C7 term 4 exam 2

When planning to evaluate a patient's satisfaction with a teaching activity, the most appropriate strategy would be to a. include a survey instrument. b. observe for level of skill mastery. c. present information more than one time. d. provide for a return demonstration.

ANS: A A survey or questionnaires can be used to measure affective behavior change as well as patient satisfaction with the teaching experience. Observing for level of skill mastery would evaluate achievement of a psychomotor goal rather than satisfaction with the experience. Repeating information more than one time or in more than one way may be appropriate strategies to include in the teaching plan but would provide no evaluation data. Providing for a return demonstration would help in evaluating achievement of a psychomotor goal, not satisfaction with the activity.

In determining patient goals, the nurse should complete which action? a. Allow patients to identify what is most important to them. b. Take the lead and determine what is best for the patient. c. Focus on health promotion and staying healthy. d. Explain the importance of avoiding complications.

ANS: A As health care educators, nurses should allow patients to identify what is most important to them. If a newly diagnosed diabetic patient is interested in learning techniques of care that will allow discharge to home rather than to an extended care facility, the patient is more likely to be receptive to learning about self-monitoring blood sugar levels. After the learning goals related to the issues that the patient feels are a priority have been met, the patient may then be able to focus on health promotion and avoiding complications.

Aspects of safety culture that contribute to a culture of safety in a health care organization include a. communication. b. fear of punishment. c. malpractice implications. d. team nursing.

ANS: A Aspects that contribute to a culture of safety include leadership, teamwork, an evidence base, communication, learning, a just culture, and patient-centered care. Fear of professional or personal punishment and concern about malpractice implications are considered barriers to a culture of safety. No model of nursing care has been related to a culture of safety.

A nursing instructor assigns their clinical group the task of writing a journal depicting the student's clinical day. What is the most likely rationale for this assignment? a. Journaling allows reflection, an important critical thinking skill. b. Journaling gives you time to review what happened in your clinical. c. Journaling is a way to organize your thoughts about your experiences. d. Journaling teaches open-mindedness, a critical thinking disposition.

ANS: A Critical thinking requires reflection on what occurred, how data were processed, and how decisions were made. Journaling is one method of developing critical thinking skills. Journaling does give nurses time to review what happened in their clinical, but this statement does not go far enough in explaining the importance of the journal-writing process. Journaling may be a way to organize thoughts about one's experiences, but this statement is too narrow an explanation and does not account for the critical aspect of reflection. Open-mindedness is a critical thinking disposition that allows one to be tolerant of divergent views. Journaling can assist with developing this disposition, but only if what is written reflects that specific topic.

A home care nurse receives a physician order for a medication that the patient does not want to take because the patient has a history of side effects from this medication. The nurse carefully listens to the patient, considers it in light of the patient's condition, questions its appropriateness, and examines alternative treatments. This nurse would most likely a. call the physician, explain rationale, and suggest a different medication. b. consult an experienced nurse on whether there are other similar treatments. c. hold the drug until the physician returns to the unit and can be questioned. d. question other staff as to the physician's acceptance of nursing input.

ANS: A Determining how best to proceed on behalf of a patient's best health care outcomes may require clinical judgment. At the committed level of critical thinking, the nurse chooses an action after all possibilities have been examined. A home care nurse who is using good clinical judgment techniques should have confidence in their decision and may not have another nurse available as this is an autonomous setting. Holding the drug might jeopardize the patient's health, so this is not the best solution. The nurse working at this level of critical thinking makes choices based on careful examination of situations and alternatives; whether or not the physician is open to nursing input is not relevant.

Exemplars of the health informatics concept include a. clinical research informatics. b. hardware and software. c. privacy and security. d. standard terminology.

ANS: A Exemplars of the health informatics concept include clinical health care informatics, clinical research informatics, public/population health informatics, and translational bioinformatics. Hardware and software, privacy and security, and standardized information systems and terminology are considered attributes related to the concept, not exemplars.

The nurse has established a teaching plan including goals and identifies this type of education is termed by what term? a. Formal teaching b. Informal teaching c. Psychomotor teaching d. Affective teaching

ANS: A Formal patient education is delivered throughout the community in the form of media, in a variety of educational and group settings, or in a planned, goal-directed, one-on-one session with a patient in the acute care setting. Informal education is usually learner or patient directed. The psychomotor domain incorporates physical movement and the use of motor skills in learning. Teaching the newly diagnosed diabetic how to check blood sugar is an example of a psychomotor skill. Affective domain learning recognizes the emotional component of integrating new knowledge. Successful education in this domain takes into account the patient's feelings, values, motivations, and attitudes.

A nurse is discharging a patient and is planning on what material to give the patient to take home. What action by the nurse is best? a. Assess the patient's ability to read and understand. b. Determine if the patient wants to take written material home. c. Give the patient the same material as other patients get. d. Ask the patient if he/she has a need for written material.

ANS: A Health literacy in an important concept in health. If the patient cannot read or comprehend written material, it will be of limited use. The nurse first assesses the patient's ability to read and comprehend written material before choosing the material with which to send him/her home. Patients may or may not realize what they need for discharge, if anything. Giving the patient the same material other patients get does not acknowledge their need for holistic and individualized care.

A hospital is experiencing a drop in patient admissions, resulting in the implementation of a hiring freeze. What is a potential critical consequence of this internal organizational decision? a. A decrease in the availability of future nurses to hire b. A savings of salaries and benefits c. Increased scholarships to nursing students from the local high school d. Increased cross-training of current staff

ANS: A In an economic climate where hospitals are not hiring, nursing schools may limit enrollment which will limit the availability of future nurses available to be hired when the current nurses retire or reduce their hours. Salary savings is minimal as the number of patients, staffing, and revenue are closely aligned. Scholarships will decrease as hiring commitments to scholarship holders will no longer be in effect. Cross-training may occur, but it is not a critical consequence of a hiring freeze.

Understanding cultural differences in health care is important because it will help the nurse to understand the manner in which people decide on obtaining treatments and medical care. In independent cultures an individual will a. put himself first. b. consult family members for advice. c. ask for a second opinion. d. travel great distances to receive the best care.

ANS: A In independent cultures, an individual will put himself first in the case of a life-threatening illness, whereas even in dire circumstances, members of collectivist cultures may still consult other family members for the best course of action. In independent cultures, an individual will not consult with other family members, ask for a second opinion, or travel great distances to receive the best care.

A new graduate nurse (GN) is working with an experienced nurse to chart assessment findings. The GN notes that the physical therapist wrote on the chart that the patient is lazy and did not want to participate in assigned therapies this AM. The experienced nurse asks the GN what may be going on here. What is the best explanation for this statement? a. Data on the chart can sometimes be documented in a biased manner. b. Data on the chart changes as the patient's condition changes. c. Data on the chart is usually accurate and can be verified from the patient. d. Reading the chart is not a wise use of time as this can be time consuming and tedious.

ANS: A It is important that the nurse records only what is assessed, without adding judgments or interpretations to the record. Data do indeed change (and need to be charted) as the patient's condition changes, but this would not be the best answer to this question. Assessment data may at times be difficult to obtain, but that would not occur often enough to warrant a warning about the difficulty in charting it. Also, obtaining data is clearly a different activity from charting it. Charting can be time consuming and tedious, but this is not the most complete answer to this question.

A student nurse is studying clinical judgment theories and is working with Tanner's Model of Clinical Judgment. The student nurse can generalize the process as a. a reflective process where the nurse notices, interprets, responds, and reflects in action. b. one conceptual mechanism for critiquing ideas and establishing goal-oriented care. c. researching best practice literature to create care pathways for certain populations. d. assessing, diagnosing, implementing, and evaluating the nursing care plans.

