Taylor Chapter 1 PrepU
The nurse is conducting a class for nursing assistants. One of the students asks the nurse why blood pressure, pulse, and temperature are called "vital signs." Which explanations would the nurse offer the student?
"Because significant deviation from normal is not compatible with life." Temperature, pulse, respirations, and blood pressure are considered the vital signs because significant deviations from normal ranges are not compatible with life.
The nurse is caring for a client who ascribes to the theory of animism. When attempting to explain this theory to other staff members, the nurse should state:
"Everything in nature is alive with invisible forces." rationale: The theory of animism attempts to explain the cause of mysterious changes in bodily functions. This theory is based on the belief that everything in nature is alive with invisible forces and endowed with power. Good spirits bring health; evil spirits bring sickness and death. In cultures that ascribe to animism, the roles of the physician and the nurse are separate and distinct. The physician is the medicine man who treats disease by chanting, inspiring fear, or opening the skull to release evil spirits (Dolan, Fitzpatrick, & Herrmann, 1983). The nurse usually is the mother who cares for her family during sickness by providing physical care and herbal remedies. Pets are not involved in the theory of animism.
The registered nurse is teaching a community health class about illness prevention. Which statement reflects understanding of this concept?
"It is important to enroll in a smoking cessation class." rationale: Enrolling in a smoking cessation class is an example of illness prevention. It will prevent conditions such as asthma and COPD. A hospice evaluation is for someone who is terminally ill. Hypertension is already a disease entity. An ambulance for injury does not denote illness prevention.
The nurse is attempting to provide anticipatory guidance for the parents of an 18-month-old child. Which statement would be best for the nurse to make?
"Keep all medications in a locked cabinet." rationale: Anticipatory guidance provides the parent with information that the child will need as the child continues to grow and develop to promote his or her health. The best example of this is telling the parents to keep all medications in a locked cabinet, as the 18-month-old can climb and reach for medications that were placed high where the parents thought the child could not reach. This could prevent accidental medication overdose. An 18-month-old would have difficulty communicating fears about nightmares to the parents. Reporting the weight is health promotion, which lets the parents know that the child is growing. Telling the parents not to give the child a bottle would be inappropriate as the child should be using a cup at this age.
A BSN nurse is discussing the benefits of a BSN to high school students. Which statement made by the nurse would be most appropriate?
"Many nursing management jobs require a BSN." The best statement by the nurse is that many nursing management jobs require a Bachelor of Science in Nursing (BSN). Nurses that have a BSN work in a variety of settings. An associate's degree in nursing (ADN) program attracts the most men, minorities, and nontraditional students.
A client asks an RN to prescribe a medication for pain. What is the best answer by the nurse?
"Only advanced practice registered nurses have prescriptive authority." rationale: The best answer by the nurse is that only advanced practice registered nurses have prescriptive authority. The registered nurse who is not an advanced practice nurse should not prescribe medications, even over-the-counter medications such as ibuprofen and acetaminophen.
Which nursing actions demonstrate the aim of nursing to facilitate coping? Select all that apply.
-Teaching a client and her family how to live with diabetes -Assisting a client and his family to prepare for death -Providing counseling for the family of a teenager with an eating disorder Coping is another important broad aim of nursing. Nurses facilitate client and family coping for those experiencing altered function, life crisis, and death. Examples of coping would be teaching a client and the client's family about how to live with diabetes. Another example would be assisting a client and the client's family to prepare for death. A third example would be providing counseling for the family of a teenager with an eating disorder. Changing bandages, starting an IV, or teaching a class on an expected health care issue or need would not be examples of the aim of facilitating coping with disability or death.
Nursing is described in various ways. The focus of all nursing interventions should involve which factor? Select all that apply.
-The human experience and responses of individuals, families, and groups -The birth, health, illness, and death of individuals -Advanced through the use of evidence-based practice to ensure the best care
The nurse is performing care for a client in the end stage of cancer. How can the nurse best facilitate the client and family's ability to cope? Select all that apply.
