CUMULATIVE CONCEPTS FINALS PRACTICE PROBLEMS!!!

Responsibilities and Roles

Autonomy and accountability Caregiver Advocate Educator Communicator Manager

Describes the anguish experienced when a person feels unable to act according to closely held core values

Moral Distress

Many older homes in a neighborhood are undergoing a lot of restoration. Lead paint was used. The community clinic in the neighborhood is initiating a lead screening program. This activity is based on which social determinant of health?

Physical environment

Distress

bad stress related to negative events

burnout s/s

decreased mental and physical energy low morale increased cynicism physical symptoms

situational stressors

from personal or family job changes or relocation, adjusting to chronic illness, being a care giver

trauma

if symptoms of stress persist beyond the duration of the stressor a person has trauma

compensation

making up for a deficiency in one aspect of self image by strongly emphasizing a feature considered an asset

In-service education

programs are instruction or training provided by a health care agency or institution

flashbacks

recurrent and intrusive recollections of the event common in PTSD patients

coping

the persons effort to manage psychological stress when under stress a person obtains information, takes action to change the situation, and regulates, emotions tied to the stress

Nursing Practice

-Nurse Practice Acts overseen by state board of nursing -Must pass the NCLEX-RN for licensure -May choose to certify in a specific area of nursing practice

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

1, 2, 3, 5

The nurse understands that the health care system has many challenges. What are the current challenges facing leaders in health care? Select all that apply. 1 Improving access to health care 2 Generating profits 3 Providing high-quality care 4 Reducing the cost of health care 5 Increasing the focus on rehabilitation

1, 3, 4 The challenges to health care leaders include reducing costs while maintaining high-quality care for patients, and improving access and coverage. Improving access to health care involves increasing the number of health care facilities and changing appropriate health policies to include more people. Reducing health care costs involves many elements from reforming insurance to changing incentives. Generating profits and focusing on rehabilitation are not major challenges for health care leaders.

The hospice nurse identifies an abnormal grief reaction in the wife of a dying patient who says, 1. "I don't think that I can live without my husband to take care of me." 2. "I wonder if expressing my sadness makes my husband feel worse." 3. "We have shared so much that it is hard to realize that I will be alone." 4. "I feel guilty about leaving him to go to lunch with my friends."

1. "I don't think that I can live without my husband to take care of me." (abnormal grief and possible sucuidal)

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. Caregiver 2. Autonomy and Accountability 3. Patient advocate 4. Health Promotion 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.

In the United States, there has never been a president of Asian or Hispanic culture. This is an example of: 1. Social inequality 2. Marginalization 3. Under inclusion 4. Social location

2

A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

2 Beneficence Pg. 293; Beneficence means "doing well" by taking positive actions. It implies that the best interest of the patient (and society) outweighs self-interest.

When you care for a patient who does not speak English, it is necessary to call on a professional interpreter. Which of the following are proper principles for working with interpreters? (Select all that apply) 1. Expect the interpreter to interpret your statements word-for-word so there is no misunderstanding by the patient 2. If you feel an interpretation is not correct, stop and address the situation directly with the interpreter 3. Pace a conversation so there is time for the patient's response to be interpreted 4. Direct your questions to the interpreter 5. Ask the patient for feedback and clarification at regular intervals

2,3,5

Which is the best method of negotiating or processing difficult ethical situations? 1 Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain. 2 Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes. 3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. 4 Medical experts are best able to resolve conflicts about outcome predictions.

3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus.

An experience a person is exposed to through a stimulus or stressor: A. Stress B. Allostatic load C. Appraisal D. Stressors

A

A nurse is teaching a 27-year-old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this? A) Cognitive B) Affective C) Adaptation D) Psychomotor

A) Cognitive Cognitive learning requires thinking; learning how to adjust insulin requires analysis, synthesis, and evaluation, which are all types of cognitive learning.

Participatory action research aims to produce which of the following? Select all that apply. A) Knowledge B) Action C) Empowerment D) Stability

A, B, C

Which of the following characteristics refers to qualitative nursing research design? Select all that apply. A) The focus is to develop a rich understanding of a phenomenon. B) Researchers strive to eliminate extraneous variables. C) It is critical to maintain constancy of conditions. D) Most studies are retrospective.

A, D

A nurse is teaching a 27-year-old gentleman how to adjust his insulin dosages based on his blood sugar results. What type of learning is this? A. Cognitive B. Affective C. Adaptation D. Psychomotor

A. Cognitive Rationale Cognitive learning requires thinking; learning how to adjust insulin requires analysis, synthesis, and evaluation, which are all types of cognitive learning.

anterior pituitar

ACTH goes to the adrenal cortex increases cortisol which... --increases gluconeogenesis --increases protein catabolism --increases fat catabolism increases aldosterone which... --increases sodium re-absorption --increases water re-absorption --decreases urine output --increases potassium excretion

posterior pituitary

ADH... increases water re-absorption decreases urine output

Which of the following is (are) an example of an advanced practice nurse? (Select all that apply.) a. Nurse practitioner b. Clinical nurse specialist c. Patient advocate d. Certified registered nurse anesthetist e. Nurse midwife

ANS: A, B, D, E Although all nurses should function as patient advocates, "advanced practice nurse" is an umbrella term for an advanced clinical nurse such as a nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or nurse midwife.

An 18 yr. old woman 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

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

nurse is planning a teaching session about healthy nutrition with a group of children who are in first grade. The nurse determines that after the teaching session the children will be able to name three examples of foods that are fruits. This is an example of: A. A teaching plan. B. A learning objective. C. Reinforcement of content. D. Enhancing the children's self-efficacy.

B. A learning objective. Rationale A learning objective describes what the learner will do after the teaching session.

Nurses practice primarily as a service to others, even in the details of daily work

Beneficence

sympathetic nervous system and adrenal medulla

Epinephrine which... --inc. heart rate --inc. o2 intake --inc blood glucose --inc mental acuity Norepinephrine --inc blood flow to skeletal muscle --inc arterial blood pressure

Acts that are ethical reflect a commitment to standards beyond personal preferences (i.e., standards that individuals, professions, and societies strive to meet). However, when decisions must be made about health care, differing values and opinions among individuals can result in disagreement about the right thing to do.

Ethics

Refers to the agreement to keep promises. Refers to the unwillingness to abandon patients even when care becomes controversial or complex.

Fidelity

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

Informatics

Professional Nursing Organizations

NLN, ANA, ICN, SNA

The first practicing nurse epidemiologist was a. Florence Nightingale. b. Mildred Montag. c. Clara Barton. d. Mary Agnes Snively.

Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentery. Mildred Montag, Clara Barton, and Mary Agnes Snively came after Nightingale, each contributing to the nursing profession in her own way. Clara Barton founded the American Red Cross. Dr. Mildred Montag established the first associate degree nursing program in 1952. Mary Agnes Snively began forming the Canadian National Association of Trained Nurses in 1883.

Which of the following nursing roles may have prescriptive authority in their practice? 1. Critical Care 2. Nurse Practitioner 3. Certified clinical nurse specialist 4. Charge nurse

Nurse practitioner and certified clinical nurse specialist

The nurse has been working in the clinical setting for several years as an advanced practice nurse and has earned her master's degree as a family nurse practitioner. However, she seems unfulfilled and has a strong desire to do research. To fulfill her desire, the nurse most likely would apply to attend a program that would lead to a a. Doctor of Nursing Science degree (DNSc). b. Doctor of Philosophy degree (PhD). c. Doctor of Nursing Practice degree (DNP). d. Doctor in the Science of Nursing degree (DSN).

PhD programs emphasize basic research and theory and are research oriented. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. The DNP is a practice doctorate that prepares advanced practice nurses such as nurse practitioners.(B)

A nurse is caring for an older-adult couple in a community-based assisted living facility. During the family assessment he noted that the couple has many expired medications and multiple medications for their respective chronic illnesses. They note that they go to two different health care providers. The nurse begins to work with the couple to determine what they know about their medications and helps them decide on one care provider rather than two. 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

Safety

The greatest good for the greatest number of people is the guiding principle for determining right action in this system.

Teleology

The nurse spends time with the patient and family receiving 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

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.

A nurse meets with the registered dietician 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 Eduction of Nurses (QSEN) competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Informatics

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.

adventitious crises

a major natural disaster, man made disaster, or crime of violence

Which learning objective/outcome has the highest priority for a patient with life-threatening, severe food allergies that require an EpiPen (epinephrine)? a. The patient will administer epinephrine. b. The patient will identify the main ingredients in several foods. c. The patient will list the side effects of epinephrine. d. The patient will learn about food labels.

a. The patient will administer epinephrine. Once you assist in meeting patient needs related to basic survival (how to give epinephrine), you can discuss other topics, such as nutritional needs and side effects of medications. For example, a patient recently diagnosed with coronary artery disease has deficient knowledge related to the illness and its implications. The patient benefits most by first learning about the correct way to take nitroglycerin and how long to wait before calling for help when chest pain occurs. Thus, in this situation, the patient benefits most by first learning about the correct way to take epinephrine. "The patient will learn about food labels" is not objective and measurable and is not correctly written.

Refers to the ability to answer to ones actions

accountability

s/s of stress

dry mouth; excessive perspiration; gi disturbances; grinding teeth; head ache; hypertension; increased vital signs; stiff neck or aching back; sexual dysfunction ; non verbal behaviors; edginess irritability; anxiety crying; depression fatigue; sleep disturbances; changed eating habits; social isolation; inattentiveness; decreased short term memory

appraisal

how people interpret the impact of the stressor on themselves or on what is happening and what they are able to do about it

exhaustion stage

occurs when the body is no longer able to resist the effects of the stressor and has depleted the energy necessary to maintain adaptation

identification

patterning behavior after that of another person and assuming that person qualities, characteristics, and actions

repression

selective amnesia

sociocultural stressors

stressors related to poverty and physical handicap -living under conditions of continuing violence, disintegrated neighborhoods, or homelessness -children become vulnerable when they lose parents and caregibers through divorce, imprisonment, or death or when parents have mental illness or substance abuse disorders

maturational stressors

stressors vary with life stages, related to developmental stage in life and normal life changes as a result of aging

substitution

substitute one feeling with another feeling or object.

resistance stage

the body stabilizes and responds in a manner opposite to that of the alarm rxn hormone levels, heart rate, blood pressure, and cardiac output return to normal ; and the body repairs any damage that has occurred

allostatic load

the chronic arousal with the presence of powerful hormones causes excessive wear and tear on the person leads to chronic illness leads to long term psysiological problems such as chronic HTN; depression; sleep deprivation; chronic fatigue syndrome; and autoimmune disorders

QSEN Project

• Quality and safety education for nurses • Overall goal is improve the quality and safety of health care systems by preparing future nurses

A nurse is planning a teaching session about healthy nutrition with a group of children who are in first grade. The nurse determines that after the teaching session the children will be able to name three examples of foods that are fruits. This is an example of: A) A teaching plan. B) A learning objective. C) Reinforcement of content. D) Enhancing the children's self-efficacy.

B) A learning objective A learning objective describes what the learner will do after the teaching session.

A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress the nurse says: A."Tell me who I can call to help you." B."Tell me what bothers you the most about this experience." C."I'll contact someone who can help get you temporary housing." D."I'll sit with you until other family members can come help you get settled."

B."Tell me what bothers you the most about this experience."

Expert clinical nursing practice

commitment to the application of knowledge and clinical experience

regression

coping with a stressor trough actions and behaviors associated with an earlier developmental period

developmental crises

occur as a person moves through the stages of life

The nurse is learning about the different health care plans for the benefit of patients. Which provisions does the nurse classify under Managed Care Organization (MCO)? Select all that apply. 1 Health care providers are considered salaried employees. 2 An MCO contracts with a single group practice. 3 An MCO contracts with multiple group practices. 4 An MCO offers a funded program for old people. 5 An MCO limits an enrollee's choice to preferred hospitals.

1, 2, 3 A Managed Care Organization (MCO) provides comprehensive preventive and treatment services to a specific group of people voluntarily enrolled in the plan. MCOs can have different structural models. Under the staff model, physicians are salaried employees of an MCO. An MCO with a group model contracts with a single group practice. An MCO with a network model may contract with multiple group practices. Medicare is a funded program for people in the United States who are above 65 years of age. In the case of a Preferred Provider Organization (PPO), the enrollee's choice is limited to the list of preferred hospitals.

Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system? A. Patient safety B. Evidence-based practice C. Patient satisfaction D. Maintenance of competency

A Nursing work groups or councils who had a commitment to patient safety were a positive characteristic of the patient safety climate on the nursing unit. Open communication and nurses involved in problem solving related to errors were other factors contributing to patient safety.

A set of guiding principles that all members of a profession accept

Code of Ethics

A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, "The hemoglobin A1C is wrong. My blood sugar levels have been excellent for the last 6 months." The patient is using the defense mechanism: A. Denial. B. Conversion. C. Dissociation. D. Displacement.

A. Denial.

The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the PDSA model. Which of the following is an example of "Do" from that model? A. Implement the new skin care protocol on all medicine units. B. Review the data collected on patients cared for using the protocol. C. Review the QI reports on the six patients who developed ulcers over the last 3 months. D. Based on findings from patients who developed ulcers, implement an evidence-based skin care protocol.

A. Implement the new skin care protocol on all medicine units. In the Do step, the nurse selects an intervention and implements it.

The school nurse is about to teach a freshman-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes? A. Provide information using a lecture B. Use simple words to promote understanding C. Develop topics for discussion that require problem solving D. Complete an extensive literature search focusing on eating disorders

C. Develop topics for discussion that require problem solving Rationale Adolescents learn best when they are able to use problem solving to help them make choices

A nurse is working with a terminally ill adult patient. The nurse decides totell the adult children that they need to decide how to advise their father about taking analgesics during the terminal phase of his illness. This step of the processing an ethical dilemma is A. Articulation of the problem B. Evaluation of the action C. Negotiation of the outcome D. Determination of values surrounding the problem

C. Negotiation of the outcome

Refers to the support of a particular cause "nurses ability to help speak up for the patient"

Advocacy

A nurse is providing care to a patient who is experiencing major abdominal trauma following a car accident. The patient is losing blood quickly and needs a blood transfusion. The nurse finds out that the patient is a Jehovah's Witness and cannot have blood transfusions because of religious beliefs. He or she notifies the patient's health care provider and receives an order to give the patient an alternative to blood products. This is an example of: A. A qualified improvement study. B. An evidence-based practice change. C. A time when calling the hospital's ethics committee is essential. D. Considering the patient's preferences and values while providing care.

D. Considering the patient's preferences and values while providing care. Providing evidence-based practice requires that you take the patient's values and beliefs into consideration while providing care.

Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient's only treatment choice. This example describes the ethical principle of A. Autonomy B. Fidelity C. Justice D. Nonmaleficence

D. Nonmaleficence

The nurse is evaluating the coping success of a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. The nurse realizes that the patient is coping successfully when the patient says: A."I'm going to learn to drive a car so I can be more independent." B."My sister says she feels better when she goes shopping, so I'll go shopping." C."I've always felt better when I go for a long walk. I'll do that when I get home." D."I'm going to attend a support group to learn more about multiple sclerosis."

D."I'm going to attend a support group to learn more about multiple sclerosis."

Nurses in an acute care hospital care attending a unit-based eduction program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of eduction? 1. Continuing eduction 2. Graduate eduction 3. In-service education 4. Professional Registered Nurse 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 patient is diagnosed with pneumonia, and during data collection, the nurse finds that the patient is economically disadvantaged. Which type of health care plan would be beneficial for the patient's treatment? 1 Medicaid 2 Private insurance 3 Long-term care (LTC) insurance 4 Preferred provider organization (PPO)

1 Medicaid is a federally funded, state-operated program that provides health insurance to low-income families diagnosed with long-term disabilities such as pneumonia. Therefore, a Medicaid health care plan would be beneficial for the patient's treatment. Private insurance policies are typically expensive, and patients have to meet deductibles before insurance pays. LTC insurance is very expensive, so this health care plan is not suitable. A preferred provider organization (PPO) health care plan limits an enrollee's choices to a list of preferred hospitals, physicians, and providers. It is also expensive and, therefore, not suitable for patients who are economically disadvantaged.

Professional Nursing Education

-Associate degree or baccalaureate degree -Graduate/Post graduate education (masters, doctoral) -Continuing and in-service education

Match the following definitions with the key terms related to intersectionality 1. Under inclusion 2. Social inequality 3. Social location a. Groups have unequal access to resources, services, and positions b. A group has been overlooked in research and the design of interventions c. One's place in society is based on membership in a social group that determines access to resources

1b, 2a, 3c

Before conducting any study with human subjects, the researcher must obtain approval from the agency's human subjects committee or institutional review board (IRB). The IRB ensures that the researcher (Select all that apply.) A. Obtains informed consent. B. Minimizes risk to subjects. C. Ensures confidentiality. D. Identifies risks and benefits of participation. E. Ensures that subjects complete the study.

A. Obtains informed consent. B. Minimizes risk to subjects. C. Ensures confidentiality. D. Identifies risks and benefits of participation. Researchers must protect the confidentiality of those who participate in the study, obtain informed consent, minimize risk to subjects, identify risks and benefits of participation, ensure that participation in the study is voluntary, and allow subjects to withdraw from studies at any time.

The hospital quality improvement committee has noted that the incidence of needlestick injuries on a particular unit has increased. When faced with issues, the committee applies the PDSA model, a formal model for exploring and resolving quality concerns. Because the committee is multidisciplinary in nature, and few members are nurses, it is imperative that the committee first: A. Plan. B. Do. C. Study. D. Act.

A. Plan. "Plan" is the first step of the process; it involves a review of available data to understand existing practice conditions or problems to identify the need for change. "Do" involves selecting an intervention on the basis of the data reviewed and implementing the change. "Study" means to evaluate the results of the change. "Act" involves incorporating the change if it is successful.

The nurse is teaching a parenting class to a group of pregnant adolescents. The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach did the nurse use? A. Role play B. Discovery C. An analogy D. A demonstration

A. Role play Rationale In role play people are asked to play themselves or someone else in a situation to enhance their confidence in handling that situation in the future.

When a patient faces surgery, the surgeon has an obligation to review the surgical procedure, including risks and benefits, out of respect for the patient's _________.

Autonomy

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A) The patient will verbalize the steps involved in breast self-examination within 1 week. B) The nurse will explain the importance of performing breast self-examination once a month. C) The patient will perform breast self-examination correctly on herself before the end of the teaching session. D) The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society.

C) The patient will perform breast self-examination correctly on herself before the end of the teaching session. Return demonstration provides an excellent source of feedback and reinforcement to evaluate learning.

HIPAA or Health Insurance Portability and Accountability Act of 1996 is an example of what?

Confidentiality

Main emphasis is on the outcome or consequence of action

Consequentialism

Which of the following statements is true regarding Magnet status recognition for a hospital? A. Nursing is run by a Magnet manager who makes decisions for the nursing units B. Nurses in Magnet hospitals make all of the decisions on the clinical units C. Magnet is a term that is used to describe hospitals that are able to hire the nurses they need D. Magnet is a special designation for hospitals that achieve excellence in nursing practice

D Magnet status is a process and review that hospitals go through that shows achievement of excellence in nursing practice. The designation is given by the American Nurses Credentialing Center and focuses on demonstration of quality patient care, nursing excellence, and innovations in professional practice.

A researcher who used Burke's pentadic dramatism approach would be undertaking which of the following? A) Historical research B) Qualitative description C) A case study D) A narrative analysis

D

If you try to make a decision about the ethics of a controversial medical procedure, ________ guides you to focus on how the procedure ensures fidelity to the patient, truthfulness, justice, and beneficence.

Deontology

In 1923, the Goldmark Report was an important study that a. Formed formal nurse midwifery programs. b. Established the Center for Ethics and Human Rights. c. Revised the ANA code of ethics. d. Led to the development of the Yale School of Nursing.

In 1923, the Goldmark Report identified the need for increased financial support for university-based schools of nursing. As a result, the Yale School of Nursing was developed. Graduate nurse midwifery programs did not come into existence until the 1940s, and the Center for Ethics and Human Rights was founded in 1990. The ANA code of ethics was published in 1985 and was last updated in 2001.

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

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 personal belief about the worth of a given idea, attitude, custom, or object that set standards that influence behavior. In some cultures decisions about health care flow from group or family-based discussion rather than independent decisions by one person.

