Clinical CHP 1 Chronic

The student nurse asks the nursing instructor what advocacy means in terms of patient care. What is the instructor's best response?

"Advocacy means the nurse acknowledges and protects the rights of patients." The nurse educator best describes advocacy as acknowledging and protecting patient rights. Keeping patients happy is a superficial task that does not ensure patient rights are protected. Assuring all patient information is kept confidential is part of the Health Insurance Portability and Protection Act (HIPAA). Assuring HIPAA is followed may be considered part of patient advocacy, but it is not the best definition. Competency means the nurse has the knowledge to carry out tasks safely.

Which part of the PICOT format that is used in step 1 of the evidence-based practice (EBP) process covers teaching a postoperative patient who has had abdominal surgery to splint with a binder?

"I" Teaching a postoperative patient who has had abdominal surgery to splint with a binder falls under "I" in the PICOT formula that is used in step 1 of the EBP process. The "I" represent intervention. "P" represents patient/population, "O" represents outcome, and "T" represents time period.

At the end of a very long day involving the death of a patient, the nurse uses her social media account to share her experience and find some support. According to the Health Insurance Portability and Accountability Act (HIPAA), which posting would be acceptable?

"It was a very difficult day for me due to the death of one of my favorite patients." The Health Insurance Portability and Accountability Act (HIPAA) prohibits the sharing of any health information which could potentially identify a patient. Stating that the nurse had a difficult day due to the death of a favorite patient does not contain any personally identifying information and generally would not be considered a violation. Sharing any information pertaining to location (Affinity Hospital), age (27), or diagnosis (cancer) could aid in identification of the individual and is thus prohibited by HIPAA standards.

The nurse is giving a report using situation-background-assessment-recommendation (SBAR). Which statement is an appropriate example of "B - Background"?

"The patient's current medications are..." "The patient's current medications are..." refers to pertinent background or circumstances leading up to the situation. "The patient needs to be seen now" is a recommendation or request. "I am concerned about..." is the situation to be discussed. "The patient's condition is worsening..." is an assessment.

The nurse is assigned to care for a newly admitted patient. Place the steps in the correct order for using the nursing process to provide care.

1. Collect patient data 2. Diagnose any health problems 3. Decide on a plan of action 4. Implement the plan of action 5. Evaluate the plan's effectiveness The basic order of the nursing process is assessment, diagnosis, planning, implementation, and evaluation.

After performing assessments on patients, a nurse refers them for appropriate care. Which patient would require long-term care?

A ventilator-dependent patient Long-term care is appropriate for patients that require care for more than 30 days. It is required for individuals who are severely developmentally disabled, are mentally impaired, or have physical deficits requiring continuous medical or nursing management. A patient who is ventilator-dependent requires long-term care. Flu, fever, and diarrhea do not require long-term care because the patients' recovery period is less than 30 days. In these conditions the patient is not severely disabled and does not require long-term care.

A nurse asks a clinical question using the PICOT format. What does PICOT stand for?

P - Patient, I - Intervention, C - Comparison, O - Outcome, T - Time The PICOT system is used for asking clinical questions correctly. In the PICOT system, P stands for patient, I stands for intervention, C stands for comparison, O stands for outcome, and T stands for time. A clinical question does not necessarily need all the components.

What organization is a primary professional organization for nursing?

American Nurses Association American Nurses Association is a primary professional organization for nursing. The AACN, OCN, and AORN are three of the numerous specialty nursing organizations.

"Protecting and maintaining patient privacy and confidentiality are basic obligations." Which of the following organizations has defined this code of ethics for nurses?

American Nurses Association (ANA) The ANA has defined the code of ethics for nurses that states that protecting and maintaining confidentiality is a basic obligation. The NDNQI provides data on nursing-sensitive measures to evaluate the impact of nursing care on patient outcomes. The NPSGs address patient safety concerns that have been initiated by The Joint Commission. The SBON protects the public's health and welfare through the licensing and monitoring of registered nurses.

Which professional organization states that the authority for the practice of nursing is based on a contract with society?

American Nurses Association (ANA) The ANA states that the authority for the practice of nursing is based on a contract with society. TJC evaluates and accredits healthcare facilities. QSEN addresses the preparation of nurses to work in the healthcare field. The State Board of Nursing protects the public's health and welfare through the licensing and monitoring of registered nurses.

Attainment of high-quality, longer lives free of preventable disease, disability, injury, and premature death is a goal of which initiative established by the United States government?

