Chapter 1 Fundamentals of Nursing
Which of the following demonstrates a health restoration activity? Select all that apply. 1) Administering an antibiotic every day 2) Teaching the importance of handwashing 3) Assessing a client's surgical incision 4) Advising a woman to get an annual mammogram after age 50 years
Answer: 1) Administering an antibiotic every day 3) Assessing a client's surgical incision Rationale: Health restoration activities help an ill client return to health. This would include taking an antibiotic every day and assessing a client's surgical incision. Handwashing and mammograms both involve healthy people who are trying to prevent illness.
A patient who underwent a total abdominal hysterectomy is assisted out of bed as soon as her vital signs are stable. This intervention is most likely being directed by a: 1) Critical pathway 2) Nursing care plan 3) Social worker 4) Traditional care model
Answer: 1) Critical pathway Rationale: This patient's care is most likely being directed by a critical pathway. A critical pathway is a multidisciplinary approach to care that sequences interventions over a length of stay for a given case type, such as total abdominal hysterectomy. Using this model, the patient can be assisted out of bed as soon as her vital signs are stable. Using the traditional model, the nurse would have to obtain a physician's order to assist the patient out of bed after surgery. The nursing care plan guides nursing care but cannot specify when the patient can get out of bed postoperatively without a physician's order. When case management is used, care is coordinated by the case manager across the healthcare setting, but the case manager does not direct each care intervention.
Nurses have the potential to be very influential in shaping healthcare policy. Which of the following factors contributes most to nurses' influence? 1) Nurses are the largest health professional group. 2) Nurses have a long history of serving the public. 3) Nurses have achieved some independence from physicians in recent years. 4) Political involvement has helped refute negative images portrayed in the media.
Answer: 1) Nurses are the largest health professional group. Rationale: Nurses are trusted professionals and the largest health professional group. As such, they have political power to effect changes. If nursing was a small group, there would be little potential for power in shaping policies, even if all the other answers were true. Serving the public, while positive, does not necessarily help nurses to be influential in establishing health policy. Independence from physicians, although positive, does not necessarily make nurses influential in establishing healthcare policy. Refuting negative media, although a worthwhile activity, does not necessarily make nurses influential in establishing healthcare policy.
All of the following are aspects of the full-spectrum nursing role. Which one is essential for the nurse to do in order to successfully carry out all of the others? 1) Thinking and reasoning about the patient's care 2) Providing hands-on patient care 3) Carrying out physician orders 4) Giving instructions to assistive personnel
Answer: 1) Thinking and reasoning about the patient's care Rationale: A substantial portion of the nursing role involves using clinical judgment, critical thinking, and problem-solving, which directly affect the care the client will actually receive. Providing hands-on care is important; however, clinical judgment, critical thinking, and problem-solving are essential in order to do it successfully. Carrying out physician orders is a small part of a nurse's role; it, too, requires nursing assessment, planning, intervention, and evaluation. Many simple nursing tasks are being delegated to nursing assistive personnel; delegation requires careful analysis of patient status and the appropriateness of support personnel to deliver care. Another way to analyze this question is that none of the options of providing hands-on care, carrying out physician orders, and giving instructions to assistive personnel is required in order for the nurse to think and reason about a client's care; therefore, the answer must be 1.
Which of the following are examples of a health promotion activity? (Select all that apply). 1) Helping a client develop a plan for a low-fat, low-cholesterol diet 2) Disinfecting an abraded knee after a child falls off a bicycle 3) Administering a tetanus vaccination after an injury suffered in a car accident 4) Distributing educational brochures about the benefits of exercise
Answer: 1, 4) Helping a client develop a plan for a low-fat, low-cholesterol diet; Distributing educational brochures about the benefit of exercise. Rationale: Health promotion includes strategies that promote positive lifestyle changes. Disinfecting an abraded knee is a treatment/intervention for an injury. Administering a vaccination is a disease-prevention and treatment activity.
A healthy patient tells the nurse that he uses acupuncture and yoga to obtain pain relief and does not take pain medication. The nurse recognizes this as what type of treatment? 1) Rationing 2) Complementary and alternative medicine 3) Tertiary 4) High-technology medicine
Answer: 2) Complementary and alternative medicine Rationale: Complementary and alternative medicine involve treatments and practices that are outside traditional medicine. They include yoga, herbal medications, massage therapy, and acupuncture, to name a few. CAM is becoming more acceptable as alternatives to traditional medicine. Rationing is the limitation of access to or the equitable distribution of resources. Tertiary care occurs during the last stages of life or with long-term rehabilitation. Today's healthcare environment involves more technology and nurses must treat the patient without overreliance on technology.