-assist the client with activities of daily living (ALDs) -Assist the client and family with the preparation for end-of-life. -Refer the client and family to hospice services. rationale: Nurses facilitate client and family coping with altered function, life crisis, and death. Altered function decreases an individual's ability to carry out ADLs and expected roles, and it is appropriate for the nurse to assist in a previously independent client role. Nurses facilitate an optimal level of function through maximizing the person's strengths and potentials, through teaching, and through referral to community support systems such as hospice services. Nurses provide care to both clients and families at the end of life, and they do so in hospitals, long-term care facilities, hospices, and homes. Nurses are active in hospice programs, which assist clients and their families in multiple settings in preparing for death and in living as comfortably as possible until death occurs. Informing the family that there is nothing that they can do for their loved one creates further grieving and a feeling of loss and hopelessness.
During the course of any given day of work in the acute care setting, the nurse may need to perform which roles? Select all that apply.
-communicator -counselor -teacher rationale: The roles and functions of the nurse are many and include caregiver, communicator, teacher, counselor, leader, researcher, and advocate. Acting as financier and statistician are not the roles of the nurse.
Which are approved as nursing diagnoses? Select all that apply.
-impaired skin integrity -Caregiver Role Strain -Compromised Family Coping Both congestive heart failure and abdominal hernia are medical diagnoses; the rest are nursing diagnoses.
in what time period did nursing care as we now know it begin?
18th to 19th century rationale: From the middle of the 18th century to the 19th century, social reforms changed the roles of nurses and of women in general. It was during this time that nursing as we now know it began, based on the beliefs of Florence Nightingale.
The nurse is evaluating client health. Which client should the nurse determine to be exhibiting the most signs of health?
A client with a leg amputation who performs activities of daily living with a prosthesis rationale: As defined by the World Health Organization, one's health includes physical, social, and mental components and is not merely the absence of disease or infirmity. Health is often a subjective state—a person may be medically diagnosed with an illness, but still consider himself or herself healthy. The client with an amputation is performing activities of daily living, thereby demonstrating healthy behaviors. A client with diabetes who is refusing to take insulin is in denial of the illness. A client in acute emotional distress related to the spouse's death is experiencing a normal pattern but not demonstrating a healthy behavior. A client with depression who will not get out of bed is also experiencing denial as opposed to a healthy behavior and coping.
After hearing a presentation about the American Nurses Association (ANA), a nurse decides to join the organization based on the understanding that:
ANA aims at fostering high standards of nursing in the United States. rationale: ANA aims at fostering high standards of nursing in the United States. Membership is not open to all nurses in the United States; only registered nurses can become members. Members of the National League for Nursing, not the ANA, include nurses, other health care providers, and lay people. Sigma Theta Tau, not ANA, invites students showing excellence in scholarship to become members.
Which advancement in the nursing profession occurred immediately after World War II?
Advanced nursing education was established.
The first nursing journal owned, operated, and published by nurses was:
American Journal of Nursing rationale: The American Journal of Nursing was first published in 1900 and was owned, operated, and published by nurses. It continues to provide information that may be of interest to nurses in all nursing specialties, and those who practice general nursing. Nurse Educator is a more recently developed journal which specializes in nursing education and targets nurse educators. Nursing Research is also a more recently developed nursing journal with a focus on nursing research and targets nurses interested in research. Standards of Clinical Nursing Practice are directives and guidelines that may be published as books available to nurses for purchase and review. It is not a nursing journal.
The new nursing graduate is concerned about some of the critical changes that will be occurring in nursing. What changes does the nurse anticipate will impact nursing care?
Difficulty for nurses to remain current in a rapidly changing medical and technology environment rationale: The National Advisory Council on Nurse Education and Practice (NACNEP) identifies critical challenges to nursing practice in the 21st century: a growing population of hospitalized clients who are older and more acutely ill, increasing health care costs, and the need to stay current with rapid advances in medical knowledge and technology. Nursing is limitless and, with opportunities for furthering education, there are many various ways nurses can practice. Health costs are rising and there are more citizens needing health care. There is a projected nursing shortage that may be severe and there are no shortages of jobs for nurses.