Value

How can nurse work on developing cultural awareness? (Select all that apply) 1. Reflect on his or her past learning about health, illness, race, gender, and sexual orientation 2. Develop greater self-knowledge about personal biases 3. Recognize consciously the multiple factors that influence his or her own world view 4. Engage in an in-depth self-examination of his or her own background 5. Learn as many facts as possible about an ethnic group

1,2,3,4

The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other ethical practices? (select all that apply) 1 Ethics of care pays attention to the environment in which caring occurs. 2 Ethics of care pays attention to the stories of the people involved in the ethical issue. 3 Ethics of care is used only in nursing practice. 4 Ethics of care focuses only on the code of ethics for nurses. 5 Ethics of care focuses only on understanding relationships.

2, it's about relationships Pg. 292; All answers are valid concepts, but ethics of care focuses on understanding relationships.

A patient with advanced cancer is referred for hospice care. The nurse explains to the patient and the family that the goal of hospice care differs from the goal of traditional care in that hospice care 1. Provides for more complete pain control. 2. Focuses on helping the patient and family prepare for death. 3. More readily recognizes advance directives related to "right to die." 4. Is delivered in the home and does not rely on the technology of hospitals.

2. Focuses on helping the patient and family prepare for death because it provides compassion, concern, support dying

The nurse is explaining Medicare to a patient. Which statement about Medicare is true? 1 All medical expenses are funded by the hospital. 2 All medical expenses are funded by the government. 3 A monthly deduction is taken from the payroll of all working people. 4 The medical expenses are funded by the government and hospital jointly.

3 Medicare is a federally administered health care funded program. The program is funded by a payroll deduction. In Medicare, medical expenses are not funded by the hospital, the government, or a joint effort of the government and the hospital.

When the nurse uses information and technology to communicate, locate and use knowledge, reduce and eliminate errors, and help make decisions, in which area is the nurse is working? 1 Integrated delivery system 2 Health care patient system 3 Nursing informatics 4 Computerized nursing network

3 Nursing informatics is the use of information, data, and technology to communicate, manage knowledge, mitigate errors, and support decision making. It requires knowledge, skills, and attitudes from the nurse to be able to effectively use information and technology. Nursing informatics is focused on the organization, analysis, and dissemination of information.

The nurse is caring for a patient with hypertension. Which nursing intervention indicates that the nurse is providing patient-centered care focused on transition and continuity? 1 Involving the patient's family members in decision making 2 Respecting the patient's cultural values while providing care 3 Teaching the patient about the administration of medications 4 In simple language, explaining the tests and procedures required

3 Teaching the patient about medication administration indicates that the nurse is providing patient-centered care focused on transition and continuity. Patients have the right to decide if the family members are to be involved in the decision-making processes related to their care. Therefore, the nurse should always ask the patient whether to pass the care-related information to the family. Respecting the cultural values of the patient while providing care indicates patient-centered care focused on physical comfort. Explaining, in simple language, the tests and procedures required indicates patient-centered care focused on information, communication, and education.

The question, "What are the basic social processes women use to maintain balance through their menopausal transition?" is an example of a research question within which of the following traditions? A) Grounded theory B) Ethnography C) Phenomenology D) Qualitative description

A

Which of the following names does not belong with the others? A) Heidegger B) Corbin C) Strauss D) Glaser

A

Which concept means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided? a. Autonomy b. Accountability c. Patient advocacy d. Patient education

Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. As a patient advocate, the nurse protects the patient's human and legal rights and provides assistance in asserting these rights if the need arises. As an educator, the nurse explains concepts and facts about health, describes the reasons for routine care activities, demonstrates procedures such as self-care activities, reinforces learning or patient behavior, and evaluates the patient's progress in learning.

A nurse is caring for a patient with end stage lung cancer 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 the family. The nurse is acting as the patient's: 1. Educator 2. Advocate 3. Caregiver 4. Case manager

Advocate means protecting patients rights. In this case the nurse is discussing the patient wishes to the family saying the patient is going a different route other than surgery

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 discuss the patient's wishes with them. The nurse is acting as the patients: 1. Education 2. Advocate 3. Caregiver 4. Case Manager

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.

A three-stage reaction to stress: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

B

During the assessment interview of an older woman experiencing a developmental crisis, the nurse asks which of the following questions? A.How is this flood affecting your life? B.Since your husband has died, what have you been doing in the evening when you feel lonely? C.How is having diabetes affecting your life? D.I know this must be hard for you. Let me tell you what might help.

B.Since your husband has died, what have you been doing in the evening when you feel lonely?

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of: A. A situational crisis. B. A maturational crisis. C. An adventitious crisis. D. A developmental crisis.

C

An ethnographic study of a clinic that specialized in abortion services by someone from outside that culture would most likely be an example of which of the following? A) An auto-ethnography B) A critical ethnography C) A microethnography D) A macroethnography

C

The question, "What is the essence of men's experiences of chemotherapy treatment for prostate cancer?" is an example of a research question within which of the following traditions? A) Grounded theory B) Ethnography C) Phenomenology D) Qualitative description

C

A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient correctly. A change is needed quickly. What type of quality improvement method would be most appropriate? A. PDSA B. Six Sigma C. Rapid-improvement event D. A randomized controlled trial

C. Rapid-improvement event Rapid-improvement events are appropriate to use when a serious problem that affects patient outcomes exists and needs to be resolved quickly.

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. The supervising nurse recognizes that: A. Nurses who feel stress usually pass the stress along to their patients. B. A nurse who feels stress is ineffective as a nurse and should not be working. C. Nurses who talk about feeling stress are unprofessional and should calm down. D. Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.

D

A study that focused on the meaning of sacrifice among wounded military personnel during war time would likely use which of the following? A) A descriptive phenomenological approach B) A grounded theory approach C) An ethnography D) A hermeneutic approach

D

How does knowledge of genomics affect patient treatment decisions?

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.

Nurses at a community hospital are in an 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

In-service education because there are institutions or training provided by health care agency. Designed to increase knowledge, skills, competencies

List the two criteria for admission to a hospice program. a. b.

a. Patient must desire services and agree in writing that only hospice care can be used to treat the terminal illness (palliative care) b. Patient must meet eligibility, which is less than 6 months to live, certified initially by two physicians

secondary appraisal

identifying the event or circumstance as harm, loss, threat, or challenge, the person experiences stress if stress is present secondary appraisal focuses on possible coping strategies

burnout

occurs as a result of chronic stress

ego defense mechanisms

regulate emotional distress and thus give a person protection from anxiety and stress -help a person cope with stress indirectly and offer psychological protection from a stressful event

Local adaptation syndrome LAS

response to body tissue, organ, or part to stress of trauma, illness or other physiologic change --reglexive pain response --inflammatory response

alarm reaction

rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine amounts, heart rate, blood flow to muscles, oxygen intake, and mental alertness the pupils of the eyes dilate to produce a greater visual field

projection

see traits in someone else that you have but don't recognize them as a trait that you have

Key steps in the resolution of an ethical dilemma

step 1 ask the questions, is this an ethical dilemma? step 2 gather information relevant to the case step 3 clarify values step 5 verbalize the problem step 6 negotiate a plan step 7 evaluate the plan over time

NIC nursing interventions

three primary modes for coping -decrease stress producing situations -reduce physiological response to stress -increase resistance to stress

displacement

transferring emotions, ideas, or wishes from a stressful situation to a less anxiety producing substitue

conversion

unconsciously repressing an anxiety producing emotional conflict and transforming it into non-organic symptoms

What is the purpose of an ethic committee in health care institutions?

used to process ethical dilemmas used for education, policy recommendation, and case consultation

crisis

when stress overwhelms existing coping mechanisms, patients lose emotional balance

fight or flight response

which is the arousal of the sympathetic nervous system prepares a person for action

prevention of stress

-exercise, sleep, eat healthy -mobilize support system, foster relationships -improve time management skills-- know when to say NO -CT guided imagery; visualization; progressive relaxation and controlled breathing; journaling; emptying the mind; laughter and music; touch

Which statement made by a new graduate nurse about the teach back technique requires intervention and further instruction by the nurse's preceptor? 1. "After teaching a patient how to use an inhaler, I need to use the Teach Back technique to test my patent's understanding 2. "The Teach Back technique is an ongoing process of asking patients for feedback: 3. "Using Teach Back will help me identify explanations and communication strategies that my patients will most commonly understand" 4. Using pictures, drawings, and models can enhance the effectiveness of the Teach Back technique

1

Which force of magnetism is associated with the component that focuses on structure and processes, and demonstration of positive clinical, workforce, patient, and organizational outcomes? 1 Quality of Care 2 Image of Nursing 3 Management Style 4 Quality Improvement

1 Empirical Quality Results is the component of the Magnet model that focuses on structure and processes, and demonstration of positive clinical, workforce, and patient and organizational outcomes. The force of magnetism associated with this component is Quality of Care. Image of Nursing is the force of magnetism associated with the component Structural Empowerment. Management Style is the force of magnetism associated with the component Transformational Leadership. Quality Improvement is the force of magnetism associated with the component New Knowledge, Innovations, and Improvements.

A patient has leukemia and is in the terminal stage. The patient has opted for a service that provides palliative care at home. Which service has the patient selected? 1 Hospice 2 Respite care 3 Assisted living 4 Adult day care

1 Hospice is a service in which palliative care is provided to terminally ill patients in their homes. Respite care is a service that provides short-term relief to the family and caregivers of ill patients. Assisted living is an example of a service offered in a long-term care setting. Adult day care is a service that provides care to patients in a facility when their caregivers have other commitments.

Which statement made by the nurse is an example of applying the principle of patient-centered care while focusing on alleviating the patient's fear and anxiety? 1 "Let's talk about the concerns that you have about going home." 2 "I'll get the medication prescriptions for you before discharge." 3 "I'll be back in 30 minutes to help you get cleaned up." 4 "I'll make a referral to the home health nurse for you."

1 Interventions that focus on the alleviation of fear and anxiety are related to allowing the patient and family time to express fears and concerns, understand the impact that illness will have on the patient's ability to care for himself or herself, and express worries about their ability to pay for medical care. Identifying staff that can help with payment plans alleviates fear and anxiety.

Which policy covers medical expenses for very poor children? 1 Medicaid 2 Medicare 3 Long-term care (LTC) insurance 4 State Children's Health Insurance Program (SCHIP)

1 Medicaid is a federally funded, state-operated program that provides health insurance to the low-income population. Medicare is a policy for the elderly and disabled. LTC is supplemental insurance for long-term care services. The state children's health insurance policy (SCHIP) is a federally funded, state-operated program to provide health coverage for uninsured children. Children not poor enough to be covered by Medicaid are covered by this policy.

Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system? 1 Client safety 2 Evidence-based practice 3 Client satisfaction 4 Maintenance of competency

1 Near-miss events are events that could have caused a problem with patient safety had they not been stopped before patient harm occurred. Nurses who investigate ways to prevent near-miss events work on issues surrounding patient safety.

A patient who is diagnosed with diabetes mellitus is discharged to home. The primary health care provider asks the patient to continue the follow-up in a nurse-managed clinic. What could be one reason for referring the patient to the nurse-managed clinic? 1 It provides management of chronic illness. 2 It provides services for accident and illness prevention. 3 It provides diagnostic services and treatment of illness. 4 It provides mental health counseling to the community.

1 Nurse-managed clinics provide services for chronic disease management and support for self-care and caregivers. It helps to provide continuity of care. Occupational health care centers provide services for accident and illness prevention in workplaces. The physician's office provides diagnostic services and treatment for illness. Mental health counseling can be provided by community health centers.

Which option below is an example of the nurse participating in primary care activities? 1 Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2 Working with patients in a cardiac rehabilitation program 3 Assessing a patient at an emergent care facility 4 Providing home wound care to a patient

1 Primary care activities are focused on health promotion. Health promotion programs contribute to quality health care by helping patients acquire healthier lifestyles. Health promotion activities keep people healthy through exercise, good nutrition, rest, and the adoption of positive health attitudes.

The nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which option is an appropriate goal for restorative care? 1 Patient will be able to walk 200 feet without shortness of breath. 2 Wound will heal without signs of infection. 3 Patient will express concerns related to return to home. 4 Patient will identify strategies to improve sleep habits.

1 Restorative interventions focus on returning a patient to his or her previous level of functioning or a new level of function limited by his or her illness or disability. The goal of restorative care is to help individuals regain maximal functional status and enhance quality of life by promoting independence.

Match the examples with the professional nursing code of ethics: 1 You see an open medical record on the computer and close it so no one else can read the record without proper access. 2 You administer a once a day cardiac medication at the wrong time, but nobody sees it. However, you contact the primary care provider and your head nurse and follow agency procedure. 3 A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patients request. 4 You tell your patient that you will return in 30 minutes to give him his next pain medication.

1 Confidentiality 2Accountability 3 Advocacy 4 Responsibility

When designing a plan for pain management for a postoperative patient, the nurse assess that the patients priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. Which principle is used to encourage the nurse to monitor the patient's response to the pain? 1 Fidelity 2 Beneficence 3 Nonmaleficence 4 Respect for autonomy

1 Fidelity Pg. 293; Fidelity means keeping promises. Keeping the promise in this case includes not just tending to the clinical need, but evaluating the effectiveness of the interventions.

Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas? 1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations 2 To study the literature on current research about the possible clinical interventions available for the patient in question. 3 To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal opinion. 4 To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues

1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations Pg. 296; A nurse's point of view is essential to full discussion of ethical issues because of the nature of the relationship that nurses develop with patients and the intensity and intimacy of contact with the patient and family.

Managed Care Organizations (MCOs) are important components of the health care system. What are the services provided by MCOs? Select all that apply. 1 Preventive services 2 Treatment services 3 Direct specialist care 4 Tertiary care 5 Coverage of the whole population

1, 2 Managed care organizations (MCOs) provide comprehensive preventive and treatment services. MCOs do not include direct specialist care; a referral is needed to access specialists. The focus of MCOs is on primary care, not on tertiary care. MCOs do not cover the whole population; they serve groups of voluntarily enrolled people.

A group of health care professionals in the medical-surgical unit of a 600-bed urban hospital is working to assess and improve the quality of health care delivery. The staff nurse has been told to collect the data required to assess the quality of health care delivery. Which relevant data is the nurse expected to collect? Select all that apply. 1 Rate of infections after surgery 2 Readmission rates of patients 3 Time frame for returning to work after discharge 4 The number of health care providers in the hospital 5 Average number of patients admitted in the hospital per day

1, 2, 3 The meaning of quality in a health care delivery system is the "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (IOM, 2001). To assess the quality of health care delivery, the data on the infection rates after surgery should be collected, which would indicate the sanitation of the hospital and whether proper aseptic methods are used during procedures. The readmission rates and time frame for returning to work after discharge indicate the effectiveness of health care delivery. The number of health care providers and number of patients admitted to the hospital are not indicators of the quality of health care delivery.

The nursing staff is developing a quality program for the floor. Which options are nursing-sensitive indicators from the National Database of Nursing Quality Indicators that the nurses can use to measure patient safety and quality for the unit? Select all that apply. 1 Number of medication errors committed by registered nurses (RNs) 2 Turnover rate of nurses on the unit 3 Incidence of patient falls 4 Number of certified RNs 5 Number of emergency department admissions per year

1, 2, 3, 4 Nursing-sensitive outcomes are patient outcomes that are directly related to nursing care such as changes in patient's symptom experiences, functional status, safety, psychological distress, and costs. They are also related to the environment in which nurses practice, which affect patient outcomes. For example, the nursing staff that implements strategies to decrease turnover on the nursing unit affects overall hospital turnover rates. Nurses assume accountability and responsibility for the consequences of these outcomes. The number of emergency department admissions per year is not a measure of patient safety or quality of care.

The nurse is explaining to a nursing student about discharge planning. Which objectives are included in the discharge planning? Select all that apply. 1 Encourage the patient to seek medical help if complications arise. 2 Identify appropriate resources to ensure continuity of care. 3 Help the patient learn safe and effective use of medication. 4 Teach the patient self-administration of intravenous fluids. 5 Teach rehabilitation techniques to support adaptation.

1, 2, 3, 5 Discharge planning is based on anticipating the patient's needs once he or she leaves the health care establishment. The patient should be encouraged to identify complications and seek timely help. The patient should be referred to appropriate resources to maintain continuity of care. The patient should be taught about safe use of medications. Teaching rehabilitation techniques is important to help the patient adapt to a new lifestyle or resume daily activities. Intravenous fluids should be administered only by a professional. The patient should not be encouraged to self-administer IV fluids.

Which activities performed by the nurse are focused on the patient-centered care principle of physical comfort? Select all that apply. 1 Asking the patient what a tolerable level of pain is for him or her following surgery 2 Providing a back rub at bedtime 3 Offering the patient a warm washcloth for his or her hands before eating 4 Teaching the patient about the new antihypertensive medication ordered 5 Scheduling the patient's follow-up appointments on discharge 6 Changing the bed linens for a patient who is experiencing diaphoresis

1, 2, 3, 6 Interventions for the patient-centered care principle of physical comfort are focused on care that increases the comfort of the patient. Responding to patient's need for pain medications and using nursing interventions that increase comfort are important. Teaching is focused on the principle of continuity and transition; scheduling appointments is an intervention for access to care.

A patient is being discharged from the hospital following a surgical procedure. What is the role of the nurse in discharge planning? Select all that apply. 1 Develop a plan for further care. 2 Ensure a smooth transition from the hospital to another health care level. 3 Exclude referrals to other disciplines. 4 Anticipate and identify patient needs. 5 Begin planning immediately once the discharge instruction is given.

1, 2, 4 Discharge planning is an important nursing activity that requires critical thinking. When planning a discharge, the nurse develops a plan for further care of the patient ensuring that there is a smooth transition from the hospital to another level of health care such as a nursing home. The nurse anticipates and identifies the patient's needs so that the plan includes the care needed once the patient leaves the hospital setting. Referrals are important in ensuring that all the patient's needs are met. Discharge planning starts as soon as the patient is admitted.

A patient is on Medicare, a national health insurance program of the United States. What care costs are covered by part A of Medicare? Select all that apply. 1 Basic medical care costs 2 Basic surgical care costs 3 Basic outpatient care costs 4 Basic psychiatric care costs 5 Premium prescription drug costs

1, 2, 4 Medicare is a national health insurance program in the United States for people aged 65 and older. Part A of Medicare provides basic protection for medical, surgical, and psychiatric care based on diagnosis-related groups. Part B of Medicare covers outpatient care costs and provides voluntary medical insurance for additional benefits. Part D of Medicare is the voluntary plan that provides improved drug coverage.

The nurse works in a long-term care unit. Which rules of performance should the nurse keep in mind? Select all that apply. 1 Sharing of knowledge 2 Individualization of care 3 Exclusion of the patient from decision-making 4 Transparency with the patient 5 Patient needs are not anticipated but expressed

1, 2, 4 The Institute of Medicine (IOM) has identified 10 important rules of performance for a health care system to follow to better meet patient needs. As per the rules, knowledge is shared with the patient and information flows freely. Patient care is individualized based on needs and values. The patient should be encouraged to actively participate in decision making and take control of his or her own health. Patient needs should be anticipated through planning and met effectively.

The nurse is developing a discharge plan for a patient. What should the nurse include in the discharge plan? Select all that apply. 1 Necessary rehabilitation techniques 2 Counseling regarding nutrition and diet 3 Documentation of necessary medical history 4 Correct and effective use of medications 5 Inclusion of diagnostic reports and tests

1, 2, 4 The nurse prepares a discharge plan for a patient to ensure continuity of care. The plan includes necessary rehabilitation techniques to support adaptation to the environment. The nurse provides counseling regarding nutrition and diet to help the patient lead a healthy life. The plan also includes information about safe and effective use of medications. The patient's history is taken and diagnostic tests are performed when the patient is admitted. These are not included in the discharge planning.

What information should the nurse include when providing information about Medicaid to a patient? Select all that apply. 1 It provides health insurance to low-income families. 2 It includes supplemental coverage and long-term care assistance to older adults. 3 The payment for Medicaid is deducted from the individual's account every month. 4 It provides health assistance to low-income people with disabilities who require long-term care. 5 It provides comprehensive preventive and treatment services to a group of volunteers.