Which statement pertaining to Benner's practice model for clinical competence is true? 1) Progression through the stages is constant, with most nurses reaching the proficient stage. 2) Progression through the stages involves continual development of thinking and technical skills. 3) The nurse must have experience in many areas before being considered an expert. 4) The nurse must have experience in many areas before being considered an expert.
Answer: 2) Progression through the stages involves continual development of thinking and technical skills. Rationale: Movement through the stages is not constant. Benner's model is based on integration of knowledge, technical skill, and intuition in the development of clinical wisdom. The model does not mention experience in many areas. Nurses reach the stages based on their individual abilities; thus, one cannot give definitive time frames for reaching the stages.
Which of the following best explains why it is difficult for the profession to develop a definition of nursing? 1) There are too many different and conflicting images of nurses. 2) There are constant changes in healthcare and the activities of nurses. 3) There is disagreement among the different nursing organizations. 4) There are different education pathways and levels of practice.
Answer: 2) There are constant changes in healthcare and the activities of nurses. Rationale: The conflicting images of nursing make it more important to develop a definition; they may also make it more difficult but not to the extent that constant change does. Healthcare is constantly changing and with it come changes in where, how, and what nursing care is delivered. Constant changes make it difficult to develop a definition. Although different nursing organizations have different definitions, they are similar in most ways. The different education pathways affect entry into practice, not the definition of nursing
The student nurse asks her preceptor why the patient is being discharged 2 days after surgery when he still needs wound care and help with basic hygiene. The preceptor should educate the student nurse on which concept? 1) Preferred Provider Organizations (PPOs) 2) Health Maintenance Organizations (HMOs) 3) Diagnosis-Related Groups (DRGs) 4) Point of Service (POS)
Answer: 3) Diagnosis-Related Groups Rationale: Discharge planning begins on admission. A diagnosis-related group is a prospective reimbursement system. Insurance companies will reimburse hospitals on a per-case flat rate determined by patient groups (DRGs). Hospitals will lose money if the patient's hospital costs are greater than the amount reimbursed. Therefore, a patient's length of stay corresponds with the reimbursement rate. The patient will be discharged and followed up by home healthcare nurses.
Which of the following aspects of nursing is essential to defining it as both a profession and a discipline? 1) Established standards of care 2) Professional organizations 3) Practice supported by scientific research 4) Activities determined by a scope of practice
Answer: 3) Practice supported by scientific research Rationale: The ANA has developed standards of care, but they are unrelated to defining nursing as a profession or discipline. Having professional organizations is not included in accepted characteristics of either a profession or a discipline. A profession must have knowledge that is based on technical and scientific knowledge. The theoretical knowledge of a discipline must be based on research, so both are scientifically based. Having a scope of practice is not included in accepted characteristics of either a profession or a discipline.
The patient says to the Charge Nurse, "I have a great group of nurses. The RN and UAP are all very attentive to my care needs and work very well together." Which nursing model of care is this unit following? 1) Team nursing 2) Case method nursing 3) Functional nursing 4) Primary nursing
Answer: 3) Team nursing Rationale: With team nursing, an RN or LVN is paired with a NAP. The pair is then assigned to render care for a group of patients. In case method nursing, one nurse cares for one patient during the entire shift. Private duty nursing is an example of this care model. This nursing unit is following the functional nursing model of care in which care is partitioned and assigned to a staff member with the appropriate skills. For example, the NAP is assigned vital signs, and the LVN is assigned medication administration. When the primary nursing model is used, one nurse manages care for a group of patients 24 hours a day, even though others provide care during part of the day.
The nurse assesses her patient to determine whether his condition has changed since her assessment 4 hours earlier. What process is the nurse using? 1) Critical thinking 2) Reciprocity 3) Problem-solving 4) Clinical judgment
Answer: 4) Clinical judgment Rationale: Clinical judgment involves observing, comparing, contrasting, and evaluating the client's condition to determine whether the patient's condition has changed. The nurse must know what to expect based on the patient's condition and treatment regimen. The nurse then uses critical thinking to analyze the information and determine options for care. Reciprocity is used by nurses licensed in one state to obtain a license to practice nursing in another state.