Which action should the nurse implement when working with a medically homeless client?
Encourage client to utilize the free health care clinic.
The registered nurse is performing a nutritional assessment to ensure that the client's diet is optimal for wound healing. The nurse's intervention can be traced back to which key contributor to nursing?
Florence Nightingale Florence Nightingale's contributions to nursing included the recognition of the importance of nutrition to health. Clara Barton established the Red Cross. Dorothea Dix was a pioneer for reform of treatment for the mentally ill. Linda Richards began the practice of keeping records and writing orders.
The nurse going back to school for nurse midwifery can trace education for nurse midwifery to which nursing leader?
Mary Breckinridge The nurse can trace education for nurse midwifery back to Mary Breckinridge, who established one of the first midwifery schools in the United States. Sojourner Truth and Lavinia Dock worked for the women's movement. Margaret Sanger was the founder of Planned Parenthood.
Which scenario is the best example of a nurse implementing care according to the ANA standards of practice?
Providing nutrition teaching to a client with diabetes According to the ANA standards of practice, standard 5 is implementation. This is when the registered nurse implements the identified plan, coordinates care delivery, and employs strategies to promote health and a safe environment. When providing nutrition education to a client with diabetes, the nurse is implementing the teaching plan. When the nurse is analyzing a client's blood glucose level or taking a pulse rate, the nurse is performing the standard related to assessment. When the nurse is determining that a client is at risk for falls, the nurse is implementing the standard relating to diagnosis.
Which nursing intervention would be most appropriate for a new mother that calls the nursery for help with breastfeeding?
Refer the mother for a home care visit. rationale: It is the role of the nurse to encourage health promotion by providing information and referrals; therefore, the nurse should refer the mother for a home care visit, as this will enable the mother to receive all of the breastfeeding help that is needed. Emailing a link for breastfeeding provides information, but not the support that is needed if a mother is having difficulty with breastfeeding. Suggesting bottle feeding and/or going to the emergency room is inappropriate and does not encourage using available resources.
The nurse conducts a home safety assessment for a client. Which statement best explains the standard of care being implemented?
The RN promotes a safe environment. rationale: The standard of care being exemplified is standard 5b: health teaching and promotion: The RN employs strategies to promote health and a safe environment. Standard 3, which is outcomes identification, involves the registered nurse identifying expected outcomes for a plan individualized to the health care consumer or the situation. Standard 12 is education, in which the registered nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking. Standard 4 is planning, in which the registered nurse develops a plan that prescribes strategies and alternatives to attain expected, measurable outcomes.
Which is the best example of a client-centered approach to care?
The nurse asks the client about health goals. rationale: Client-centered care is one of the quality and safety education requirements for nursing competencies (QSEN). The intent of client-centered care is to ensure that care is centered on the client, and not the needs of the nurse. An example of this is the nurse asking the client about personal health goals so that they can be addressed on the client's plan of care. Helping the client ambulate, asking the client what he or she would like from the menu, and drawing a blood sample are examples of client care, but are not client-centered care.
The American Nurses Association (ANA) Standards of Professional Nursing Practice provides standard of care for all nurses. Which statement on the assessment of the nursing process is accurate?
The nurse collects comprehensive data pertinent to the client's health or situation. rationale: The nursing process is used for all nurses as the standard of care. In the assessment phase, the RN collects comprehensive data pertinent to the client's health or situation. In the diagnosis phase, the RN analyzes the assessment data to determine the diagnoses or issues pertinent to the client. Next the RN identifies expected outcomes for a plan individualized to the client or the situation and develops a plan that prescribes strategies and alternatives to attain expected outcomes. The nurse does not dictate the plan. The RN implements the identified plan. This includes coordination of care, health teaching and health promotion, consultation, and prescriptive authority and treatment. Finally, in the evaluation phase, the RN evaluates progress toward attainment of outcomes. From the ethical standpoint, the nurse advocates for the client and makes sure that ethical standards are upheld, but this is not part of the nursing process.