ANS: A Looking across theories and definitions of clinical judgment, they all have in common the ability to reflect on data and choose actions. Reflection also considers evaluating the result of the actions to determine whether they were effective. Although critiquing ideas and establishing goal-oriented care could be considered part of a generalized statement of critical thinking, this is not broad enough without the reflection and evaluation. Clinical judgment would most likely be used to create care paths derived from the evidence; however, this is not the cornerstone of the Tanner Model. Clinical judgment is used when engaging in the nursing process, but this is too narrow in focus to capture the essence of critical thinking definitions and theories. Critical thinking is not synonymous with the nursing process.

A nurse has committed a serious medication error and has reported their error to the hospital's adverse medication error hotline as well as to the unit manager. The manager is a firm believer in developing critical thinking skills. From this standpoint, what action by the manager would best nurture this ability in the nurse who made the error? a. Have the nurse present an in-service related to the cause of the error. b. Instruct the nurse to write a paper on how to avoid this type of error. c. Let the nurse work with more experienced nurses when giving medications. d. Send the nurse to refresher courses on medication administration.

ANS: A Nurturing critical thinking skills is done in part by turning errors into learning opportunities. If the nurse presents an in-service on the cause and prevention of the type of error committed, not only will the nurse learn something but many others nurses on the unit will learn from it to. This is the best example of developing critical thinking skills. This option would allow the nurse to learn from the mistake, which is a method of developing critical thinking skills, but the paper would benefit only the nurse, so this option is not the best choice. Letting the nurse work with more experienced nurses might be a good option in a very limited setting, for example, if the nurse is relatively new and the manager discovers a deficiency in the nurse's orientation or training on giving medications in that system. Otherwise, this option would not really be beneficial. Sending the nurse to refresher courses might be a solution, but it is directed at the nurse's learning, not critical thinking. The nurse might feel resentful at having to attend such classes, but even if they were helpful, only this one nurse is learning. Going to generic classes also does not address the specific reason this error occurred, and thus might be irrelevant. Critical thinking and learning can be enhanced by a presentation to the staff on the causes of the error.

The nurse understands ongoing evaluation of patient education occurs by which team member? a. Each member of the health care team who provides teaching b. The nurse who evaluates the patient's physical abilities c. The patient stating that he understands the instruction d. Not allowing review from the provider so the focus remains forward

ANS: A Ongoing evaluation of patient education occurs by each member of the health care team who provides teaching according to the patient's teaching plan. Having the learner repeat what has been learned can help the nurse evaluate the teaching plan and adjust the plan for future patient education sessions. Future sessions should review what was learned previously and continue to add to what has been taught. Health care team members can view documentation on the electronic health record (EHR) before beginning an education session to determine the patient's progress in meeting educational goals.

When the nurse is preparing to teach a 5-year-old child postoperative care that will be anticipated after a tonsillectomy, the nurse would incorporate what concept? a. Use pictures and simple words to describe care to the patient. b. Teach the parents alone to reduce fear in the patient. c. Exclude the parents to reduce parental anxiety. d. Use clear simple explanations to convey information.

ANS: A Patient education provided for children should be age specific. Use pictures and simple words for young children. Use clear, simple explanations for school-age children. The patient's age directly affects the instructional methods and materials used. Effective patient education involving a child requires the presence of a parent or caregiver, who is likely the target of teaching. Children should not be excluded from the learning session unless exclusion is deemed appropriate by the parent or caregiver; a presentation using an age-appropriate strategy may complement the instructions reviewed with the adult. The stages of development should be explored as the foundation for the choice of educational materials.

A nurse is planning primary prevention activities. Which activity would the nurse include in this plan? a. Safer sex education for teens b. Mammogram screening c. Medication compliance d. Annual physical exams

ANS: A Primary prevention includes activities designed to prevent a disease or condition from occurring in the first place. Examples of primary prevention activities include vaccinations, wellness programs, good nutrition for health, and safer sex programs. Mammograms and physical exams are secondary prevention measures. Medication compliance would be tertiary prevention.

A GN appears to be second-guessing herself and is constantly calling on the other nurses to double-check their plan of care or rehearse what they will say to the doctor before she call on the patient's behalf. This seems to be annoying some of the nurse's coworkers. The nurse manager's best response to this situation is to a. explain to coworkers that this is a characteristic of critical thinking and is important for the GN to improve reasoning skills. b. agree with the staff and have someone follow and work more closely with a preceptor. c. have a talk with the nurse and suggest asking fewer questions. d. tell the staff that all new nurses go through this phase, and ignore their behavior.

ANS: A Reflection-on-action is critical for development of knowledge and improvement in reasoning. It is where learning from practice is incorporated into experience. Inquisitiveness is a characteristic of critical thinking and reflects a desire to learn even when the knowledge may not appear readily useful. The manager should promote this. Suggesting the nurse work more closely with a preceptor implies that the manager thinks the nurse needs to learn more and increase confidence. In reality, this nurse is demonstrating a characteristic of critical thinking. Suggesting that the nurse ask fewer questions would hamper the development of the nurse as a critical thinker. All new nurses do go through a phase of asking more questions at one time, but dismissing the nurse's behavior with this explanation is simplistic and will discourage critical thinking.

Mr. Giuseppe is a 60-year-old Italian immigrant who presents for an annual physical. He is counseled about diagnostic testing including laboratory testing, colonoscopy, influenza vaccination, and pneumococcal vaccination. His reply is "If it ain't broke, don't try to fix it." Understanding that respect for traditions and fulfilling obligations is important in developing a nursing plan of care. Mr. Giuseppe's cultural orientation is towards a. short term. b. long term. c. leisurely term. d. noncommittal.

ANS: A Short-term cultural orientation is towards the present or past and emphasizes quick results. Long-term cultural orientation is towards the future and long-term rewards. Long-term-oriented cultures favor thrift, perseverance, and adopting to changing circumstances. Leisurely term and noncommittal are undefined in cultural orientation

A nurse manager recognizes that systems theory identifies that there is a social component within an organization that affects the overall functioning of the system. What indicator would demonstrate to the nurse manager that the social needs of an organization are being met? a. Most employees from the organization attend an annual holiday celebration. b. Separate eating areas for each discipline are set up in the cafeteria. c. Nurse managers are planning to move to a centralized area away from the care units. d. The summer softball teams are canceled due to lack of interest.

ANS: A Systems theory focuses on the needs and desires of people who work in the organization. Good attendance at a work-sponsored function indicates that staff enjoy interacting and are meeting social and relationship roles. Separating disciplines does not foster a sense of team. Moving administration away from staff limits interaction and informal conversations that build trust. Lack of participation in sponsored events such as a softball team indicates that staff relationships are not strong, and a social component is not being achieved within the work environment.

A mother is talking with the community-based nurse concerning her adult son. The son is mentally challenged and not able to live on his own. The mother is concerned about her son's welfare when she is no longer able to care for him. The best response by the nurse would be which of the following? a. "Let's look into the community resources that are available to assist you." b. "You have raised your son well, and he will be okay on his own." c. "Contact your distant relatives to see if anyone would take your son." d. "There are places for mentally challenged adults; let's place him there."

ANS: A The mother, with the assistance of the nurse, can research resources in the community that will service and care for her son when she is no longer able to do so. How the son is raised does not mean that he will be okay on his own. Distant relatives may not want or be able to care for the son, so this may not be a viable option. Placing the son is too general of an option, and he may not do well in this setting.

The community health nurse is assessing a family who has a chronically ill child. The child needs special care, and the nurse has to coordinate the care for the home setting. What behavior will the nurse assess for to know that the family can care for the child? a. The family is willing to learn about the care and share the caregiving needs. b. The mother is going to care for the child and the family herself. c. The older siblings are going to care for the child while the parents are at work. d. An outside agency will be coming to the home three times a week to give care.