1, 2, 4 Medicaid is a state-operated and federally funded program. It provides health insurance to low-income families. It also provides supplemental coverage and long-term care assistance to older adults and health assistance to low-income people with disabilities who require long-term care. It is a federally funded program; the payment is not deducted from the person's account. Managed care organizations (MCOs) provide comprehensive preventive and treatment services to a group of voluntarily enrolled people.

The nurse is teaching a group of nursing students about improvements in health care systems through managed care. Which statements are true about managed care? Select all that apply. 1 The provider receives a predetermined capitated payment for each patient. 2 The provider assumes financial risk in addition to providing patient care. 3 The focus of care shifts to individual illness care. 4 The services focus on improving the functional status of individuals. 5 The services focus on reducing patient costs and improving patient satisfaction.

1, 2, 4, 5 Managed care is a health care system in which the health care provider receives a predetermined capitated payment for each patient enrolled in the specific program. Therefore, the provider takes the risk of financial management in addition to providing health care services. The health care services focus on keeping patients healthy and functional. Health costs can be reduced by keeping patients healthy and satisfied with the health care provided. The focus of care is not individual illness but the prevention of illness, prompt detection and timely treatment, and outpatient care.

The nursing department of a 600-bed urban hospital is planning to apply to the American Nurses Credentialing Center for Magnet status. Before applying, the administration decides to examine the quality of the nursing care provided in the hospital. Which data should be collected to assess the quality of nursing care? Select all that apply. 1 Incidence of pressure ulcers 2 Nursing hours per patient per day 3 Number of patients admitted to the hospital per day 4 Average duration from admission to discharge of patients 5 Education and certifications of the nurses working in the hospital

1, 2, 5 Achievement of Magnet status in a health care establishment requires excellence in nursing practice. This depends on quality patient care, nursing excellence, and innovations in professional practice. Assessment of the quality of nursing is important before an establishment applies for Magnet status. Quality indicators of nursing are the incidence of pressure ulcers, nursing hours per patient per day, and education and certification status of the nurses. The number of patients admitted to the hospital and duration of admission of the patient do not indicate nursing quality.

A patient wishes to know about managed care organizations (MCO) in anticipation of enrolling in one. What does the nurse tell the patient? Select all that apply. 1 In an MCO, the focus is on health maintenance and primary care. 2 In an MCO, all the care is provided by a primary health care practitioner. 3 An MCO provides basic protection for medical, surgical, and psychiatric care costs. 4 Generally, an MCO provides health assistance to low-income people with long-term care disabilities. 5 MCOs provide comprehensive preventive and treatment services to those who are voluntarily enrolled.

1, 2, 5 In MCOs, the focus is on health maintenance and primary care. In an MCO, all of the care is provided by a primary health care practitioner, who is a salaried employee of the MCO. MCOs provide comprehensive preventive and treatment services to a group of voluntarily enrolled people. Medicare provides basic protection for medical, surgical, and psychiatric care costs for those who are age 65 and above. Medicaid is health assistance to low-income people, including those with long-term care disabilities.

As part of a quality training program, the nurse prepares a report on patient management. According to the National Database of Nursing Quality Indicators (NDNQI), what indicators of quality nursing should the nurse include in the report? Select all that apply. 1 Patient falls 2 Number of beds available 3 Hospital-acquired infections 4 Patients developing pressure ulcers 5 Number of health care practitioners available

1, 3, 4 The National Database of Nursing Quality Indicators (NDNQI) was developed by the American Nurses Association. It helps measure nursing-related outcomes to improve the standard of care and patient safety. According to NDNQI, the indicators for quality nursing are patient falls, development of hospital-acquired infections, and development of pressure ulcers. Other indicators are nurse turnover, staff mix, registered nurse certification, psychiatric patient assault rate, and restraint prevalence. The number of beds in the hospital and the number of health care practitioners are not indicators of quality nursing.

An elderly patient in a long-term care facility complains of abdominal pain. The patient has been on calcium supplements for the past 3 years. The patient worked as a flight attendant for an airline several years before, and she traveled to Egypt many times in her youth. She also has had liposuction. Which components of this information should the nurse include in the minimum data set (MDS)? Select all that apply. 1 Abdominal pain 2 Vacation to Egypt 3 Calcium supplements 4 History of liposuction 5 Occupation-flight attendant

1, 3, 4, 5 The MDS serves as an information source for nurses to help determine the best intervention for the patient. In this scenario, the patient's physical complaint, medication history, and history of liposuction are relevant for the MDS. The patient's occupation gives an idea of her lifestyle and possible cause of the trouble. The trips to Egypt were taken long ago and are not relevant for the MDS.

A patient is admitted to the hospital for cardiac surgery. The patient is very apprehensive and emotionally overwhelmed. Based on the eight dimensions of patient care, what does the nurse do while providing emotional support to the patient? Select all that apply. 1 Talk to the patient and share the patient's fears and concerns. 2 Explain to the patient and his or her family how to manage care independently. 3 Help the patient understand the impact of the illness on the patient and his or her family. 4 Explain the procedures and tests in a language that the patient can understand. 5 Identify staff that can alleviate the patient's fear about paying for medical care needs.

1, 3, 5 According to the eight dimensions of patient care, it is necessary to provide emotional support to the patient. Emotional support includes talking to the patient and sharing the patient's fears and concerns. The nurse should also help the patient understand the impact of the illness onthe patient's and his or her family's life. Many times this fear may be about paying the medical care bills, so the nurse should identify staff that can alleviate the patient's fear about paying for medical care. Explaining to the patient and the family how to manage care independently is included in the informational, communicational, and educational aspects of patient care. Similarly, explaining procedures and tests in a language the patient can understand is a part of the informational, communicational, and educational aspects of patient care.

The nurse administrator in a 600-bed urban hospital is addressing a group of nurses and explaining strategies to improve patient-centered care. Which strategies proposed by the nurse administrator are appropriate? Select all that apply. 1 The nurse should provide thorough information about health care delivery and encourage the patient to participate in the decision-making process. 2 The nurse should administer analgesics whenever a patient complains of pain. 3 The nurse should be able to diminish all fears and concerns of the patient about the health care provided. 4 The nurse should always involve the family members in the decision-making process regarding the patient's care. 5 The patient should be assured that the nursing professional would be around to help.

1, 3, 5 To improve patient-centered care, it is important that the nurse treat the patient with respect and dignity. The patient should be informed about every step of the health care delivery process. Another strategy to improve patient-centered care is to provide emotional support to the patient and relieve his or her anxiety. The nurse should be able to alleviate all doubts or fears related to the patient's condition and the care provided. The nurse should ensure that patient issues are addressed as soon as possible. Whenever a patient complains of pain, it is important that the nurse assess the pain first before administering any medication. Alternative, nonpharmacological pain treatment is preferred over pain-relieving drugs. Patients have the right to decide if the family members are to be involved in the decision-making processes related to their care. Therefore, the nurse should always ask the patient whether to pass the care-related information to the family.

The nurse is learning about the effects of globalization of health care on nursing. Which factors should the nurse evaluate while considering globalization and increased worldwide communication? Select all that apply. 1 Well-informed health care consumers 2 Smaller number of health care consumers 3 More negligent health care consumers 4 Preference for accessible health care provider 5 Increasing demand for quality by health care consumers

1, 4, 5 As an effect of globalization, consumers read information available on the Internet and are well informed about their medical conditions. With the use of the Internet, health care consumers can easily get information and choose their health care service providers, and so, the most accessible providers are preferred by consumers. With increasing worldwide communication and sharing of health information, health care consumers demand quality and service from health care providers. It is not accurate to say there fewer health care consumers; with increased health awareness, a greater number of informed patients are being seen. With globalization, health care consumers are more knowledgeable and well informed.

Which options are characteristics of managed care systems? Select all that apply. 1 The provider receives a predetermined payment for each patient in the program. 2 Payment is based on a set fee for each service provided. 3 The system includes a voluntary prescription drug program for an additional cost. 4 The system tries to reduce costs while keeping patients healthy. 5 The focus of care is on prevention and early intervention.

1, 4, 5 Managed care programs have administrative control over primary health care services for a defined patient population. The provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. In this case, the managed care organization assumes the financial risk in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care. If people remain healthy, the cost of medical care declines. Systems of managed care focus on containing or reducing costs, increasing patient satisfaction, and improving the health or functional status of the individual.

Which population does Medicaid cover? Select all that apply. 1 Very poor children 2 All pregnant women 3 All children under age 10 4 Low-income individuals with disabilities 5 Low-income pregnant women

1, 4, 5 Medicaid is a federally funded program that covers health care for low-income individuals. This program finances care for very poor children, low-income people with disabilities, and low-income pregnant women. Pregnant women and children who do not belong to low-income groups do not benefit from this program.

Which of the following are considered social determinants of health? (Select all that apply) 1. Lack of primary health care providers in a zip code 2. Poor-quality public school education that prevents a person from developing adequate reading skills 3. Lack of affordable health insurance 4. Employment opportunities that do not provide paid vacation or sick leave 5. The number of times a person exercises during a week 6. Neighborhood safety that prevents a person from walking around the block or socializing with neighbors outside of his or her home

1,2,3,4,6

Which of the following changes can help create a more inclusive environment for lesbian, gay, bisexual, and transgender (LGBT) patients? (Select all that apply) 1. Explicitly including sexual orientation and gender identity into nondiscrimination policies 2. Displaying art that reflects LGBT community 3. Modifying health care forms to provide opportunities for gender identity and sexual orientation disclosure 4. Not asking patients about their gender identity and sexual orientation to avoid making them uncomfortable 5. Ensuring access to unisex or single-stall bathrooms

1,2,3,5

Which of the following properly applies an ethical principle to justify access to health care? (select all that apply) 1 Access to health care reflects the commitment of society to principles of beneficence and justice. 2 If low income compromises access to care, respect for autonomy is compromised. 3 Access to health care is a privilege in the United States, not a right. 4 Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics.

1,2,4 Pg. 298-299; Justice is the ethical principle that justifies the agreement to ensure access to care for all, but it does not necessarily clarify how to resolve issues of limited resources, like money or organs available for transplant. Privilege is not an ethical principle. Nonmaleficense means "first do no harm". A lack of care because of poor access causes harm (no preventative services, no early detection, no risk reduction) and is therefore ethically troubling. The principal of fidelity implies that we agree to ensure access to care even for people whose beliefs and behaviors may differ from our own, including drug addicts.

A patient is admitted through the emergency department (ED) after a serious car accident. The nurse assesses the patient and quickly learns that he speaks little English. Spanish is his primary language. The nurse speaks some Spanish. Which interventions would be appropriate at this time? (Select all that apply) 1. The nurse requests a professional interpreter 2. Since this is an emergent situation, the nurse will interpret and identify the patient's priority needs 3. The nurse determines the interpreter's qualifications and makes sure that the interpreter can speak the patient's dialect. 4. The nurse uses short sentences to explain the treatments provided in the ED 5. The nurse directs questions to the patient by looking at the patient instead of at the interpreter

1,3,4,5

Which of the following are examples of problems with the health care system that contribute to health disparities (Select all that apply) 1. A health care provider assumes that the patient missed two appointments because the patient does not care about his or her health and does not inquire about the reason for missed visits 2. The discharge nurse at a hospital uses Tech Back with a patient to ensure that she has communicated the discharge instructions clearly. 3. A community hospital lacks an adequate staff of social workers who are able to ensure patient's access to resources they need to take care of their health 4. A hospital discharges a patient without ensuring that the patient has a primary care provider 5. A nurse uses a family member as an interpreter to explain the patients modifications 6. The hospital conducts quality improvement without stratifying data by race, ethnicity, language, socioeconomic status, sexual orientation and other axes of social group identities

1,3,4,5,6

Profession defined

1. Extended education 2. Theoretical body of knowledge 3. Specific service provided 4. Autonomy in decision making and practice 5. Code of ethic

A nurse enters the examination room of the emergency clinic and meets a 29-year-old patient who missed her last two follow-up appointments. The nurse notes from the medical record that the patient has high blood pressure that the doctor has been trying to help her manage. The patient just spoke with her doctor who left the room frustrated because the patient has not been taking her medication as prescribed. The patient confronts the nurse, saying "I'm tired of being treated this way; no one cares. I need to find another doctor!" Using the C-LARA mnemonic, match the nurse's response to the correct letter of the mnemonic. 1.C, 2. L, 3. A, 4.R, 5.A a. The nurse acknowledges that it is absolutely reasonable for patients to expect that their health care providers care about their situations and that it is disappointing when they have experiences that make them feel like they do not. b. The nurse uses a relaxation technique before responding to the patient's concerns. Calm yourself. Take a breath. Check your pulse c. The nurse says, " I want to help you. I can do that better if you tell me what's making it difficult for you to come to your appointments and take your medicine everyday." d. The nurse maintains eye contact and allows the patient to discuss her perspective while remaining attentively quiet e. the nurse explains " One thing I want you to understand is that your blood pressure medicine will only work if you take the same amount each day. "Your follow-up appointments are important so we can get this blood pressure under control. Let me get a social worker who can help you figure out these transportation issues or see if he can find a doctor closer to your home"

1b, 2d, 3a, 4c, 5e

Match each letter of the RESPECT mnemonic with a statement that describes the concept the letter represents 1.R, 2.E, 3.S, 4.P, 5. E, 6. C, 7.T a. Ask about and try to understand barriers to care and adherence and then offer resources to help the patient overcome them, involving family members if appropriate, and reassuring the patient that you are and will be available to help. b. Patients may have different reasons for not disclosing important information. Earn a patient's confidence through actions and attitude that demonstrate respect, compassion, and your interest in partnership. c. Work closely together with the patient by being flexible with regard to issues of control, negotiating roles when necessary and stressing that you will be working together to mutually address medical problems. d. Provide explanations for the process and your action, checking often for understanding and using verbal clarification techniques such as Teach Back. e. Approach each encounter thinking about cultural competence and how you can demonstrate respect for the patient and his or her culture and beliefs f. Approach the encounter with empathy, remembering that the patient has come to you for help. Seek out and understand the patient's rationale for his or her behaviors or illness, verbally acknowledging and legitimizing his or her feelings g. Connect on a social level, seeking the patient's point of view; consciously attempt to suspend judgment; and avoid making assumptions

1g, 2f, 3a, 4c, 5d, 6e, 7b

While evaluating a student nurse's performance, the head nurse finds that the student nurse has identified errors and hazards in care and has designed and tested interventions. What does the head nurse infer from this evaluation? 1 The student nurse is using evidence-based practice. 2 The student nurse is applying quality improvement. 3 The student nurse is providing patient-centered care. 4 The student nurse is working in an interdisciplinary team.

2 Identifying errors and hazards in care, and designing and testing interventions to change processes means that the student nurse is applying quality improvement in practice. If the student nurse integrates the best research with clinical practice and patient values, it indicates the use of an evidence-based practice. If the student nurse coordinates continuous care, communicates effectively, and educates patients, the nurse is providing patient-centered care. If the student nurse integrates care and ensures continuous and reliable care, he or she is working in an interdisciplinary team.

The nurse is caring for a patient and finds that the patient is uncomfortable in the hospital. Which intervention is most appropriate to ensure the patient's comfort? 1 Leave the patient alone and give him or her time to adjust. 2 Give adequate privacy to the patient. 3 Administer pain medication. 4 Allow visitors throughout the day to keep the patient engaged.

2 In order to make the patient physically comfortable, the nurse must provide adequate privacy for the patient. At the same time, the nurse must regularly check on the patient and should be easily accessible to the patient. The nurse should not leave the patient completely alone, because it may make the patient feel isolated. Pain medications should be given only when necessary. The patient should have access to his family, but visitation should be controlled.

A patient's caregiver wants to know if there are support services that would give him some time off from caregiving. Which services can the nurse suggest? 1 Hospice 2 Respite care 3 Nursing clinics 4 Assisted living

2 Respite care is a service that gives time off to the caregivers of patients. This service can be provided at home or in a day care center. Professionals take care of the patient while the caregiver completes his or her chores or handles other responsibilities. Hospice is a service in which terminally ill patients receive palliative care in their homes. Nursing clinics diagnose and treat medical conditions. Assisted living is associated with long-term care facilities where patients live with other individuals in a home-like surrounding.

The nurse works in a primary health care center. For which service might the nurse be responsible in this health care setup? 1 Respite care 2 Health screening 3 Mental health counseling 4 Environmental surveillance

2 The primary health care center offers services such as health screening, routine physical examinations, diagnostic studies, and management of medical conditions. Respite care, mental health counseling, and environmental surveillance are not provided by primary health care centers. Respite care is provided by certain community agencies. Mental health counseling is provided by mental health care centers. Environmental surveillance is a part of community health in general.

Which option is an example of the principle of patient-centered care that is focused on continuity and transition? 1 The nurse asks the patient which family member should have access to patient information. 2 The nurse teaches the patient how to change the wound dressing at home. 3 The nurse responds promptly to the patient's request for pain medication. 4 The nurse schedules the patient's diagnostic scan following the physical therapy session.

2 Which option is an example of the principle of patient-centered care that is focused on continuity and transition? 1 The nurse asks the patient which family member should have access to patient information. 2 The nurse teaches the patient how to change the wound dressing at home. 3 The nurse responds promptly to the patient's request for pain medication. 4 The nurse schedules the patient's diagnostic scan following the physical therapy session.

The application of utilitarianism does not always resolve an ethical dilemma. Which of the following statements best explains why? 1 Utilitarianism refers to usefulness and therefore eliminates the need to talk about spiritual values. 2 In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. 3 Even when an agreement about a definition of usefulness exist in a community, laws prohibit an application of utilitarianism 4 Difficult ethical decisions cannot be resolved by talking about the usefulness of a procedure.

2 In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. Pg. 295; In our increasingly diverse communities, ideas of usefulness have become equally diverse.

Which options are examples of the principle of patient-centered care that are focused on respect, values, preferences, and expressed needs? Select all that apply. 1 Administering antihypertensive medications to the patient daily 2 Pulling the curtain around the patient's bed before changing the wound dressing on the patient's leg 3 Allowing the patient to ask questions and express his or her concern about surgery 4 Explaining a colonoscopy procedure to the patient 5 Working with the family to bring in ethnic foods that the patient prefers

2, 3, 5 Patient-centered care that is focused on respect, values, preferences, and expressed needs focuses on treating the patient with dignity and respect. A component is keeping the patient informed and involved in decision making. Consider patient preferences and perspectives when planning care. An environment where the patient is respected focuses on quality of life.

The nurse is learning about health care settings and levels of health care services. Which actions should the nurse perform under preventive care? Select all that apply. 1 Intensive care 2 Immunizations 3 Family planning 4 Cancer screening 5 Mental health counseling

2, 4, 5 Immunizations deals with vaccinating patients against specific illnesses and are performed under preventive health care. Cancer screening helps in early detection of cancer patients; hence, it is a part of preventive care. Mental health counseling helps to prevent mental disorders and is preventive care. A patient in intensive care needs immediate medical attention after the occurrence of medical illness or accident and is performed under tertiary care. Family planning is meant for the health of the family and is performed under health promotion.

The nurse works in a nurse-managed clinic. What is the purpose of nurse-managed clinics? Select all that apply. 1 Illness management 2 Health education 3 Diagnosis and treatment 4 Health promotion 5 Support for self-care and caregivers

2, 4, 5 Nurse-managed clinics are managed by nurses. The nursing services focus on educating patients and promoting healthy practices. Nurse-managed clinics also provide services to assess and manage chronic diseases. They also provide assistance for self-care and support for caregivers. Illness management, diagnosis, and treatment are not performed in these clinics, because these activities require hospital-based care.

A patient admitted to the hospital wants to know about respite care. What does the nurse explain to this patient about respite care? Select all that apply. 1 Respite care is included in Medicare. 2 Respite care gives the caregiver time to run errands or socialize. 3 Respite care is provided only in the long-term care facility, which resembles the home. 4 Respite care provides the caregiver some time off from providing care to the ill person. 5 Respite care can include overnight care.

2, 4, 5 Respite care is a program in which the caregiver can get some time off from providing care to the ill person. This provides short-term relief to the caregiver. Respite care can include overnight care, and it can be provided at home, in a day care setting, or in a health care institution. The caregiver can use this time to care for himself or herself, to run errands, or have some social time. Respite care is not included in Medicare.