A 34-year-old patient who suffered a stroke has right-sided weakness and impaired mobility. Which facility will the patient be sent to after discharge from the hospital? 1) Assistive living 2) Behavioral health center 3) Independent living facility 4) Rehabilitation center
Answer: 4) Rehabilitation center Rationale: Rehabilitation centers employ respiratory therapists, physical therapists, speech-language pathologists, occupational therapists, nurses, and other healthcare providers to treat stable patients who require additional treatment. The patient will, at the least, require physical therapist and occupational therapy. Physical therapists help patients regain muscle functioning and mobility. Occupational therapists help patients regain function and independence.
Match the following terms and definitions. Write the number of the correct definition beside the matching term. Terms A. Health promotion _______ B. Illness prevention _______ C. Health restoration _______ Definitions 1. Activities that foster a return to health for those already ill 2. Focus on avoidance of disease 3. Activities that foster the highest state of well-being of the recipient 4. Activities that provide for comfort and a peaceful death
Answer: A: 3 B: 2 C: 1
Identify five images of nurses that have emerged over time.
Answer: Angel of mercy depicts the nurse as an angelic, serene, compassionate person. Battle-ax image shows the nurse as an unkind, mean-spirited person who lacks compassion for patients. Naughty nurse portrays the nurse as a sex symbol who lacks clinical judgment and critical-thinking skills. Handmaiden image describes the nurse in a submissive role with no autonomy in patient care decisions. Professional image illustrates the nurse as an educated, competent, and caring patient care provider.
The NSNA is the professional organization for which of the following? Newly licensed nurses Student nurses Licensed practical nurses Certified nursing assistants
Answer: B. Student nurses
Based on the ICN definition of nursing, what does a nurse do?
Answer: Based on the ICN definition, the nurse practices independently and collaboratively and does the following: Provides care for individuals, families, groups, and communities Cares for people sick and well Works in a variety of settings Provides care to promote health; prevent illness; and care for the ill, disabled, and dying Advocates for improved healthcare Promotes a safe environment Engages in research and education Participates in shaping health policy and patient and health systems
What type of custodial care activities can the RN assign to the NAP? Assisting the patient with grooming Walking the stable patient Changing the patient's wound dressing A and B only
Answer: D. A and B only Rationale: The NAP can provide custodial care that consists of helping patients with activities of daily living such as bathing, grooming, eating, and toileting. The NAP works under the direction/supervision of the RN.
In the United States, the practice of nursing is regulated by which of the following? ANA's Code for Nurses With Interpretive Statements ANA's Nursing's Social Policy Statement ANA's Standards for Nursing Practice State nurse practice acts
Answer: D. State nurse practice acts Rationale: Each state's nurse practice act defines and regulates the scope and practice of nursing within the state. State nurse practice acts legally define nursing and are the laws that regulate the scope of practice for all levels of nursing within a state. The ANA Code for Nurses and Nursing's Social Policy Statement and Standards "provide a means by which a profession clearly describes the focus of its activities, the recipients of service, and the responsibilities for which its practitioners are accountable" (ANA, 1998, p. vii). Standards are guidelines that the profession develops to promote the delivery of quality care by competent professionals.
What health insurance plans are associated with managed care? A. Health maintenance organizations (HMOs) B. Preferred provider organizations (PPOs) C. Point of service (POS) D. All of the above
Answer: D: All of the above Rationale: Managed care insurance plans are based on agreements between the insurance company (managed care organization) and healthcare providers to treat patients for a predetermined, fixed amount. HMOs, PPOs, and POS are types of managed care plans.
Name and describe five educational pathways leading to licensure as an RN.
Answer: Diploma program—3 years, associated with a hospital. Focuses on clinical experience and direct patient care. Associate degree—2 years, community college. Includes liberal arts and science and nursing courses. Baccalaureate degree—At least 8 semesters, college or university. Includes more emphasis on community care and utilization of research. Master's entry programs—The typical student has a baccalaureate degree in another field and has entered nursing as a second career. Programs usually last 3 years. At the completion, the student is eligible to take the licensing exam and is awarded a master's degree in nursing. Doctoral entry—The nursing doctorate (ND) path parallels the pathway through which physicians enter the healthcare field. This entry path has very limited enrollment.
To be considered a discipline, a profession must have a _____________________ that has theoretical and practical boundaries.
Answer: Domain of knowledge Rationale: The theoretical boundaries of a healthcare profession are the questions that arise from clinical practice and are then investigated through research. The practical boundaries are the current state of knowledge and research in the field. To be considered a discipline, a profession must have a domain of knowledge that has both theoretical and practical boundaries (Meleis, 1991).
Nurses are not expected to use critical thinking when caring for patients.
