CONCEPTS - Exam #1 (Practice Questions)

Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples? (Select all that apply.) 1. Caregiver 2. Autonomy and accountability 3. Patient advocate 4. Health promotion 5. Lobbyist

*1, 2, 3, 4. * Each of these roles or skills includes activities for the professional nurse. Each of these is used in direct care or are part of professionalism that guides nursing practice.

Match the following types of theory with the appropriate description. 1. Middle-range theory 2. Shared theory 3. Grand theory 4. Practice theory a. Very abstract; attempts to describe nursing in a global context b. Specific to a particular situation; brings theory to the bedside c. Applies theory from other disciplines to nursing practice d. Addresses a specific phenomenon and reflects practice

*1d, 2c, 3a, 4b. *

Theory is essential to nursing practice because it: (Select all that apply.) 1. Contributes to nursing knowledge. 2. Predicts patient behaviors in situations. 3. Provides a means of assessing patient vital signs. 4. Guides nursing practice. 5. Formulates health care legislation. 6. Explains relationships between concepts.

*1, 2, 4, 6* A theory contains a set of concepts, definitions, and assumptions that explain a phenomenon. The theory explains how these elements are uniquely related in the phenomenon. These components provide a foundation of knowledge for nurses to direct and deliver caring nursing practices. A theory helps explain an event by defining ideas or concepts, explaining relationships between the concepts, and predicting outcomes of nursing care. A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care.

Which of the following statements related to theory-based nursing practice are correct? (Select all that apply.) 1. Nursing theory differentiates nursing from other disciplines. 2. Nursing theories are standardized and do not change over time. 3. Integrating theory into practice promotes coordinated care delivery. 4. Nursing knowledge is generated by theory. 5. The theory of nursing process is used in planning patient care. 6. Evidence-based practice results from theory-testing research.

*1, 3, 4, 6. * The overall goal of nursing knowledge is to explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines. Theory generates nursing knowledge for use in practice, thus supporting evidence-based practice. The integration of theory into practice leads to coordinated care delivery and therefore serves as the basis for nursing. Although the nursing process is central to nursing, it is not a theory. Nursing theories are not stagnant and continue to evolve over time.

The nurse spends time with the patient and family reviewing the dressing change procedure for the patient's wound. The patient's spouse demonstrates how to change the dressing. The nurse is acting in which professional role? 1. Educator 2. Advocate 3. Caregiver 4. Case manager

*1. Educator* The nurse is demonstrating the role of educator. An educator explains concepts and facts about health, describes the reason for routine care activities, demonstrates procedures such as home-care activities, reinforces learning or patient behavior, and evaluates the patient's progress in learning through return demonstration.

Health care reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform? 1. Moving from an acute illness to a health promotion, illness prevention model 2. Moving from an illness prevention to a health promotion model 3. Moving from an acute illness to a disease management model 4. Moving from a chronic care to an illness prevention model

*1. Moving from an acute illness to a health promotion, illness prevention model* Health care reform also affects how health care is delivered. There is greater emphasis on health promotion, disease prevention, and management of illness.

A nurse just started working at a well-baby clinic. One of her recent experiences was to help a mother learn the steps of breastfeeding. During the first clinic visit the mother had difficulty positioning the baby during feeding. After the visit the nurse considers what affected the inability of the mother to breastfeed, including the mother's obesity and inexperience. The nurse's review of the situation is called: 1. Reflection. 2. Perseverance. 3. Intuition. 4. Problem solving.

*1. Reflection.* The mother had difficulty the first time breast feeding. The nurse relied on reflection to consider her previous actions, review what was successful and the opportunities for improvement. The nurse has not yet problem solved but might do so after reflection and anticipating the patient's next clinic visit.

A nurse is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following theories? 1. Roy 2. Levine 3. Watson 4. Johnson

*1. Roy* When applying Roy's adaptation model, the nurse helps the patient cope with/adapting to changes in physiological, self-concept, role function, and interdependence domains.

Tracy is in her last semester of nursing school where she is taking a course in which her class learns about the importance of evidence-based practice. Dr. Minturn, the nursing professor who teaches the course, has asked the students to write a paper about a mock research study of their choosing. The students are to pose a clinical question and then map how they would create a research study around the question. They are not to actually carry out the research, but they are to envision what their study would look like and then map it on paper. *____________________________________________* 1. Tracy uses the six steps of evidence-based practice to help formulate her mock research study. Rank in order the six steps of evidence-based practice. A. Evaluate the practice decision or change. B. Ask a clinical question. C. Critically appraise the evidence you gather. D. Collect the most relevant and best evidence. E. Share the outcomes of evidence-based changes with others. F. Integrate all evidence with one's clinical expertise and patient preferences and values in making a practice decision or change. 2. Tracy relies on PICOT to help her develop a clinical question for the research project. She knows that the "C" in PICOT refers to which of the following? A. Caring B. Clinical component C. Comparison of interest D. Compiled data E. Complicated patient 3. Tracy writes her mock research purpose statement. In the purpose statement she includes a ___________ that predicts the relationship between the study variables. 4. Tracy knows that the __________ __________ is the foundation of research; thus she includes this in her mock research paper objectively test her hypothesis.

*1.* Answer: B, D, C, F, A, E Rationale: The six steps of evidence-based practice are: ask a clinical question; collect the most relevant and best evidence; critically appraise the evidence you gather; integrate all evidence with one's clinical expertise and patient preferences and values in making a practice decision or change; evaluate the practice decision or change; and share the outcomes of evidence-based practice with others. *2.* Answer: C Rationale: The "C" in PICOT refers to the "comparison of interest" that identifies the usual standard of care or current intervention used now in practice. *3.* Answer: Hypothesis Rationale: A hypothesis or hypotheses are research questions found in the purpose statement of a research article that predicts the relationship or difference among study variables. *4.* Answer: Scientific method Rationale: The scientific method is the foundation of research and is the most reliable and objective of all methods of gaining knowledge.

Match the following descriptions to the appropriate grand theorist. 1. King 2. Henderson 3. Orem 4. Neuman a. Based on the theory that focuses on wellness and prevention of disease b. Based on the belief that people who participate in self-care activities are more likely to improve their health outcomes c. Based on 14 activities, the belief that the nurse should assist patients with meeting needs until they are able to do so independently d. Based on the belief that nurses should work with patients to develop goals for care

*1d, 2c, 3b, 4a*

Which of the following Internet resources can help consumers compare quality care measures? (Select all that apply.) 1. WebMD 2. Hospital Compare 3. Magnet Recognition Program 4. Hospital Consumer Assessment of Healthcare 5. The American Hospital Association's webpage.

*2, 4* Both of these are Internet sites that collect patient data to document hospitals' quality of care and patient satisfaction. WebMD is an internet source that is disease/condition specific. The Magnet Recognition Program is a hospital-initiated recognition that assesses the quality of nursing care and patient safety.