Which parameters are included in the Resident Assessment Instrument/Minimum Data Set (RAI/MDS) protocol? Select all that apply. 1 Fatigue 2 Schizophrenia 3 Patient age above 40 4 Fracture of femur 5 Urinary incontinence

2, 4, 5 The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) protocol is used to determine the functional ability and overall well-being of a patient in a care facility. It consists of assessments of mood, behavior, activity pattern, and psychosocial well-being. Therefore, schizophrenia, fracture of femur, and presence of urinary incontinence are parameters assessed in an RAI/MDS. The age of the patient and presence of fatigue are not included in the assessment.

A patient tells the nurse about receiving green card status in the United States and wishes to learn about the health care system in the country. The nurse is educating this patient about the types of health care services available in the United States. The nurse says that the health care services are divided into categories. What are some examples of primary health care centers? Select all that apply. 1 Immunization centers 2 Family planning centers 3 Mental health counseling centers 4 Spinal injury rehabilitation centers 5 Prenatal and well-baby care centers

2, 5 A primary health center aims to improve the health and wellness of the entire population; it includes family planning, and prenatal and well-baby care programs. Immunization and mental health counseling are included under preventive care. They aim to reduce and control the risk factors for diseases. Spinal injury rehabilitation is a type of restorative care. It helps individuals with spinal cord injuries to regain maximum functional status and improve the quality of life

It can be difficult to agree on a common definition of the word quality when it comes to quality of life. Why? (select all that apply) 1 Average income varies in different regions of the country. 2 Community values influence definitions of quality, and they are subject to change over time. 3 Individual experiences influence perceptions of quality in different ways, making consensus difficult. 4 The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 5 Statistical analysis is difficult to apply when the outcome cannot be quantified. 6 Whether or not a person has a job is an objective measure, but it does not play a role in understanding quality of life.

2,3,4,5 Pg. 298; A person's average income and whether the person is employed are incorrect answers because income level is not necessarily a determining factor in measuring quality of life, but the ability to do meaningful work usually does influence the definition.

What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in the correct order. 1 Clarify values 2 Ask the question, Is this an ethical dilemma? 3 Verbalize the problem. 4 Gather information. 5 Identify course of action 6 Evaluate the plan 7 Negotiate a plan.

2,4,1,3,5,7,6 Pg. 296-297 an important concept in resolving ethical dilemmas is the idea that resolution is more complicated than simply doing what you want--it's about doing what's right, and figuring out what's right requires discourse.

A new nurse is caring for a hospitalized obese patient who is homeless. This is the first time the patient has been admitted to the hospital, and the patient is scheduled for surgery. Which of the following is a universal skill that will help the nurse work effectively with this patient? 1. The nurse shifts her focus to understanding the patient by asking her, "Describe for me the course of your illness 2. The nurse tells the patient "Your choices of foods and unwillingness to exercise are adding to your health problems." 3. The nurse asks the patient "Tell me about the main problems you have had with your health from not having a home" 4. The nurse explains, "Because you have obesity, it is important to know the effects it has on wound healing because of reduced tissue perfusion"

3

A nurse has worked in a home health agency for a number of years. She goes to visit a patient who has diabetes and who lives in a public housing facility. This is the first time the nurse has cared for the patient. The patient has four other family members who live with her in the one-bedroom apartment. Which of the following, based on Campinha-Bacote's (2002) model of cultural competency, is an example of cultural awareness. 1. The nurse begins a discussion with the patient by asking "Tell me about your family members who live with you" 2. The nurse asks, " What do you believe is needed to make you feel better?" 3. The nurse silently reflects about how her biases regarding poverty can influence how she assesses the patient 4. The nurse uses a therapeutic and caring approach to how she interacts with the patient

3

During an encounter with an elderly patient, the nurse recognizes that a thorough cultural assessment is necessary because the patient has recently come to the United States from Russia and has never been hospitalized before. The nurse wants to discuss cultural similarities between herself and the patient. Which step of the LEARN mnemonic is this? 1. Listen 2. Explain 3. Acknowledge 4. Recommend treatment 5. Negotiate treatment

3

Which parameter indicates a high quality of nursing care provided in the care unit? 1 The high number of patient falls 2 The high number of patients developing pressure ulcers 3 The low rate of hospital-acquired infections 4 The low rate of patient admissions

3 As per the National Database of Nursing Quality Indicators (NDNQI), there are some parameters on which the quality of care offered by nurses can be judged. Some of these parameters are falls, falls with injury, hospital-acquired infections, pressure ulcers, psychiatric patient assault rate, and restraint prevalence. A low rate of hospital-acquired infections indicates that the quality of nursing care is good. A high number of patient falls and high number of patients developing pressure ulcers indicate subpar nursing care. The low rate of patient admissions is not related to the quality of nursing care being provided.

The caregiver of a patient with terminal illness is receiving respite care. Which type of primary and preventive care service offers this kind of care? 1 Physicians' offices 2 Nurse-managed clinics 3 Block and parish nursing 4 Community health centers

3 Block and parish nursing is a preventive and primary care service that provides services for respite care, homemaker aides, spiritual health, help with errands, and transportation. Respite care provides short-term relief or time off for people providing home care to an ill, disabled, or frail older adult. Physicians' offices offer services such as routine physical examinations and treatment of acute and chronic illnesses. Nurse-managed clinics help in wellness counseling and acute and chronic care management. Community health centers offer services such as health screenings, disease management, counseling, and physical assessments.

The nurse works in a community health center. What program might the nurse be responsible for at the community health center? 1 Diagnostics 2 Spiritual health 3 Health education 4 Environmental surveillance

3 Community health centers are outpatient clinics that cater to the health needs of the community. They are usually associated with a community organization. Services provided in community health centers are health education, physical assessment, health screening, treatment of medical conditions, and counseling. Community health centers do not provide diagnostic services, spiritual health services, or environmental surveillance.

The patient tells the nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO? 1 This health plan is for people who cannot afford their own health insurance. 2 This health plan is operated by the government to provide health care to older adults. 3 This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose. 4 This is a fee-for-service plan in which you can choose any physician or hospital.

3 Preferred provider organization (PPO) plans limit the enrollee's choice to a list of preferred providers such as hospitals and physicians. A participant pays more to use a provider not on the preferred list. PPO plans focus on health maintenance.

The nurse is employed in a health care setting and is responsible for immunizations. In which health care setting is the nurse working? 1 Tertiary care 2 Primary care 3 Preventive care 4 Restorative care

3 Preventive care provides preventive programs for the general population or people who are at risk. Immunization is an example of preventive care, because it helps to prevent infections. Tertiary care is the management of various medical and surgical conditions. Primary care focuses on improving health outcomes for the entire population. Primary care includes nutrition counseling, family planning, and health promotion and exercise classes. Restorative care is a service to help people restore their functional abilities.

A patient wants to know about the State Children's Health Insurance Program (SCHIP). What does the nurse tell this patient? 1 It provides health insurance to all children who are American citizens. 2 It includes health promotion through school curriculum. 3 It provides health insurance to children who are not poor enough to be covered by Medicaid. 4 It covers health screening, medications, and insurance for all the children of a community.

3 The State Children's Health Insurance Program (SCHIP) is a federally funded and state-operated program that provides health coverage to uninsured children. It is a program for children who are not poor enough to be covered under Medicaid. The program is not limited to children who are American citizens but is applicable to all children who are uninsured. School health programs include health promotion through curriculum, screening, and counseling. The SCHIP program provides services such as health screening, medications, and insurance only to the uninsured children; the program is not meant for all the children.

A community health nurse is explaining the levels of health care to a group of patients. Which service is included in primary health care? 1 Intensive care 2 Assisted living 3 Family planning 4 Sports medicine

3 The aim of primary health care is to improve health outcomes for the entire population. It includes services like health education, proper nutrition, maternal/child health care, family planning, and immunizations. Intensive care is a tertiary service that includes diagnosis and treatment of illness. Assisted living is included under continuing care, which is provided when a person leaves the health care facility and goes home or to a subacute care facility. Sports medicine is a type of restorative care that helps individuals regain functional status.

The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you deleted all patient identifiers? 1 Yes because patient privacy would not be violated as long as the patient identifiers were removed 2 Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy 3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work 4 No because the principal of justice requires you to allocate resources fairly

3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work Comments, photos, etc. on social media are widely distributed and become a risk for violation of privacy. People often inadvertently give "clues" or hints to the identity of a person plus people accessing your site could know your actual assignment or put "two and two" together.

The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful and harmful way possible. Which principle describes this agreement? 1 Beneficence 2 Accountability 3 Nonmaleficence 4 Respect for autonomy

3 Nonmaleficence Pg. 293; Nonmaleficence is an important concept, but can be difficult to grasp at first. It refers to the balancing the risks and benefits of care while doing least amount of harm and suffering.

In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? 1 Nurses understand the principle of autonomy to guide respect for patient's self-worth. 2 Nurses have a scope of practice that encourages their presence during ethical discussions. 3 Nurses develop a relationship to the patient that is unique among all professional health care providers. 4 The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.

3 Nurses develop a relationship to the patient that is unique among all professional health care providers. Pg. 296; A fundamental goal of this chapter is to promote and nurture the value of the nursing voice in ethical discourse.

The nurse is discussing dimensions of patient-centered care identified by the Picker Institute. What could be said about the Physical Comfort dimension in patient-centered care? Select all that apply. 1 Patients need to know at all times whom to call for help. 2 Patients look to care providers to share their fears and concerns. 3 Patients often need help with completing activities of daily living. 4 Patients expect privacy and to have their cultural values respected. 5 Patients want to be informed and share in decisions about their care.

3, 4 The Physical Comfort dimension states that patients often need help with completing activities of daily living and expect privacy and to have their cultural values respected. The Coordination and Integration of Care dimension states that patients need to know at all times whom to call for help. The Emotional Support and Relief of Fear and Anxiety dimension states that patients look to care providers to share their fears and concerns. The Respect for Patients' Values, Preferences, and Expressed Needs dimension states that patients want to be informed and share in decisions about their care.

What roles do nurses play in providing quality care to all populations? Select all that apply. 1 They partner with political decision makers. 2 They partner with major insurance providers. 3 They practice to the full extent of their education and training. 4 They partner with physicians and other health care providers. 5 They improve data collection for planning and policy making.

3, 4, 5 To have a health care system with quality care for all populations, nurses need to practice to the full extent of their education and training, become full partners with physicians and other health care providers, and improve data collection, which in turn helps workforce planning and policy making. Partnering with political decision makers and major insurance providers is not a nursing role.

A patient tells the nurse that he has just received green card status in the United States and wishes to learn about the health care system in the country. The nurse explains to this patient about the various health care plans available in the United States. Which statements are true for the Medicare plan? Select all that apply. 1 It provides health coverage for children. 2 It reimburses for all home health care services. 3 It is a funded national health insurance program in the United States. 4 It has the minimum waiting period for payment to health care providers. 5 The payment for the plan is deducted on a monthly basis from the patient's social security check.

3, 5 Medicare is a federally administered program by the Commonwealth Fund or the Centers for Medicare and Medicaid Services (CMS). Medicare is a national health insurance program in the United States that is funded by through payroll deductions. Medicare reimburses for only selected home health services. The payment for this plan is deducted on a monthly basis from the patient's social security check. Medicare provides health coverage for people who are 65 years or older. It has a long waiting period (around 2 years) for payment to health care providers.

A nurse is preparing to perform a cultural assessment of a patient. Which of the following questions is an example of a contrast question? 1. Tell me about your ethnic background 2. Have you had this problem in the past? 3. Where do other members of your family live? 4. How different is this problem from the one you had previously?

4

The nurse is presenting information to a management class of nursing students on the topic of groups of in-patient hospital services that have a fixed reimbursement amount, with adjustments made based on case severity and regional costs. The nurse is presenting information to the class on which topic? 1 Utilization review committee 2 Resource utilization group 3 Capitation payment system 4 Diagnosis-related groups

4 Diagnosis-related groups (DRGs) are grouped in-patient hospital services for Medicare patients. Each group has a fixed reimbursement amount, with adjustments based on case severity, rural/urban/regional costs, and teaching costs. Hospitals receive a set amount for each patient based on the assigned DRG regardless of the patient's length of stay or use of services. DRGs are part of the prospective payment system.

Which activity performed by the nurse is related to maintaining competency in nursing practice? 1 Asking another nurse about how to change the settings on a medication pump 2 Regularly attending unit staff meetings 3 Participating as a member of the professional nursing council 4 Earning certification in a specialty area

4 Maintaining ongoing competency is the nurse's responsibility. Earning certification in a specialty area is one mechanism that demonstrates competency. Specialty certification has been shown to be positively related to patient safety.

A patient who works in a coal mine is referred to an occupational health center. Which services are provided to ensure the safety of the patient? 1 It provides coverage to pay the bills of patients who get ill or injured. 2 It provides health promotion services through a school curriculum. 3 It provides services to older patients or those unable to leave their homes. 4 It provides services for health promotion, and accident and illness prevention.

4 Occupational care centers provide services for health promotion and accident and illness prevention in the workplace. Health insurance pays a portion of the bills of a patient who gets ill or injured. School health is a program that includes health promotion through the school curriculum. Block and parish nursing provide services to older patients or those unable to leave their homes.

Which statement is true regarding Magnet status recognition for a hospital? 1 Nursing is run by a Magnet manager who makes decisions for the nursing units. 2 Nurses in Magnet hospitals make all of the decisions on the clinical units. 3 Magnet is a term that is used to describe hospitals that are able to hire the nurses they need. 4 Magnet is a special designation for hospitals that achieve excellence in nursing practice.

4 Through a review process, hospitals that can demonstrate achievement of excellence in nursing practice can achieve Magnet status. The designation is given by the American Nurses Credentialing Center and focuses on demonstration of quality patient care, nursing excellence, and innovations in professional practice.

A patient is admitted to a medical unit. The patient is fearful of hospitals. The nurse carefully assesses the patient to determine the exact fears and then establishes interventions designed to reduce these fears. In this setting how is the nurse practicing patient advocacy? 1 Seeking out the nursing supervisor to talk with the patient 2 Documenting patients fears in the medical record in a timely manner 3 Working to change the hospital environment 4 Assessing the patient's point of view and preparing to articulate it

4 Assess the patient's point of view and prepare to articulate it Pg. 293; All answers are correct behaviors, but assessing the patient's point of view and preparing to articulate it best reflects the concept of advocacy because it is standing up for the patient and having his/her views/wishes heard.

The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. Even though several ethical principles are at work in this case, list the principles from highest to lowest priority. 1 Accountability because you as the nurse are accountable for the well-being of this patient 2 Respect for autonomy because this patient's autonomy will be violated if he does not receive the liver transplant 3 Ethics of care because the caring thing that a nurse could provide this patient is resources for a liver transplant 4 Justice because the first and greatest question in this situation is how to determine the just distribution of resources

4, 2, 3, 1 Pg. 296; Box 22-2 Key steps in the resolution of an ethical dilemma Understanding the concept of Justice helps to enrich the conversation about how to act, and lifts the conversation above and beyond the circumstances of the patient. If justice is compromised, then respect for autonomy will be hard to maintain. The nurse will be able to care for the patient, but her commitment to care does not, unfortunately, give her the power to resolve the difficult issue of limited resources. Other concepts are valid but not as relevant to the case.

Ethical dilemmas often arise over a conflict of opinion. Reliance on a predicable series of steps can help people in conflict find common ground. All of the following actions can help resolve conflict. What is the best order of these actions in order to promote the resolution of an ethical dilemma? 1 List the actions that can be taken to resolve the dilemma. 2 Agree on a statement of the problem or dilemma that you are trying to resolve. 3 Agree on a plan to evaluate the action over time. 4 Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 5 Take time to clarify values and distinguish between facts and opinions--your own and those of others involved. 6 Negotiate a plan.

4,5,2,1,6,3 Pg. 296-297; This is the correct order to determine the dilemma and influencing factors. This process provides opportunities for the nurse and healthcare team to reflect on personal values and then identify the exact nature of the ethical problem, design a plan, and evaluate the success of the plan.

A 34-year-old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. Your best response would be which of the following? A. "Are you thinking of suicide?" B. "You've been doing a good job raising your children. You can do it!" C. "Is there someone who can help you?" D. "You have so much to live for."

A

A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, "The hemoglobin A1C is wrong. My blood sugar levels have been excellent for the last 6 months." The patient is using the defense mechanism: A. Denial. B. Conversion. C. Dissociation. D. Displacement.

A

A trauma occurs, and its effects sometimes last well after the event ends: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

A

Arousal of the sympathetic nervous system: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

A

Body stabilizes and responds in the opposite manner to the alarm reaction: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

A

Critical research differs from traditional qualitative research in which of the following? A) Its goal to be transformative B) Its use of interviews as a data source C) Its use of reflexivity D) Its desire to gain an in-depth understanding of phenomena

A

Ethnographers strive to do which of the following? A) Understand human cultures B) Develop an etic perspective C) Link the etic and emic perspectives into a unified whole D) Understand the essence of a phenomenon

A

In a qualitative study, the researcher becomes involved with the research process and must ensure that his or her own preconceived beliefs and opinions do not influence the data that is emerging from the study. The way the researcher does this is by which of the following? A) Bracketing B) Hermeneutics C) Narrative analysis D) Pentadic dramatism

A

Major homeostatic mechanisms are controlled by all of the following except: A. Thymus gland B. Pituitary gland C. Medulla Oblongata D. Reticular Formation

A

Participant observation is a data collection strategy used in almost all of which of the following? A) Ethnographic studies B) Case studies C) Phenomenological studies D) Descriptive qualitative studies

A

Person's effort to manage psychological stress: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

A

The focus of case study design is which of the following? A) Understanding why an individual thinks or behaves in a particular manner B) Focusing on a story as the object of inquiry C) Emergence of content analysis D) Presentation of pentadic dramatism

A

When teaching a patient about the negative feedback response to stress, the nurse includes which of the following to describe the benefits of this stress response? A. Results in neurophysiological response. B. Reduces body temperature C. Causes a person to be hypervigilant D. Reduces level of consciousness to conserve energy.

A

Which characteristic of qualitative research design is similar to quantitative research design? A) Use of both cross-sectional and longitudinal designs to observe the evolution of a phenomenon B) Generalizing the finding of a study C) Use of power analysis for determining sample size D) Avoidance of using field notes during the data collection process, to prevent bias

A

Which definition does not characterize stress? A. Efforts to maintain relative constancy within the internal environment. B. A condition eliciting an intellectual, behavioral, or metabolic response. C. Any situation in which a nonspecific demand requires an individual to respond or take action. D. A phenomenon affecting social, psychological, developmental, spiritual, and physiological dimensions.

A

Which of the following approaches involves the use of a procedure known as constant comparison? A) Grounded theory B) Ethnography C) Phenomenology D) Historical

A

Which of the following is an example of the general adaptation syndrome? A. Alarm reaction B. Inflammatory response C. Fight-or-flight response D. Ego-defense mechanisms

A

Which of the following is characteristic of qualitative research? A) It is capable of adjusting to what is being learned during data collection. B) It depends on the robust nature of statistical analysis. C) It does not have to obtain Institutional Review Board approval before conducting the study. D) It involves survey research design.

A

A nurse is using data collected from the unit to monitor the incidence of falls after the unit implemented a new fall protocol. The nurse is working in which area? A. Quality improvement B. Health care patient system C. Nursing informatics D. Computerized nursing network

A Quality data are the outcome of both QI initiatives. QI is an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy. The QI program of an institution focuses on improvement of health care-related processes such as fall prevention.

A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an appropriate goal for restorative care? A. Patient will be able to walk 200 feet without shortness of breath B. Wound will heal without signs of infection C. Patient will express concerns related to return to home D. Patient will identify strategies to improve sleep habits

A Restorative interventions focus on returning patients to their previous level of function or reaching a new level of function limited by their illness or disability. The goals of restorative care are to help individuals regain maximal functional status and enhance quality of life through promotion of independence.

A 74-year-old female admitted for pneumonia tells the nurse that she does not want health care professionals to attempt CPR. What is important for the nurse to verify in the medical record related to the patient's directive? A. The physician has written and signed the DNR order. B. The living will is signed by the patient and two witnesses. C. The patient's durable power of attorney agrees with the decision. D. There is an advance directive related to artificial nutrition and hydration.

