Chapter 1: Professional Nursing Practice

After teaching nursing students about the health-illness continuum, the instructor determines that teaching was successful when the students state which of the following?

"A person can be both healthy and ill at the same time."

A nurse is a member of which entity within the larger health care environment?

health care team

Which type of nursing diagnosis is a clinical judgment of a client's motivation and behavior to increase his or her well-being?

health promotion

Which type of nursing diagnosis identifies an existing condition that the client is experiencing?

problem-focused

A client was discharged from the hospital 3 weeks ago following surgery and has now been contacted to complete the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This survey will primarily address the client's:

satisfaction with the care he or she received in the hospital.

A nurse using critical thinking interprets data and determines appropriate interventions. What factor will affect the nurse's ability to employ critical thinking with data interpretation?

the nurse's personal biases

A longterm care facility's newest client refuses to attend group activities or social events offered by the facility. Which level of Maslow's hierarchy do social events address?

third: love and belonging needs

A client presents to the acute care facility with several signs and symptoms. How will the nurse determine and prioritize the client's healthcare needs?

using a systematic method to plan and implement care to reach desired outcomes

The use of patient restraints limits which ethical principle?

Autonomy

According to the Centers for Disease Control (CDC, 2006), this chronic illness has tripled in occurrence since 1980:

Diabetes

Which of the following is a true statement about critical thinking according to Alfaro-LeFevre (2010)?

It is guided by professional standards and codes of ethics.

The RN develops an outcome standard of "client will ambulate with an assistive device 60 feet with assistance twice a day" for a client who had a hip replacement. What part of the nursing process is involved with this outcome statement?

Planning

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

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

The physician asks the nurse not to disclose a client's diagnosis of end-stage cancer with the client until the client's family can be available to provide support. During the nurse's shift, the client asks the nurse, "What is wrong with me? Everyone is treating me like I am dying." Which of the following replies by the nurse allows the nurse to maintain integrity while providing care for the patient?

"You feel like people are treating you like you are dying?"

A client, 50 years old, is admitted for treatment of a gastric tumor. The client asks the nurse, "Do you think I have cancer?" Which response by the nurse would be most therapeutic?

"You sound concerned about what the physicians will tell you."

Which of the following best reflects the rationale for evidence-based practice?

A means to ensure quality care

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

A patient's progress toward desired outcomes

The following nursing diagnoses are formulated with a client: constipation, acute pain, and caregiver role strain. During the planning phase of the nursing process, the nurse will prioritize the diagnoses in what order?

Acute pain, constipation, caregiver role strain

A nurse is changing employment and will be working at a community nursing center. With which activities would the nurse be most likely involved? Select all that apply.

Administering immunizations Performing screening assessments Providing ambulatory care

A certified nurse practitioner (CNP) working in the emergency department (ED) provides advanced cardiac life support (ACLS) to a client experiencing asystole. What care planning tool will the CNP use in this situation in order to care for the client based on response to treatment?

Algorithm

Which critical thinking skill involves identification of client problems indicated by data?

Analysis

Although nurse practice acts may vary state by state, all recognize several basic principles supporting the legal parameters for all registered nurses. Select the activity that falls under the scope of nursing practice.

Appraising and enhancing an individual's health-seeking perspective

Which element would be included as a goal of case management?

Appropriateness of services

Which is a goal of case management?

Appropriateness of services

A client has been diagnosed with cardiac dysfunction and admitted to a health care center. The nurse notices that the client's ankles and feet are swollen. Using critical thinking skills, which nursing intervention does the nurse know to perform next?

Assess client for dependent edema

A client has been diagnosed with small cell lung cancer. The client has met with the oncologist and is now weighing the relative risks and benefits of chemotherapy and radiotherapy. This client is demonstrating which ethical principle in making a final decision?

Autonomy

The nurse is administering a medication to a client for the treatment of his constipation. The client expresses preferring not to take the medication today. The nurse respects the client's right and says if the client needs it later, just let the nurse know. What professional value is the nurse displaying?

Autonomy

A nurse working in the intensive care unit refers to the Institute for Healthcare Improvement (IHI) Ventilator Bundle before planning patient care. The nurse realizes nursing interventions outlined in the bundle will improve clients' outcomes. Which statement best describes how nursing interventions established by the IHI should be included in each bundle?

Best practices derived from valid and reliable research studies guided nursing interventions being added to the IHI bundles

A nurse is beginning a health history with a client and states, "Which part of your health history would you like to start with?" This type of communication technique is called

Broad opening

A nurse is unsure how best to respond to a client's vague complaint of "feeling off." The nurse is attempting to apply the principles of critical thinking, including metacognition. How can the nurse best foster metacognition?

By examining the way that she thinks and applies reason

A nursing instructor is lecturing on ethics. To start the lecture, the instructor asks which issues students believe to be most common for nurses today. The students would choose which of the following? Choose all that apply.