Jennifer is a first-semester nursing student who is studying the theoretical foundations of nursing practice. She learns that nursing theory is the foundation of nursing research, which builds the scientific knowledge base of nursing that is applied to practice. As more research is conducted, the discipline learns to what extent a given theory is useful in providing information to improve patient care. Once Jennifer completes nursing school, she plans to obtain her master's degree in nursing research. Therefore Jennifer is interested in learning how components in a theory help drive research questions to improve nursing. *_______________________________________________* 1. Jennifer knows that ______________ _________ describe phenomena, speculate on why they occur, and describe their consequences. 2. Jennifer learns about the focus of nursing theories. Nursing theories focus on the ___________ of nursing and nursing care. 3. Jennifer learns the difference between internal and external patient factors. Which of the following is an example of an external factor that affects the patient? (Select all that apply.) A. Change in health care policy B. Increase in health insurance premium C. Change in cognitive function D. Increase in respiratory rate

*1.* Answer: Descriptive theories Rationale: Descriptive theories are the first level of theory development that describe phenomena, speculate on why they occur, and describe their consequences. *2.* Answer: Phenomenon Rationale: A phenomenon is the term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations. The phenomenon of nursing and nursing care is the focus of nursing theories. *3.* Answer: A, B Rationale: External factors exist outside the patient system (e.g., such as a change in health care policy and an increase in health insurance premium). Internal factors exist within the patient system (e.g., physiological and behavioral responses to illnesses). Change in cognitive function and increase in respiratory rate are examples of internal factors.

Mrs. Celia Shirer is a 33-year-old German woman admitted to the medical-surgical unit for management of a bowel infection secondary to a colostomy. She has had a colostomy and colostomy pouch for 3 years, but she is not compliant in correctly cleaning the area and changing the dressing and pouch as required. She is placed on antibiotics to fight the infection, intravenous fluids to maintain hydration, and nonsteroidal antiinflammatory medications for pain. Lucy is the nursing student assigned to Mrs. Shirer. Lucy's priority in caring for Mrs. Shirer is to educate the patient about the importance of maintaining hygiene and to promote comfort. *__________________________________________* 1. Lucy uses an analytical process to determine the cause of Mrs. Shirer's noncompliance. Lucy is using the process of __________ _____________. 2. Lucy does not approve of Mrs. Shirer's lack of compliance with her medical regimen. However, Lucy always treats Mrs. Shirer with ____________ and deals with situations justly. 3. Lucy tries several different teaching methods to try to improve Mrs. Shirer's compliance to her medical regimen. She keeps at the process, hoping to find an approach that works with Mrs. Shirer. Lucy is demonstrating which attitude for critical thinking? A. Discipline B. Risk taking C. Responsibility D. Perseverance E. Accountability 4. Lucy asks Mrs. Shirer, "Why do you think it's difficult for you to manage your colostomy and colostomy bag as indicated?" Lucy is expressing integrity by asking Mrs. Shirer this question. A. True B. False

*1.* Answer: Diagnostic reasoning Rationale: Diagnostic reasoning is the analytical process for determining a patient's health problems. Accurate recognition of a patient's problems is necessary before determining a course of action. *2.* Answer: Fairness Rationale: Regardless of how the nurse feels about a patient, he or she must always treat the patient with fairness and justice to promote positive outcomes for him or her. *3.* Answer: D Rationale: To persevere means to keep looking for resources until a successful approach is found. It leads the nurse to try different communication approaches. *4.* Answer: B Rationale: Curiosity involves asking patients why they do the things they do. Curiosity motivates the nurse to investigate a clinical situation.

Maylie is a new nurse graduate who is attending orientation at the local hospital. Before she is assigned to a preceptor and can begin taking patients, she must attend a 2-day classroom orientation at the hospital where she learns about institution policies and procedures. Maylie is anxious to begin work in the intensive care unit (ICU) caring for patients, but she understands that part of her job is to represent the hospital in a professional manner. She cannot do this until she learns institution protocols. *__________________________________________* 1. Maylie learns about the hospital's protocols regarding bioterrorism. Which of the following are examples of public health simulation exercises that help train nurses for threats of bioterrorism? (Select all that apply.) A. Vaccine research B. Prioritization C. Decontamination D. Triage 2. The hospital in which Maylie is employed is a large county health care facility that cares for thousands of medically underserved patients. Which of the following contribute to increases in the medically underserved population? (Select all that apply.) A. Government funding B. Mental illness C. Homelessness D. Rising health care costs 3.Since nursing is a caring profession, Maylie does not need to be concerned about budgets and rising costs when it comes to caring for her patients. A. True B. False

*1.* A, C, D, - Examples of public health simulation exercises that help train nurses for threats of bioterrorism are vaccine research, decontamination, and triage. *2.* B, C, D - The rising rates of unemployment, underemployment, low- paying jobs, mental illness, and homelessness and rising health care costs contribute to increases in the medically underserved population. *3.* B - Nurses are responsible for providing the patient with the best-quality nursing care in an efficient and economically sound manner by adhering to budgets and helping to decrease rising health care costs.

Match the advanced practice nurse specialty with the statement about the role. 1. Clinical nurse specialist 2. Nurse anesthetist 3. Nurse practitioner 4. Nurse-midwife a. Provides independent care, including pregnancy and gynecological services b. Expert clinician in a specialized area of practice such as adult diabetes care c. Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients who are healthy or have chronic conditions d. Provides care and services under the supervision of an anesthesiologist

*1b, 2d, 3c, 4a. * The role statements describe the activities performed and the role of the advanced practice nurse specialty. Nurse midwives care for women who are pregnant or have women's health needs. Clinical nurse specialists typically see hospitalized patients with a specific type of illness or health problem. Nurse practitioners usually practice in a primary care setting and care for patients who are healthy or have minor acute or stable chronic conditions. Certified nurse anesthetists care for patients during the surgical experience and administer anesthesia during surgery.

Match the following description to the appropriate middle-range theory. 1. Benner's Skill Acquisition 2. AACN's Synergy Model 3. Mishel's Uncertainty in Illness 4. Kolcaba's Theory of Comfort a. The nurse strives to relieve patients' distress. b. The nurse progresses through five stages of expertise. c. The nurse helps the patient to process and find meaning related to his or her illness. d. Matching nurse competencies to patient needs can improve patient outcomes.

*1b, 2d, 3c, 4a.*

Match the concepts for a critical thinker on the right with the application of the term on the left. a. Anticipate how a patient might respond to a treatment. b. Organize assessment on the basis of patient priorities. c. Be objective in asking questions of a patient. d. Be tolerant of the patient's views and beliefs. ___ 1. Truth seeking ___ 2. Open-mindedness ___ 3. Analyticity ___ 4. Systematicity

*1c, 2d, 3a, 4b. *

A nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with them. The nurse is acting as the patient's: 1. Educator. 2. Advocate. 3. Caregiver. 4. Case manager.