A CPR will be performed for respiratory or cardiac arrest unless a DNR (do not resuscitate) order is written and signed by the physician in the patient's medical record. The DNR order documents the patient's desire to avoid CPR.

A patient with terminal cancer tells the nurse, "I know I am going to die pretty soon, perhaps in the next month." What is the most appropriate response by the nurse? A. "What are your feelings about being so sick and thinking you may die soon?" B. "None of us know when we are going to die. Is this a particularly difficult day?" C. "Would you like for me to call your spiritual advisor so you can talk about your feelings?" D. "Perhaps you are depressed about your illness. I will speak to the doctor about getting some medications for you."

A The most appropriate response to psychosocial questions is to acknowledge the patient's feelings and explore his or her concerns. This option does both and is a helpful response that encourages further communication between the patient and nurse.

The nurse in a community health clinic noticed an increase in the number of positive TB skin tests from students in a local high school during the most recent academic year. After comparing these numbers to previous years, 10% increase in positive tests were found. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community health nurse was acting in which nursing role(s)? (Select all that apply) A. Epidemiologist B. Counselor C. Collaborator D. Case manager E. Caregiver

A & C - Epidemiologist & Collaborator Initially when the nurse noticed an increase in the number of positive TB skin tests, she was comparing current data with previous data to track positive skin test rates. Once the increase was noted, she collaborated with the school nurse and other members of the health department to determine the impact of the increased TB skin testing.

Evidence-based Practice 1. Nursing care based on tradition 2. Scholarly inquiry of nursing and biomedical research literature 3. A problem solving approach that integrates best current evidence with clinical practice 4. Quality nursing care provides in an efficient and economically sound manner

A problem solving approach that integrates best current evidence with clinical practice

A nurse needs to teach a young woman newly diagnosed with asthma how to manage her disease. Which of the following topics does the nurse teach first? A) How to use an inhaler during an asthma attack B) The need to avoid people who smoke to prevent asthma attacks C) Where to purchase a medical alert bracelet that says she has asthma D) The importance of maintaining a healthy diet and exercising regularly

A) How to use an inhaler during an asthma attack It is important to start with essential life-saving information when teaching people because they usually remember what you tell them first.

The nurse is teaching a parenting class to a group of pregnant adolescents. The nurse pretends to be the baby's father, and the adolescent mother is asked to show how she would respond to the father if he gave her a can of beer. Which teaching approach did the nurse use? A) Role play B) Discovery C) An analogy D) A demonstration

A) Role play In role play people are asked to play themselves or someone else in a situation to enhance their confidence in handling that situation in the future

A patient with chest pain is having an emergency cardiac catheterization. Which teaching approach does the nurse use in this situation? A) Telling approach B) Selling approach C) Entrusting approach D) Participating approach

A) Telling approach The telling approach is most appropriate when preparing a patient for an emergency procedure.

A nursing student in the last semester of the baccalaureate nursing program is beginning the community health practicum and will be working in a community based clinic with a focus on asthma and allergies. What is the focus of the community health nurse in this clinic setting? (Select all that apply) A. Decrease the incidence of asthma attacks in the community. B. Increase patients' ability to self-manage their asthma. C. Treat acute asthma attack in the home care setting. D. Provide asthma education programs for the teacher in the local schools. E. Provide scheduled immunizations to people who come to the clinic.

A, B & D - Decrease the incidence of asthma attacks in the community, increase patients' ability to self-manage their asthma & provide asthma education programs for the teachers in local schools. Community-based nursing care takes place in community settings such as the home or a clinic, where the focus is on the needs of the individual or family (e.g., immunization). It involves the safety needs and acute and chronic care of individuals and families, and enhances their capacity for self-care.

The public health nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2020. In the immigrant community, most of the population does not have a primary care provider, nor do they participate in health promotion activities; the unemployment rate in the community is 25%. How does the nurse determine which goals need to be included or updated? (Select all that apply) A. Assess the health care resources within the community. B. Assess the existing health care programs offered by the county health department. C. Compare existing resources and programs with Healthy People 2020 goals. D. Initiate new programs to meet Healthy People 2020 goals. E. Implement educational sessions in the schools to focus on nutritional needs of the children.

A, B, & C - Assess the health care resources within the community, Assess the existing health care programs offered by the county health department, and Compare existing resources and programs with Healthy People 2020 goals.

The nurse caring for a Bosnian community identifies that the children are under vaccinated and the community is unaware of resources. The nurse assess the community and determines that there is a health clinic within a 5-mile radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources. Which of the following practices is the nurse providing? (Select all that apply) A. Providing community resources for the children. B. Teaching the community about health promotion and illness prevention. C. Promoting autonomy in decision-making about health practices. D. Improving the health care of the community's children. E. Participating in professional development activities to maintain nursing competency.

A, B, & D - Provide community resources for the children, Teach the community about health promotion and illness prevention, & Improve the health care of the community's children.

On the basis of an assessment, the nurse identifies an increase in the immigrant population group in the community. How would the nurse determine some of the health needs of this population? (Select all that apply) A. Identify what the immigrant population views as the two most important health needs. B. Apply information from Healthy People 2020 C. Determine how the population uses available health care resources. D. Determine which health care agencies will accept immigrant populations. E. Identify perceived barriers for health care

A, B, C, & E - Identify what the immigrant population views as the two most important health needs, Apply information from Healthy People 2020, and Determine how the population uses available health care resources.

Which of the following are major public health problems commonly affecting older adults? (Select all that apply) A. Substance abuse B. Confusional states C. Financial limitations D. Communicable diseases E. Acute and chronic physical illnesses

A, B, C, & E - Substance abuse, Confusional states, Financial limitations, and Acute and chronic physical illnesses.

A critical researcher is concerned with which of the following? Select all that apply. A) A critique of society and envisioning new possibilities B) An aim to make people aware of contradictions and disparities in beliefs and social practices C) Understanding how individuals construct and narrate stories to make sense of their world D) Fostering enlightened self-knowledge

A, B, D

Which of the following is an issue that a qualitative researcher attends to in planning a study? Select all that apply. A) Selecting a site B) Identifying needed equipment for field work C) Selecting research instruments D) Determining the maximum amount of time available for field work

A, B, D

Which of the following statements are true? Select all that apply. A) Reflexive journals can be used in the bracketing process. B) Hermeneutics focuses on interpreting the meaning of experiences. C) Descriptive phenomenology aims at understanding tacit knowledge. D) Interpretive phenomenologists often supplement in-depth interviews with an analysis of texts (e.g., novels, poetry).

A, B, D

The nursing staff is developing a quality program. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators (NDNQI) that the nurses can use to measure patient safety and quality for the unit? (Select all that apply.) A. Use of physical restraints B. Pain assessment, intervention, and reassessment C. Patient satisfaction with food preparation D. Registered nurse (RN) education and certification E. Number of outpatient surgical cases per year

A, B, D Physical restraint use, pain management, and RN education and certification are among the reportable nursing sensitive indicators for NDNQI. The other options are not nursing-sensitive indicators.

Using Healthy People 2020 as a guide, which of the following would improve delivery of care to a community? (Select all that apply) A. Community assessment B. Implementation of public health policies C. Home safety assessment D. Increased access to care E. Determining rates of specific illnesses

A, B, D & E - Community Assessment, Implementation of Public Health Policies, Increased Access to Care & Determining Rates of Specific Illnesses. Assessment includes systematic data collection on the population, monitoring of the population's health status, and accessing available information about the health of the community. Although option C, home assessment, might be valuable to an individual patient, it may not benefit the community as a whole.

Which of the following are examples of the nurse participating in primary care activities? (Select all that apply.) A. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester B. Assessing the nutritional status of older adults who come to the community center for lunch. C. Working with patients in a cardiac rehabilitation program D. Providing home wound care to a patient E. Teaching a class to parents at the local grade school about the importance of immunizations.

A, B, E Primary care activities are focused on health promotion. Health promotion programs contribute to quality health care by helping patients acquire healthier lifestyles. Health promotion activities help keep people healthy through exercise, good nutrition, rest, and adopting positive health attitudes and practices.

Which of the following is a step in descriptive phenomenology? Select all that apply. A) Bracketing B) Inferring C) Analyzing D) Describing

A, C, D

Which of the following is a type of research with an ideological perspective? Select all that apply. A) Critical ethnography B) Symbolic interaction C) Participatory action research D) Feminist research

A, C, D

Which aspects of anticipatory grief are associated with positive outcomes for the caregiver of a palliative patient (select all that apply)? A. Strong spiritual beliefs B. Medical diagnosis of the patient C. Advanced age of the patient D. Acceptance of the expected death of the patient E. Adequate time for the caregiver to prepare for the death

A, D, C Acceptance of an impending loss, spiritual beliefs, and adequate preparation time are all associated with positive outcomes regarding anticipatory grief. The age and diagnosis of the patient are not key factors in influencing the quality of the anticipatory grief of the caregiver. Awarded 1.0 points out of 3.0 possible points.

Which of the following are characteristics of managed care systems? (Select all that apply.) A. Provider receives a predetermined payment for each patient in the program. B. Payment is based on a set fee for each service provided. C. System includes a voluntary prescription drug program for an additional cost. D. System tries to reduce costs while keeping patients healthy. E. Focus of care is on prevention and early intervention.

A, D, E Managed care programs have administrative control over primary health care services for a defined patient population. The provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. In this case the managed care organization assumes financial risk in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care. If people stay healthy, the cost of medical care declines. Systems of managed care focus on containing or reducing costs, increasing patient satisfaction, and improving the health or functional status of the individual.

The nurse in a new community based clinic is requested to complete a community assessment. What is the order for completing this assessment? 1. Structure or locale, 2. Social systems, and 3. Population A. 1, 3, 2 B. 2, 1, 3 C. 3, 2, 1 D. 3, 1, 2

A. 1, 3 ,2 To begin a community assessment, first, structure and geographic boundaries of the community are identified. Look at the structures in the community (e.g., schools, churches, types of residences). Second, obtain data about the population and the demographics of the community. Who are the residents of the community, what is the age range, which types of ethnicity are represented? Third, review the social systems in the community.

To provide patient care of the highest quality, nurses utilize an evidence-based practice approach because evidence-based practice is: A. A guide for nurses in making clinical decisions. B. Based on the latest textbook information. C. Easily attained at the bedside. D. Always right for all situations.

A. A guide for nurses in making clinical decisions. Evidence-based practice (EBP) is a guide for nurses to structure how to make accurate, timely, and appropriate clinical decisions. A textbook relies on the scientific literature, which is often outdated by the time the book is published and is not the most reliable source for EBP. Unfortunately, most of the best information in evidence never reaches the bedside. EBP is not to be blindly applied without using good judgment and critical thinking skills. It is not appropriate for all settings.

The hospital's quality improvement committee has identified a problem on one of the units. In using the PDSA method to help determine ways to deal with the issue, the committee decides to do a literature review. This is an example of quality improvement: A. Combined with evidence-based practice. B. With inability to make the right decision. C. With delay in the action needed. D. With no designated method for dealing with issues

A. Combined with evidence-based practice. Quality improvement combined with evidence-based practice is the foundation for excellent patient care and outcomes. Once a committee defines a problem, it applies a formal model for exploring and resolving quality concerns. One part of the PDSA cycle is the "Do" section, which requires the selection of an intervention on the basis of data reviewed. Therefore the committee is taking the right action and is not unduly delaying action; data must be obtained that are needed to make the right decision as part of the PDSA method, which is in place.

The nurse is preparing to conduct research that will allow precise measurement of a phenomenon. Which of the following methods will provide the nurse with the right kind of data? (Select all that apply.) A. Experimental research B. Surveys C. Evaluation research D. Phenomenology e. Grounded theory

A. Experimental research B. Surveys C. Evaluation research Experimental research, surveys, and evaluation research are all forms of quantitative research. Phenomenology and grounded theory are forms of qualitative research.

A nurse researcher decides to complete a study to evaluate how Florence Nightingale improved patient outcomes in the Crimean War. This is an example of what type of research? A. Historical. B. Evaluation. C. Exploratory D. Experimental

A. Historical. Historical studies establish facts concerning past events.

A nurse needs to teach a young woman newly diagnosed with asthma how to manage her disease. Which of the following topics does the nurse teach first? A. How to use an inhaler during an asthma attack B. The need to avoid people who smoke to prevent asthma attacks C. Where to purchase a medical alert bracelet that says she has asthma D. The importance of maintaining a healthy diet and exercising regularly

A. How to use an inhaler during an asthma attack Rationale It is important to start with essential life-saving information when teaching people because they usually remember what you tell them first.

In reviewing literature for an evidence-based practice study, the nurse realizes that the most reliable level of evidence is the: A. Systematic review and meta-analysis. B. Randomized control trial (RCT). C. Case control study. D. Control trial without randomization.

A. Systematic review and meta-analysis. In a systematic review or meta-analysis, an independent researcher reviews all of the RCTs conducted on the same clinical question and reports whether the evidence is conclusive, or if further study is needed. A single RCT is not as conclusive as a review of several RCTs on the same question. Control trials without randomization may involve bias in how the study is conducted. Case control studies also have room for bias.

A patient with chest pain is having an emergency cardiac catheterization. Which teaching approach does the nurse use in this situation? A. Telling approach B. Selling approach C. Entrusting approach D. Participating approach

A. Telling approach Rationale The telling approach is most appropriate when preparing a patient for an emergency procedure.

In collecting the best evidence, the gold standard for research is: A. The randomized controlled trial (RCT). B. The peer-reviewed article. C. Qualitative research. D. The opinion of expert committees

A. The randomized controlled trial (RCT). Individual RCTs are the gold standard for research. A peer-reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT. Expert opinion is on the bottom of the hierarchical pyramid of evidence.

A 34-year-old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. Your best response would be which of the following? A."Are you thinking of suicide?" B."You've been doing a good job raising your children. You can do it!" C."Is there someone who can help you?" D."You have so much to live for."

A."Are you thinking of suicide?"

When teaching a patient about the negative feedback response to stress, the nurse includes which of the following to describe the benefits of this stress response? A.Results in neurophysiological response. B.Reduces body temperature C.Causes a person to be hypervigilant D.Reduces level of consciousness to conserve energy.

A.Results in neurophysiological response.

The nurse in the twenty-first century is facing an extremely complex profession with multiple external forces affecting the nursing profession. Factors influencing the nursing profession include which of the following? (Select all that apply.) a. Demography b. Women's health care c. Human rights d. The threat of bioterrorism e. The medically underserved

ANS: A, B, C, D, E Multiple external forces affect nursing. These include demographic changes in the population, human rights, increasing numbers of medically underserved, and the threat of bioterrorism. The women's movement brought greater sensitivity to the health care needs of women and the role of women in health care research.

The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses. The orthopedic unit has agreed to "float" two of its nurses to the oncology unit if oncology can "float" a nursing assistant to the orthopedic unit to help with obtaining vital signs. This is an example of (Select all that apply.) a. Autonomy. b. Accountability. c. Political activism. d. Politics.

ANS: A, B, D Staffing is an independent nursing intervention and is an example of autonomy. Along with increased autonomy comes accountability or responsibility for outcomes of an action. Nurses are involved in politics when seeking additional resources. However, political activism usually involves more than day-to-day activities such as unit staffing

After licensure, the practicing nurse is required to update his or her knowledge about the latest research and practice developments. The most common way nurses do this is through _____ programs. (Select all that apply.) a. Continuing education b. Master's degree c. In-service education d. DNP

ANS: A, C Continuing education updates the nurse's knowledge about the latest research and practice developments. In-service education programs are provided by a health care agency to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can provide the nurse with continuing education credit. Master's degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. The DNP is a practice doctorate that prepares advanced practice nurses.

The physician is planning to take the patient to surgery in the morning and leaves an order for the nurse to get the patient to sign the surgical permit. The physician's note indicates that the patient has been educated on the procedure. However, the patient tells the nurse, "I have no idea what he's going to do. He rushed in and rushed out so fast, I couldn't ask any questions." The nurse does not allow the patient to sign the permit and calls the physician to inform him of the patient's statement. This is an example of the nurse acting as a. Patient advocate. b. Patient educator. c. Manager. d. Clinical nurse specialist.

As a patient advocate, the nurse protects the patient's human and legal rights, including the right of the patient to understand procedures before signing permits. Although nurses can be educators, it is the responsibility of the surgeon to provide education for the patient in preparation for surgery, and it is the nurse's responsibility to notify the physician if the patient is not properly educated. Managers coordinate the activities of members of the nursing staff in delivering nursing care, and clinical nurse specialists are experts in a specialized area of nursing practice in a variety of settings.

An 18 year old woman is in the emergency department with fever and cough. The nurse obtains her vital signs, auscultates (listening) her lung sounds, listens to her 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

Assessment because key word is obtains vital signs and collecting blood for analysis

The nurse is caring for the patient who has had major abdominal surgery and also has a large sacral pressure sore. The nurse implements coughing and deep breathing exercises and consults the wound care specialist to evaluate and prescribe care for the pressure sore, even though no physician order has provided instructions to do so. In doing this, the nurse is implementing the element of a. Autonomy. b. Accountability. c. Advanced practice. d. Nurse practitioner.

Autonomy is an essential element of professional nursing. Some independent nursing interventions such as implementing coughing and deep breathing exercises and collaboration with other health professionals can be initiated without medical orders. Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. "Advanced practice nurse" is an umbrella term for advanced clinical nurses such as nurse practitioners who provide care to a group of patients.

A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress the nurse says: A. "Tell me who I can call to help you." B. "Tell me what bothers you the most about this experience." C. "I'll contact someone who can help get you temporary housing." D. "I'll sit with you until other family members can come help you get settled."

B

A crisis intervention nurse working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her entitlement check while the child is hospitalized can expect the mother to regain stability after how long? A. After 2 weeks when the child's pneumonia begins to improve B. After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks C. After 1 month when the child goes home and the mother gets help from a food pantry D. After 6 months when the child is back in school

B

Allows a person to cope with stress indirectly: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

B

Chronic arousal that causes excessive wear and tear on the person: A. Stress B. Allostatic load C. Appraisal D. Stressors

B

During the assessment interview of an older woman experiencing a developmental crisis, the nurse asks which of the following questions? A. How is this flood affecting your life? B. Since your husband has died, what have you been doing in the evening when you feel lonely? C. How is having diabetes affecting your life? D. I know this must be hard for you. Let me tell you what might help.

B

Ethnographers seek to learn from members of a cultural group to understand their world view. Ethnographic researchers refer to which of the following two perspectives? A) Ying and yang B) Emic and etic C) Data saturation and generalization D) Significant and nonsignificant

B

Ethnographers use a very specific strategy for making observations of the culture under study while being involved in activities. This is referred to as which of the following? A) Surveys B) Participant observation C) Hermeneutics D) Bracketing

B

Hermeneutics is closely allied with which research tradition? A) Ethnography B) Phenomenology C) Grounded theory D) Symbolic Interaction

B

Occurs in stable conditions and from stressful roles: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

B

Occurs when the body is no longer able to resist the effects of the stressor: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

B

The qualitative method that uses an inductive approach using a systematic set of procedures to create a theory about social processes is known which of the following? A) Phenomenology B) Grounded Theory C) Ethnography D) Historical Method

B

When doing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. The nurse recognizes this as: A. Conversion. B. Post Traumatic Stress Disorder (PTSD). C. Dissociation. D. Displacement.

B

Which of the following design features can apply to both a qualitative and quantitative study? A) Manipulation of the independent variable B) Cross-sectional versus longitudinal data collection C) Control over confounding variables D) Random assignment of study participants

B

A nurse is presenting information to a management class of nursing students on the topic of financial reimbursement for achievement of established, measurable patient outcomes. The nurse is presenting information to the class on which topic? A. Prospective payment system B. Pay for performance C. Capitation payment system D. Managed care systems

B Pay for performance programs and public reporting of hospital quality data are designed to promote quality, effective, and safe patient care by physicians and health care organizations. These programs are quality improvement strategies that reward excellence through financial incentives to motivate change to achieve measurable improvements.

A community center is presenting a nurse-led program on the Patient Protection and Affordable Care Act. Which statement made by a participant indicates a need for further teaching? A. "My small company will now have to offer the 75 employees health insurance or pay a penalty." B. "As long as my son is a full-time student in College, I will be able to keep him on my health insurance until he is 26 years old." C. "I signed up for the state health insurance exchange before the designated deadline to make sure I had health insurance." D. "Since I have now been diagnosed with diabetes, my health insurance plan cannot charge me higher premiums."