ANS: A The nurse will look for a family who is willing to provide care plus support each other in this need. Having a situation where just siblings or a mother or an outside agency give care puts an undue burden on the caregiver and brings disharmony to the family.

Nurses work to serve the population, and they know that the priority population who needs to be served by care coordination is the a. most vulnerable and the frail. b. uninsured and the very young. c. underinsured and the elderly population. d. whole population of the community.

ANS: A The priority population is the most vulnerable and the frail, because they have the most health care needs. Other populations do need health care, but they do not always have immediate need of the health care system.

For children and teens, the model that includes school-based services is the _____ Model a. Social b. Integrated c. Medically-Oriented

ANS: A The social models focus on community-based services, and the other models do not.

The nurse understands the unique ability of the patient to understand and integrate health-related knowledge is known by which term? a.Health literacy b.Formal patient education c.Informal patient education d.Primary education

ANS: A The unique ability of a patient to understand and integrate health-related knowledge is known as health literacy. Formal patient education is delivered throughout the community in the form of media, in a variety of educational and group settings, or in a planned, goal-directed, one-on-one session with a patient in the acute care setting. Informal education is usually learner or patient directed. Many health care consumers begin receiving information as children through their primary education. Hand washing, proper dental care, and nutrition are examples of early instructions.

The nurse is preparing to teach a patient for the first time and needs to evaluate the health literacy of the patient. The nurse uses the VARK assessment to gather what information? a. Assess the learning styles of the patient. b. Find the one method that the patient uses to learn. c. Be sure that the patient is a unimodal learner. d. Reduce the need for creating a collaborative learning plan.

ANS: A Tools have been developed to help health care workers evaluate the health literacy of their patients. One such tool is the VARK (verbal, aural, read/write, kinesthetic) assessment of learning styles of people who are having difficulty learning. Individuals typically learn through more than one method. For example, a patient's VARK assessment may indicate learning through VAR or ARK. When the use of more than one style facilitates learning, the individual is considered a multimodal learner, meaning that the person does best when more than one teaching strategy is used or that the person is able to adapt to a variety of teaching strategies on the basis of what is being presented. Understanding how patients learn best makes collaborative learning plans most effective. It is good practice to provide multiple means of learning, because most individuals learn through more than one style and repetition enhances learning.

The nurse is to teach an 84-year-old Spanish-speaking patient newly diagnosed with diabetes how to self-administer insulin. The patient has hearing and visual impairments. To be effective as a teacher, the nurse should carry out which tasks? (Select all that apply.) a. Assess reading level and learning style. b. Determine readiness to learn. c. Use family members as interpreters. d. Provide written instruction in English. e. Place the patient in group classes.

ANS: A, B Before health care teaching sessions for adults, assess reading level, learning styles, and readiness to learn. Family members should not be used as interpreters of specific medical information to maintain the patient's right to privacy and to avoid possible misinterpretation of medical terminology. Access to interpretation or translation for deaf and limited English proficiency (LEP) patients is required by Title VI of the Civil Rights Act of 1964, which mandates equal rights for people regardless of race, color, or national origin. Use photos, drawings, or video to enhance understanding. A patient whose cultural beliefs and values are considered is more likely to demonstrate compliance. Patients with learning disabilities or cognitive alterations need individualized instruction geared to their special needs.

On completion of assessment, a nursing diagnosis relevant to the educational needs of the patient or caregiver can be determined. The nurse recognizes that diagnoses specifically related to patient education include which responses? (Select all that apply.) a. Deficient knowledge b. Readiness for enhanced knowledge c. Noncompliance d. Pain e. Alteration in elimination

ANS: A, B, C On completion of assessment, a nursing diagnosis relevant to the educational needs of the patient or caregiver can be determined. Diagnoses specifically related to patient education include deficient knowledge, readiness for enhanced knowledge, and noncompliance.

In addressing patient education, the nurse recognizes that patient education is a process involving what components? (Select all that apply.) a. Assessment b. Diagnosis c. Planning d. Implementation and evaluation e. Reliance on evidence-based practice (EBP)

ANS: A, B, C, D Assessment of health literacy occurs with each patient encounter. On completion of assessment, a nursing diagnosis relevant to the educational needs of the patient or caregiver can be determined. After working with the patient or caregiver to determine the appropriate nursing diagnosis, the next step is developing the patient education plan. In all patient education situations, a return demonstration by the patient (i.e., repeating what has been taught) helps the nurse to assess the level of learning that has taken place. Although evidence-based practice is important, it is sometimes insufficient when making patient care decisions.

Nurses can be health advocates in which of the following ways? (Select all that apply.) a. Supporting their professional nursing organization when discussing upcoming legislation b. Discussing the upcoming classes with a neighbor c. Rallying for coverage for childhood immunizations d. Arranging for a patient to meet with case management for home health care e. Discussing a patient they are concerned about with a fellow student in the public cafeteria

ANS: A, C, D Supporting a professional nursing organization, rallying for coverage for childhood immunizations, and arranging for a patient to meet with case management are examples of how nurses can be a positive influence on health care policy. Discussing an upcoming class with a neighbor is not effective because it could be determined to be negative. Talking about a patient in a public area is an example of inappropriate communication between health care workers and is a violation of patient confidentiality.

A nursing student is preparing a care plan for an assigned patient. When accessing the electronic medical record, what is acceptable information to view? (Select all that apply.) a. Laboratory data of the assigned patient b. Admission diagnosis for a patient who is a former neighbor c. The patient's age, date of birth, and gender d. The history and physical of the assigned patient e. A classmate's brother's chest x-ray report

ANS: A, C, D The laboratory data, age, date of birth, gender, history, and physical of an assigned patient are necessary for identification and care of the patient so it is acceptable to view this information in the electronic medical record. The patient information in the medical record, whether electronic or print, is only to be viewed by those who have a legitimate role in the patient's care. Viewing information on patients other than the assigned patient is not appropriate, because the student does not have a need to view the information for patient care. These are violations of patient privacy.

In preparing to teach the patient, the nurse must consider which concepts? (Select all that apply.) a. Background b. Race c. Pain level d. Emotional status e. Readiness to learn

ANS: A, C, D, E Consideration must be given to the patient's background, readiness to learn, and current condition before education can occur. A patient's ability to read, write, and comprehend health care materials enhances health literacy. Race, by itself, is not a factor.

According to the Healthy People 2020 initiative, health information and the associated access issues have become more complicated. There are many considerations when determining whether an individual has proficient health literacy. The nurse acknowledges that the patient should be able to do what actions? (Select all that apply.) a. Read and identify credible health information. b. Recognize abnormalities on an x-ray. c. Navigate complex insurance programs. d. Evaluate EKG findings. e. Advocate for appropriate care.

ANS: A, C, E The patient should be able to exhibit certain competencies such as reading and identifying credible health information, understanding numbers in the context of the patient's health care, making appointments, filling out forms, gathering health records and asking appropriate questions of physicians, advocating for appropriate care, navigating complex insurance programs (Medicare or Medicaid, and other financial assistance programs), and using technology to

Strategies to include in a teaching plan for an adult who has repeatedly not followed the written discharge instructions would include a. individualized handout. b. instructional videos. c. Internet resources. d. self-help books.

ANS: B An instructional video would provide a visual/auditory approach for discharge instructions. Repeatedly not following written instructions is a clue that the patient may not be able to read or understand the information. While assessing the literacy level of an adult patient can be challenging, the information that they have not been able to follow previous written instructions would suggest that the nurse use an alternate strategy that does not require a high degree of literacy. An individualized handout would be written, very similar to previous instructions, and would not address a concern about literacy. Internet resources generally require an individual to be able to read, and although videos are available through the Internet, this is not the best response. Self-help books would be appropriate for an individual who reads. There is a question about whether this patient is literate, so these would not be the best choice.