*2. Advocate.* An advocate protects the patient's human and legal right to make choices about his or her care. An advocate may also provide additional information to help a patient decide whether or not to accept a treatment or find an interpreter to help family members communicate their concerns

Using Maslow's hierarchy of needs, identify the priority for a patient who is experiencing chest pain and difficulty breathing. 1. Self-actualization 2. Air, water, and nutrition 3. Safety 4. Esteem and self-esteem needs

*2. Air, water, and nutrition* According to Maslow's theory, basic physiological needs are the patient's first priority, especially when a patient is severely dependent physically. In this example, the patient's need for adequate oxygenation (air) is the priority

Which of the following types of theory influence the "evidence" in current "evidence-based practice (EBP)"? 1. Grand theory 2. Middle-range theory 3. Practice theory 4. Shared theory

*2. Middle-range theory* The original grand theories served as springboards for the development of the more modern middle-range theories, which, through testing in research studies, provide the "evidence" for EBP and promotes the translation of research into practice.

The nurse is caring for a patient admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. The nurse assumes responsibility for bathing and feeding the patient until the patient is able to begin performing these activities. The nurse in this situation is applying the theory developed by: 1. Neuman. 2. Orem. 3. Roy. 4. Peplau.

*2. Orem.* When applying Orem's self-care deficit theory, the nurse continually assesses the patient's ability to perform self-care and intervenes as needed to ensure that physical, psychological, sociological, and developmental needs are being met. As the patient's condition improves, the nurse encourages the patient to begin doing these activities independently.

Two patient deaths have occurred on a medical unit in the last month. The staff notices that everyone feels pressured and team members are getting into more arguments. As a nurse on the unit, what will best help you manage this stress? 1. Keep a journal 2. Participate in a unit meeting to discuss feelings about the patient deaths 3. Ask the nurse manager to assign you to less difficult patients 4. Review the policy and procedure manual on proper care of patients after death

*2. Participate in a unit meeting to discuss feelings about the patient deaths* By connecting and meeting with staff colleagues, the nurse can talk about the experiences of caring for dying patients and learn that her feelings are likely shared by others. A journal is helpful but not the best way to relieve stress. A policy and procedure manual will not help the nurse examine and understand the nature of the stress. Asking for a different assignment is no guarantee that another stressful experience will develop.

An 18-year-old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, listens to her lung and heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed? 1. Diagnosis 2. Evaluation 3. Assessment 4. Implementation

*3. Assessment* Assessment is the collection of comprehensive data pertinent to the patient's health and the situation.

Nurses in an acute care hospital are attending a unit-based education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education? 1. Continuing education 2. Graduate education 3. In-service education 4. Professional Registered Nurse Education

*3. In-service education* In-service education programs are instruction or training provided by a health care agency or institution. An in-service program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution.

A nurse is preparing to begin intravenous fluid therapy for a patient. Which category of theory would be most helpful to the nurse at this time? 1. Grand theory 2. Middle-range theory 3. Practice theory 4. Shared theory

*3. Practice theory* Practice theories bring theory to the bedside. Narrow in scope and focus, these theories guide the nursing care of a specific patient population at a specific time.

Which of the following categories of shared theories would be most appropriate for a patient who is grieving the loss of a spouse? 1. Biomedical 2. Leadership 3. Psychosocial 4. Developmental

*3. Psychosocial* Rationale: You can use various psychosocial theories to help patients with loss, death, and grief.

A nurse meets with the registered dietitian and physical therapist to develop a plan of care that focuses on improving nutrition and mobility for a patient. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Informatics

*3. Teamwork and collaboration* This is an example of the competency of teamwork and collaboration. This competency focuses on the nurse functioning effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care.

You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient with terminal cancer. As part of the preparation you have your classmates read the Nursing Code of Ethics for Professional Registered Nurses. Your instructor asks the class why this document is important. Which of the following statements best describes this code? 1. Improves self-health care 2. Protects the patient's confidentiality 3. Ensures identical care to all patients 4. Defines the principles of right and wrong to provide patient care

*4. Defines the principles of right and wrong to provide patient care* When giving care, it is essential to provide a specified service according to standards of practice and to follow a code of ethics. The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. It serves as a guide for carrying out nursing responsibilities to provide quality nursing care and the ethical obligations of the profession.

A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed? 1. Planning 2. Evaluation 3. Assessment 4. Implementation

*4. Implementation* Implementation is completing coordinating care and completing the prescribed plan of care.

A critical care nurse is using a computerized decision support system to correctly position her ventilated patients to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Informatics

*4. Informatics* Using decision support systems is one example of using informatics and gaining competency in informatics.

A nurse ensures that each patient's room is clean; well ventilated; and free from clutter, excessive noise, and extremes in temperature. Which theorist's work is the nurse practicing in this example? 1. Henderson 2. Orem 3. King 4. Nightingale

*4. Nightingale* Nightingale's environmental theory directs the nurse to manipulate the environment to promote rest and healing.

The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career? 1. Clinical nurse specialist 2. Nurse administrator 3. Nurse educator 4. Nurse researcher

*4. Nurse researcher* The nurse researcher investigates problems to improve nursing care and to further define and expand the scope of nursing practice. He or she often works in an academic setting, hospital, or independent professional or community service agency.

1. The components of the nursing metaparadigm include: 1. Person, health, environment, and theory 2. Health, theory, concepts, and environment 3. Nurses, physicians, health, and patient needs 4. Person, health, environment, and nursing

*4. Person, health, environment, and nursing* Person, health, environment, and nursing are the four components that comprise the nursing metaparadigm.

The examination for registered nurse (RN) licensure is exactly the same in every state in the United States. This examination: 1. Guarantees safe nursing care for all patients. 2. Ensures standard nursing care for all patients. 3. Ensures that honest and ethical care is provided. 4. Provides a minimal standard of knowledge for an RN in practice.

*4. Provides a minimal standard of knowledge for an RN in practice.* RN candidates must pass the NCLEX-RN® to attain licensure. Regardless of educational preparation, the examination for RN licensure is exactly the same in every state in the United States.

The use of standard formal nursing diagnostic statements serves several purposes in nursing practice, including which of the following? (Select all that apply.) 1. Defines a patient's problem, giving members of the health care team a common language for understanding the patient's needs 2. Allows physicians and allied health staff to communicate with nurses how they provide care among themselves 3. Helps nurses focus on the scope of nursing practice 4. Creates practice guidelines for collaborative health care activities 5. Builds and expands nursing knowledge

*Answer 1, 3, 5. * The use of nursing diagnosis creates a common language for nurses to communicate patient care needs and allows nurses to focus on the realm and scope of nursing practice. It is not a language for physicians and allied health staff because they do not rely on providing nursing interventions. Terminology in nursing diagnosis may be familiar to other healthcare providers but not in a way for directing nursing interventions. Nursing diagnosis has the purpose of creating practice guidelines for nursing.

Review the following problem-focused nursing diagnoses and identify the diagnoses that are stated correctly. (Select all that apply.) 1. Impaired Skin Integrity related to physical immobility 2. Fatigue related to heart disease 3. Nausea related to gastric distention 4. Need for improved Oral Mucosa Integrity related to inflamed mucosa 5. Risk for Infection related to surgery

*Answer 1, 3. * The related factors in diagnoses "Fatigue related to heart disease" and "Need for improved oral mucosa integrity related to inflamed mucosa" are incorrect. The related factor of a medical diagnosis (in Fatigue related to heart disease) cannot be corrected through nursing intervention. In "Need for improved oral mucosa integrity related to inflamed mucosa" there is no diagnosis, but instead a goal of care. "Risk for infection related to open wound" is incorrect because At Risk diagnoses do not have related factors match between clinical cues and the nursing diagnosis.