B This is an incorrect statement because, with the Patient Protection and Affordable Care Act, dependents can remain on health plans until the age of 26, regardless of their status in school. They are not required to be full-time students to be eligible for the benefit. All other options are correct.

A 39-year-old woman near death from metastatic cancer becomes restless and confused. What interventions would be the most appropriate for the nursing management of these symptoms? A. Avoid administering pain medication until the patient is calm and alert. B. Stay physically close to the patient and use a soothing voice and soft touch. C. Turn on the television to provide a distraction, and contact the hospital chaplain. D. Restrain the patient to prevent injury, and ask family and visitors to leave the room.

B Appropriate interventions for restlessness and confusion when a patient is near death include the following: use soft touch and voice, stay physically close to the patient, and remain calm. Use soothing music instead of the radio or television. Make referrals (e.g., hospital chaplain, spiritual leader) based on patient's spiritual and cultural preferences. Family visitors may provide comfort. Uncontrolled pain may be the cause of restlessness and confusion. Withholding pain medication or restraining the patient would be inappropriate and may cause more restlessness.

The nurse is providing anticipatory guidance to the family of a patient who is expected to die within the next 12 to 24 hours. What physical manifestations of approaching death will the nurse discuss with the family? A. The patient will be incontinent of urine after frequent seizures. B. The skin will feel cold and clammy, with mottling on the extremities. C. The patient will have increased pain, and the sense of touch will be enhanced. D. The gag reflex is exaggerated, and the patient will exhibit deep, rapid respirations.

B As death approaches, the following physical manifestations occur: cold, clammy skin; mottling on hands, feet, arms, and legs; jerking (not seizures) occurs in patients on large amounts of opioids; bowel and bladder incontinence; decreased perception of pain and touch; loss of gag reflex; and Cheyne-Stokes respirations.

The dying patient is experiencing confusion, restlessness, and skin breakdown. What nursing interventions will best meet this patient's needs? A. Encourage more physical activity. B. Assess for pain, constipation, and urinary retention. C. Assess for spiritual distress and restrain in varying positions. D. Assess for quality, intensity, location, and contributing factors of discomfort.

B Assessing for all reversible causes of delirium (i.e., pain, constipation, urinary retention, dyspnea, sensory hyperstimulation) so they can be reversed may help decrease confusion and restlessness. Encouraging more physical activity may prevent further skin breakdown, but it will be difficult as weakness and fatigue are expected at the end of life. Keeping the skin clean and dry and preventing shearing forces will better avoid further skin breakdown. Spiritual distress may be a cause of restlessness, but the patient should not be restrained.

The nurse is caring for a patient who has been admitted to the hospital while receiving home hospice care. The nurse interprets that the patient has a general prognosis of ___________. A. 3 months or less to live B. 6 months or less to live C. 12 months or less to live D. 18 months or less to live

B There are two criteria to be eligible for hospice care. The first is that the patient wishes to receive hospice, not curative care, and the second is that the physician certifies that the patient has a prognosis of 6 months or less to live.

When the nurse assesses the patient, what manifestation indicates to the nurse that the patient is very near death? A. The patient responds to noises. B. The patient's skin is mottled and waxlike. C. The heart rate and blood pressure increase. D. The patient is reviewing his life with his family.

B When a patient is very near death, the skin will be waxlike, cold, clammy, and mottled or cyanotic. Although hearing is the last sense patients lose before death, it is unlikely that they will be responding to noises when very near death. Initially the heart rate increases, but later slows and the blood pressure decreases. Near death, speaking may be slow and unusual and indicate confusion.

When a nurse is teaching a patient about how to administer an epinephrine injection in case of a severe allergic reaction, he or she tells the patient to hold the injection like a dart. Which of the following instructional methods did the nurse use? A) Telling B) Analogy C) Demonstration D) Simulation

B) Analogy Analogies use familiar images when teaching to help explain complex information.

A patient who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. Which teaching method does the nurse use? A) Simulation B) Demonstration C) Group instruction D) One-on-one discussion

B) Demonstration Demonstration is used to help patients learn psychomotor skills.

A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? A) Describing difficulties a family member has had in taking insulin B) Expressing the importance of learning the skill correctly C) Being able to see and understand the markings on the syringe D) Having the dexterity needed to prepare and inject the medication

B) Expressing the importance of learning the skill correctly Patients are ready to learn when they understand the importance of learning and are motivated to learn.

The nurse is planning to teach a patient about the importance of exercise. When is the best time for teaching to occur? (Select all that apply.) A) When there are visitors in the room B) When the patient's pain medications are working C) Just before lunch, when the patient is most awake and alert D) When the patient is talking about current stressors in his or her life

B) When the patient's pain medications are working C) Just before lunch, when the patient is most awake and alert Plan teaching when the patient is most attentive, receptive, alert, and comfortable.

The nurse is developing a PICO question related to whether her patient's blood pressure is more accurate while measuring with the patient's legs crossed versus with the patient's feet flat on the floor. With P being the population of interest, I the intervention of interest, C the comparison of interest, and O the outcome, the nurse determines that this is: A. A true PICO question, because the outcome always comes before the intervention. B. A true PICO question regardless of placement of elements. C. Not a true PICO question, because the comparison comes after the intervention. D. Not a true PICO question, because the outcome comes after the population

B. A true PICO question regardless of placement of elements. Note that a well-designed PICO question does not have to follow the sequence of P, I, C, and O. The aim is to ask a question that contains as many of the PICO elements as possible.

If a nurse decides to withhold a medication because it might further lower a patient's blood pressure, the nurse will be practicing the principle of A. Responsibility B. Accountability C. Competency D. Moral behavior

B. Accountability

When a nurse is teaching a patient about how to administer an epinephrine injection in case of a severe allergic reaction, he or she tells the patient to hold the injection like a dart. Which of the following instructional methods did the nurse use? A. Telling B. Analogy C. Demonstration D. Simulation

B. Analogy Rationale Analogies use familiar images when teaching to help explain complex information.

The hospital policy states that when starting an intravenous (IV) catheter, the nurse must first prepare the potential IV site with alcohol and dress it using a gauze dressing. The nurse has done a literature review and believes that evidence-based practice dictates the use of a transparent dressing to prevent catheter dislodgment. What should the nurse do? A. Begin to use transparent dressing instead of gauze dressings. B. Bring findings to the policy and procedure committee. C. Use transparent dressings on half of her IV starts and gauze on the other. D. Continue following hospital policy without saying anything

B. Bring findings to the policy and procedure committee. As a result of her finding, the nurse should meet with the policy and procedure committee to recommend routine use of transparent dressings. However, until the policy is changed, or the nurse receives approval to conduct a pilot study, the nurse is obligated to follow hospital procedure. If the nurse has information that can lead to better patient care, he or she has an obligation (moral and professional) to bring it to the attention of policy makers.

In conducting a research study, the researcher must guarantee that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. This concept is known as: A. Anonymity. B. Confidentiality. C. Informed consent. D. The research process.

B. Confidentiality. Confidentiality guarantees that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. Anonymity occurs when even the researcher cannot link the subject to the data. Informed consent means that research subjects (1) are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research; (3) have the power to voluntarily consent or decline participation; and (4) understand how confidentiality or anonymity is maintained. The research process is a broader concept that provides an orderly series of steps that allow the researcher to move from asking a question to finding the answer.

Following a community assessment that focused on adolescent health behaviors, the nurse determines that a large number of adolescents smoke and designs a smoking cessation as the youth community center. This is an example of which nursing role: A. Educator B. Counselor C. Collaborator D. Case manager

B. Counselor To engage a patient to participate in a smoking cessation program or any program that requires changing a behavior requires the nurse to act as a counselor to support the patient in changing that behavior (e.g., in this case a smoking habit). The nurse does not educate the patient about the dangers of smoking but first must actively counsel him or her to decide to change the behavior. Without support and counseling, the smoking cessation education may not be used effectively by the patient.

A patient who is hospitalized has just been diagnosed with diabetes. He is going to need to learn how to give himself injections. Which teaching method does the nurse use? A. Simulation B. Demonstration C. Group instruction D. One-on-one discussion

B. Demonstration Rationale Demonstration is used to help patients learn psychomotor skills.

A nurse researcher is developing a research proposal and is in the process of selecting an instrument to measure anxiety. In which part of the research process is this nurse? A. Analyzing the data B. Designing the study C. Conducting the study D. Identifying the problem

B. Designing the study During study design the researcher selects instruments to measure variables.

Your 88 year old pt with terminal lung cancer is visited frequently by his spouse, 46 year old daughter and her 23 year old son. In view of the client's extreme weakness and dyspnea, client care plans should include: A. Allowing self-activity whenever possible B. Encouraging family members to feed and assist the client. C. Limiting family visiting hours to the evening before the client sleeps. D. Planning all necessary care at one time with long rest periods in between.

B. Encouraging family members to feed and assist the client. because family members are old enough to understand the client's needs, they should be encouraged to particpate in the care. A would increase fatigue, C would deprives the client of a support system and D would over work the client causing undue fatigue; frequent rest periods are indicated

A patient needs to learn how to administer a subcutaneous injection. Which of the following reflects that the patient is ready to learn? A. Describing difficulties a family member has had in taking insulin B. Expressing the importance of learning the skill correctly C. Being able to see and understand the markings on the syringe D. Having the dexterity needed to prepare and inject the medication

B. Expressing the importance of learning the skill correctly Rationale Patients are ready to learn when they understand the importance of learning and are motivated to learn.

The nurse is doing a literature review related to a potential problem that has been identified on the nursing unit. The nurse realizes that nursing research is important in that it is designed to (Select all that apply.) A. Enhance the nurse's chance at promotion. B. Identify new knowledge. C. Improve professional practice. D. Enhance effective use of resources. E. Lead to decreases in budget expenditures

B. Identify new knowledge. C. Improve professional practice. D. Enhance effective use of resources. Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively. Effective use of resources does not always result in lower budget expenditures, but rather more effective use of resources. A promotion is not a direct result of research.

The nurse is writing a research article on a patient care topic. The nurse realizes that the section that will get the reader to read the article because of the value of the topic for the reader is the: A. Abstract. B. Introduction. C. Literature review or background. D. Results

B. Introduction. The introduction contains information about its purpose and the importance of the topic to the audience who reads the article. The abstract is a brief summary of the article. The literature review or background offers a detailed background of the level of science or clinical information that is available about the topic of the article. The results section is the summary section of the article.

A patient is worried about her 76 year old grandmother who is in a very good health and wants to live at home. The patients concerns are related to her grandmother's safety. The neighborhood does not have a lot of crime. Using this scenario, which of the following are the most relevant to assess for safety? A. Crime rate, locks, lighting, neighborhood traffic B. Lighting, locks, clutter, medications C. Crime rate, medications, support system, clutter D. Locks, lighting, neighborhood traffic, crime rate

B. Lighting, locks, clutter, medications

A group of staff educators are reading a research study together at a journal club meeting. While reviewing the study, one of the nurses states that it evaluates if newly graduated nurses progress through orientation more effectively when they participate in patient simulation exercises. Which part of the research process is reflected in this nurse's statement? A. Introduction B. Purpose statement C. Methods D. Results

B. Purpose statement The purpose statement includes research questions or hypotheses—predictions made about the relationship or difference between study variables (concepts, characteristics, or traits that vary within or among subjects).

A nurse researcher interviews parents of children who have diabetes and asks them to describe how they deal with their child's illness. The analysis of the interviews yields common themes and stories describing the parents' coping strategies. This is an example of which type of study? A. Historical B. Qualitative C. Correlational D. Experimental

B. Qualitative The data in this study were collected during interviews; information from the interviews was used to describe common themes and experiences of the parents. These are characteristics of qualitative research.

A group of nurses have implemented an evidence-based practice (EBP) change and have evaluated the effectiveness of the change. Their next step is to: A. Conduct a literature review. B. Share the findings with others. C. Conduct a statistical analysis D. Create a well-defined PICOT question.

B. Share the findings with others. After completing an EBP project and evaluating its effectiveness, it is important to communicate the results with others.

When evaluating quality improvement (QI) programs in relation to evidence-based practice (EBP), it is easy to note that: A. Both are designed to improve performance. B. When implementing EBP projects, it is important to review QI data. C. EBP is not at all related to QI. D. Evaluation of processes is the realm of performance improvement (PI), not QI.

B. When implementing EBP projects, it is important to review QI data. Evidence-based practice and quality improvement go hand in hand. When implementing an EBP project, it is important to review available QI data. Reliable QI data improve the relevance and scope of an EBP project. Performance improvement (PI) analyzes performance. QI analyzes processes.

The nurse is planning to teach a patient about the importance of exercise. When is the best time for teaching to occur? (Select all that apply.) A. When there are visitors in the room B. When the patient's pain medications are working C. Just before lunch, when the patient is most awake and alert D. When the patient is talking about current stressors in his or her life

B. When the patient's pain medications are working C. Just before lunch, when the patient is most awake and alert Rationale Plan teaching when the patient is most attentive, receptive, alert, and comfortable.

A crisis intervention nurse working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her entitlement check while the child is hospitalized can expect the mother to regain stability after how long? A.After 2 weeks when the child's pneumonia begins to improve B.After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks C.After 1 month when the child goes home and the mother gets help from a food pantry D.After 6 months when the child is back in school

B.After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks

The major difference between a baccalaureate degree nursing program and an associate's degree nursing program is that the baccalaureate program includes studies in a. Basic sciences and theoretical courses. b. Social sciences and humanities. c. Theoretical and clinical courses. d. Basic sciences and clinical courses.

Both associate's degree programs and baccalaureate programs focus on basic sciences and on theoretical and clinical courses. Baccalaureate programs, however, also focus on courses in the social sciences, arts, and humanities to support nursing theory.

A nurse observes that a patient whose home life is chaotic with intermittent homelessness, a child with spina bifida, and an abusive spouse appears to be experiencing an allostatic load. As a result, the nurse expects to detect which of the following while assessing the patient? A. Posttraumatic stress disorder B. Rising hormone levels C. Chronic illness D. Return of vital signs to normal

C

After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. The nurse's first response is which of the following? A. "Don't be sad. People live with cancer every day." B. "Have you thought about how you are going to tell your family?" C. "Would you like for me to sit down with you for a few minutes so you can talk about this?" D. "I know another patient whose colon cancer was cured by surgery."

C

Controls heart rate, blood pressure and respirations: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

C

Crisis intervention is a specific measure used for helping a patient resolve a particular, immediate stress problem. This approach is based on: A. An in-depth analysis of a patient's situation B. The ability of the nurse to solve the patient's problems C. Effective communication between the nurse and patient D. Teaching the patient how to use ego-defense mechanisms.

C

Emergent design is used in qualitative research and is described as a research design that does which of the following? A) Is specified before data is collected B) Tends to be reductionistic C) Evolves during the study D) Involves a short period of time to collect data

C

Grounded theory tries to account for people's actions from the perspective of those involved. It seeks to discover this main concern or problem and the behavior that is designed to resolve it. The manner in which people resolve this main concern is known as which of the following? A) Participatory action research B) Constant comparison C) The core variable D) A single entity

C

How people interpret the impact of the stressor on themselves: A. Stress B. Allostatic load C. Appraisal D. Stressors

C

Monitors the physiological status of the body through connections with sensory and motor tracts: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

C

Recurrent or intrusive recollections of the event: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

C

Symptoms of stress persist beyond the duration of a stressor: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

C

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments includes which of the following? A. The amount of family support B. A 3-day diet recall C. A thorough physical assessment D. Threats to safety in her home

C

Which of the following is most likely to be at "center stage" in a case study? A) A phenomenon such as attempted suicide B) The culture within an organization such as a diabetic clinic C) A person, such as a person who repeatedly self-harms D) A story, such as the life story about chronic health problems of political refugees

C

A patient tells a nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO? A. This health plan is for people who cannot afford their own health insurance B. This health plan is operated by the government to provide health care to older adults C. This health plan gives you with a list of physicians and hospitals from which you can choose D. This is a fee-for-service plan in which you can choose any physician or hospital

C PPO plans limit the enrollee's choice to a list of preferred providers such as hospitals and physicians. A participant pays more to use a provider not on the preferred list. PPO plans focus on health maintenance.

A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient correctly. A change is needed quickly. What type of quality improvement method would be most appropriate? A. PDSA B. Six Sigma C. Rapid-improvement event D. A randomized controlled trial

C RIEs are very intense, usually week-long events, in which a group gets together to evaluate a problem with the intent of making radical changes to current processes. Changes are made within a very short time. The effects of the changes are measured quickly, results are evaluated, and further changes are made when necessary. An RIE is appropriate to use when a serious problem such as the increased occurrence of medication errors exists that greatly affects patient safety and needs to be solved quickly.

When going to the hospital, which forms should patients be taught to bring with them in case end-of-life care becomes an ethical or legal issue? A. Euthanasia B. Organ donor card C. Advance directives D. Do not resuscitate (DNR)

C Advance directives are written documents that provide information about the patient's wishes for medical care and treatments and his or her designated spokesperson. Euthanasia is not a form; it is a deliberate act of hastening death. Organ donor cards only state that the patient wants to donate organs or their body for transplants or for scientific research. Do not resuscitate (DNR) or comfort measures only is a written order from the physician that documents a patient's wishes to avoid CPR.

A man died at the age of 71 following a myocardial infarction that he experienced while performing yard work. What would indicate that his wife is experiencing prolonged grief disorder? A. Initially she denied that he died. B. Talking about her husband extensively in year following his death C. Stating that she expects him home soon on the anniversary of his death D. Crying uncontrollably and unpredictably in the weeks following her husband's death

C Denial of an individual's death that persists beyond 6 months is indicative of prolonged grief disorder. Strong emotions or denial immediately following the death are considered to be expected responses, and talking about the deceased loved one is not considered to be evidence of the disorder.

How should the nurse provide appropriate cultural and spiritual care for the patient and family to best be able to help them when nearing the end of the patient's life? A. Assess the individual patient's wishes. B. Call a pastor or priest for the family to help them cope. C. Assess the beliefs and preferences of the patient and family. D. Do not insult African Americans by suggesting hospice care.

C Differences among spiritual and culture beliefs and values related to death and dying are innumerable. The individual patient and family must be assessed to avoid stereotyping individuals with different spiritual and cultural belief systems.

During admission of a patient diagnosed with metastatic lung cancer, what should the nurse assess for as a key indicator of clinical depression related to terminal illness? A. Frustration with pain B. Anorexia and nausea C. Feelings of hopelessness D. Inability to carry out activities of daily living

C Feelings of hopelessness are likely to be present in a patient with a terminal illness who has clinical depression. This can be attributed to lack of control over the disease process or outcome. The nurse should routinely assess for depression when working with patients with a terminal illness.

After an 18-year-old patient died of severe injuries from a motor vehicle crash, the nurse who provided care is feeling helpless and powerless. What intervention would be most appropriate to help this nurse deal with these emotions and the death of this patient? A. Maintain daily contact with the adolescent's family for the next 2 to 3 months. B. Request a prescription for an anxiolytic to aid in dealing with the death of this patient. C. Attend a debriefing session with health team members to allow expression of feelings. D. Avoid caring for any other patients who are terminally ill until the feelings of grief subside.

C he nurse needs to express feelings of loss and grief. Interventions such as a peer support, professionally assisted groups, or informal discussion sessions are appropriate ways for the nurse to express feelings related to death and dying.

The school nurse is about to teach a freshman-level high school health class about nutrition. What is the best instructional approach to ensure that the students meet the learning outcomes? A) Provide information using a lecture B) Use simple words to promote understanding C) Develop topics for discussion that require problem solving D) Complete an extensive literature search focusing on eating disorders

C) Develop topics for discussion that require problem solving Adolescents learn best when they are able to use problem solving to help them make choices.

A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient? A) Teach the patient's spouse B) Focus on knowledge the patient will need in a few weeks C) Provide only the information that the patient needs to go home D) Convince the patient that learning about her health is necessary

C) Provide only the information that the patient needs to go home This patient is in denial; thus it is appropriate to only give her information that is needed immediately.