Answer: False Rationale: The ability to use critical-thinking skills is the hallmark of a safe and competent nurse. Nurses are expected to use critical thinking in all aspects of patient care.
A person who cares for the sick but has not taken the National Council Licensure Examination (NCLEX) can use the title "Nurse."
Answer: False Rationale: The title "Nurse" is regulated and can be used only by persons who have completed a nursing program of study and passed the NCLEX.
Compare and contrast formal and informal education.
Answer: Formal education is a structured program of study that is provided by an institution of learning. A program of learning may culminate in a degree that is bestowed by the institution (e.g., associate, baccalaureate, or master's degree). Usually it takes place on the campus of a school, college, or university. However, it can also include distance learning (e.g., online courses) and in-service and continuing education programs offered at work sites, colleges, and professional organizations. Formal education offerings are usually evaluated, accredited, or in some way regulated by agencies external to the school itself (e.g., by the Accreditation Commission for Education in Nursing [ACEN]). Informal education occurs through socialization and self-study. It is the knowledge gained by direct experience, observation in the real world, and informal discussion with peers and colleagues. Benner's process of moving from novice to expert describes professional socialization, during which the nurse acquires a personal integration of knowledge that requires technical skill, thoughtful application, and insight.
The purpose of nursing care is to achieve the goals of__________, illness prevention, __________, and end-of-life care.
Answer: Health promotion, health restoration
According to the American Nurses Association, nursing is the diagnosis and treatment of ____________________________________________.
Answer: Human responses to actual and potential health problems. Rationale: In 1980, the ANA defined nursing as the diagnosis and treatment of human responses to actual and potential health problems. This definition continues to be the nursing profession's standard.
Identify two forces within healthcare that influence the nursing profession.
Answer: Increased autonomy and advanced practice roles, increased use of nursing assistive personnel, increased variety of work settings, increased use of complementary and alternative medicine, nurses' ability to influence healthcare policy, increased use of technology, interdisciplinary collaboration
How does being uninsured affect a person's health status?
Answer: Less likely to seek medical treatment until he is seriously ill. Unable to access routine healthcare. Does not obtain health screening to detect cancer, blood disorders, and other medical conditions. Limited finances and the high cost of healthcare can lead to "medical bankruptcy". Less likely to receive necessary post-hospitalization care and follow-up.
Identify two outside forces that influence the nursing profession.
Answer: National economy, consumers, direct-to-consumer marketing, the women's movement, collective bargaining
List five settings in which nurses can work.
Answer: Nurses today have a wide variety of practice settings within which they may be employed. Some of the options mentioned in this text are hospitals, ambulatory care centers, rehabilitation centers, extended care facilities, physician offices, health insurance offices, HMOs, and public or community health organizations.
What are factors that impact your view (draw on your self-knowledge to answer this question)?
Answer: Personal values Past experiences with requiring medical care Past experiences of having, or not having, health insurance Expectations from employer Belief about taxes Perspective regarding how access to care should be made available.
Do you view healthcare as a right or a privilege?
Answer: Persons who view healthcare as a right have a perspective that people should receive medical treatment regardless of the ability to pay. The healthcare system should be structured to provide access to care for all persons. Employers have a responsibility to ensure that healthcare coverage is available to employees, and the government at both the state and federal levels should provide programs for the unemployed. The United States Supreme Court's ruling that upheld key provisions of the Affordable Care Act supports the view that healthcare is a right. Persons who view healthcare as a privilege do not believe that it is the government's role to provide health insurance to persons who do not have coverage associated with employment. Government-funded health insurance should be available on a limited basis to those who need assistance. Because health insurance is funded through taxes, only a certain percentage of citizens are paying to provide coverage to all persons. This is viewed as inherently unfair and unjust. People with this view also tend to believe that with rights go responsibilities; for example, that people are responsible for helping to preserve their own health by making healthy lifestyle choices.
Compare and contrast privately funded and government-funded health insurance.
Answer: Private healthcare insurance is purchased by a person directly or for persons by a third party such as an employer. Premiums (the insurance costs) are paid directly to the insurance company by the person (for individual insurance) or the person's employee. Employers purchase insurance under a group plan, which lowers costs and the employer pays the premium to the insurance company. The employee's portion of the cost is deducted directly from his paycheck. Employer-provided health insurance is considered a fringe benefit. Government-funded health insurance is funded by collecting taxes from its citizens. These programs can be offered at the federal level, such as Medicare, or be a joint venture between the federal government and the state, such as Medicaid. Government-funded programs offer insurance to persons who meet the eligibility criteria. For example, Medicare is available to persons aged 65 years and older and to those with permanent disabilities.