A nurse reviews data gathered regarding a patient's ability to cope with loss. The nurse compares the defining characteristics for Ineffective Coping with those for Readiness for Enhanced Coping and selects Ineffective Coping as the correct diagnosis. This is an example of the nurse avoiding an error in: (Select all that apply.) 1. Data collection. 2. Data clustering. 3. Data interpretation. 4. Making a diagnostic statement. 5. Goal setting.

*Answer 1, 3. * This is an example of an error in interpretation and data collection. When making a diagnosis you must interpret data you have collected by identifying and organizing relevant assessment patterns to support the presence of patient problems. In the case of the two diagnoses in this question, there can be conflicting cues. The nurse must obtain more information and recognize the cues that point to the correct diagnosis.

In which of the following examples are nurses making diagnostic errors? (Select all that apply.) 1. The nurse who observes a patient wincing and holding his left side and gathers no additional assessment data 2. The nurse who measures joint range of motion after the patient reports pain in the left elbow 3. The nurse who considers conflicting cues in deciding which diagnostic label to choose 4. The nurse who identifies a diagnosis on the basis of a patient reporting difficulty sleeping 5. The nurse who makes a diagnosis of Ineffective Airway Clearance related to pneumonia.

*Answer 1, 4, 5. * When the nurse observes the patient wincing and holding his left side, but does not gather additional assessment data, the nurse makes a data collection error by omitting important data, pain severity. A nursing diagnosis cannot be made on basis of a single defining characteristic, as seen when the nurse identifies a diagnosis on the basis of a patient reporting difficulty sleeping. The nurse that measures joint range of motion after the patient reports pain is correctly validating findings. Considering conflicting clues ensures the nurse does not make an interpretation error.

Which of the following nursing diagnoses is stated correctly? (Select all that apply.) 1. Fluid Volume Excess related to heart failure 2. Sleep Deprivation related to sustained noisy environment 3. Impaired Bed Mobility related to postcardiac catheterization 4. Ineffective Protection related to inadequate nutrition 5. Diarrhea related to frequent, small, watery stools.

*Answer 2, 4.* The correct diagnoses of sleep deprivation and ineffective protection are worded with related factors that will respond to nursing interventions. Nursing interventions do not change a medical diagnosis or diagnostic test. . Instead, you direct nursing interventions at behaviors or conditions that you are able to treat or manage. The two incorrect diagnoses use a medical diagnosis and diagnostic procedure respectively as related or etiological factors. These are not conditions that nursing interventions can treat.

A nursing student is working with a faculty member to identify a nursing diagnosis for an assigned patient. The student has assessed that the patient is undergoing radiation treatment and has had liquid stool and the skin is clean and intact; therefore she selects the nursing diagnosis Impaired Skin Integrity. The faculty member explains that the student has made a diagnostic error for which of the following reasons? 1. Incorrect clustering 2. Wrong diagnostic label 3. Condition is a collaborative problem. 4. Premature closure of clusters

*Answer 2. * The more appropriate nursing diagnosis for this patient would be Risk for Impaired Skin Integrity because of two risk factors, radiation and secretions on the skin.

A researcher is studying the effectiveness of an individualized evidence-based teaching plan on young women's intention to wear sunscreen to prevent skin cancer. In this study which of the following research terms best describes the individualized evidence-based teaching plan? 1. Sample 2. Intervention 3. Survey 4. Results

*Answer 2. * An intervention is an action or treatment performed by a researcher on a sample.

The nursing diagnosis Impaired Parenting related to mother's developmental delay is an example of a(n): 1. Risk nursing diagnosis. 2. Problem-focused nursing diagnosis. 3. Health promotion nursing diagnosis. 4. Wellness nursing diagnosis.

*Answer 2. * This is an example of a problem focused nursing diagnosis with a related factor, based on NANDA - I diagnostic terminology. Most health promotion diagnoses do not have established related factors based on NANDA - I, their use is optional. Wellness diagnoses are not one of the types of NANDA-I diagnoses.

A nurse in a mother-baby clinic learns that a 16-year-old has given birth to her first child and has not been to a well-baby class yet. The nurse's assessment reveals that the infant cries when breastfeeding and has difficulty latching on to the nipple. The infant has not gained weight over the last 2 weeks. The nurse identifies the patient's nursing diagnosis as Ineffective Breastfeeding. Which of the following is the best "related to" factor? 1. Infant crying at breast 2. Infant unable to latch on to breast correctly 3. Mother's deficient knowledge 4. Lack of infant weight gain

*Answer 3. * In this scenario the related factor is the mother's deficient knowledge. A related factor is a condition, historical factor, or etiology that gives a context for the defining characteristics, in this case the infant crying, inability to latch on to breast and absent weight gain.

A nurse interviewed and conducted a physical examination of a patient. Among the assessment data the nurse gathered were an increased respiratory rate, the patient reporting difficulty breathing while lying flat, and pursed-lip breathing. This data set is an example of: 1. Collaborative data set. 2. Diagnostic label. 3. Related factors. 4. Data cluster.

*Answer 4. * A data cluster is a set of cues, the signs or symptoms gathered during assessment.

A nurse is reviewing a patient's list of nursing diagnoses in the medical record. The most recent nursing diagnosis is Diarrhea related to intestinal colitis. For which of the following reasons is this an incorrectly stated diagnostic statement? 1. Identifying the clinical sign instead of an etiology 2. Identifying a diagnosis on the basis of prejudicial judgment 3. Identifying the diagnostic study rather than a problem caused by the diagnostic study 4. Identifying the medical diagnosis instead of the patient's response to the diagnosis.

*Answer 4. * Intestinal colitis is a medical diagnosis. The related factor in a nursing diagnostic statement is always within the domain of nursing practice and a condition that responds to nursing interventions. Nursing interventions do not change a medical diagnosis.

Nurses have developed theories in response to: (Select all that apply.) 1. Changes in health care. 2. Prior nursing theories. 3. Changes in nursing practice. 4. Research findings. 5. Government regulations. 6. Theories from other disciplines. 7. Physician opinions.

*Answer: 1, 2, 3, 4, 6. * Nursing theories often build on the works of prior theories from nursing and other disciplines. As nursing education has expanded, so has the practice of nursing in response to changes in society and health care. In addition, nursing research, which serves as the foundation for evidence-based practice, has increased.

Which of the following examples are steps of nursing assessment? (Select all that apply.) 1. Collection of information from patient's family members 2. Recognition that further observations are needed to clarify information 3. Comparison of data with another source to determine data accuracy 4. Complete documentation of observational information 5. Determining which medications to administer based on a patient's assessment data

*Answer: 1, 2, 3. * Assessment includes collection of data from secondary sources such as the patient's family. Recognizing that more observation is needed is an example of validation of data. Comparing data to determine accuracy is a feature of interpretation. Although complete documentation is an important step in communicating assessment data, it is not an assessment step.