Which of the following nursing activities is provided in a secondary health care environment? (Select all that apply.) A. Conducting blood pressure screenings for older adults at the Senior Center. B. Teaching a clinic patient with chronic obstructive pulmonary disease purse-lipped breathing techniques. C. Changing the postoperative dressing for a patient on a medical-surgical unit. D. Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit.

C, D In secondary care the diagnosis and treatment of illnesses are traditionally the most common services. Secondary services are usually provided in an acute care facility. Critical care units and inpatient medical-surgical units provide secondary and tertiary care.

A nursing student is giving a presentation to a group of other nursing students about the needs of patients with mental illnesses in the community. The nursing professor needs to clarify the student's presentation when the student states: A. "Many patients with mental illness do not have a permanent home." B. "Unemployment is a common problem experienced by people with a mental illness." C. "The majority of patients with mental illnesses live in long-term care settings." D. Patients with mental illnesses are often at a higher risk for abuse and assault."

C. "The majority of patients with mental illnesses live in long-term care settings."

In caring for patients, it is important for the nurse to realize that evidence-based practice is: A. The only valid source of knowledge that should be used. B. Secondary to traditional or standard care knowledge. C. Dependent on patient values and expectations. D. Not shown to provide better patient outcomes

C. Dependent on patient values and expectations. Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience, or the standard, "It has always been done this way." Although these sources have value, it is important to learn to rely more on research evidence than on non-research evidence. Patients who receive care based on the most recent and best evidence experience 28% better outcomes.

The first step in evidence-based practice is to ask a clinical question. In doing so, the nurse needs to realize that in researching interventions, the question: A. Is more important than its format. B. Will lead you to hundreds of articles that must be read. C. May be easier if in PICO format. D. May be more useful the more general it is

C. May be easier if in PICO format. The PICO format allows the nurse to ask questions that are intervention focused. Inappropriately formed questions will likely lead to irrelevant sources of information. It is not beneficial to read hundreds of articles. It is more beneficial to read the best four to six articles that specifically address the question. The more focused the question asked, the easier it will become to search for evidence in the scientific literature.

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? A. Incidence of asthma among children of parents who smoke. B. Frequency of low blood sugar episodes in children at a local school. C. Number of patients who fall and experience subsequent injury on the evening shift. D. Number of sexually active adolescent girls who attend the community-based clinic for birth control.

C. Number of patients who fall and experience subsequent injury on the evening shift. Nursing-sensitive outcomes are outcomes that are sensitive to nursing care.

A nurse who works in a newborn nursery asks, "I wonder if the moms who breastfeed their babies would be able to breastfeed more successfully if we played peaceful music while they were breastfeeding." In this example of a PICOT question, the I is: A. Breastfeeding moms. B. Infants. C. Peaceful music. D. The nursery.

C. Peaceful music. The Intervention in this PICOT question is playing peaceful music.

A patient newly diagnosed with cervical cancer is going home. The patient is avoiding discussion of her illness and postoperative orders. What is the nurse's best plan in teaching this patient? A. Teach the patient's spouse B. Focus on knowledge the patient will need in a few weeks C. Provide only the information that the patient needs to go home D. Convince the patient that learning about her health is necessary

C. Provide only the information that the patient needs to go home Rationale This patient is in denial; thus it is appropriate to only give her information that is needed immediately.

The nurse is trying to identify common general themes relative to the effectiveness of cardiac rehabilitation for patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. What type of research is the nurse conducting? A. Evaluation research B. Experimental research C. Qualitative research D. Nonexperimental research

C. Qualitative research Qualitative research involves using inductive reasoning to develop generalizations or theories from specific observations or interviews. Evaluation and experimental research are forms of quantitative research. Nonexperimental descriptive studies describe, explain, or predict phenomena such as factors that lead to an adolescent's decision to smoke cigarettes.

A client with a terminal illness reaches the stage of "acceptance". The client has been hostile towards staff and difficult to work with during his hospitalization. The nurse can best help the client during this stage by: A. Verbal defense of the staff's actions. B. Reasonable exploration of the situation. C. Silent acceptance of the client's behavior. D. Complete physical withdrawal from the client

C. Silent acceptance of the client's behavior.( At this time client is using the behaviors as a defensive, Quiet acceptance can be effective)

A nurse is going to teach a patient how to perform breast self-examination. Which behavioral objective does the nurse set to best measure the patient's ability to perform the examination? A. The patient will verbalize the steps involved in breast self-examination within 1 week. B. The nurse will explain the importance of performing breast self-examination once a month. C. The patient will perform breast self-examination correctly on herself before the end of the teaching session. D. The nurse will demonstrate breast self-examination on a breast model provided by the American Cancer Society.

C. The patient will perform breast self-examination correctly on herself before the end of the teaching session Rationale Return demonstration provides an excellent source of feedback and reinforcement to evaluate learning.

A research study is investigating the following research question: What is the effect of the diagnosis of breast cancer on the roles of the family? In this study "the diagnosis of breast cancer" and "family roles" are examples of: A. Surveys B. The sample C. Variables D. Data collection points

C. Variables Variables are concepts, characteristics, or traits that vary within or among subjects.

After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. The nurse's first response is which of the following? A."Don't be sad. People live with cancer every day." B."Have you thought about how you are going to tell your family?" C."Would you like for me to sit down with you for a few minutes so you can talk about this?" D. "I know another patient whose colon cancer was cured by surgery."

C."Would you like for me to sit down with you for a few minutes so you can talk about this?"

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments includes which of the following? A.The amount of family support B.A 3-day diet recall C.A thorough physical assessment D.Threats to safety in her home

C.A thorough physical assessment

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of: A.A situational crisis. B.A maturational crisis. C.An adventitious crisis. D.A developmental crisis.

C.An adventitious crisis

A nurse observes that a patient whose home life is chaotic with intermittent homelessness, a child with spina bifida, and an abusive spouse appears to be experiencing an allostatic load. As a result, the nurse expects to detect which of the following while assessing the patient? A.Posttraumatic stress disorder B.Rising hormone levels C.Chronic illness D.Return of vital signs to normal

C.Chronic illness

Who is the founder of the American Red Cross? 1. Isabel Hampton Robb 2. Florence Nightingale 3. Mary Mahoney 4. Clara Barton

Clara Barton Not Isabel because she founded Nurse Association Alumnae later ANA Not Florence because she was the first practice nurse epidemiologist Not Mary because she was the first professional African American nurse

While caring for his dying wife, the husband states that his wife is a devout Roman Catholic but he is a Baptist. Who is considered the most reliable source for spiritual preferences concerning EOL care for the dying if? a. a priest b. dying wife c. hospice staff d. husband of dying wife

Correct answer: b Rationale: Assessment of spiritual needs for palliative care is a key consideration, and individual choices should be respected. The preferences of the patient and family with regard to spiritual guidance or pastoral care services should be assessed and appropriate referrals made. The patient is the most reliable source for the spiritual assessment.

A 67 year old woman was recently diagnosed with inoperable pancreatic cancer. Before the diagnosis she was very active in her neighborhood association. Her husband is concerned because his wife is staying at home and missing her usual community activities. Which common EOL psychologic manifestation is she most likely demonstrating? a. peacefulness b. decreased socialization c. decreased decision making d. anxiety about unfinished business

Correct answer: b Rationale: Decreased socialization is a common psychosocial manifestation of approaching death.

The home health nurse visits a 40 year old patient with metastatic breast cancer who is receiving palliative care. The patient is experiencing pain at a level of 7 (on a 10point scale). In prioritizing activities for the visit, the nurse would do which first? a. auscultate for breath sounds b. administer PRN pain medication c. check pressure points for skin breakdown d. ask family about patients's food and fluid intake

Correct answer: b Rationale: Meeting the patient's physiologic and safety needs is the priority. Physical care focuses on the needs for oxygen, nutrition, pain relief, mobility, elimination, and skin care. The patient is not experiencing oxygenation problems; the priority is to treat the severe pain with pain medication.

A nurse has been working full time with terminally ill patients for 3 years. He has been experiencing irritability and mixed emotions when expressing sadness since four of his patients died on the same day. To optimize the quality of his nursing care, he should examine his own. a. full-time work schedule b. past feelings toward death c. patterns for dealing with grief d. demands for involvement in patient care.

Correct answer: c Rationale: Caring for a dying patient is intense and emotionally charged, and nurses must be aware of how grief affects them. The nurse may have feelings of loss, helplessness, and powerlessness when dealing with death. Feelings of sorrow, guilt, and frustration need to be expressed. Recognizing personal feelings allows openness in exchanging feelings with the patient and family.

The family attorney informed a patient's adult children and wife that the patient did not have an advance directive after he suffered a serious stroke. Who is responsible for making the decision about EOL measures when the patient cannot communicate his or her specific wishes? a. notary and attorney b. physician and family c. wife and adult children d. physician and nursing staff

Correct answer: c Rationale: In the event that the patient is not capable of communicating his or her wishes, the surrogate decision maker, who is usually the next of kin (spouse or other family member), determines what measures will or will not be taken. The surrogate decision maker is responsible for making the final decision. The physician and nurse should discuss with surrogate decision makers what the options are.

The primary purpose of hospice is to a. allow patients to die at home b. provide better quality of care than the family can c. coordinate care for dying patients and their families d. provide comfort and support for dying patients and their family

Correct answer: d Rationale: Hospice provides support and care at the end of life to help patients live as fully and as comfortable as possible. The emphasis is on symptom management, advance care planning, spiritual care, and family support, including bereavement.

For the past 5 years Tom has repeatedly asked his mother to donate his deceased father's belongings to charity, but his mother has refused. She sits in the bedroom closet, crying and talking to her long-dead husband. What type of grief is Tom's mother experiencing? a. adaptive grief b. disruptive grief c. anticipatory grief d. prolonged grief disorder

Correct answer: d Rationale: Prolonged grief disorder is prolonged, intense mourning and includes symptoms such as recurrent distressing emotions and intrusive thoughts related to the loss of a loved one, severe pangs of emotion, self-neglect, and denial of the loss for longer than 6 months

The children caregivers of an elderly patient whose death is imminent have not left the bedside for the past 36 hours. In the nurse's assessment of the family, what findings indicate the potential for an abnormal grief reaction to occur(SATA)? a. family cannot express their feelings to one another b. dying patient is becoming more restless and agitated c. a family member is going through a difficult divorce d. Family talks with and reassures the patient at frequent intervals e. siblings who were estranged from each other have now reunited

Correct answers: a, c Rationale: The nurse must be able to recognize signs and behaviors among family members who may be at risk for abnormal grief reactions. They may include dependency and negative feelings about the dying person, inability to express feelings, sleep disturbances, a history of depression, difficult reactions to previous losses, perceived lack of social or family support, low self-esteem, multiple previous bereavements, alcoholism, and substance abuse. Caregivers with concurrent life crises are especially at risk.

An 80 year female patient is receiving palliative care for heart failure. Primary purpose(s) of her receiving palliative care is (are) to (SATA) a. improve her quality of life b. asses her coping ability with disease c. have time to teach patient and family about disease. d. focus on reducing the severity of disease symptoms e. provide care that the family is unwilling or unable to give

Correct answers: a, d Rationale: The focus of palliative care is reduction of the severity of disease symptoms. The goals of palliative care are to (1) prevent and relieve suffering and (2) to improve quality of life for patients with serious, life-limiting illnesses.

Graduates of baccalaureate degree or associate's degree nursing programs are eligible to take which of the following to become registered nurses in the state in which they will practice? a. Continuing education credits b. In-service education programs c. National Council Licensure Examination d. Graduate education

Currently, in the United States, the most common way to become a registered nurse (RN) is through completion of an associate's degree or baccalaureate degree program. Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become registered nurses in the state in which they will practice. Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurse associations, professional nursing organizations, and educational and health care institutions. In-service education programs consist of 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. A nurse who is completing a graduate program can receive a master's degree in nursing.

A patient newly diagnosed with type 2 diabetes says, "My blood sugar was just a little high. I don't have diabetes." The nurse responds: A. "Let's talk about something cheerful." B. "Do other members of your family have diabetes?" C. "I can tell that you feel stressed to learn that you have diabetes." D. With silence.

D

Are tension-producing stimuli operating within or on any system: A. Stress B. Allostatic load C. Appraisal D. Stressors

D

Identifying the event or circumstance as a threat: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

D

Occurs as the person moves through life's stages: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

D

Produces hormones necessary for adaptation to stress: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

D

Rising hormone levels result in increased blood volume: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

D

The nurse is evaluating the coping success of a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. The nurse realizes that the patient is coping successfully when the patient says: A. "I'm going to learn to drive a car so I can be more independent." B. "My sister says she feels better when she goes shopping, so I'll go shopping." C. "I've always felt better when I go for a long walk. I'll do that when I get home." D. "I' m going to attend a support group to learn more about multiple sclerosis."

D

The nurse plans care for a 16-year-old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following? A. Loss of autonomy caused by health problems B. Physical appearance, family, friends, and school C. Self-esteem issues, changing family structure D. Search for identity with peer groups and separating from family

D

The term emergent design in qualitative inquiry refers to a research design that emerges at which of the following times? A) During the conduct of a literature review B) While the researcher develops a conceptual framework C) Before the study is begun D) While the researcher is in the field collecting data

D

When considering the evidence that men in nursing had an important role in the evolution of nursing as a profession, what qualitative research design is appropriate to study this phenomenon of interest? A) Phenomenology B) Grounded theory C) Ethnography D) Historical

D

Which activity performed by a nurse is related to maintaining competency in nursing practice? A. Asking another nurse about how to change the settings on a medication pump B. Regularly attending unit staff meetings C. Participating as a member of the professional nursing council D. Attending a review course in preparation for a certification examination

D Maintaining ongoing competency is a nurse's responsibility. Earning certification in a specialty area is one mechanism that demonstrates competency. Specialty certification has been shown to be positively related to patient safety.

The nurses on a medical unit have seen an increase in the number of pressure ulcers that develop in their patients. They decide to initiate a quality improvement project using the Plan-Do-Study-Act (PDSA) model. Which of the following is an example of "Do" from that model? A. Implementing the new skin care protocol on all medicine units. B. Reviewing the data collected on patients cared for using the protocol. C. Reviewing the quality improvement reports on the six patients who developed ulcers over the last 3 months. D. Based on findings from patients who developed ulcers, implementing an evidence-based skin care protocol.

D The PDSA cycle is a model for quality and performance improvement. The model is: Plan—review available data to understand existing practice conditions or problems to identify the need for change; Do—select an intervention on the basis of the data reviewed and implement the change; Study—study (evaluate) the results of the change; and Act—if the process change is successful with positive outcomes, act on the practices by incorporating them into daily unit performance.

A nurse is using the Plan-Do-Study-Act (PDSA) strategy to do a quality improvement project to decrease patient falls on a nursing unit. What is the correct sequence for PDSA? 1. Bedside change of shift report is piloted on two medical-surgical units 2. Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change 3. The nursing council develops a strategy for bedside change of shift report 4. After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units A. 1, 3, 2, 4 B. 2, 1, 3, 4 C. 1, 2, 3, 4 D. 3, 1, 2, 4

D This is the sequence of the steps in the PDSA process.

A patient has been receiving palliative care for the past several weeks in light of her worsening condition following a series of strokes. The caregiver has rung the call bell, stating that the patient now "stops breathing for a while, then breathes fast and hard, and then stops again." What should the nurse recognize that the patient is experiencing? A. Apnea B. Bradypnea C. Death rattle D. Cheyne-Stokes respirations

D Cheyne-Stokes respiration is a pattern of breathing characterized by alternating periods of apnea and deep, rapid breathing. This type of breathing is usually seen as a person nears death.

The nurse is evaluating whether a hospice referral is appropriate for a 69-year-old man with end-stage liver failure. What is one of the two criteria necessary for admission to a hospice program? A. The hospice medical director certifies admission to the program. B. The physician guarantees the patient has less than 6 months to live. C. The patient has completed both advance directives and a living will. D. The patient wants hospice care and agrees to terminate curative care.

D here are two criteria for admission to a hospice program. The first criterion is the patient must desire the services and agree in writing that only hospice care (and not curative care) can be used to treat the terminal illness. The second criterion is that the patient must be considered eligible for hospice. Two physicians must certify that the patient's prognosis is terminal with less than 6 months to live.

An older adult is being started on a new antihypertensive medication. In teaching the patient about the medication, the nurse: A) Speaks loudly. B) Presents the information once. C) Expects the patient to understand the information quickly. D) Allows the patient time to express himself or herself and ask questions

D) Allows the patient time to express himself or herself and ask questions. When teaching older adults, it is important to establish rapport, involve them in their care, and allow them to progress at their own pace.

A nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing? A) Simulation B) Restoring health C) Coping with impaired function D) Health promotion and illness prevention

D) Health promotion and illness prevention Health promotion and illness prevention are the focus when nurses provide information to help patients improve their health and avoid illness.

A patient needs to learn to use a walker. Which domain is required for learning this skill? A) Affective domain B) Cognitive domain C) Attentional domain D) Psychomotor domain

D) Psychomotor domain Using a walker requires the integration of mental and muscular activity.

The nurse is caring for a patient with chronic low back pain. In providing care for this patient, the nurse wonders whether the guidelines utilized for this type of pain are adequate. The nurse wants to determine the best evidence-based practice regarding these guidelines. What is the best database for the nurse to access? A. MEDLINE B. EMBASE C. PsycINFO D. AHRQ

D. AHRQ The Agency for Healthcare Research and Quality (AHRQ) includes clinical guidelines and evidence summaries. MEDLINE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. EMBASE includes biomedical and pharmaceutical studies. PsycINFO deals with psychology and related health care disciplines.

An older adult is being started on a new anti-hypertensive medication. In teaching the patient about the medication, the nurse: A. Speaks loudly. B. Presents the information once. C. Expects the patient to understand the information quickly. D. Allows the patient time to express himself or herself and ask questions.

D. Allows the patient time to express himself or herself and ask questions. Rationale When teaching older adults, it is important to establish rapport, involve them in their care, and allow them to progress at their own pace

The researcher is preparing to publish his study findings. In doing so, the researcher is aware of many ways that the study could have been done better, but that he did not have the ability to do. The researcher discloses these limitations in the manuscript, but they are most likely detected during which phase of the research process? A. Problem identification B. Study design C. Formulation of recommendations D. Analysis of data

D. Analysis of data During analysis of data, the researcher interprets the demographics of the study population, as well as results, including limitations. Problem identification involves identifying the area of interest and study variables, reviewing the literature, formulating the theoretical framework, and devising research questions. Study design involves selection of research methods. Formulation of recommendations involves determining the implications of the study for nursing.

A nurse is aware that characteristic behavior in the initial stage of coping with dying includes: A. Crying uncontrollably. B. Criticizing medical care. C. Refusing to receive visitors. D. Asking for additional medical consultations.

D. Asking for additional medical consultations. -(seeking other opinions to disprove the inevitable is a form of denial employed by individuals having illness w/ a poor prognosis)

The quality improvement committee has been alerted to an increased number of falls in the hospital. Most of these falls have occurred at night and have involved patients who were trying to crawl over bedrails. A literature review brought out that most falls occur because patients are trying to go to the bathroom. The committee created a practice change that bedrails should be left in the down position, and hourly nursing rounds should be conducted. What is the committee's next step? A. Evaluate the changes in 1 month. B. Wait a month before implementing the changes. C. Implement the changes as a pilot study. D. Communicate to staff the results of this inquiry

D. Communicate to staff the results of this inquiry Quality improvement combined with evidence-based practice is the foundation for excellent patient care and outcomes. Once a QI committee makes a practice change, it is important to communicate the results to staff. Practice changes will not likely last when QI committees fail to report findings and results of interventions. Once communicated, changes should be put in place as the committee deems reasonable (i.e., either fully or as a pilot study) and as soon as practical; this should be followed by re-evaluation.

The nurse has used her PICO question to develop an evidence-based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more support staff than is available at this time. What is the nurse's best option? A. Drop the idea of making the change at this time. B. Insist that management hire the needed staff to facilitate the change. C. Seek employment in another institution that may have the staff needed. D. Conduct a pilot study to develop evidence to support the change.

D. Conduct a pilot study to develop evidence to support the change. When evidence is not strong enough to apply in practice, or if resources are limited, the next option is to conduct a pilot study to investigate the PICO question. Dropping the idea would be counterproductive; insisting that management hire staff could be seen as a mandate and could produce negative results. Seeking employment at another institution most likely would not be the answer because most institutions operate under similar established guidelines.