Attainment of high-quality, longer lives free of preventable disease, disability, injury, and premature death is a goal of Healthy People 2020. QSEN is a national effort that addresses the preparation of future nurses. The SBON protects the public's health and welfare through licensing and monitoring of registered nurses. The American Nurses Association is a primary professional organization for nursing.

A nurse can specialize in nursing education. What is the name of the formal process to obtain recognition for expertise in this specialty area?

Certification

When planning care for a patient, the nurse may use a visual diagram of patient problems and interventions to illustrate the relationships among pertinent clinical data. What is this format called?

Concept map A concept map is another method of recording a nursing care plan. In a concept map, the nursing process is recorded in a visual diagram of client problems and interventions. A clinical (critical) pathway is a prewritten plan that directs the entire health care team in the daily care goals for select health care problems. A nursing care plan is a documented plan of care for a patient.

A nurse reviewing charts is participating in what part of the system of quality improvement?

Data collection plan A nurse reviewing charts is participating in the data collection plan part of the quality improvement system. Measures refer to the assessment of how well the healthcare team performed. Aim is a measurable description of the desired improvement. Goals are the proficiencies that need to be met.

A patient with a diagnosis of aggression secondary to psychosis has been admitted to the critical care unit. The nurse consults with the mental health team to provide a set of planned interventions to meet certain goals regarding the aggression. This is an example of what type of care plan?

Patient care protocols Patient care protocols are developed to provide a consistent application of nursing to ensure outcomes are met. Nursing diagnosis, evaluation, and SMART goals should be developed for each patient to individualize patient care.

A patient has visited a hospital twice. A computerized record of the patient's protected health information is generated for both visits. What is this record called?

Electronic health record (EHR) The electronic health record (EHR) is a computerized record of protected health information (PHI). It is generated when the patient visits any care delivery setting. A discharge summary is the document made when a patient is about to be discharged. It contains the information about medications and interventions that a patient needs to follow after discharge. A personal health record is maintained by an individual to track and maintain personal health. Evidence-based practice is a problem solving approach that helps with clinical decision making.

A nurse understands that a patient's medical information should be kept confidential. Which regulation protects the privacy of the patient and promotes confidentiality?

Health Insurance Portability and Accountability Act (HIPAA) The Health Insurance Portability and Accountability Act (HIPAA) protects the personal information of the patient. QSEN stands for Quality and Safety Education for Nurses. It has six components aimed at improving the nursing practice through the development of specific competencies. CPOE stands for computerized provider order. It is used to eliminate errors due to misread handwritten orders. NANDA is concerned with nursing diagnoses, definitions, and classification.

The Quality and Safety Education for Nurses (QSEN) was project established to address the educational link between professional nursing practice and what?

Healthcare delivery

What is the U.S. government initiative that establishes ten-year goals and objectives for improving the health of the nation by empowering people to adhere to healthy lifestyles?

Healthy People 2020 is a government initiative establishing 10-year goals and objectives for improving the nation's health by empowering people to adhere to healthy lifestyles. WIC is a federal grant program that provides nutritious foods to low-income breastfeeding mothers, nonbreastfeeding postpartum mothers and infants, and children up to their fifth birthdays. Patient-centered care is a strategy to improve the quality of care and patient care outcomes. QSEN is a project that provides resources that promote safe and effective care for nursing students and nurse educators.

According to the American Nurses Association (ANA), to which of these should nursing diagnosis and treatment be directed?

Human response to actual or potential health problems The American Nurses Association (ANA) defines nursing as dealing with the human response to health issues, not specifically medical diagnoses, signs and symptoms, or patient complaints and concerns. Although these may be related to or contribute to the human response, by this definition nurses deal with the human response.

When the nurse teaches a patient with heart failure to alternate rest and activity periods to reduce cardiac workload, what phase of the nursing process is being used?

Implementation Carrying out a specific, individualized plan constitutes the implementation phase of the nursing process. The nurse's action of encouragement and instruction to the patient is part of carrying out a plan of action. Planning, diagnosis, and evaluation all come at different points in the nursing process.

Which of the following is a nursing-sensitive measure by the National Databases of Nursing Quality Indicators (NDNQI)?

Incidence of pressure ulcers Incidence of pressure ulcers is a nursing-sensitive measure by the NDNQI. Identifying patients correctly, safely using clinical system alarms, and calling timeouts prior to surgical procedures are National Patient Safety Goals identified by The Joint Commission.

The nurse is writing a plan of care for a patient admitted with chronic obstructive pulmonary disease (COPD). Which planning method is likely to increase patient compliance with the plan of care?