The nurse enters the room of an 82-year-old patient for whom she has not cared previously. The nurse notices that the patient wears a hearing aid. The patient looks up as the nurse approaches the bedside. Which of the following approaches are likely to be effective with an older adult? (Select all that apply.) 1. Listen attentively to the patient's story. 2. Use gestures that reinforce your questions or comments. 3. Stand back away from the bedside. 4. Maintain direct eye contact. 5. Ask questions quickly to reduce the patient's fatigue.

*Answer: 1, 2, 4. * Approaches for collecting an older adult assessment include listening patiently, using nonverbal communication when a patient has a hearing deficit, and maintaining patient-directed eye gaze. Leaning forward, not backward shows interest in what the patient has to say.

A 62-year-old patient had a portion of the large colon removed and a colostomy created for drainage of stool. The nurse has had repeated problems with the patient's colostomy bag not adhering to the skin and thus leaking. The nurse wants to consult with the wound care nurse specialist. Which of the following should the nurse do? (Select all that apply.) 1. Assess condition of skin before making the call 2. Rely on the nurse specialist to know the type of surgery the patient likely had 3. Explain the patient's response emotionally to the repeated leaking of stool 4. Describe the type of bag being used and how long it lasts before leaking 5. Order extra colostomy bags currently being used

*Answer: 1, 3, 4. * The nurse should have as much information available before making the call to the nurse specialist. It is also important for the nurse to interpret and explain the problem. In addition it is important to explain the patient's perspective. Assuming the nurse specialist knows the extent of the surgery is not appropriate.

When a nurse conducts an assessment, data about a patient often comes from which of the following sources? (Select all that apply.) 1. An observation of how a patient turns and moves in bed 2. The unit policy and procedure manual 3. The care recommendations of a physical therapist 4. The results of a diagnostic x-ray film 5. Your experiences in caring for other patients with similar problems

*Answer: 1, 3, 4. * There are many sources of data for an assessment, including the patient through interview, observations, and physical exam; family members or significant others, health care team members like a physical therapist, the medical record which includes x ray results and the scientific and medical literature.

A nurse is getting ready to assess a patient in a neighborhood community clinic. He was newly diagnosed with diabetes just a month ago. He has other health problems and a history of not being able to manage his health. Which of the following questions reflects the nurse's cultural competence in making an accurate diagnosis? (Select all that apply.) 1. How is your diabetic diet affecting you and your family? 2. You seem to not want to follow health guidelines. Can you explain why? 3. What worries you the most about having diabetes? 4. What do you expect from us when you do not take your insulin as instructed? 5. What do you believe will help you control your blood sugar?

*Answer: 1, 3, 5. * Asking "How is your diabetic diet affecting you and your family" and "What worries you the most about having diabetes" are open ended and allow the patient to share his values and health practices. The statements "You seem to not want to follow health guidelines. Can you explain why?" and "What do you expect from us, when you do not take your insulin as instructed" both show the nurse's bias.

A nursing student is preparing to read the methods section of a research article. Which type of information will the student expect to find in this section? (Select all that apply.) 1. How the researcher conducted the study 2. A description about how to use the findings of the study 3. The number and type of subjects who participated in the study 4. Summaries of other research articles that support the need for this study 5. Implications for future research studies

*Answer: 1, 3. * The methods section explains how a research study was organized and conducted to answer the research question or test the hypothesis as well as how many subjects or people participated in the study.

A nurse gathers the following assessment data. Which of the following cues together form(s) a pattern suggesting a problem? (Select all that apply.) 1. The skin around the wound is tender to touch. 2. Fluid intake for 8 hours is 800 mL. 3. Patient has a heart rate of 78 beats/min and regular. 4. Patient has drainage from surgical wound. 5. Body temperature is 38.3° C (101° F). 6. Patient states, "I'm worried that I won't be able to return to work when I planned."

*Answer: 1, 4, 5. * Tender skin around the wound, drainage from the surgical wound, and a temperature of 101° indicate a wound infection. Fluid intake of 800 mL over 8 hours and a heart rate of 78 and regular are normal assessment findings. A patient's expressed concern about returning to work is a patient's subjective response about a separate issue and insufficient to form a pattern.

A nurse makes the following statement during a change-of-shift report to another nurse. "I assessed Mr. Diaz, my 61-year-old patient from Chile. He fell at home and hurt his back 3 days ago. He has some difficulty turning in bed, and he says that he has pain that radiates down his leg. He rates his pain at a 6, and he moves slowly as he transfers to a chair." What can the nurse who is beginning a shift do to validate the previous nurse's assessment findings when she conducts rounds on the patient? (Select all that apply.) 1. The nurse asks the patient to rate his pain on a scale of 0 to 10. 2. The nurse asks the patient what caused his fall. 3. The nurse asks the patient if he has had pain in his back in the past. 4. The nurse assesses the patient's lower-limb strength. 5. The nurse asks the patient what pain medication is most effective in managing his pain.

*Answer: 1, 4. * Validation of assessment data is the comparison of data with another source to determine data accuracy. The nurse compares data reported by the previous nurse with data collected directly with the patient, including assessing pain on the rating scale and assessing the patient's lower limb strength. Asking the patient what caused his fall and asking about past back pain would offer the nurse new information about the patient.

A nurse on a busy medicine unit is assigned to four patients. It is 10 AM. Two patients have medications due and one of those has a specimen of urine to be collected. One patient is having complications from surgery and is being prepared to return to the operating room. The fourth patient requires instructions about activity restrictions before going home this afternoon. Which of the following should the nurse use in making clinical decisions appropriate for the patient group? (Select all that apply.) 1. Consider availability of assistive personnel to obtain the specimen 2. Combine activities to resolve more than one patient problem 3. Analyze the diagnoses/problems and decide which are most urgent based on patients' needs 4. Plan a family conference for tomorrow to make decisions about resources the patient will need to go home 5. Identify the nursing diagnoses for the patient going home

*Answer: 1,2,3. * Analyzing urgency of problems helps in prioritization as does considering the resources that are available (such as assistive personnel) to complete patient care activities. Deciding on how to combine activities is good time management. Holding a family conference is a good idea but in this case would be too late to be beneficial to the patient. The nurse must identify nursing diagnoses for all patients in order to determine priorities.

Which of the following describes a nurse's application of a specific knowledge base during critical thinking? (Select all that apply.) 1. Initiative in reading current evidence from the literature 2. Application of nursing theory 3. Reviewing policy and procedure manual 4. Considering holistic view of patient needs 5. Previous time caring for a specific group of patients

*Answer: 1,2,4. * A nurse's specific knowledge base will vary but includes basic nursing education, continuing education courses, and additional college degrees. In addition, it includes the knowledge gained from a nurse reading the nursing literature, and acquiring information and theory from the basic sciences, humanities, behavioral sciences, and nursing. Nurse's knowledge base also involves a different way of thinking holistically about patient problems.

In which of the following examples is a nurse applying critical thinking skills in practice? (Select all that apply.) 1. The nurse thinks back about a personal experience before administering a medication subcutaneously. 2. The nurse uses a pain-rating scale to measure a patient's pain. 3. The nurse explains a procedure step by step for giving an enema to a patient care technician. 4. The nurse gathers data on a patient with a mobility limitation to identify a nursing diagnosis. 5. A nurse offers support to a colleague who has witnessed a stressful event.