A registered nurse wishes to work as a nurse researcher. Which is true regarding nurse researchers?
They are responsible for the continued development and advancement of nursing. rationale: Nursing research requires extensive education and is a uniquely specialized field. Nurse researchers are responsible for the continued development and refinement of nursing. They usually have advanced education post baccalaureate degree in nursing and most often work in large teaching hospitals or research centers. Nurse administrators, not nurse researchers, serve as liaisons between staff members and directors of nursing, Nurse researchers may be found with a school of nursing at academic institutions, but not at community health centers and long-term care units.
The need for university-based nursing education programs was brought to light during which important historical time?
WW2 rationale: During the middle of the twentieth century, Esther Lucile Brown, in her report on nursing education published at that time, wrote that nursing education belonged in colleges and universities, not in hospitals. During the Spanish-American War, nursing was still in its earliest phase of development. Even with the input of Florence Nightingale and her followers after WWI, nursing continued to struggle. Professional nursing began during the period and crisis needs of WWII. Nursing continues to evolve today.
The RN is working with hospital administrators to transform care at their facility. Which nursing competency will be critical for the nurse to utilize?
Work effectively in interdisciplinary teams rationale: The RN working with administrators to transform care will need to be able to work effectively as part of an interdisciplinary team. The nurse will need to work as a team member with members of the administration, as well as representatives from other health disciplines involved in the project. The ability to use and troubleshoot equipment and to navigate the electronic medical records are important to the nurse, but will not necessarily help when working with administration to transform care. Doing things the way they have always been done is a barrier to transformation of care.
Establishing the criteria for the education and licensure of nurses is a component of:
a state's nurse practice act. rationale: Although nurse practice acts vary from state to state, they typically specify the criteria for the education and licensure of nurses. The American Nurses Association Standards of Practice and Healthy People 2030 do not address such legal and licensure issues. The philosophy of evidence-based practice does not encompass specific criteria for educating and licensing nurses.
A nurse must possess several characteristics to be successful in this profession. Secondary to critical thinking skills, which is of great value?
advocating for the client at all times Nursing is caring, commitment, and dedication to meeting the health needs of all people. Nurses direct care to promote, maintain, and restore health in various settings. They are prepared to identify and to assist with the health care needs of individuals, families, communities, and populations. Advocating for the client is an essential skill needed. A RN does not need to have a masters degree to advocate. Any healthcare provider can delegate responsibilities. A nurse can learn to work with teams and team build as necessary.
Which organization has established standards that help the nurse determine which clinical actions fall under the scope of nursing practice?
american nurses association rationale: The American Nurses Association (ANA) has established standards of clinical nursing practice that define the specific and unique activities of nurses. Standards serve as protection for the nurse, the client, and the institution where health care is given. The other organizations provide valuable services that differ from those of ANA. The National Council of State Boards of Nursing have the nurse practice acts which define state specific guidelines for nurses to practice. The National League for Nursing is a national organization for faculty nurses and leaders in nurse education. The International Council of Nurses is a federation of more than 130 national nurses associations.
A nurse is considering relocating to another state to practice nursing. Which is the most appropriate action by the nurse to ensure ability to practice in the new state?
applying for a reciprocal license in the new state rationale: Nurses gain legal rights to practice nursing in another state by applying to that state's board of nursing and receiving reciprocal licensure. The nurse does not need to retake the licensure exam. The nursing licenses are not transferable.
The nurse is caring for a client with a new diagnosis of cancer, and allows the client to verbalize fears relating to how to tell the children. The nurse's intervention reflects which aspect of nursing?
art of nursing rationale: In this example, the nurse is utilizing a holistic approach to the provision of nursing care based on the knowledge of providing psychosocial interventions, such as allowing the client to verbalize feelings/fears. This application of knowledge is the art of nursing. The science of nursing is the knowledge base for the provision of care. Evidence-based practice and application of research are using research to make decisions on how to care for clients.
