient care during recent disasters
A patient's surgical wound has become swollen, red, and tender. The nurse notes that the patient has a new fever, purulent wound drainage, and leukocytosis. Which interventions would be appropriate and in what order?
Use aseptic technique to change the dressing. Reassure the patient and recheck the wound later. Notify the health care provider of the patient's status. Support the patient's fluid and nutritional needs.
The nursing staff is developing a quality program. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators (NDNQI) that the nurses can use to measure patient safety and quality for the unit? (Select all that apply.)
Use of physical restraints Pain assessment, intervention, and reassessment Registered nurse (RN) education and certification
The nurse is caring for a patient who is having a seizure. Which of the following measures will protect the patient and the nurse from injury? (Select all that apply.)
With patient on floor, clear surrounding area of furniture or equipment. Do not restrain patient; hold limbs loosely if they are flailing. Never force apart a patient's clenched teeth.