*Answer: 1,2,4. * Reflection, using a pain rating scale to be precise and specific, and nursing assessment (the first step of the nursing process) are examples of critical thinking skills. Explaining a procedure based on policy is not critical thinking - however performing a procedure following policy is basic critical thinking. Offering support to a colleague is an important way to assist another in managing stress but is not a critical thinking skill.

A nurse is reading a research article. The nurse just finished reading a brief summary of the research study that included the purpose of the study and its implications for nursing practice. Which part of the article did the nurse just read? 1. Abstract 2. Analysis 3. Discussion 4. Literature review

*Answer: 1. * An abstract is a brief summary that summarizes the purpose of the article. It also includes the major themes or findings and the implications for nursing practice.

Which of the following statements about evidence-based practice (EBP) made by a nursing student would require the nursing professor to correct the student's understanding? 1. "In evidence-based practice the patients are the subjects." 2. "It is important to talk with experts and patients when making an evidence-based decision." 3. "A nurse wanting to investigate the evidence to solve a problem starts by forming a PICOT question." 4. "It is important to ask a librarian for help when searching for literature to help you answer your PICOT question."

*Answer: 1. * Multiple research studies, expert opinion, personal experience, and patient preferences create the data source for evidence-based practice. Patients are not the subjects of EBP; they are typically the subjects in a research study.

A nurse is checking a patient's intravenous line and, while doing so, notices how the patient bathes himself and then sits on the side of the bed independently to put on a new gown. This observation is an example of assessing: 1. Patient's level of function. 2. Patient's willingness to perform self-care. 3. Patient's level of consciousness. 4. Patient's health management values.

*Answer: 1. * Observing a patient perform activities physical, socially, psychologically and developmentally assesses their level of function. In the case of this question the nurse assesses physical functional level. Observation does not measure willingness to perform self care but the ability to do so. Observing physical performance of self-hygiene is not a measure of level of consciousness nor does it reveal a patient's values.

A nurse is preparing medications for a patient. The nurse checks the name of the medication on the label with the name of the medication on the doctor's order. At the bedside the nurse checks the patient's name against the medication order as well. The nurse is following which critical thinking attitude: 1. Responsible 2. Complete 3. Accurate 4. Broad

*Answer: 1. * The nurse is demonstrating responsibility for correct medication and patient identification. The other three choices are critical thinking intellectual standards.

A nurse is assigned to a new patient admitted to the nursing unit following admission through the emergency department. The nurse collects a nursing history and interviews the patient. Place the following steps for making a nursing diagnosis in the correct order, beginning with the first step. 1. Considers context of patient's health problem and selects a related factor 2. Reviews assessment data, noting objective and subjective clinical information 3. Clusters clinical cues that form a pattern 4. Chooses diagnostic label

*Answer: 2, 3, 4, 1. *

A nurse researcher wants to conduct historical research. Which of the following ideas for a study could the nurses conduct? (Select all that apply.) 1. Determining the effect of unemployment on emergency room usage 2. Understanding how Clara Barton shaped nursing in America 3. Evaluating the effect of the Vietnam War on nursing leadership and practice 4. Analyzing the evolution of nursing and patient care during recent disasters 5. Investigating barriers to exercise in women who have become mothers in the past year

*Answer: 2, 3, 4. * Historical studies are designed to establish facts and relationships concerning past events.

A group of nurses on the research council of a local hospital are measuring nursing-sensitive outcomes. Which of the following is a nursing-sensitive outcome that the nurses need to consider measuring? (Select all that apply.) 1. Frequency of low blood sugar episodes in children at a local school 2. Number of patients who develop a urinary tract infection from a Foley catheter 3. Number of patients who fall and experience subsequent injury on the evening shift 4. Number of sexually active adolescent girls who attend the community-based clinic for birth control 5. Patient-reported quality of life following coronary artery bypass graft surgery and cardiac rehabilitation

*Answer: 2, 3. * Nurse sensitive indicators are outcomes that are sensitive to nursing practice; these outcomes will improve if the quantity or quantity of nursing care improves.

A nurse is conducting a patient-centered interview. Place the statements from the interview in the correct order, beginning with the first statement a nurse would ask. 1. "You say you've lost weight. Tell me how much weight you've lost in the last month." 2. "My name is Todd. I'll be the nurse taking care of you today. I'm going to ask you a series of questions to gather your health history." 3. "I have no further questions. Thank you for your patience." 4. "Tell me what brought you to the hospital." 5. "So, to summarize, you've lost about 6 lbs in the last month, and your appetite has been poor—correct?"

*Answer: 2, 4, 1, 5, 3. *

Which type of interview question does the nurse first use when assessing the reason for a patient seeking health care? 1. Probing 2. Open-ended 3. Problem-oriented 4. Confirmation

*Answer: 2. * The best interview question for determining initially the reason a patient is seeking healthcare is by asking an open ended question that allows the patient to tell their story. This is also a more patient-centered approach. Probing questions are done after data are gathered to seek more in depth information. Problem oriented and confirmation are not types of interview question

The nurse asks a patient, "Describe for me a typical night's sleep. What do you do to fall asleep? Do you have difficulty falling or staying asleep? This series of questions would likely occur during which phase of a patient-centered interview? 1. Orientation 2. Working phase 3. Data validation 4. Termination

*Answer: 2. * The gathering of information is the working phase of a patient-centered interview.

While working in a rehabilitation facility, it is important to obtain nursing histories and develop a therapeutic nurse-patient relationship. List in correct order the phases of Peplau's theory as applied in this setting. The nurse: 1. Ensures that the patient has access to appropriate community resources for long-term care. 2. Collaborates with the patient to identify specific patient needs. 3. Collects essential information from the patient's health record. 4. Works with the patient to develop a plan for resolving patient issues.

*Answer: 3, 2, 4, 1. * The following phases characterize the nurse-patient interpersonal relationship: preorientation (data gathering), orientation (defining issue), working phase (therapeutic activity), and resolution (termination of relationship).

Arrange the following steps of evidence-based practice (EBP) in the appropriate order. 1. Integrate the evidence. 2. Ask the burning clinical question. 3. Create a spirit of inquiry. 4. Evaluate the practice decision or change. 5. Share the results with others. 6. Critically evaluate the evidence you gather. 7. Collect the most relevant and best evidence.

*Answer: 3, 2, 7, 6, 1, 4, 5. *

A nurse changed a patient's surgical wound dressing the day before and now prepares for another dressing change. The nurse had difficulty removing the gauze from the wound bed yesterday, causing the patient discomfort. Today he gives the patient an analgesic 30 minutes before the dressing change. Then he adds some sterile saline to loosen the gauze for a few minutes before removing it. The patient reports that the procedure was much more comfortable. Which of the following describes the nurse's approach to the dressing change? (Select all that apply.) 1. Clinical inference 2. Basic critical thinking 3. Complex critical thinking 4. Experience 5. Reflection

*Answer: 3,4. * The nurse relies on experience and the ability to adapt a procedure such as a dressing change (complex critical thinking) to make it successful.