The nurse is caring for a client who cannot meet health needs independently. Which action made by the nurse depicts concern and attachment?
asking the client, "How are you today? I am really worried about you." rationale: Concern and attachment are the result of a close relationship of one human being with another. Thus, asking the client how the client is feeling and expressing concern exemplifies caring. Stability and security, communication and teaching, and organization and evaluation are physical care themes that are part of nursing care.
The nursing process includes step(s)? Select all that apply.
assess plan implement evaluate also diagnose rationale: The nursing process consists of assessing the client, planning the client's care, implementing the planned interventions, and evaluating the effectiveness of those interventions. Prescribing is not a part of the nursing process.
A nurse mentoring second-year nursing students from a community college plans clinical experiences for them. These students will most likely graduate in which time frame?
at the end of the year rationale: Nursing students from a community college are most likely students attempting to obtain an associate degree, which is a 2-year program. Therefore, the nurse should plan clinical experiences for students who will most likely graduate at the end of the year, as this is their second year.
A client is very upset after being told by the health care provider that test results confirm a diagnosis of colon cancer. Which action should the nurse consider most important when answering questions from this client?
avoid offering personal opinion to which action to take next rationale: It is very important for the nurse to always avoid offering his or her own personal opinion when discussing the situation with a client. The nurse should provide pertinent information without offering specific advice but allow the client to make his or her own decision. The nurse should provide the necessary information to allow the client to make up his or her own mind and support the client's final decision.
A nurse is planning to pursue further education in the hopes of becoming an expert in geriatric nursing who carries out direct care. For which expanded career role is the nurse preparing?
clinical nurse specialist rationale: Clinical nurse specialists are nurses with an advanced degree who are considered experts in a specialized area of care. They also provide direct care, consultation, and education of clients, families, and staff. Nurse managers do not normally provide direct care. Nurse-midwives specialize in obstetrical care. Physician assistants are not nurses.
During World War II, nurses were actively recruited and enlisted in the military. What effect did this have on the nursing profession?
caused a civilian nursing shortage rationale: During World War II, when many registered nurses enlisted in the military, civilian hospitals, clinics, schools, and other health care agencies faced an acute shortage of nurses. To fill the void expeditiously, abbreviated programs in practical nursing were developed across the country to teach essential nursing skills.
A registered nurse plans to return to the nursing profession after a long hiatus. Which statement about the trend in health care services would be most important for the nurse to keep in mind?
clients enter the healthcare system acutely ill These days, clients enter the health care system acutely ill. Hospital stays are much shorter, not longer. Nurses in the past relied on intuition to make decisions. Today, they have specific knowledge developed through research and evidence-based practice. The health care delivery system is more, not less, controversial now.
A client is brought to the emergency department with a head injury following an all-terrain vehicle (ATV) accident. The nurse asks the family members to describe how the accident occurred. The nurse is implementing which ANA standard?
collaboration rationale: According to the ANA Standard 13 - Collaboration, the registered nurse collaborates with the client, family, and others in the conduct of nursing practice. Standard 2 - Diagnosis states that the registered nurse analyzes the assessment data to determine the diagnoses or issues. Standard 6 - Evaluation states that the registered nurse evaluates progress toward attainment of outcomes. Standard 8 - Education pertains to the registered nurse attaining knowledge and competence that reflects current nursing practice.
The nurse is caring for a postoperative client. The health care provider has written a prescription for a pain medication, and the prescription gives a dosage range for the amount the nurse may give depending on the severity of the client's pain. This type of functioning within the health care team is called:
collaborative functioning rationale: Nurses manage collaborative problems using both nurse- and health care provider-prescribed interventions to reduce the risk of complications. In this situation, the nurse is not operating authoritatively or independently, but within the parameters established by the health care provider. The nurse is not merely acting in an assistive capacity, as the nurse is performing interventions in the absence of the health care provider.
The primary aim of the Healthy People 2030 initiative is:
health promotion rationale: Healthy People 2030 establishes health promotion guidelines for the nation as a whole. The guidelines contain Leading Health Indicators, which are used to measure the health of the nation over a 10-year period. Illness prevention, health restoration, and coping with disability are components of the Healthy People 2030 guidelines, but are not considered as the primary goal of the initiative.