The nurse understands that as the health care community explores the concept of health literacy, many organizations recognize what concept? a. Consumers need to understand has no governmental support. b. Improvements are dependent on developing operational definitions. c. Low literacy and low health literacy are interchangeable terms. d. Interest in effective patient education is unique to the United States.

ANS: B As the health care community explores the concept of health literacy, many organizations recognize that before improvements can be made, operational definitions are imperative. The realization that consumers need to be able to understand the medical information delivered by health care providers has gained recognition at many governmental levels. The Healthy People 2020 publication describes a national movement that addresses the priorities of prevention and public health in the United States. Health literacy with its impact on this initiative is being recognized and has become a key component of the project. Although low literacy and low health literacy are related terms, they are not interchangeable. Low health literacy is content-specific, meaning that the individual may not have difficulty reading and writing outside the health care arena. Interest in effective patient education is not a phenomenon unique to the United States. The Institute of Medicine Roundtable on Health Literacy held a workshop in 2012 focused on international health literacy.

The staff nurse who uses informatics in promoting quality patient care is most likely to access data in the domain of a. certified clinical information systems (CIS). b. clinical health care informatics. c. public health/population informatics. d. translational bioinformatics.

ANS: B Clinical health care informatics and the subset, nursing informatics, provides for the development of direct approaches to patients and their families which can be used by the staff nurse to promote quality patient care. Certified CIS refers to the tools for achieving quality outcomes, including electronic health records, clinical data repositories, decision support programs, and handheld devices—not the data. Public health/population informatics is the domain which relates information, computer science, and technology to public health science to improve the health of populations; this domain would provide data for the nurse working with communities. Translational bioinformatics refers to the research science domain where biomedical and genomic data are combined; it's a new term that describes the domain of where bioinformatics meets clinical medicine, generally for health care research rather than direct patient care.

To design and implement a decubitus ulcer risk management protocol in the electronic health record, the informatics nurse would first a. build the screens in the electronic health record. b. determine evidence supporting decubitus ulcer risk management. c. develop the training program for staff. d. select the appropriate standardized language.

ANS: B Collecting the evidence related to the issue is the first step in addressing a problem (remember the nursing process, the foundation of nursing practice). Based on the evidence, an assessment tool or tools and data needed from a patient perspective would be identified. The screens in the electronic record would be based on the workflow surrounding the patient assessment. A training program could not be developed until the protocol is adopted. The appropriate standardized language is selected based on what needs to be documented and what has been approved for use by the agency (e.g., ANA recognized terminologies).

The nurse identifies which patient would most likely need to have adjustments made to the education plan for discharge because of role function? a. A 67-year-old married female who lives with her retired husband b. A 32-year-old single mother of a toddler following hysterectomy c. A 13-year-old who lives at home with his parents after appendectomy d. A 50-year-old married mother with two children in college and teenager at home

ANS: B Exploration of the patient's roles is an important task that must be done before development of a patient education plan. For example, a 32-year-old, single mother of five young children who has just undergone a hysterectomy may require a different perspective in her discharge instructions than that in the instructions of a 67-year-old female living with her husband who recently retired after 35 years as a family practice physician. The first patient may have less support and less flexibility regarding rest, lifting limitations, and cost of prescriptions than the second. It is important not to stereotype and assign roles but rather to develop a plan in collaboration with the individual. The patient's support system should be taken into consideration when the nurse plans patient education.

A nurse has designed an individualized nursing care plan for a patient, but the patient is not meeting goals. Further assessment reveals that the patient is not following through on many items. Which action by the nurse would be best for determining the cause of the problem? a. Assess whether the actions were too hard for the patient. b. Determine whether the patient agrees with the care plan. c. Question the patient's reasons for not following through. d. Reevaluate data to ensure the diagnoses are sound.

ANS: B Having patient and/or family provide input to the care plan is vital in order to gain support for the plan of action. The actions may have been too difficult for the patient, but this is a very narrow item to focus on. The nurse might want to find out the rationale for the patient not following through, but instead of directly questioning the patient, which can sound accusatory, it would be best to offer some possible motives. Reevaluation should be an ongoing process, but the more likely cause of the patient's failure to follow through is that the patient did not participate in making the plan of care.

Student nurses are being questioned by the nursing instructor about the health care coordination system. The instructor knows the students understand health care delivery when they state, "Health care a. is available for everyone at every time." b. needs are best met with a collaborative effort." c. is adequately meeting the needs of the homeless populations." d. needs are mostly in third world countries."

ANS: B Health care needs many times are not met by one discipline. When a collaborative effort is used, the patient is better served. Health care is not available for everyone, nor is it meeting the needs of the homeless population. Health care needs are worldwide, not just in third world countries.

A hospital organization is working to improve a feeling of being valued and respected among all staff members. Which action by administration would reinforce the feeling of being valued? a. Create professional pathways that require advanced education for any advancement of staff. b. Seek staff input when planning a remodeling project of patient rooms. c. Form committees that consist of upper management to plan organizational goals. d. Consistently schedule required staff meetings at the same time each month.

ANS: B Including staff at all levels of an organization in planning and projects demonstrates respect for the intelligence and creativity of the individual. Requiring advanced education for any advancement limits those with barriers to attending additional schooling; advancement should be available in a variety of ways to show the value of the individual. Committees that only consist of upper management cause a feeling of disconnect between staff and administration. Scheduling meetings at the same time does not consider those who work shifts and either have to come in on their day off or must disrupt sleep to attend.

A patient has been admitted for a skin graft following third degree burns to the bilateral calves. The plan of care involves 3 days inpatient and 6 months outpatient treatment, to include home care and dressing changes. When should the nurse initiate the educational plan? a. After the operation and the patient is awake b. On admission, along with the initial assessment c. The day before the patient is to be discharged d. When narcotics are no longer needed routinely

ANS: B Initial discharge planning begins upon admission. After the operation has been completed is too late to begin the discharge planning process. The day before discharge is too late for the nurse to gather all pertinent information and begin teaching and coordinating resources. After a complicated operation, the patient may well be discharged on narcotic analgesics. Waiting for the patient to not need them anymore might mean the patient gets discharged without teaching being done.

The nurse is implementing a patient teaching plan regarding diabetes mellitus. One of the short-term goals of the plan is that the patient will be able to verbalize three symptoms of hypoglycemia. The nurse recognizes that this is what type of teaching? a. Psychomotor teaching b. Cognitive teaching c. Affective teaching d. VARK teaching

ANS: B Learners in the cognitive domain integrate new knowledge through first learning and then recalling the information. They then categorize and evaluate, making comparisons with previous knowledge that result in conclusions related to the new content. The psychomotor domain incorporates physical movement and the use of motor skills in learning. Teaching the newly diagnosed diabetic how to check blood sugar is an example of a psychomotor skill. Affective domain learning recognizes the emotional component of integrating new knowledge. Successful education in this domain takes into account the patient's feelings, values, motivations, and attitudes. Tools have been developed to help health care workers evaluate the health literacy of their patients. One such tool is the VARK (verbal, aural, read/write, kinesthetic) assessment of learning styles of people who are having difficulty learning.

A nurse is interviewing at an agency owned by a national religious organization that serves homeless and uninsured patients. A large poster display shows a proposed addition that would add 16 beds to the facility that will be funded from profits of the previous 3 years of operation. The nurse recognizes that the agency is most likely what type of agency? a. For-profit b. Not-for-profit c. Publicly-owned d. Investor-owned

ANS: B Many religious organizations are privately owned and administer not-for-profit health facilities, where profits are returned into the facility for improvements or equipment. For-profit agencies distribute profits to shareholders. Publicly-owned facilities are government supported and not linked to religious organizations. Investor-owned agencies would be for-profit agencies with profits distributed to investors.