During a visit to the clinic, a patient tells the nurse that he has been having headaches on and off for a week. The headaches sometimes make him feel nauseated. Which of the following responses by the nurse is an example of probing? 1. So you've had headaches periodically in the last week and sometimes they cause you to feel nauseated—correct? 2. Have you taken anything for your headaches? 3. Tell me what makes your headaches begin. 4. Uh huh, tell me more.

*Answer: 3. * A probing question such as "Tell me what makes your headaches begin" encourages a more full description of a situation by asking an open ended question. The statement "So you've had headaches periodically in the last week and sometimes they cause you to feel nauseated—correct?" is a summarative statement. Asking whether the patient has taken anything for the headaches is a close ended question. Saying "Uh huh, tell me more" is an example of back channeling.

Nurses in a community clinic have seen an increase in the numbers of obese children. The nurses who care for children are discussing ways to reduce childhood obesity. One nurse asks a colleague, "I wonder what the most effective ways are to help school-age children maintain a healthy weight?" This question is an example of a/an: 1. Hypothesis. 2. PICOT question. 3. Problem-focused trigger. 4. Knowledge-focused trigger.

*Answer: 3. * A problem-focused trigger is a clinical problem you face while caring for patients; the nurses in this question have identified a clinical problem which they desire to investigate further.

The nurse observes a patient walking down the hall with a shuffling gait. When the patient returns to bed, the nurse checks the strength in both of the patient's legs. The nurse applies the information gained to suspect that the patient has a mobility problem. This conclusion is an example of: 1. Cue. 2. Reflection. 3. Clinical inference. 4. Probing.

*Answer: 3. * An inference is your judgment or interpretation of cues, such as the shuffling gait and reduced leg strength. Any information gathered through your senses is a cue. Probing is a technique used in interviewing. Reflection is an internal though process of thinking back about a situation.

A nurse researcher is collecting data following approval from the institutional review board (IRB). In which part of the research process is this nurse? 1. Analyzing the data 2. Designing the study 3. Conducting the study 4. Identifying the problem

*Answer: 3. * Conducting the study includes tasks such as obtaining necessary approvals and implementing the study protocol to guide data collection.

When recruiting subjects to participate in a study about the effects of an educational program to help patients at home take their medications as ordered, the researcher tells the subjects that their names will not be used and no one but the research team will have access to their information and responses. This is an example of: 1. Bias. 2. Anonymity. 3. Confidentiality. 4. Informed consent.

*Answer: 3. * Confidentiality - Confidentiality guarantees that any information a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team.

A nurse researcher wants to know which factors are associated with a person's decision to exercise. The nurse distributes a survey to people who recently joined an exercise wellness program and analyzes the data to determine which factors and characteristics are most significantly linked to the decision to start exercising. Which type of a research study is this? 1. Qualitative 2. Descriptive 3. Correlational 4. Randomized controlled trial

*Answer: 3. * Correlational: in this study the nurse researcher is correlating characteristics or factors with the decision to start exercising.

A nursing student reports to a lead charge nurse that his assigned patient seems to be less alert and his blood pressure is lower, dropping from 140/80 to 110/60. The nursing student states, "I believe this is a nursing diagnosis of Deficient Fluid Volume." The lead charge nurse immediately goes to the patient's room with the student to assess the patient's orientation, heart rate, skin turgor, and urine output for last 8 hours. The lead charge nurse suspects that the student has made which type of diagnostic error? 1. Insufficient cluster of cues 2. Disorganization 3. Insufficient number of cues 4. Evidence that another diagnosis is more likely

*Answer: 3. * It is likely the charge nurse suspects the student has not collected enough cues to support the diagnosis. A change in blood pressure and mental status changes can be attributed to fluid volume excess as well as other diagnoses. The recommendation of the symptom cluster by the RN would allow the student to have sufficient data to confirm a deficient fluid volume.

The nurses on a medical unit have seen an increase in the number of medication errors on their unit. They decide to evaluate the medication administration process on the basis of data gained from chart reviews and direct observation of nurses administering medications. Which process are the nurses using? 1. Evidence-based practice 2. Research 3. Quality improvement 4. Problem identification

*Answer: 3. * Quality improvement studies evaluate how processes work in an organization. The nurses in this example are evaluating the medication administration process.

A nurse enters the room of a 32-year-old patient newly diagnosed with cancer at the beginning of the 0700 evening/night shift. The nurse noted in the patient's nursing history that this is her first hospitalization. She is scheduled for surgery in the morning to remove a tumor and has questions about what to expect after surgery. She is observed talking with her mother and is crying. The patient says, "This is so unfair." An order has been written for an enema to be given this evening in preparation for the surgery. The nurse establishes priorities for which of the following situations first? 1. Giving the enema on time 2. Talking with the patient about her past experiences with illness 3. Talking with the patient about her concerns and acknowledging her sense of unfairness 4. Beginning instruction on postoperative procedures

*Answer: 3. * The patient is obviously emotionally upset. Her concerns, whether they be about surgery or cancer or both, need to be addressed first for her to be able to be instructed and to be comfortable for the enema. Talking with the patient about her past experiences may be appropriate in the long term, but is less important than the other three priorities.

A nurse is assigned to a 42-year-old mother of 4 who weighs 136.2 kg (300 lbs), has diabetes, and works part time in the kitchen of a restaurant. The patient is facing surgery for gallbladder disease. Which of the following approaches demonstrates the nurse's cultural competence in assessing the patient's health care problems? 1. "I can tell that your eating habits have led to your diabetes. Is that right?" 2. "It's been difficult for people to find jobs. Is that why you work part time?" 3. "You have four children; do you have any concerns about going home and caring for them?" 4. "I wish patients understood how overeating affects their health."

*Answer: 3. * This is the only assessment approach that is not biased or showing judgment about the patient's weight or occupational status. With the other options, the nurse is reacting to the patient based on personal stereotypes and biases.

By using known criteria in conducting an assessment such as reviewing with a patient the typical characteristics of pain, a nurse is demonstrating which critical thinking attitude? 1. Curiosity 2. Adequacy 3. Discipline 4. Thinking independently

*Answer: 3.* Discipline is being thorough in whatever you do. Using known criteria for assessment and evaluation, as in the case of pain, is an example of discipline

An aspect of clinical decision making is knowing the patient. Which of the following is the most critical aspect of developing the ability to know the patient? 1. Working in multiple health care settings 2. Learning good communication skills 3. Spending time establishing relationships with patients 4. Relying on evidence in practice

*Answer: 3.* Knowing the patient relates to a nurse's experience with caring for patients, time spent in a specific clinical area and having a sense of closeness with them. However a critical aspect to knowing the patient and thus being able to make timely and appropriate decisions is spending time establishing relationships with patients.

Place the steps of the scientific method in their correct order with number 1 being the first step of the process. 1. Formulate a question or hypothesis. 2. Evaluate results of the study. 3. Collect data. 4. Identify the problem. 5. Test the question or hypothesis.

*Answer: 4, 3, 1, 5, 2. * The correct order of the steps of the scientific method are: 1. Identifying the problem, 2. Collecting data, 3. Formulating a question or hypothesis, 4. Testing the question or hypothesis, and 5. Evaluating results of the test or study.