Confidentiality Use of restraints Trust End-of-life concerns

Which of the following is involved in the implementation step of the nursing process?

Documenting nursing care and client responses

Which of the following is a cognitive or mental activity that nurses use in critical thinking?

Drawing on past clinical experiences and knowledge to explain what is happening

A client has designated a family member to make healthcare decisions for the client if the client is not able to do so. What type of advance directive is this considered?

Durable power of attorney (DPOA) for healthcare

To address the needs of a chronically ill patient and promote the concept of wellness, a nursing care plan should outline steps to:

Encourage positive health characteristics within the limits of the disease.

The licensed practical nurse is caring for a client who has been admitted to the unit with a possible head injury caused by a motor vehicle accident. The LPN would contact the RN before implementing which nursing intervention?

Encourage the client to turn, deep breathe, and cough every 2 hours.

There are central characteristics of nursing practice that are applicable across the wide variety of contexts in which nurses practice. A nurse can best demonstrate these principles by performing which of the following actions?

Ensuring that all of their actions exemplify caring

Which term is defined as a formal systematic study of moral beliefs?

Ethics

Healthcare providers use a problem-solving approach for ethical dilemmas. Which is the last step of the ethical decision-making model?

Evaluate the decision in terms of effects and results.

In response to a client's report of pain, the nurse has given a PRN dose of pain medication. In what phase of the nursing process should the nurse determine whether this medication has had the desired effect?

Evaluation

A nurse with 20 years' experience attends a hospital-required training session and learns a new method for assessing nasogastric (NG) tube placement. During the training the nurse educator provides the nurse with a bibliography of peer-reviewed articles related to NG tube placement. The nurse recognizes the change in procedure developed from which method?

Evidence-based practice

What is the first step in becoming culturally competent?

Exploring one's own cultural beliefs

After teaching a group of students about health, wellness and illness, a nursing instructor determines that additional instruction is necessary when the students identify which of the following as a component of wellness?

Feeling together about one part of life

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

Fever of unknown origin

The nurse is providing a program at the local YMCA about stress-reduction techniques combined with a 1-mile walk around the indoor track once a week. What does this type of program address for the community?

Health promotion

Which element is involved in the planning phase of the nursing process?

Identify measurable outcomes

The Healthy People initiatives have targeted the improvement of health for all. In addition to eliminating health disparities, what are the broad goals of the Healthy People initiatives?

Increasing the quality and length of a healthy life

Which communication technique is helpful in health teaching about relevant aspects of a client's well-being and self-care?

Informing

A nurse is leading a community health clinic. What should the nurse emphasize in order to promote disease prevention?

It is best achieved by exhibiting behaviors that promote health.

The care team has deemed the occasional use of restraints necessary in the care of a client with Alzheimer disease. What ethical violation is most often posed when using restraints in a long-term care setting?

It threatens the client's autonomy.

A client had a total hip replacement earlier in the day. The nurse sits with the client to establish some goals. One goal they agree on is to ambulate 1 to 2 miles each day. This is an example of which type of goal?

Long-term

Based on the nurse's knowledge of the increased risk for bleeding in a client undergoing chemotherapy or radiation, which of the following interventions does the nurse need to include in the client's plan of care? Select all that apply.

Monitoring the platelet count Monitoring for signs of abnormal bleeding Instructing the client to use a soft toothbrush Instructing the client to use an electric razor

A group of nursing students are reviewing the various types of advanced practice nurses. The students demonstrate the need for additional review when they identify which of the following as an advanced practice nurse?

Nurse manager

Students are reviewing information about community health nursing. The students demonstrate understanding of the term "community-oriented nursing practice" by describing it as which of the following?

Nursing interventions that can promote wellness, reduce illness spread, and improve the health status of groups

A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which will the nurse include in presentation when describing disease patterns?

Obesity along with conditions associated with it has become a major health concern.

Which set of nursing actions demonstrates that the nurse understands the nursing process?

Obtaining vital signs and pain scale rating, documenting the nursing diagnosis as acute pain, administering analgesic, and evaluating comfort level

The central figure in health care services is the:

Patient

Nursing students are reviewing the changing patterns of disease. The students demonstrate a need for additional review when they identify which condition as being on the rise?

Pneumonia

The nurse is assisting with the development of a program to administer flu shots to a group of senior citizens. What type of prevention does this program reflect?

Primary prevention

The nurse is practicing in a community-based setting. What outcomes may be achieved by the nurse's community interventions? (Select all that apply.)

Promote wellness. Reduce the spread of disease. Improve the health status of the community.

When functioning in the practitioner role, the nurse would be involved in which of the following? Select all that apply.

Providing direct care Collaborating with other disciplines Prescribing medications Teaching clients and families

When a person authorizes another to make medical decisions on his or her behalf, the person has written which of the following?