Which scenario is the best example of the nurse implementing the ANA standard relating to diagnosis?
determining a client at risk for falls rationale: When the nurse is implementing the ANA standards relating to diagnosis, the nurse analyzes the assessment data (e.g., lab results, apical pulse) to determine a nursing diagnosis or issue to be addressed by nursing. Determining a client is at risk for falls is an example of the nurse identifying/diagnosing a nursing issue. Assessing a client's apical pulse is assessment. Evaluating a client's laboratory results is part of analysis. Teaching a diabetic client to inject insulin is an intervention.
When administering immunizations, the nurse is engaged in:
illness prevention rationale: The aim of illness prevention activities is to reduce the risk for illness, to promote good health habits (health promotion), and to maintain optimal functioning. Immunization administration is an example of illness prevention. Assisting with crutch-walking and teaching medication administration are examples of health restoration activities, which encompass early detection of a disease and rehabilitation. Hospice care is an example of facilitating coping with disability and death.
Due to the rising cost of health care services, many procedures and treatments are being delivered in what type of setting?
outpatient facilities Many procedures and treatments are being delivered in outpatient settings because hospital and medical center stays significantly increase health care costs to the client and/or insurance company. "Community health care centers" typically refers to facilities such as day care centers or ambulatory clinics.
A nurse manager is teaching staff how to use a new piece of hospital equipment. Which educational setting would be most appropriate for this process?
in-service education rationale: In-service education is designed to increase the knowledge and skills of the nursing staff. Education about a new piece of hospital equipment would fall into this category. Continuing education is educational experiences designed to enrich the nurse's contribution to health. Many state nursing organizations require continuing education hours to maintain licensure. Undergraduate studies are the educational programs for pre-licensure in the field of nursing. For the nurse, this could be a diploma, associate degree, or baccalaureate in nursing. Graduate education would include the educational programs for the advanced practice nurse. This could be master's degree or doctoral preparation.
What was one barrier to the development of the nursing profession in the United States after the Civil War?
lack of educational standards A lack of educational standards was one barrier to the development of the nursing profession after the Civil War. Other barriers included a male dominance of health care and the pervading belief that women were dependent on men.
The client's plan of care is created by the nurse using which guideline for nursing practice?
nursing process Nursing process is used to identify the client's strengths, limitations, and health care needs, to formulate a plan of care to address the health care needs, to implement that plan of care, and to evaluate the effectiveness of the plan to achieve established outcomes. The ANA Standards of Nursing Practice defines the activities of nurses that are specific and unique to nursing. Nurse practice acts are laws established by each state to regulate the practice of nursing. Nursing's Social Policy Statement describes the values and social responsibility of nursing, provides a definition and scope of practice for nursing and nursing's knowledge base, as well as the methods by which nursing is regulated.
A prospective nursing student desires a career that will allow the opportunity to provide client care and to assist professional nurses with routine technical procedures. The prospective student needs to be employed in a full-time position quickly due to economic hardship. What type of nursing program would best suit this student?
licensed or vocational nursing program rationale: A licensed practical or vocational nursing program will allow the student to earn a technical certificate in 1 year and sit for the state board of nursing examination to be licensed as an LPN or LVN. This would allow employment that will allow the graduate to provide client care and to assist professional nurses with routine technical procedures as desired. An associate program will take 2 years and a baccalaureate program will take 4 years; additionally these prepare new nurses to work in a more independent role than this person is seeking. There are very few diploma programs remaining in the U.S., and these programs typically take 3 years to complete.
In the role of entrepreneur, the nurse's primary responsibility is:
managing a health-related business rationale: A nurse entrepreneur is primarily concerned with organizing, developing, and managing a clinic or health-related business. Although a nurse entrepreneur may also administer resources, manage personnel, and teach, the primary responsibility of this role is managing a health-related business. A nurse administrator is primarily concerned with administering resources and managing personnel. A nurse educator is primarily concerned with teaching in a clinical setting.