Include the patient in the development of the goals and interventions in the plan of care. The patient is more likely to be compliant with the plan of care when he or she is actively involved in the development of goals and interventions. It is not the responsibility of the health care provider to assign nursing goals and desired outcomes. The nurse is responsible for identifying patient diagnoses, goals of care, evidence-based interventions, and desired patient outcomes founded on the nursing process. As such, asking other health care team members to write at least one intervention is not appropriate. Prewritten plans of care may be used; the nurse should review any plan and individualize it to the patient's unique needs before placing it on the medical record for use by others caring for the patient. However, these do not contribute to increased patient compliance.

What type of prospective payment system do current health care organizations utilize as a means of offering cost-effective health care delivery?

Managed care Current health care organizations utilize managed care systems as a means of offering cost-effective health care delivery. Medicaid, Medicare, and private health insurance are other designated payers for health care.

In order to focus on more complex patient care needs and deliver efficient, economic care to the patients, which task may the nurse delegate to an unlicensed assistive personnel (UAP)?

Measuring urine output The delegation and assignment of nursing activities is a process that, when used appropriately, can result in safe, effective, and efficient patient care. Delegating can allow the nurse more time to focus on complex patient care. State boards of nursing and agency policies identify activities that may be delegated to a UAP. Measuring urine output is a task that may be delegated to a UAP. Discharging a patient, administering oral medications, and performing an initial assessment are nursing interventions that require independent nursing knowledge, skill, and judgment, and therefore cannot be delegated to a UAP.

A patient with coronary artery disease is admitted to the hospital. An electronic health record (EHR) is generated for the patient. Which information will be present in the EHR? Select all that apply.

Medications Laboratory data Medical and surgical history The electronic health record (EHR) is a computerized record of protected health information (PHI). It includes information such as patient demographics, progress notes, problems and medications, vital signs, medical history, immunizations, and laboratory and radiology reports. The educational qualifications of the patient are not included in EHR. Similarly, the financial background of the patient is not mentioned in the EHR.

Which of the following provides nursing interventions that are selected to achieve patient outcomes for which nursing is accountable?

Nursing diagnosis The nursing diagnosis provides nursing interventions that are selected to achieve patient outcomes for which nursing is accountable. NANDA-I is the organization that develops and maintains the standard classification system for nursing diagnosis. The nursing assessment is part of the nursing process. The NOC is a list of patient outcomes developed to evaluate the effects of interventions provided by nurses.

What is an individual, family, or community state, behavior, or perception that is measured along a continuum in response to a nursing intervention?

Nursing-sensitive patient outcome An individual, family, or community state, behavior, or perception that is measured along a continuum in response to a nursing intervention is a nursing-sensitive patient outcome. The nursing process is a problem-solving approach to the identification and treatment of patient problems that is the foundation of nursing. NANDA-NOC-NIC linkage shows how three distinct nursing terminologies can be connected and used together when planning care for patients. NANDA-I develops and maintains the standard classification system for nursing diagnoses.

A nurse is helping a patient share his or her feelings about a recent diagnosis of mental illness contributing to psychosis. What method best helps the patient explore his or her feelings?

Open-ended questions Therapeutic communication is a method to help the patient explore their feelings using open-ended questions. Yes-or-no questions do not promote an easy flow of communication. Past patient experiences are not appropriate to with the patient. Leaving the patient alone does not promote sharing feelings.

A patient is recovering from a stroke and needs help with improving muscle strength, gait training, and transfer training. The nurse should refer the patient to what health care professional?

Physical therapist A physical therapist helps the patient improve strength and endurance and provides gait training and transfer training. Pastoral care offers spiritual support to the patient and family. A speech therapist focuses on the management of speech disorders. An occupational therapist helps the patient improve motor-sensory coordination, cognitive-perceptual skills, and the ability to perform activities of daily living.

In the Medicare program, the payment for hospital services is based on flat fees. These are determined by the diseases and problems treated during the hospital admission. For example, the hospital will receive a fixed amount of $45,000 for the care of a patient who had a total knee replacement. What is the term for this type of payment?

Prospective payment system A prospective payment system was established in the Medicare program to reimburse hospitals using a flat fee based on the disease and problems treated during the admission. Value-based purchasing programs base reimbursement to health care providers on their performance on certain quality measures. Preferred provider organizations and health maintenance organizations are programs through which charges are negotiated in advance of the delivery of care using predetermined reimbursement rates or capitation fees.

A patient diagnosed with psychosis is complaining of being anxious on a newly prescribed medication. Which action by the nurse promotes the patient's psychosocial integrity?