Proxy directive

A terminally ill client the nurse is caring for is reporting pain. The physician has prescribed a large dose of intravenous opioids by continuous infusion. When the nurse assesses the client's respiratory status, the rate has decreased from 16 to 10 breaths per minute. What action should the nurse take?

Report the decreased respiratory rate to the physician.

Telling the truth (veracity) is one of the basic principles of North American culture. Three ethical dilemmas in clinical practice can directly conflict with this principle. Choose the three from the list below.

Revealing a diagnosis to people other than the client with the diagnosis Using placebos Not revealing a diagnosis to a client

A nurse is caring for a patient who is experiencing fear, anxiety, and feelings of powerlessness after receiving a diagnosis of cancer. The nurse develops a teaching plan focusing on the patient's diagnosis and treatment options to promote the patient's sense of control over the situation. Using Maslow's Hierarchy of Human Needs, which of the following categories is the nurse attempting to meet?

Safety and security

The nurse working in the clinic has had several incidences of positive chlamydia cultures return in women with pelvic pain. The nurse understands that early diagnosis and treatment are essential measures in which to reduce contagion and limit the complications related to this infection. What type of prevention will the nurse use when these infections are treated?

Secondary prevention

According to the Maslow hierarchy of needs, which of the following is the highest level of needs?

Self-actualization

Which of the following is the highest level of human need according to Maslow (1968)?

Self-actualization

A local college is having a career-day seminar for student nurses. Booths from various agencies and facilities have been set up. One of the students approaches the booth of a home care agency and asks the nurse there about what is required to become a home care nurse. Which of the following would the nurse incorporate into the response?

Strong clinical decision-making skills

Which therapeutic communication technique may occur during the planning stage, when the client is presented with alternative ideas for consideration relative to problem solving?

Suggesting

A client has been admitted in the emergency care unit with conditions of respiratory distress and pneumonia. The client's condition worsens and requires mechanical ventilation. While visiting this client in the hospital, the family observes members of the health care team washing their hands upon entering and leaving the room. By implementing recommended hand hygiene measures, which organization's goals is the health care team supporting?

The Joint Commission

An older adult client who enjoyed watercolor painting when young has recently indicated a desire to begin painting again. According to Maslow's theories on human needs, what is the best reason the client will express an interest in painting again?

The client is motivated for creative expression because lower level needs are being met.

A client has a nursing diagnosis of "Feeding self-care deficit related to right-sided weakness. Which of the following would be the most appropriate expected outcome for this client?

The client will demonstrate an ability to feed himself with a spoon at the morning meal.

The nurse is revising a client's care plan. When determining goals for the client, what is the process for the expected outcomes? Select all that apply.

The outcomes are derived from nursing diagnoses. The outcomes are measurable goals. The outcomes include a time estimate for the achievement of short- and long-term outcomes.

A nurse walks into a client's room to find the client trying to get out of bed. The client is confused and combative and states a need to get up to check on the cat. What actions are appropriate for the nurse to take? Select all that apply.

Use the services of a trained sitter. Develop a schedule for employees to sit with the client. Be compliant with annual education regarding appropriate use of restraints.

Which ethics theory focuses on ends or consequences of actions?

Utilitarian theory

A hospital board of directors decides to close a pediatric burn treatment center (BTC) that annually admits 50 patients and to open a treatment center for terminally ill AIDS patients (with an expected annual admission of 200). This decision means that the nearest BTC for children is now 300 miles away. What example of ethical reasoning is this decision consistent with?

Utilitarianism

The nurse admits a client to an oncology unit that is a site for a study on the efficacy of a new chemotherapeutic drug. The client knows that placebos are going to be used for some participants in the study but does not know that he is receiving a placebo. When is it ethically acceptable to use placebos?

When the client knows placebos are being used and is involved in the decision-making process

A student nurse has been assigned to provide basic care for a 58-year-old man with a diagnosis of AIDS-related pneumonia. The student tells the instructor that she is unwilling to care for this client. What key component of critical thinking is most likely missing from this student's practice?

Withholding judgment

The nurse is preparing to serve on the hospital's ethics committee. What are ethical dilemmas in the nurse's clinical practice that can show direct conflict with the principle of veracity? Select all that apply.

administering placebos for pain relief keeping a client's medical diagnosis from the client revealing a diagnosis to people other than the client with the diagnosis

Future healthcare policy in the United States will be significantly affected by a population that is:

aging and becoming more culturally diverse.

How is assessment defined as part of the nursing process?

careful observation and evaluation of a client's health status

Ethical theories provide a means to determine if a particular action is good or bad. Which theory of ethics holds that a person's duties are as important as the outcome or consequences of one's actions?

deontology

The nurse is developing a client's care plan. What activity best exemplifies the assessment phase of the nursing process?

determines the client has a pulse rate of 88 bpm