Florence Nightingale transformed nursing and is associated with which image of the nurse?
Answer: Professional
What factors make it difficult to define nursing?
Answer: Several factors make it difficult to define nursing; among them are the following: Rapid changes in the nursing role. Rapid changes in healthcare. Highly complex role. Ongoing expansion of nursing knowledge. Changes over time in beliefs and expectations of nursing.
Benner defines five stages of nursing competence. List and define these.
Answer: Stage 1: Novice. This phase begins with the onset of education. The novice is receptive to education and is learning the rules. Stage 2: Advanced Beginner. After considerable exposure to clinical situations, performance improves and the nurse begins to recognize elements of a situation. The result is progression to the advanced beginner stage. Stage 3: Competence. After several years of practice, this stage is achieved. Competent performers have gained additional experience and wrestle with more complex concerns. They are able to handle their patient load and prioritize situations. They are also more involved in their caregiving role and may be emotionally involved in the clinical choices made. Stage 4: Proficient. Proficient nurses are a resource for newer nurses. They are able to see the "big picture," coordinate services, forecast needs, and plan intuitively as well as consciously. Stage 5: Expert. Expert nurses are able to see what needs to be achieved and how to do it. They trust in and use their intuition. They have expert skills and are often consulted when others need advice or assistance.
Compare and contrast advanced practice clinical roles for nurses.
Answer: The Nurse Practitioner (NP) has advanced education and training to work in collaborative relationships with physicians. These practitioners can work autonomously and can diagnose and treat individuals across the life span. In many states, the advanced practice registered nurse (APRN) can prescribe medications. The Clinical Nurse Specialist (CNS) has advanced education and training in a specialized area of practice. The CNS has extensive theoretical and practical knowledge to be the clinical expert and resource for the practice area. The Certified Registered Nurse Anesthetist (CRNA) has advanced education and training to administer anesthesia to persons undergoing surgery or certain diagnostic procedures. The CRNA provides perioperative services (before, during, and after surgery) to clients and works closely with surgeons, anesthesiologists, and other physicians. The Certified Nurse Midwife (CNM) is an advanced practitioner who specializes in women's health. A CNM can perform pap smears and breast examinations but most commonly provides care to women before, during, and after childbirth.
Recall the last time that you had a cold. Identify health-promotion, illness-prevention, and health-restoration activities for individuals, families, groups, and communities in relation to the common cold.
Answer: There are numerous possible answers. Health-promotion activities Encouraging frequent handwashing Getting adequate nutrition and rest Instructing children at school and at home on the need to wash their hands regularly, cover their mouths while coughing or sneezing, and eat a balanced diet Illness-prevention activities Thoroughly washing glasses, utensils, and dishes used by persons with colds with hot, soapy water Avoiding close contact with people known to have colds Instructing persons with infection to avoid contact with individuals who are frail, elderly, newborn, or suffering from chronic disease Thoroughly washing hands after coming in contact with someone who has a cold Health-restoration activities Getting additional rest Increasing fluids Taking ibuprofen or decongestants
What Are the Main Points in This Chapter?
Religious organizations and the military have played a major role in the development of nursing and healthcare organizations. Initially, the role of the nurse was limited to bathing, feeding, and supporting the patient; keeping the patient environment clean and orderly; and providing support for the physician. Contemporary nursing care includes activities that are performed in collaboration with other members of the healthcare team and also independently. Licensed practical nurses (LPNs or LVNs) are nurses who have successfully completed a practical nursing program and have passed a licensure exam (NCLEX-PN). They are prepared to give direct patient care. Registered nurses (RNs) are nurses who have successfully completed a registered nurse education program and have passed a licensure exam (NCLEX-RN). There are several types of RN education programs. Graduate nursing education is designed to prepare the RN for advanced practice, expanded roles, nursing education, or research. Benner has identified a five-step progression of skill acquisition in nurses: novice, advanced beginner, competence, proficiency, and expert. Nurse practice acts are laws that regulate nursing practice at the state level. Nurses engage in health promotion, illness prevention, health restoration, and care of the dying. Nurses work in a variety of inpatient and outpatient settings, including hospitals, extended care facilities, ambulatory care, and community or home health settings. Nurses provide care using either the case method, functional, team, primary, or differentiated model. The economy, technology, an aging population, increased consumer involvement in healthcare, the women's movement, and the change in nursing role are forces that have strongly affected nursing. The healthcare delivery system is complex, with a multitude of players.