A group of nurses have identified that the elderly patients on their unit have a high incidence of pressure ulcers after they have a stroke. During a unit meeting they discuss different interventions that they think may reduce the development of pressure ulcers. What is the nurses' next step to investigate this clinical problem further? 1. Conduct a literature review 2. Share the findings with others 3. Conduct a statistical analysis 4. Create a well-defined PICOT question

*Answer: 4. * In this case, the nurses need to develop a PICOT question next to search for appropriate evidence that might offer answers to this clinical problem.

A nurse assesses a young woman who works part time but also cares for her mother at home. The nurse reviews clusters of data that include the patient's report of frequent awakenings at night, reduced ability to think clearly at work, and a sense of not feeling well rested. Which of the following diagnoses is in the correct PES format? 1. Disturbed Sleep Pattern evidenced by frequent awakening 2. Disturbed Sleep Pattern related to family caregiving responsibilities 3. Disturbed Sleep Pattern related to need to improve sleep habits 4. Disturbed Sleep Pattern related to caregiving responsibilities as evidenced by frequent awakening and not feeling rested

*Answer: 4. * A nursing diagnosis in a PES format includes the diagnostic label, related factor and the defining characteristics the diagnosis is evidenced by. The second nursing diagnosis is the correct format in the 2-part format for writing a diagnosis. The first diagnosis has no related factor. The third diagnosis is an error, using a goal as a related factor.

A nurse prepares to insert a Foley catheter. The procedure manual calls for the patient to lie in the dorsal recumbent position. The patient complains of having back pain when lying on her back. Despite this, the nurse positions the patient supine with knees flexed as the manual recommends and begins to insert the catheter. This is an example of: 1. Accuracy. 2. Reflection. 3. Risk taking. 4. Basic critical thinking.

*Answer: 4. * Basic critical thinking is concrete and based on a set of rules or principles, such as the guidelines in a hospital procedure manual. The nurse's approach is not accurate, as accuracy requires use of all of the facts (e.g. the patient's discomfort). A critical thinker is willing to take risks in trying different ways to solve problems; following one basic approach is not risk taking. This is also not an example of reflection.

A nurse researcher studies the effectiveness of a new program designed to educate parents to promote the immunization of children. The nurse divides the parents randomly into two groups. One group receives the typical educational program and the other group receives the new program. This is an example of which type of study? 1. Historical 2. Qualitative 3. Correlational 4. Experimental

*Answer: 4. * Experimental; in experimental studies, the subjects are randomly assigned into groups with one group receiving the standard treatment and the other group receiving the intervention.

A nurse who works on a pediatric unit asks, "I wonder if children who interact with therapy dogs have reduced anxiety when they are in the hospital." In this example of a PICOT question, which of the following is the O? 1. Children 2. Therapy dogs 3. The pediatric unit 4. Anxiety

*Answer: 4. * O stands for outcome; in this PICOT question, the outcome the nurse is concerned about is anxiety.

A nurse assesses a patient who comes to the pulmonary clinic. "I see that it's been over 6 months since you've been here, but your appointment was for every 2 months. Tell me about that. Also I see from your last visit that the doctor recommended routine exercise. Can you tell me how successful you've been in following his plan?" The nurse's assessment covers which of Gordon's functional health patterns? 1. Value-belief pattern 2. Cognitive-perceptual pattern 3. Coping-stress-tolerance pattern 4. Health perception-health management pattern

*Answer: 4. * The nurse's assessment covers health perception and health management pattern, which is a patient's self report of how he or she manages their health and their knowledge of preventive health practices. The coping stress tolerance pattern would include questions focused on how the patient manages stress and sources of support. An assessment covering the value belief pattern leads a patient to describe patterns of values, beliefs and life goals. An assessment of the cognitive-perceptual pattern includes questions that focus on the patient's language adequacy, memory and decision making ability.

A nurse has seen many cancer patients struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of: 1. Creativity. 2. Fairness. 3. Clinical reasoning. 4. Applying ethical criteria.

*Answer: 4. * The use of ethical criteria for nursing judgment allows a nurse to focus on a patient's values and beliefs. Clinical decisions are then just, faithful to the patient's choices, and beneficial to the patient's well-being

A 72-year-old male patient comes to the health clinic for an annual follow-up. The nurse enters the patient's room and notices him to be diaphoretic, holding his chest and breathing with difficulty. The nurse immediately checks the patient's heart rate and blood pressure and asks him, "Tell me where your pain is." Which of the following assessment approaches does this scenario describe? 1. Review of systems approach 2. Use of a structured database format 3. Back channeling 4. A problem-oriented approach

*Answer: 4. * This is an example of a problem focused approach. The nurse focuses on assessing one body system (cardiovascular) to determine nature of the patient's pain and other presenting symptoms.

A patient who visits the surgery clinic 4 weeks after a traumatic amputation of his right leg tells the nurse practitioner that he is worried about his ability to continue to support his family. He tells the nurse he feels that he has let his family down after having an auto accident that led to the loss of his left leg. The nurse listens and then asks the patient, "How do you see yourself now?" On the basis of Gordon's functional health patterns, which pattern does the nurse assess? 1. Health perception-health management pattern 2. Value-belief pattern 3. Cognitive-perceptual pattern 4. Self-perception-self-concept pattern

*Answer: 4. * This is an example of assessment of a patient's feelings about his worth and body image which is the self-perception and self-concept health pattern

A nurse enters a 72-year-old patient's home and begins to observe her behaviors and examine her physical condition. The nurse learns that the patient lives alone and notices bruising on the patient's leg. When watching the patient walk, the nurse notes that she has an unsteady gait and leans to one side. The patient admits to having fallen in the past. The nurse identifies the patient as having the nursing diagnosis of Risk for Falls. This scenario is an example of: 1. Inference. 2. Basic critical thinking. 3. Evaluation. 4. Diagnostic reasoning.

*Answer: 4.* Diagnostic reasoning begins when you interact with a patient or make physical or behavioral observations. An expert nurse sees the context of a patient situation (e.g., Patient lives alone, has fallen in past, observes patterns and themes and makes a diagnostic decision.

Fill in the Blank. When a nurse tries to understand a patient's and family caregiver's perspective of why a patient is falling at home, the nurse applies the intellectual standard of _________________________ to understand all viewpoints.

*Answer: Broad. * The intellectual standard of 'broad' covers multiple viewpoints.

A nurse identified that a patient has difficulty turning in bed, moves slowly when assisted into a chair, and expresses having breathlessness after walking to the bathroom and back. The patient has been in the hospital for over 4 days. Write a three-part nursing diagnostic statement using the PES format.

An appropriate PES diagnostic statement would be: Impaired physical mobility related to deconditioning evidenced by difficulty turning in bed and breathlessness after walking.

How does knowledge of genomics affect patient treatment decisions?

Answer Genomics describes the study of all the genes in a person, as well as interactions of those genes with each other and with that person's environment. Genomic information allows health care providers to determine how genomic changes contribute to patient conditions and influence treatment decisions.