For the nurse to become a nurse practitioner, what is the minimal degree the nurse will need to acquire?
master's rationale: A master's degree is the minimal degree for a nurse to become a nurse practitioner. Diploma, associate, and baccalaureate degrees are the minimal degree for an RN.
Which advanced nurse practitioner is specifically qualified to provide prenatal care for a pregnant client?
nurse-midwife rationale: A nurse-midwife provides prenatal and postnatal care and also delivers newborns for clients with uncomplicated pregnancies. A nurse anesthetist carries out preoperative visits and assessments; administers and monitors anesthesia during surgery; and evaluates the postoperative status of clients. A clinical nurse specialist is considered to be an expert in a specialized area of nursing and carries out direct client care; consultation; teaching of client, families, and staff; and research. A nurse educator teaches in educational or clinical settings, teaches theoretical knowledge and clinical skills, and conducts research.
What might a nurse need to do to ensure the continuation of his or her nursing license?
obtain continuing education credits rationale: In many states, continuing education is required for an RN to maintain licensure. These are defined as professional development experiences designed to enrich the nurse's contribution to health. Obtainment of an ongoing degree is not necessary to maintain licensure. While hospital in-services may provide continuing education, not all in-services are designed to do so.
Which is the best example of a nurse demonstrating the role of caregiver?
starting an intravenous line in the client's arm rationale: In the role of caregiver, the nurse provides care to clients to meet their needs, such as when starting an intravenous line. The role of caregiver is the primary role of the nurse. Teaching a client about medication is the role of educator. Telling a doctor a lab value is the role of communicator. Securing a referral to the local clinic is the role of counselor. Assigning rooms is a management role.
The registered nurse communicates with the physical therapist that a client is now on strict bed rest due to bradycardia. Which statement best explains the standard exemplified by the nurse?
the RN coordinates care delivery rationale: There are 12 Standards of Practice: assessment, diagnosis, outcomes identification, planning, implementation, evaluation, ethics, culturally congruent practice, communication, collaboration, leadership, and education. The standard exemplified by the nurse is 5a, implementation via coordination of care in which the RN coordinates care delivery. Standard 5b is health teaching and health promotion in which the registered nurse employs strategies to promote health and a safe environment. Standard 3 is outcomes identification, in which the registered nurse identifies expected outcomes for a plan individualized to the health care consumer or the situation. Standard 2, diagnosis, is when the registered nurse analyzes the assessment data to determine the actual or potential diagnoses, problems, and issues. Standard 1 is assessment, in which the registered nurse collects pertinent data and information relative to the health care consumer's health or the situation.
A nurse is providing care for clients in a long-term care facility. What should be the central focus of this care?
the client receiving the care rationale: The client receiving the care is always the central focus of the nursing care provided. The central focus is not the nurse, the nursing actions, or nursing as a profession.
The nurse is utilizing knowledge about a blood pressure medication's actions and side effects to determine whether or not to give a client, whose blood pressure is low, the prescribed blood pressure medication. What best describes the aspect of nursing demonstrated?
the science of nursing rationale: The science of nursing is the knowledge base for the care provided by the nurse. In this example, the nurse is using this knowledge base to decide how best to care for the client by giving or not giving the blood pressure medication. The art of nursing is the application of the knowledge. In this example, it would be demonstrated by the nurse actually giving or holding the medication. Quality improvement activities and the conduction of research influence the science and the art of nursing by helping build the body of knowledge that is the science of nursing.
The nurse is caring for a client after a stroke rendered the client's right side weaker than the left. The nurse coordinates the plan of care with the physical therapist. The nurse's interventions reflect which one of nursing's four broad goals?
to restore health rationale: The four broad aims of nursing practice are to promote health, prevent illness, restore health, and facilitate coping with death and/or disability. In the example, the nurse is coordinating care with the other disciplines in an attempt regain some of the strength in the client's right side. This is an example of restoring a client's health. The nurse is not preventing the stroke or promoting health prior to the stroke. The nurse is not facilitating coping with the stroke.