A nurse is completing an OASIS assessment on a patient. What data would be most important for the nurse to assess? a. Presence of grocery stores nearby b. Safety concerns within the home c. Number and kind of pets d. Proximity to a health care facility

ANS: B OASIS (Outcomes and Assessment Information Set) is a data set of outcome measures for adult home health care clients that is used to track outcome-based quality improvement. Factors that could potentially affect patient safety in the home are particularly important. The other options are not included in this assessment.

A nurse wants to volunteer for a community group providing secondary prevention. What activity would the nurse attend? a. Stroke rehabilitation support group b. Blood pressure screening at the mall c. Bicycle safety class at the elementary school d. Drop by nutrition station at the grocery store

ANS: B Secondary prevention activities are aimed at early diagnosis and prompt intervention. Blood pressure screening events are a good example. Stroke rehabilitation is tertiary prevention. Bicycle safety classes and nutrition education are examples of primary prevention.

Which level of government is responsible for the regulation of a nurse's license? a. Federal government b. State government c. Local government d. International coalition

ANS: B State boards of nursing oversee the regulation of nursing practice. These agencies are established by legislatures to implement and enforce laws through a rule-making process. Federal, local, and international coalitions are not correct, because they do not have control of the state boards of nursing.

A nurse is interested in epidemiology. What work activity would best fit this role? a. Studying census data to determine common causes of death b. Researching population variables that contribute to disease c. Developing sanitary measures to prevent foodborne illness d. Designing research to determine the connection between pollution and cancer

ANS: B The epidemiologist works to develop programs to prevent the development and spread of disease. Studying census data, researching population variables, and designing studies do not fall in this field.

Prior to drug administration the nurse reviews the seven rights, which include right patient, right medication, right time, right dose, right education, right documentation, and right a. room. b. route. c. physician. d. manufacturer.

ANS: B The right route (e.g., oral or intramuscular) is an essential component to verify prior to the administration of any drug. The patient does not need to be in a specific location. There may be a number of physicians caring for a patient who prescribe medications for any given patient. A similar drug may be made by a number of different companies, and checking the manufacturer is not considered one of the seven rights. However, the nurse will want to be aware of a difference, because different companies prepare the same medication in different ways with different inactive ingredients, which can affect patient response.

Which of the following components are included in health policy at the state level? a. Americans with Disabilities Act of 1990 b. Scope of nursing practice c. Health Insurance Portability and Accountability Act (HIPAA) of 1996 d. Patient Safety and Quality Improvement Act of 2005

ANS: B The scope of nursing practice is correct, because it is controlled at the state level by state boards of nursing. The Americans with Disabilities Act of 1990, the HIPAA of 1996, and the Patient Safety and Quality Improvement Act of 2005 are all regulated at the national level.

The nurse is preparing a teaching plan and is applying evidence-based practice. To promote involvement, the nurse must include which concept? a. Provide the latest professional literature to the patient. b. Ensure that the patient understands relevant information. c. Use only one teaching method to reduce confusion. d. Not review previously learned information.

ANS: B To promote involvement, nurses must ensure that patients understand the information relevant to their care. Nurses need to provide patients with easy-to-understand information and speak in a clear, distinct voice, using short sentences and understandable terminology. Multiple teaching methods should be used to meet the needs of all types of learners. Patient education sessions should be reassessed after two to three key points to ensure that the patient is still engaged in learning and ready to assimilate more information. Information taught at previous sessions can be reviewed before proceeding with new key points.

To teach effectively, nurses must recognize which concept? a. Age and socioeconomic status play a large role in understanding. b. 90% of Americans possess rudimentary literary skills. c. The ability to comprehend is a very new concept in health care. d. Most health care teaching is effective and understood.

ANS: B To teach effectively, nurses must recognize that patients of all ages come from diverse cultural and socioeconomic backgrounds. Each has a different ability to comprehend health care information. Results of the NAAL research indicate that among American adults, 30 million (14%) had below basic health literacy in English and 47 million (22%) had basic health literacy. This means that 77 million (36%) American adults possessed very rudimentary literacy skills that allowed them to read only short, simple printed and written materials. Although discussion of Nightingale's work often focuses on her efforts to distinguish nursing as a profession and address the impact of sanitation on health, she advocated exploring all aspects of the patient. She thought that patients needed care that is "delicate and decent" and that demonstrates "the power of giving real interests to the patient." Exploring patients' interests and abilities was an early acknowledgment that nurses must be aware of patients' ability to comprehend the health care information provided. Often, health care professionals assume that the explanations and instructions given to patients and families are readily understood. In reality, research has shown that these instructions are frequently misunderstood, sometimes resulting in serious errors.

The student studying community health nursing learns that vulnerable populations can be best assisted by which activity? a. Researching their genetic risk for health problems b. Working with the community to decrease health risks c. Studying vital statistics to determine their causes of death d. Making sure the population maintains immunizations

ANS: B Vulnerable populations have some characteristic that puts them at higher risk for identified health problems. The nurse can best assist vulnerable populations by identifying and working with them to decrease their risks. Researching genetic risks, studying vital statistics, and improving immunizations are all part of the solution, but the overarching priority action is to help the community decrease its risks.

When teaching an Asian patient with newly diagnosed diabetes, the nurse notes the patient nodding yes to everything that is being said. With a better understanding of cultural interdependence in self-concept, a nurse should immediately a. write everything down for the patient to refer to later. b. prompt further to elicit additional questions or concerns. c. call the recognized elder for this patient. d. call the oldest male relative for help with decision making.

ANS: B When a nurse provides nutritional education to a patient who is from a culture that values greater power distance, it might appear that the patient is willing to accept all that the nurse suggests, when further prompting would elicit additional questions or concerns. The patient from a collectivist culture will usually consult family members for a best course of action. It is not acceptable for nurses to take it upon themselves to call the recognized elder or oldest male relative for help with decision making. While writing everything down may be OK for some cultures, with Asian patients it may be best to prompt further to elicit additional questions or concerns.

When teaching children, the nurse should include which concepts? (Select all that apply.) a. Exclude the children from teaching. b. Encourage parents or caregivers to be present. c. Use age-specific strategies. d. Consider the stages of development. e. Remember that parents are not the targets of the teaching.

ANS: B, C, D Patient education provided for children should be age specific. Effective patient education involving a child requires the presence of a parent or caregiver, who is likely the target of teaching. Children should not be excluded from the learning session unless exclusion is deemed appropriate by the parent or caregiver; a presentation using an age-appropriate strategy may complement the instructions reviewed with the adult. The stages of development should be explored as the foundation for the choice of educational materials.

The nurse must provide patient education to a patient who has just been given the diagnosis of stage III cancer. The patient is complaining of chest and bone discomfort. Before providing the needed education, the nurse will complete which tasks? (Select all that apply.) a. Draw the curtain in the semi-private room. b. Medicate the patient to ease the pain. c. Place the patient in a private room if possible. d. Wait until later in the day. e. Attend to any other personal needs first.

ANS: B, C, D, E The location of patient education influences the outcome. The setting should be quiet, and the session should have minimal interruptions. Providing privacy is difficult in settings such as emergency rooms, outpatient surgery centers, and semi-private inpatient rooms, but the nurse should make every effort to ensure confidentiality. Environmental considerations such as good lighting and the availability of resources should be explored to enhance the outcome of patient education. The nurse should examine the patient's situation and comfort level before beginning teaching. For example, a postoperative patient who is rating pain at 7 of 10 will be much more receptive to learning after being medicated for pain. A patient who just received a diagnosis of metastatic cancer will learn and assimilate more information later in the day or perhaps the next day. The nurse must also take care of any other personal needs first, such as the need to use the bathroom.

Many grandparents today are caring for grandchildren in place of a parent. Identify the reasons why this phenomenon is happening. (Select all that apply.) a. Children prefer living with their grandparents. b. Parents are incarcerated. c. Parents are deceased. d. Grandparents are better caregivers. e. Parents are mentally ill. f. Parents are substance abusers.