Provide time for the patient to verbalize his or her complaint. The nurse should first provide time for the patient to verbalize his or her complaint to help the patient better understand his or her feelings; this promotes psychosocial integrity. Yelling at other patients is not acceptable and should be discouraged. A letter may help the patient express him or herself, but this is not an example of patient advocacy. If the nurse or patient feels the medication may be causing anxiety, the doctor should be notified but this is less about promoting psychosocial integrity.

The student nurse knows leadership includes Quality and Safety Education for Nurses (QSEN) competencies. Which are QSEN competencies? Select all that apply.

Quality improvement Patient-centered care Evidence-based practice QSEN competencies include quality improvement, evidence based-practice, patient-centered care, teamwork and collaboration, safety, and informatics. Nursing diagnosis is a phase in the nursing process. Nursing outcomes classification is a list of patient outcomes developed to evaluate the effects of interventions provided by nurses.

The registered nurse (RN) is delegating tasks to the licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). Which statement reflects inappropriate delegation?

RN delegates to LPN: Complete admission assessment and documentation on a new patient. The RN cannot delegate an admission assessment to an LPN, as this is not within the LPN's scope of practice. LPNs can gather data but cannot assess a patient. All admission assessments must be done by the RN. Obtaining and recording vital signs is within the scope of practice for the UAP. The LPN is legally permitted to administer oral medications, intramuscular medications, subcutaneous medications, simple intravenous (IV) fluids, and IV antibiotics. The UAP can assist a patient in ambulating to the bathroom.

In any clinical setting, which health care team member is responsible for developing an individualized plan of care that includes nursing diagnoses, interventions, and outcomes including the patient's self-management care plan?

Registered nurse The registered nurse (RN) is responsible for developing individualized plans of care for patients. The nursing plan of care includes identification of nursing diagnosis based on assessment data, patient goals or outcomes, provision of interventions, and continued evaluation of the plan's effectiveness. The primary health care provider determines the medical diagnosis based on testing and physical examination, prescribes medications, and orders testing as needed. It is the nurse's responsibility to carry out the primary health care provider's prescription. The NAP works under the supervision of an RN. The nursing supervisor is a manager or administrator responsible for overseeing and directing multiple healthcare team members

The nurse knows effective communication is a part of nursing leadership. Which is a communication tool that guides health care providers to provide clear information in a predictable, structured manner?

SBAR SBAR (situation, background, assessment, and recommendation) is the method used in the health care environment to provide clear communication. EBP (evidence-based practice) is a problem-solving approach to clinical decision making that leads to improved patient outcomes. NOC (Nursing Outcomes Classification) is a list of patient outcomes developed to evaluate the effectiveness of nursing interventions. QSEN (Quality and Safety Education for Nurses Institute), developed by the Robert Wood Johnson Foundation, defines multiple competencies that nurses must have to practice safely and effectively in today's healthcare system

In health care, value-based purchasing programs base reimbursement to hospitals on their performance and quality measures. When an adverse event that is considered preventable happens to a patient, the insurance company can withhold payment. What is this type of event called by the National Quality Forum (NQF)?

Serious reportable event A serious reportable event is an event that happens to a patient that is considered preventable and can affect reimbursement to the health care organization from insurance companies. Health care error event, adverse health care event, and serious preventable event are not terms that refer to an event that happens to a patient and is considered preventable.

What communication tool will the nurse utilize to provide safe, effective care when reporting a change in a patient's condition?

Situation-Background-Assessment-Recommendation (SBAR) tool The SBAR tool is a structured technique that provides a way for members of the healthcare team to talk about a patient's condition. A nursing diagnosis provides a basis for selecting nursing interventions to achieve patient outcomes for which a nurse is accountable. A nursing care plan is a guide for routine nursing care. A clinical pathway is an interprofessional nursing care plan that specifies care and desired outcomes during a specific time period for patients with particular diagnoses or health conditions.

On what do the nursing terminologies, Nursing Interventions Classification (NIC), NANDA International (NANDA-I), and Nursing Outcomes Classification (NOC) specifically focus?

Specific phases of the nursing process The nursing terminologies, Nursing Interventions Classification (NIC), NANDA International (NANDA-I), and Nursing Outcomes Classification (NOC) focus on the specific phases of the nursing process. Quality patient care relates to high-quality healthcare. A nursing care plan provides an individualized plan of care for a patient. Classifications of outcomes are in the Nursing Outcomes Classification (NOC), which is a list of patient outcomes developed to evaluate the effects of interventions provided by nurses.

A nurse is discussing patient-related information with another nurse. Which data should the nurse use when identifying the "R" part of the SBAR system?

