Ch. 1, 3, 4

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The patient has become confused and attempts to climb out of bed. What interventions can the nurse provide prior to using restraints?

b. ask a family member to sit with the patient

What is the priority responsibility for the nurse providing patient education?

a. determining individual needs for education, b. motivating each person to learn, e. presenting information at the level of the learner

What does the nurse determine is the single most important factor in determining health status and longevity?

c. motivation to change

What statement does the nurse determine is a medical diagnosis rather than a nursing diagnosis?

a. fever of unknown origin

Which health promotion model does the nurse identify is the reason some people choose actions to foster health and others refuse to participate?

a. health belief model

The nurse is aware that the INstitute for Healthcare Improvement Ventilator BUndle has determined interventions that can improve patient outcomes. What interventions can the unit adopt to improve this care for the patients on ventilators?

A. Provide oral care with chlorhexidine, C. Keep the head of the bed elevated at all times, E. turn the patient every 4 hours.

Using the concept of the wellness-illness continuum, what would the nurse include in the development of a nursing care plan for a chronically ill patient?

b. encourage positive health characteristics within the limits of the specific illness

The nurse moves a confused, disruptive patient to a private room at the end of the hall so that the other patients can rest, even though the confused patient becomes more agitated. The nurse's intervention is consistent with what moral theory?

a. "Consequentialism," by which good consequences for the greatest number are maximized

What steps can the nurse take to present the need for a change in care practice to her peers?

a. Determine best practices from valid research studies

A patient is admitted to the acute care facility after an acute myocardial infarction. In order to prevent a breakdown in care transition, what nursing action is a priority?

a. Ensure a seamless transition from inpatient hospitalization to community setting

Which priority intervention illustrates planned nursing care prioritized according to Maslow hierarchy of needs?

a. administer pain medication to a patient 30 minutes before transportation to physical therapy for crutch-walking exercises.

What underlying focus in any definition of nursing is the registered nurse's responsibility in practice?

a. appraise and enhance an individual's health-seeking perspective

The nurse identifies a patient's inability to pour a liquid medication into measuring spoon. What part of the nursing process is this?

a. assessment

Which statement by the nurse shows an understanding of the focus of the quality assurance programs developed in the 1980's?

c. "The quality assurance programs focus on processes used to provide care and improving those processes"

The nurse is providing care for a patient in the hospital scheduled for discharge in the morning. The patient will require further services after discharge since recovery is not complete. What can the nurse do to ensure quality care delivery for this patient.

c. Contact the case manager for coordination of care prior to discharge of the patient

The nurse working in the operating room is scheduled to circulate for an elective abortion. The nurse tells the supervisor that it will not be possible to assist with this case due to religious beliefs. What problem is the nurse experiencing with this surgical case?

c. an ethical dilemma

What therapeutic communication technique validates what the nurse believes to be the main idea of an interaction?

c. restating

When an ethical decision is made based on the reasoning of the "greatest goo for the greatest number," what theory is the nurse following?

d. utilitarian theory

A patient that has had a stroke is not able to eat without maximum assistance and has a nursing diagnosis of "Imbalanced nutrition, less than body requirements, related to inability to feed self." What would be an immediate nursing outcome for the patient to achieve?

d. master the use of special eating utensils to feed self

How can the ICU improve the care of the patients with VAP?

b. Incorporate evidence-based findings into patient care

Which action by the nurse can negatively affect the patient's ability to learn?

b. Negative criticism when the patient is unsuccessful so that inappropriate behavior patterns will not be learned

What does the nurse determine is a moral problem rather than a moral dilemma?

b. a 32-year-old father of three with advanced cancer of lungs asks that everything be done to prolong his life, even though his chemotherapy treatments are no longer effective

The RN is responsible for delegating patient care responsibilities to licensed practical nurses as well as ancillary personnel. What would be the most appropriate task to delegate to a nursing assistant?

b. obtaining vital signs for a patient that has been hospitalized for 3 days

The nurse develops a program of increased ambulation for a patient with an orthopedic disorder. What component of the nursing process is this?

b. planning

A patient with a DNR order requires large doses of a narcotic for pain that rates a 10 on a 0 to 10 scale. After the patient requests pain medication, the nurse assesses a respiratory rate of 12 breaths per minute. What intervention by the nurse would be considered ethical?

c. give the pain medication without fear of respiratory depression

How should the registered nurse be responsive to the changing health care needs of society?

c. place increasing emphasis on wellness, health promotion, and self-care, because the majority of Americans today suffer from chronic debilitative illness

Continuous quality improvement was mandated in health care organizations in 1992. hat does the nurse understand is the primary purpose of CQI?

c.Examine processes that affect patient care and the need for improvement

What is the primary focus of the nurse advocacy role in managing a clinical pathway?

d. A patient's progress toward desired outcomes

A patient with chronic obstructive pulmonary disease has asked an adult child to make medical decisions in the event that the patient will not be able to make them. What type of advance directive should the patient sign?

d. ethical committee form

THe nurse is developing a plan of care for a patient. What is the end result of data analysis during the assessment process?

d. identification of actual or potential health problems

The registered nurse has a responsibility to practice nursing according to the Social Policy Statement of the American Nurses Association. What definition by the ANA best describes the role of registered nurses?

d. to diagnose and treat the human responses to health and illness

The nurse prepares to administer medication to the patient. THe patient states, "I would prefer not to take that medication until I speak with my healthcare provider." The nurse honors the patient's desire to make decision, following which common ethical principle?

a. autonomy

The nurse has modified a teaching program for a learner that is not experientially prepared. What nursing action is appropriate?

a. changing the wording in a teaching pamphlet so that a patient with a fourth grade reading level can understand it

A terminally ill patient asks the nurse, "Am I dying?" How will the nurse's response be influenced by moral obligation?

a. communicate the patient's wishes to the family, b. consult with the healthcare provider, c. provide correct information to the patient

Assessment, the first of five steps in the nursing process, begins with initial patient contact. What activities by the nurse are included in this component of the nursing process?

a. interviewing and obtaining a nursing history , b. observing for altered symptomatology, c. collecting and analyzing data

The home health nurse reviews a medication administration calendar with an older adult patient. In order to consider sensory changes that occur with again, how should the nurse proceed?

a. print directions in large, bold type, preferably using black ink

Since normal aging results in changes in cognition, how should the nurse teach an older adult patient to administer insulin?

a. repeat the information frequently for reinforcement

THe nurse is preparing to educate a patient about the home care of an abdominal wound. What patient behaviors does the nurse assess that demonstrate readiness to learn?

a. the patient shows the motivation to learn, b. the patient has accepted the therapeutic regimen, e. the patient requests a contact number if there are questions

The nurse develops outcome criteria for a patient with chronic obstructive pulmonary disease. Which outcome criteria are appropriate for this patient?

a. the patient will have the ability to climb a flight of stairs without experiencing difficulty breathing

Which patient is most in need of health education by the nurse?

b. A 62-year-old male with chronic kidney injury

A hospital board of directors decides to close a pediatric burn treatment center that annually admits 50 patients and to open a treatment center for terminally ill AIDS patients. This decision means that the nearest BTC for children is now 300 miles away. What example of ethical reasoning is this decision consistent with?

d. utilitarianism

A patient who adheres to the dietary laws of Judaism is in traction and confined to bed. The patient needs assistance with the evening meal of chicken, rice, beans, a roll, and a carton of milk. Which nursing approach is most representative of promoting wellness?

d.ask whether the patient would like to make any substitutions in the foods and fluids received


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