ANS: B, C, E, F Grandparents are usually caring for children because the parents are deceased, in prison, substance abusers, or mentally ill and cannot care for the children. The fact that children prefer to live with the grandparents or the grandparents may be better caregivers is not a main reason for this phenomenon to happen.

Care coordination models should be adopted in health care facilities. If models are not put into practice, the shortcomings of the health care system may display which of the following items? (Select all that apply.) a. Decrease in patients b. Fragmented services c. Low birth weight newborns d. Cost inefficiencies e. Poor health outcomes f. Increased pharmacy costs

ANS: B, D, E Fragmented services, cost inefficiencies, and poor health outcomes may be some of the shortcomings seen in health care without the proper model in place to guide the health care delivery system.

Barriers to patient education the nurse considers in implementing a teaching plan include a. family resources. b. high school education. c. hunger and pain. d. need perceived by patient.

ANS: C A patient who is hungry or in pain has limited ability to concentrate or learn. Family resources would be considered in developing a plan of care and could be an asset or a barrier to patient education. The patient's educational level would be considered in planning teaching strategies but would not be a barrier to education. A need perceived by a patient would provide motivation for learning and would not be a barrier.

The student learns that which is the best definition of a public health nurse? a. Works with the public b. Works in public areas c. Works with the greater community d. Works with public funding

ANS: C A public health nurse works with communities as a larger whole and is concerned with specific target or vulnerable groups within that community. The other options are inaccurate.

The nurse is triaging a hysterical patient in the ER. The patient is crying, with uncontrollable spasms, trembling, and shouting. It is important to identify manifestation of illness in order to effectively treat a patient. The nurse identifies this as a culture-bound syndrome called a. shenjing sharo. b. loco de la cabeza. c. ataque de nervios. d. neuroasthenia.

ANS: C Ataque de nervios is a Latin-Caribbean culture-bound syndrome that usually occurs in response to a specific stressor and is characterized by dissociation or trance-like states, crying, uncontrollable spasms, trembling, or shouting. Shenjeng sharo refers to "weakness of nerves" in Chinese culture; it is caused by a decrease in vital energy that reduces the function of the internal organ systems and lowers resistance to disease. Loco de la cabeza is a Spanish phrase meaning crazy in the mind and not necessarily manifested by physical symptoms. Neuroasthenia is an Asian term characterized by extreme fatigue after mental effort and bodily weakness of persistent duration.

The emphasis on understanding cultural influence on health care is important because of a. disability entitlements. b. HIPAA requirements. c. increasing global diversity. d. litigious society.

ANS: C Culture is an essential aspect of health care because of increasing diversity. Disability entitlements refer to defined benefits for eligible mental or physically disabled beneficiaries in relation to housing, employment, and health care. HIPAA requirements refers to the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety. Litigious society refers to excessively ready to go to law or initiate a lawsuit.

The nurse is preparing to discharge a patient home. In providing instruction about the patient's medications, the nurse should make which statement? a. "Before taking Metoprolol, you need to take your BP and rate." b. "MS should be taken only when needed for pain." c. "Take 1 baby aspirin by mouth every morning." d. "Take your water pill bid and you should be fine."

ANS: C Do not use abbreviations or medical terminology when providing patients with instructions.

Women who are given the job of caretaker for aging relatives are subject to caregiver strain due to a. feminine attributes. b. unequal gender. c. fixed gender roles. d. female inequality.

ANS: C In cultures with more fixed gender roles, women are usually given the role of caretaker for aging relatives and may suffer the stresses of caregiver strain. Feminine attributes refers to harmonious relationships, modesty, and taking care of others. Unequal gender refers to roles of males and females being unevenly distributed. Female inequality refers to female gender and roles being less than or unequal to male roles.

The nurse is admitting a patient who has cystic fibrosis. During the admission interview, it is apparent that the patient is well versed in most aspects of his illness. When asked about where he learned so much, the patient responds, "I learned most of it myself. I looked things up on the Internet and read books. You have to know what's wrong with you to be sure that you're being treated right." The nurse knows this is an example of what type of education/learning? a. Formal education b. Psychomotor learning c. Informal education d. Affective learning

ANS: C Informal education is usually learner or patient directed. Formal patient education is delivered throughout the community in the form of media, in a variety of educational and group settings, or in a planned, goal-directed, one-on-one session with a patient in the acute care setting. The psychomotor domain incorporates physical movement and the use of motor skills in learning. Teaching the newly diagnosed diabetic how to check blood sugar is an example of a psychomotor skill. Affective domain learning recognizes the emotional component of integrating new knowledge. Successful education in this domain takes into account the patient's feelings, values, motivations, and attitudes.

Medical models coordinate medical services and were traditionally designed to be a. patient specific. b. nursing oriented. c. diagnosis specific. d. community oriented.

ANS: C Medical models focus on the patient's diagnosis. The medical model is not patient specific, nursing oriented, or community oriented.

During patient teaching led by the nurse with goals established through cooperation of the nurse and patient, the patient asks questions as needed and the nurse answers. The nurse understands that this is what type of teaching? a. Formal teaching b. Informal teaching c. Both formal and informal teaching d. Psychomotor teaching

ANS: C Some patient education sessions have formal and informal elements, because the nurse and patient may set goals together before the nurse formulates and implements the plan of care, and the patient is free to ask questions that may direct the session. The health care information is considered informal because it is situation and patient specific. Formal patient education is delivered throughout the community in the form of media, in a variety of educational and group settings, or in a planned, goal-directed, one-on-one session with a patient in the acute care setting. Informal education is usually learner or patient directed. The psychomotor domain incorporates physical movement and the use of motor skills in learning. Teaching the newly diagnosed diabetic how to check blood sugar is an example of a psychomotor skill.

The nurse is preparing to teach a 90-year-old patient. In teaching an elderly patient, the nurse realizes what information? a. Most elderly patients are highly literate. b. Cognitive abilities always decline with age. c. Sensory alterations often occur with aging. d. Teaching methods are the same as for the middle aged.

ANS: C Teaching should be tailored to elderly patients. Reports indicate that two-thirds of U.S. adults 66 years old and older have inadequate or marginal literacy skills, and 81% of patients 60 years old and older at a public hospital could not read or understand basic materials such as prescription labels. Although each patient must assessed individually, cognitive and sensory alterations often occur with aging, and the teaching materials should be adjusted accordingly.

A nurse is orienting to a new job in a home health care agency and is told that most of her patients need tertiary prevention. What activity does the nurse plan to include in the daily routine? a. Household safety checks b. Well-baby checkups c. Antibiotic administration d. Monthly blood pressure assessments

ANS: C Tertiary care is aimed at people who are already experiencing a health alteration, such as those with an infection who need antibiotics. The other options are secondary prevention.

Essential elements of a standard order set to verify a medication order include a. volume only. b. number of tablets. c. metric dose/strength. d. hour of administration.

ANS: C The ISMP recommendations for standardized medication order sets include such elements as the drug name (generic followed by brand when appropriate), metric dose/strength, frequency and duration, route, and indication. Although a prescription may include volume or number of tablets, the essential component is dose or strength, because the volume or number of tablets may vary by manufacturer. The exact hour of administration can be based on factors such as the frequency, agency protocols, and patient preferences.

Which branch of government is responsible for the execution of laws passed by legislatures? a. Legislative b. Judicial c. Executive d. Local

ANS: C The executive branch of federal and state governments is responsible for execution of laws passed. The legislative branch is responsible for passing laws. The judicial branch of government determines if rights are being upheld. Local governments are not considered a branch of the government.