Specific treatments SBAR (situation-background-assessment-recommendation) is a technique that provides a mechanism for framing critical communication about a patient's condition between members of the health care team. The letter "R" indicates recommendation or request. When assessing the recommendation, a nurse has to use data that will help to understand specific treatments, tests needed, and patient needs. Information about recent vital signs, admitting diagnosis, and synopsis of treatment to date helps the health care team to understand the patient's background. It is indicated by a "B."

The student nurse asks the instructor where to find information about tasks that are legally permitted to be completed by a registered nurse (RN). Where does the instructor tell the student the nurse's scope of practice is described?

State Nurse Practice Act The State Nurse Practice Act defines the scope of practice for nurses. Each state has a nurse practice act specifically defining the state's scope of nursing practice. The ANA Code for Nurses serves as a guide for carrying out nursing responsibilities in an ethical, professional manner. The NLN position statements that address issues and trends in nursing education. The AACN white papers cover a variety of current concerns in professional nursing practice.

A nurse is caring for a patient on the cardiac care unit. A cardiologist who lives in another city consults with the health care team through videoconferencing. What is this process known as?

Telehealth Telehealth is the use of technology such as videoconferencing to provide care when patients and their health care providers are geographically separated. Electronic health records are health records maintained by clinics or hospitals in an electronic format. Evidence-based practice is a problem-solving approach used to answer clinical questions. Online health management is the use of the Internet and technology for managing health.

Which branch of nursing is defined as a care delivery model that utilizes the nursing process to provide nursing care to patients through telecommunication technologies and increase access to care for those who may not be able to afford travel to the nearest health care facility?

Telehealth nursing Telehealth nursing is using the nursing process to provide nursing care to patients through telecommunication technologies. Team care involves a group of providers who work together to deliver care. Parish nursing does not involve telecommunication technologies. Case management involves managing a patient's care with interprofessional team members across multiple care settings and levels of care.

Telehealth nursing is using the nursing process to provide nursing care to patients and increase access to care to those who may not be able to afford transportation to the nearest health care facility. What methods are considered telehealth nursing? Select all that apply.

Telehealth nursing provides nursing care to patients through telecommunication technologies, such as satellite, wireless, video communications, and high-speed Internet. Telephone conversation is not a method for telehealth nursing.

Which organization promotes safety by providing evidence-based solutions to common safety problems?

The Joint Commission The Joint Commission issues National Patient Safety Goals which promote safety by providing evidence-based solutions to common safety problems. The NDNQI provides data on nursing-sensitive measures to evaluate the impact of nursing care on patient outcomes. The National Quality Forum (NQF) is dedicated to improving quality in healthcare. The NQF provides a list of safe practices in order to address adverse events that are preventable. HIPAA is part of federal legislation that addresses actions for how protected health information (PHI) is used and disclosed.

The nurse must use critical thinking while providing nursing care. How is critical thinking defined?

The ability to focus thinking to get the desired results in various situations, which has been described as knowing how to learn, be creative, generate ideas, make decisions, and solve problems. Critical thinking is defined as the ability to focus your thinking to get the desired results in various situations, which has been described as knowing how to learn, be creative, generate ideas, make decisions, and solve problems. Understanding the medical and nursing implications of a patient's situation when making decisions involves knowledge. Using the nursing process to provide nursing care to patients using technology involves technology and informatics. The collaborative nursing process is part of teamwork and collaboration for care coordination

Delegation is a common leadership role in professional nursing practice. How is delegation defined?

Transferring authority to a competent individual to complete a selected task Delegation is defined as transferring authority to a competent individual to complete a selected task in a selected situation. When done appropriately, delegation can result in safe, effective, and efficient patient care. Assigning nursing tasks to the UAP is part of the work each staff member is to accomplish during a given shift; this is an example of delegation. Responsibility for completing a task falls on the registered nurse (RN) even when the task is delegated. RNs are responsible for monitoring patient outcomes. Distributing workload among subordinates to create a fair working environment is referred to as patient care assignments.

A nurse understands that it is very important to identify the patient accurately before any patient-related activity is performed. What method should the nurse take to improve the accuracy of patient identification?

Use at least two ways of identifying the patient, including full name and date of birth. The best way to improve the accuracy of patient identification is to use at least two ways to identify patients. The nurse can use information such as the patient's full name and date of birth or full name and birth city. Asking the patient to repeat his or her name is not practical and will not serve the purpose. Similarly, giving only numbers to patients may create confusion. Asking the other nurse to keep a backup will only increase workload and is not practical.