The nurse is counseling a woman who is caring for her 83-year-old father. The father has had mental changes and is becoming more confused. The father lives with the daughter in her home. The nurse knows the daughter understands the father's care needs when she states which of the following? a. "Dad will only need my help for a short time, and then he will get better." b. "I can leave dad alone during the day; I'll just deadbolt the door." c. "I can send dad to the adult daycare; that way I can work and care for him at night." d. "Dad misses mom since she passed; he will be okay in a few weeks."

ANS: C The father will be cared for at the adult daycare, and it is a nice alternative for the daughter. She will be able to work and know that her father is safe during the day. The daughter thinking the father will be okay in a few days is not realistic, nor can she deadbolt the door and lock him in the house.

A young wife is talking with the nurse about her husband who is returning from the military. The wife confides that her husband is physically okay but is behaving differently. The nurse's best response is which of the following? a. "He is just trying to adjust to civilian life again; he'll be okay." b. "You should observe him closely, because he could attack you." c. "Many times people need care for emotional trauma." d. "Talk with your physician to get medication, and then put it in his food."

ANS: C The nurse is alerting the young wife to the fact that people who have experienced emotional trauma need care too. The nurse does not know how the husband is adjusting so the other options are incorrect.

A community was devastated by a tornado several months ago. What nursing diagnosis would be most appropriate for the nurse to consider? a. Social isolation b. Deficient community resources c. Ineffective community coping d. Deficient community health

ANS: C This diagnosis considers those in a community who may be feeling helpless, hopeless, or frustrated because of an extraordinary event. Financial and physical resources may not be available for rebuilding. Social isolation refers to unacceptable social behavior. Deficient community resources is not a NANDA-I diagnosis. Deficient community health may become a problem if sanitary conditions lead to an outbreak of disease.

The application of information processing that deals with the storage, retrieval sharing, and use of health care data, information, and knowledge for communication and decision making is the definition of a. computer science. b. health informatics. c. health information technology. d. nursing informatics.

ANS: C This is the definition of health information technology. Computer science is a branch of engineering that studies computation and computer technology, hardware, software, and the theoretical foundations of information and computation techniques. Health informatics is a discipline in which health data are stored, analyzed, and disseminated through the application of information and communication technology. Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.

A hospital organization is applying for Magnet© status to show excellence in nursing practice. What components would indicate that the hospital is meeting Magnet© principles? (Select all that apply.) a. The education budget for nursing has been cut to provide for new laboratory equipment. b. On average, 40% of new nurses are leaving within 1 year of hire. c. Nurses are active participants on all major hospital committees. d. Quality improvement projects are planned and evaluated by nurses. e. Patient care outcome data are reported in the annual executive board meeting.

ANS: C, D To gain Magnet© status, an organization must show that nurses are active participants in the organization administrative structure, fully involved in quality improvement projects, and are recognized as a valuable resource.

Florence Nightingale, the first nurse informatician, sought hospital data for comparison purposes to a. allow faster and accurate diagnosis. b. better coordinate care. c. improve the efficiency of care. d. show people how their money was spent.

ANS: D "They would show the subscribers how their money was being spent, what amount of good was really being done with it, or whether the money was not doing mischief rather than good" (Florence Nightingale, 1863). Although health information and informatics could fulfill the other purposes, none of these were the focus of Florence Nightingale's published purposes of her requests for hospital information.

A sentinel event refers to an event that a. could have harmed a patient, but serious harm didn't occur because of chance. b. harms a patient as a result of underlying disease or condition. c. harms a patient by omission or commission, not an underlying disease or condition. d. signals the need for immediate investigation and response.

ANS: D A sentinel event is an unexpected occurrence involving death or serious physical or psychologic injury or the risk thereof called sentinel, because they signal the need for immediate investigation and response. A near-miss refers to an error or commission or omission that could have harmed the patient, but serious harm did not occur as a result of chance. Harm that relates to an underlying disease or condition provides the rationale for the close monitoring and supervision provided in a health care setting. An adverse event is one that results in unintended harm because of the commission or omission of an act.

The patient is reportedly well educated and employed as an engineer but is struggling to comprehend terms found in health-related literature given to explain his disease process. The nurse recognizes that this is evidence of what issue? a. Low literacy b. Psychomotor dysfunction c. Affective domain deficiency d. Low health literacy

ANS: D Although low literacy and low health literacy are related terms, they are not interchangeable. Low health literacy is content specific, meaning that the individual may not have difficulty reading and writing outside the health care arena. These patients may struggle to comprehend the complicated, unfamiliar terms and ideas found in health-related materials or instructions. The psychomotor domain incorporates physical movement and the use of motor skills in learning. Teaching the newly diagnosed diabetic how to check blood sugar is an example of a psychomotor skill. Affective domain learning recognizes the emotional component of integrating new knowledge. Successful education in this domain takes into account the patient's feelings, values, motivations, and attitudes.

The nurse is discussing care coordination with a patient. The patient asks the nurse to explain care coordination. The nurse's best response would be, "Care coordination a. is a cost effective method created by the community." b. forces the health care facilities in the community to work together." c. exists for the children and uninsured in the community." d. allows health care services to work together in the community."

ANS: D Care coordination allows all health care/community services to work together so that patient and family needs can be met. Care coordination does not focus on cost methods. Cost coordination does not exist just for children or the uninsured. No one service is forced to work with another service.

A definition of health policy includes which of the following elements? a. Funding for public education b. Appropriation of funds for roadwork c. Selection of congressional members of committees d. Public policy made to support health-related goals

ANS: D Health policy is defined as public policies pertaining to health that are the result of an authoritative public decision-making process. Public education funding, appropriation of funding for roads, and selection of members of committees are not part of health care policy. They are under a different funding arm of the government.

To promote a safety culture, the nurse manager preparing the staff schedule considers the anticipated census in planning the number and experience of staff on any given shift. The human factor primarily addressed with this consideration is/are a. available supplies. b. interdisciplinary communication. c. interruptions in work. d. workload fluctuations.

ANS: D Including an adequate number of staff members with experience caring for anticipated patients is a strategy to manage the workload and potential fluctuations. A safety culture requires organizational leadership (e.g., the nurse manager) that gives attention to human factors such as managing workload fluctuations. This strategy also applies principles of crew resource management in that it addresses workload distribution. Lack of supplies can create a challenge for safe care but could not be addressed with the schedule. Concerns with communication and coordination across disciplines, including power gradients, and excessive professional courtesy can create hazards but would not be the best answer. Strategies to minimize interruptions in work are essential but would not be the best answer in this situation.

When describing patient education approaches, the nurse educator would explain that informal teaching is an approach that a. addresses group needs. b. follows formalized plans. c. has standardized content. d. often occurs one-to-one.

ANS: D Informal teaching is individualized one-on-one teaching which represents the majority of patient education done by nurses that occurs when an intervention is explained or a question is answered. Group needs are often the focus of formal patient education courses or classes. Informal teaching does not necessarily follow a specific formalized plan. It may be planned with specific content, but it is individualized responses to patient needs. Formal teaching involves the use of a curriculum/course plan with standardized content.

Many middle-aged adults are called the "sandwich" generation because they are caring for their children and their aging parents. The aging parents need care due to a. mental clarity. b. immobility. c. blindness. d. multiple chronic illnesses.

ANS: D Multiple chronic illnesses come with the aging process. Middle-aged adults are becoming the caregivers for the generation before them and the one after them. Mental clarity is a positive aspect of aging and does not need care. Immobility and blindness do not always mean that the person needs direct care.

When the nurse is preparing to provide preoperative teaching to a deaf patient, what action by the nurse is best? a. Use printed materials. b. Provide recorded materials. c. Use a family member to interpret. d. Provide an interpreter.

ANS: D Patients who are deaf or have low English proficiency are entitled to professional interpretation by federal law. Printed material may be helpful but not if the patient has low literacy/low health literacy. Recorded material may be an option is the patient has some hearing and the recordings are amplified. Family members are not used as interpreters.

The nurse is implementing a plan of care for a patient newly diagnosed with type 2 diabetes mellitus. The plan includes educating the patient about diet choices. The patient states that they enjoy exercising and understand the need to diet; however, they can't see living without chocolate on a daily basis. Using the principles of responding in the Model of Clinical Judgment, how would the nurse proceed with the teaching? a. The nurse explains to the patient that chocolate has a high glycemic index. The nurse then focuses on foods that have low glycemic indexes and provides a list for the patient to choose from. b. The nurse explains that the patient may eat whatever they would like as long as the patient's glucose reading and A1c remain stable. c. The nurse derives a new nursing diagnosis of Knowledge Deficit and readjusts the plan of care to include additional sessions with the registered dietician. d. The nurse examines the patient's daily glucose log and incorporates the snack into the time of day that has the lowest readings. The nurse then follows up and evaluates the response in 1 week.

ANS: D Responding entails adjusting the plan of care to the particular patient issue through one or more nursing interventions. In this case, the nurse is working with the patient's wishes, knowing that the patient will most likely cheat. The patient will be allowed to "cheat." The plan will be evaluated to be sure the snack does not elevate the glucose excessively and be readjusted if warranted. While it is true that most chocolate has a high glycemic index, providing a list of foods that do not include the one thing the patient enjoys will most likely lead to non-adherence to the diet. Advising the patient that they can have whatever they want to eat may lead to further dietary indiscretions and cause side effects such as obesity or high glucose readings. Knowledge Deficit is an inaccurate diagnosis for this patient as evidenced by the patient stating they understand the need to exercise and the need to diet.

The strategy to avoid medication errors endorsed by the Institute for Safe Medication Practices (ISMP) to differentiate products with look-alike names is referred to as a. automatic alerts. b. bar coding. c. computer order entry. d. tallman lettering.

ANS: D Tallman lettering is a term coined by ISMP to describe the practice of using unique letter characteristics of similar drug names known to have been confused with one another. Tallman lettering is used to differentiate products with look-alike names such as BenaDRYL (antihistamine) and BenaZEPRIL (ace inhibitor). The other options are examples of safety-enhancing technologies strategies designed to minimize drug errors, but they are not directed at look-alike medications. Automatic alerts are computer-generated alarms that can be programmed to occur with such things as allergies and incompatible medications. Bar coding is used with medication administration systems that can be programmed to match patient identification bracelets with documentation. Computer order entry systems are designed to include components of a standard medication order.

Which of the following is the intent of HIPAA? a. Release of patient information for purposes of insurance reimbursement b. Prevent health care providers from billing for procedures done for the insured person c. Protect patients from reviewing their own medical records d. Limit the ability of health care providers to sell patient information to outside sources

ANS: D The intent of HIPAA is to protect patient information and prevent it from being sold to outside agencies. The right of heath care providers to bill for services is necessary for patient payment is and not prohibited. Patients have the right to view their own patient information.

Interrelated concepts to the professional nursing role a nurse manager would consider when addressing concerns about the quality of patient education include a. adherence. b. developmental level. c. motivation. d. technology.

ANS: D The interrelated concepts to the professional role of a nurse include health promotion, leadership, technology/informatics, quality, collaboration, and communication. Adherence, culture, developmental level, family dynamics, and motivation are considered interrelated concepts to patient attributes and preference.

To promote safety, the nurse manager sensitive to point of care (sharp end) and systems level (blunt end) exemplars works closely with staff to address the point of care exemplars such as a. care coordination. b. documentation. c. electronic records. d. fall prevention.

ANS: D The most common safety issues at the sharp end include prevention of decubitus ulcers, medication administration, fall prevention, invasive procedures, diagnostic workup, recognition of/action on adverse events, and communication. These are the most common issues the staff nurse providing direct patient care encounters. Each of the other options are classified as systems level exemplars.

The nurse is caring for a patient experiencing an allergic reaction to a bee sting who has an order for BenaDRYL. The only medication in the patient's medication bin is labeled BenaZEPRIL. The nurse contacts the pharmacy for the correct medication to avoid what type of error? a. Communication b. Diagnostic c. Preventive d. Treatment

ANS: D The nurse avoided a treatment error, giving the wrong medication. Benazepril is an ace inhibitor used to treat blood pressure. According to Leape, treatment errors occur in the performance of an operation, procedure, or test; in administering a treatment; in the dose or method of administering a drug; or in avoidable delay in treatment or in responding to an abnormal test. Communication errors refer to those that occur from a failure to communicate. Diagnostic errors are the result of a delay in diagnosis, failure to employ indicated tests, use of outmoded tests, or failure to act on results of monitoring or testing. Preventive errors occur when there is inadequate monitoring or failure to provide prophylactic treatment or follow-up of treatment.

What interrelated constructs facilitate a nurse to become culturally competent? a. Cultural diversity, self-awareness, cultural skill, and cultural knowledge b. Cultural desire, self-awareness, cultural knowledge, and cultural identity c. Cultural desire, self-awareness, cultural knowledge, and cultural diversity d. Cultural desire, self-awareness, cultural knowledge, and cultural skill

ANS: D The process of cultural competence consists of four interrelated constructs: cultural desire, self-awareness, cultural knowledge, and cultural skill. Cultural diversity in the context of health care refers to achieving the highest level of health care for all people by addressing societal inequalities and historical and contemporary injustices. Cultural identity is the norms, values, beliefs, and behaviors of a culture learned through families and group members

The nurse is working with a diabetic patient and is attempting to teach psychomotor skills. This is occurring when the nurse has the patient complete what action? a. Verbally describe his feelings about diabetes. b. Answer three of five true-or-false questions about diabetes. c. Identify three positive lifestyle changes to manage blood sugar. d. Draw up and self-inject insulin correctly.

ANS: D The psychomotor domain incorporates physical movement and the use of motor skills in learning. Teaching the newly diagnosed diabetic how to check blood sugar is an example of a psychomotor skill. Learners in the cognitive domain integrate new knowledge through first learning and then recalling the information. They then categorize and evaluate, making comparisons with previous knowledge that result in conclusions related to the new content. Affective domain learning recognizes the emotional component of integrating new knowledge. Successful education in this domain takes into account the patient's feelings, values, motivations, and attitudes.

A nurse manager finds an unsigned note reporting that patient care standards are not consistently being followed. Within the organizational structure, what is the best action for the manager? a. Schedule a staff meeting to ask staff who left the note. b. Send an email reminder that all staff need to review the policy and procedure book. c. Wait for a staff member to come forward who is willing to be identified. d. Form a small group to explore why staff are not comfortable reporting errors

ANS: D There are significant problems in an organization where staff are not willing to openly discuss problems, especially problems that affect patient care. A focus group can help identify what is preventing a sense of comfort to reveal problems. Scheduling a meeting is unlikely to have the person admit to complaining about care provided by coworkers in front of coworkers. A request to review policies and procedures is so broad the staff will not be able to identify a specific problem that needs to be corrected. Unless organizational changes are made, it is unlikely that staff will decide to come forward when they would not do so in the first place.

The nurse manager of a medical/surgical unit wants to increase the use of health care technology on the unit and is working with an ANA-certified informatics nurse to reduce barriers to health information exchange, including a. basic informatics knowledge and skills. b. offering the best set of tools. c. privacy and security policies. d. unit-specific terminology.

ANS: D Unit-specific terminology would be a barrier to sharing health information because there could be confusion about terms. Standardized terminology within the electronic health record is critical for communicating care to the interprofessional team and exchanging health information. Competency in informatics including basic informatics knowledge and skills could facilitate the use of informatics; lack of competency could be a barrier. Offering the best set of tools could promote the ease of data entry and access. Privacy and security policies reduce legal and ethical concerns about sharing data, thus reducing barriers to health information exchange.