Vulnerable populations of patients are those who are more likely to develop health problems as a result of: A. Chronic diseases, homelessness, and poverty. B. Poverty and limits in access to health care services. C. Lack of transportation, dependence on others for care, and homelessness. D. Excess risks, limits in access to health care services, and dependency on others for care.

D. Excess risks, limits in access to health care services, and dependency on others for care. It is the excess of risks and combination of risk factors that make this population more vulnerable. These vulnerabilities can be associated with the individual's/community's social determinants of health or individual health disparities.

A nurse is teaching a group of young college-age women the importance of using sunscreen when going out in the sun. What type of content is the nurse providing? A. Simulation B. Restoring health C. Coping with impaired function D. Health promotion and illness prevention

D. Health promotion and illness prevention Rationale Health promotion and illness prevention are the focus when nurses provide information to help patients improve their health and avoid illness.

A community nurse in a diverse community is working with health care professionals to provide for prenatal care for under employed and under insured South African women. Which overall goal of Healthy People 2020 does this represent? A. Assess the health care needs of individuals, families, or communities. B. Develop and implement public health policies and improve access to care. C. Gather information on incident rates of certain diseases and social problems. D. Increase life expectancy and quality of life and to eliminate heath disparities.

D. Increase life expectancy and quality of life and to eliminate heath disparities. By providing prenatal care to this group of women, the nurse improves the birth outcomes for their children and in turn the child's quality of life. Under insured represent a health disparity and Healthy People 2020 aims to decrease this inequity.

When recruiting subjects to participate in a study about the effects of an exercise program on balance, the researcher provides full and complete information about the purpose of the study and gives the subjects the choice to participate or not participate in the study. This is an example of: A. Bias. B. Anonymity. C. Confidentiality. D. Informed consent.

D. Informed consent. The process of informed consent includes providing research subjects full disclosure about the study and provides the subject the opportunity to participate or not to participate in the study.

Nurses on a pediatric nursing unit are discussing ways to improve patient care. One nurse asks a colleague, "I wonder how best to measure pain in a child who has sickle cell disease?" This question is an example of a/an: A. Hypothesis. B. PICOT question. C. Problem-focused trigger. D. Knowledge-focused trigger.

D. Knowledge-focused trigger. Knowledge-focused triggers are questions about information available on a specific topic.

The quality improvement committee is examining an increase in medication errors on a particular unit. In conducting its analysis, what should be the committee's primary focus? A. Nurses who administer the medications B. Pharmacy that prepares the medications C. Secretaries who enter the orders D. None of the above

D. None of the above. A well-organized QI program focuses on systems that significantly contribute to outcomes, not on individuals. Therefore, the entire process needs to be evaluated to determine effectiveness.

A patient needs to learn to use a walker. Which domain is required for learning this skill? A. Affective domain B. Cognitive domain C. Attentional domain D. Psychomotor domain

D. Psychomotor domain Rationale Using a walker requires the integration of mental and muscular activity.

A nurse researcher conducts a study that randomly assigns 100 patients who smoke and attend a wellness clinic into two groups. One group receives the standard smoking cessation handouts; the other group takes part in a new educational program that includes a smoking cessation support group. The nurse plans to compare the effectiveness of the standard treatment with the educational program. What type of a research study is this? A. Qualitative B. Descriptive C. Correlational D. Randomized controlled trial

D. Randomized controlled trial This is a randomized controlled trial because patients are randomly assigned into the control or treatment group.

Qualitative nursing research is valuable in that it: A. Excludes all bias. B. Uses randomization in structure. C. Determines associations between variables and conditions. D. Studies phenomena that are difficult to quantify.

D. Studies phenomena that are difficult to quantify. Qualitative nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients' perceptions of illness. No study can totally exclude bias. However, randomization, such as that used in randomized control studies, helps. Qualitative nursing research does not usually randomize its subjects. Control studies determine whether there is an association between one or more predictor variables and the condition.

A patient newly diagnosed with type 2 diabetes says, "My blood sugar was just a little high. I don't have diabetes." The nurse responds: A. "Let's talk about something cheerful." B. "Do other members of your family have diabetes?" C. "I can tell that you feel stressed to learn that you have diabetes." D. With silence.

D. With silence.

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. The supervising nurse recognizes that: A.Nurses who feel stress usually pass the stress along to their patients. B.A nurse who feels stress is ineffective as a nurse and should not be working. C.Nurses who talk about feeling stress are unprofessional and should calm down. D.Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.

D.Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.

The nurse plans care for a 16-year-old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following? A.Loss of autonomy caused by health problems B.Physical appearance, family, friends, and school C.Self-esteem issues, changing family structure D.Search for identity with peer groups and separating from family

D.Search for identity with peer groups and separating from family

You are participating in a clinical care coordination conference for a patient with terminal cancer. You talk with your colleagues about using the nursing code of ethics for professional registered nurses to guide care decisions. A non nursing colleague asks about this code. Which of the following statements best describes this code? 1. Improve self-health care 2. Protects the patient confidentiality 3. Ensures identical care to all patients 4. Defines the principles of right and wrong to provide patient care

Defines the principes of right and weing to provide patient care

catecholamines

Epinephrine and Norepinephrine stimulated by the sympathetic nervous system during flight or fight response found in the adrenal medulla

Attention to relationships as distinguished from other more principle based philosophies

Ethics of Care

Who was the first practice nurse epidemiologist? 1. Mary Mahoney 2. Florence Nightingale 3. Isabel Hampton Robb 4. Clara Barton

Florence Nightingale. She focused on poor sanitation It's not Mary Mahoney because she was the first African American professional nurse It's not Isabel Hampton because she was the founder of Nurses Associated Alumnae later became the ANA It's not Clara Barton because she was the founder the American Red Cross

Advanced practice registered nurses generally: 1. Function independently 2. Function as unit directors 3. Work in acute care settings 4. Work in the university setting

Function independently

A nurse is working with a young childbearing family who has one child with a congenital heart disease. The parents are trying to determine the risks of a second child being born with congenital heart disease. Describe why genomics information is important in assisting the parents in this decision.

Genomics describe the study of all genes in a person and the interactions of these genes with one another and with the environment. Genomic info allow health care providers to determine how genomic changes contribute and influence treatment decision

During the American Civil War, which of the following women was active in the Underground Railroad movement and assisted in leading more than 300 slaves to freedom? a. Harriet Tubman b. Clara Barton c. Dorothea Dix d. Mary Ann Ball (Mother Bickerdyke)

Harriet Tubman was active in the Underground Railroad movement and assisted in leading more than 300 slaves to freedom. Clara Barton, founder of the American Red Cross, tended soldiers on the battlefields, cleansing their wounds, meeting their basic needs, and comforting them in death. As superintendent of the female nurses of the Union Army, Dorothea Lynde Dix organized hospitals, appointed nurses, and oversaw and regulated supplies to the troops. Mother Bickerdyke organized ambulance services and walked abandoned battlefields at night, looking for wounded soldiers.

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

Hospital compare Hospital consumer assessment of healthcare 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.

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

Implementation because key word is gives the ordered medicated nebulizer treatment

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 hrs. Which standard of practice is performed? 1. Planning 2. Evaluation 3. Assessment 4. Implementation

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

The American Red Cross was founded by a. Florence Nightingale. b. Harriet Tubman. c. Clara Barton. d. Mary Mahoney.

In 1882, the United States ratified the American Red Cross, founded by Clara Barton. Florence Nightingale established the Training School for Nurses in London, England, in 1860. Harriet Tubman was active in the Underground Railroad movement during the American Civil War. Mary Mahoney was the first professionally trained African American nurse.

Nurses working in the Henry Street Settlement in 1893 were among the first nurses to demonstrate autonomy in practice. This was because those nurses a. Had no ability to work in the hospital setting. b. Were required to use critical thinking skills. c. Focused solely on healing the very ill. d. Planned their care around research findings.

In 1893, nurses working in the Henry Street Settlement were some of the first to demonstrate autonomy in practice because they encountered situations that required quick and innovative problem solving and critical thinking, and provided therapies aimed at maintaining wellness, as well as curing the ill. Nursing hospitals expanded in the late nineteenth century and were major providers of nursing care. Not until the early twentieth century was there a movement toward a scientific, research-based body of nursing knowledge.

Some nurses are collecting data to determine how many adolescents attempt suicide in a community. This is an example of what type of community assessment data?

Incident rates

The nurse is speaking in front of a group of ninth grade students about nursing as a profession. One student states that she does not want to be a nurse because all nurses do is take care of sick people and play politics. The most appropriate response that the nurse could give and expand on is that a. Nursing is ideal for the person who hates politics. b. Nursing focuses on curing the person's disease. c. Nursing is not political because it has its own knowledge base. d. An area of nursing exists for every interest.

It is important to remember that opportunities are limitless for caring, compassionate, and competent nursing care; an area of nursing exists for every interest. Current philosophies and definitions of nursing demonstrate the holistic trend in nursing—to address the whole person in all dimensions, in health and illness, and in interaction with family and community. Political activism and commitment are a part of professionalism and are an important aspect of the delivery of health care. Nursing continues to draw on the social sciences and other fields as the focus of nursing care expands.

discussions about health insurance, hospital locations and services, even organ transplants generally refer to issues of _________.

Justice

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 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

Model from an acute illness to a health promotion, illness prevention model

A bone marrow transplant procedure may offer a chance at cure; but the process involves periods of suffering, and it may not be possible to guarantee a positive outcome. Decisions about the best course of action can be difficult and full of uncertainty, precisely because nurses agree to avoid harm at the same time as they commit to promoting benefit.

Nonmaleficence

The student nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). It is important for the student to understand that the CRNA a. Works under the guidance of an anesthesiologist. b. Manages acute medical conditions. c. Manages gynecological services such as PAP smears. d. Must have a PhD degree in anesthesiology.

Nurse anesthetists provide surgical anesthesia under the guidance and supervision of an anesthesiologist, who is a physician with advanced knowledge of surgical anesthesia. Nurse practitioners, not CRNAs, manage self-limiting acute and chronic stable medical conditions; certified nurse midwives provide gynecological services such as routine Papanicolaou (Pap) smears. The CRNA is an RN with an advanced education in a nurse anesthesia accredited program. A PhD is not a requirement.

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 the information, the nurse consultant exemplifies which career? 1. Clinical nurse specialist 2. Nurse administrator 3. Nurse educator 4. Nurse researcher

Nurse researcher They investigate problem to improve nursing care and to further decline and expand the scope of nursing practice. He or she often works in academic setting, hospital, or independent professional or community service agency

A bill has been submitted to the State House of Representatives that is designed to reduce the cost of health care by increasing the patient-to-nurse ratio from a maximum of 2:1 in intensive care units to 3:1. The nurse realizes that a. Legislation is politics beyond the nurse's control. b. National programs have no bearing on state politics. c. The individual nurse can influence legislative decisions. d. Focusing on nursing care provides the best patient benefit.

Nurses can influence policy decisions at all governmental levels. One way is to get involved in ANA's national efforts, such as Nursing's Agenda for the Future: A Call to the Nation. This effort is critical in exerting nurses' influence early in the political process. Nurses need to become serious students of social needs, activists in influencing policy to meet those needs, and generous contributors of time and money to nursing organizations and candidates to help legislate conditions that are likely to produce the best care possible. (C)

The examination for registered nurse 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 a registered nurse in practice

Provides a minimal standard of knowledge for a registered nurse in practice

The examination for registered nurse (RN) licensure is exactly the same in every state in the US. 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

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.

For each of the following body systems, identify three physical manifestations that the nurse would expect to see in a patient approaching death. Respiratory a. b. c. Skin a. b. c. Gastrointestinal a. b. c. Musculoskeletal a. b. c.

Respiratory a. Cheyne-Stokes respiration b. Death rattle (inability to cough and clear secretions) c. Increased, then slowing, respiratory rate (Also: irregular breathing, terminal gasping) Skin a. Mottling on hands, feet, and legs that progresses to the torso b. Cold, clammy skin c. Cyanosis on nose, nail beds, and knees (Also: waxlike skin when very near death) Gastrointestinal a. Slowing of the gastrointestinal tract with accumulation of gas and abdominal distention b. Loss of sphincter control with incontinence c. Bowel movement before imminent death or at time of death Musculoskeletal a. Loss of muscle tone with sagging jaw b. Difficulty speaking c. Difficulty swallowing (Also: loss of ability to move or maintain body position, loss of gag reflex)

Which of the following resources guides faculty on structure and evaluation of the nursing curriculum? a. ANA's Standards of Nursing Practice b. Essentials of Baccalaureate Education c. NLNAC Interpretive Guidelines d. Standards of Professional Performance

The American Association of Colleges of Nursing (AACN) published Essentials of Baccalaureate Education for Professional Nursing: A Final Report (1998), which guides faculty on structure and evaluation of the curriculum and the performance of the graduate. The ANA's Standards of Nursing Practice demonstrates the critical thinking model known as the nursing process. Standards of Professional Performance describes a competent level of behavior in the professional role. NLNAC Interpretive Guidelines identifies core competencies for the professional nurse. (B)

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

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.

The patient requires routine gynecological services after giving birth to her son, and while seeing the nurse midwife, she asks for a referral to a pediatrician for the newborn. The nurse midwife should a. Provide the referral as requested. b. Offer to provide the newborn care. c. Refer the patient to the supervising physician. d. Tell the patient that she cannot make referrals.

The practice of nurse midwifery involves providing independent care for women during normal pregnancy, labor, and delivery, as well as care for the newborn. As an independent practitioner, supervising physicians are not required by the certified nurse midwife (CNM). However, a CNM practices with a health care agency that provides medical consultation, collaborative management, and referral. After being apprised of the CNM role, if the patient insists on seeing a pediatrician, the nurse midwife should provide the referral.

The nurse is caring for her patients and is focused on managing their care as opposed to managing and performing skills. This nurse demonstrates which level of proficiency according to Benner? a. Novice b. Competent c. Proficient d. Expert

The proficient nurse focuses on managing care as opposed to managing and performing skills. The novice nurse deals with a specific set of rules or procedures, which are usually stepwise and linear. The competent nurse understands the organization and the specific care required by specific types of patients and has experience with psychomotor skills. The expert nurse identifies patient-centered problems, as well as problems related to the health care system.

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 QSEN competency? 1. Patient-centered care 2. Safety 3. Teamwork and collaboration 4. Informatics

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

Research suggests that education about safe sex practices reduces the spread of human immunodeficiency virus (HIV). Reducing incidence of HIV is good for a great number of people.

Utilitarianism

Advanced beginner

a nurse that had some level of experience

Competent

a nurse who has been in the same clinical position for 2-3 years

Expert

a nurse with diverse experience

Proficient

a nurse with greater than 2-3 years

primary appraisal

a person experiences stress only if the event or circumstance is personally significant evaluation of the event for personal meaning

general adaptation syndrome

a three stage reaction to stress, describes how the body responds to stressors through the alarm reaction , the resistance stage, and the exhaustion stage triggered either directly by a physical event or indirectly by a psychological event

The dying patient and family have many interrelated psychosocial and physical care needs. Which ones can the nurse begin to manage with the patient and family (select all that apply)? a. Anxiety b. Fear of pain c. The dying process d. Care being provided e. Anger toward the nurse f. Feeling powerless and hopeless

a, b, c, d, e, f. Teaching, along with support and encouragement, can decrease some of the anxiety. Teaching about pain relief, the dying process, and the care provided will help the patient and family know what to expect. Allowing the patient to make decisions will help to decrease feelings of powerlessness and hopelessness. The nurse who is the target of anger needs to not react to this anger on a personal level.

According to the World Health Organization, palliative care is an approach that improves quality of life for patients and their families who face problems associated with life-threatening illnesses. From the list below, identify the specific goals of palliative care (select all that apply). a. Regard dying as a normal process. b. Minimize the financial burden on the family. c. Provide relief from symptoms, including pain. d. Affirm life and neither hasten nor postpone death. e. Prolong the patient's life with aggressive new therapies. f. Support holistic patient care and enhance quality of life. g. Offer support to patients to live as actively as possible until death. h. Assist the patient and family to identify and access pastoral care services. i. Offer support to the family during the patient's illness and their own bereavement.

a, c, d, f, g, i. Table 10-1 lists the goals of palliative care. Overall, goals of palliative care are to prevent and relieve suffering and to improve the quality of life for the patient.

Which statements by the nurse indicate a good understanding of patient education/teaching? (Select all that apply.) a. "Patient education is a standard for professional nursing practice." b. "Patient teaching falls within the scope of nursing practice." c. "Patient education is an essential component of safe, patient-centered care." d. "Patient education is not effective with children." e. "Patient teaching can increase health care costs." f. "Patient teaching should be documented in the chart."

a. "Patient education is a standard for professional nursing practice." b. "Patient teaching falls within the scope of nursing practice." c. "Patient education is an essential component of safe, patient-centered care." f. "Patient teaching should be documented in the chart." Patient education has long been a standard for professional nursing practice. All state Nurse Practice Acts acknowledge that patient teaching falls within the scope of nursing practice. Patient education is an essential component of providing safe, patient-centered care. It is important to document evidence of successful patient education in patients' medical records. Patient education is effective for children. Different techniques must be used with children. Creating a well-designed, comprehensive teaching plan that fits a patient's unique learning needs reduces health care costs, improves the quality of care, and ultimately changes behaviors to improve patient outcomes.

A 20-year-old patient with a massive head injury is on life support, including a ventilator to maintain respirations. What three criteria for brain death are necessary to discontinue life support? a. b. c.

a. Coma b. Absent brainstem reflexes c. Apnea

While preparing a teaching plan, the nurse described what the learner will be able to accomplish after the teaching session. Which action did the nurse complete? a. Developed learning objectives b. Provided positive reinforcement c. Implemented interpersonal communication d. Presented facts and knowledge

a. Developed learning objectives Learning objectives describe what the learner will be able to do after successful instruction. Positive reinforcement follows feedback and involves the use of praise and acknowledgment of new attitudes, behaviors, or knowledge. Interpersonal communication is necessary for the teaching/learning process, but describing what the learner will be able to do after successful instruction constitutes learning objectives. Facts and knowledge will be presented in the teaching session.

Which factors should the nurse assess to determine a patient's ability to learn? a. Developmental capabilities and physical capabilities b. Sociocultural background and motivation c. Psychosocial adaptation to illness and active participation d. Stage of grieving and overall physical health

a. Developmental capabilities and physical capabilities Developmental and physical capabilities reflect one's ability to learn. Sociocultural background and motivation are factors in readiness to learn. Psychosocial adaptation to illness and active participation are factors in readiness to learn. Readiness to learn is related to the stage of grieving. Overall physical health does reflect ability to learn; however, because it is paired here with stage of grieving (which is a readiness to learn factor), this is a wrong answer.

The nurse is developing a teaching plan on self-injection of insulin for a group of diabetic clients. The plan includes information about injections and types of insulin, and demonstrations of injection technique. What affective component is important for the nurse to plan to include in educating these clients? a. Helping clients accept the need for daily injections b. Having clients demonstrate injection procedures on themselves c. Asking clients to describe the injection procedure d. Giving a test on the types of insulin and duration of action

a. Helping clients accept the need for daily injections Rationale: The affective domain of learning is the feeling domain, and involves emotions, attitudes, interests, and appreciations. The cognitive domain is the thinking domain, and involves intellectual abilities. The psychomotor domain is the skill domain, and involves motor skills. All three domains should be included in planning client education.

A nurse is preparing to teach a kinesthetic learner about exercise. Which technique should the nurse use? a. Let the patient touch and use the exercise equipment. b. Provide the patient with pictures of the exercise equipment. c. Let the patient listen to a podcast about the exercise equipment. d. Provide the patient with a case study about the exercise equipment.

a. Let the patient touch and use the exercise equipment. Kinesthetic learners learn best while they are moving and participating in hands-on activities. Demonstrations and role playing work well with these learners. Patients who are visual learners learn best when you use pictures and diagrams to explain information. Patients who prefer auditory learning are distracted by pictures and prefer listening to information (e.g., podcasts). Patients who learn best by reasoning logically and intuitively learn better if presented with a case study that requires careful analysis and discussion with others to arrive at conclusions.

The nurse is assessing a client's psychomotor ability to learn how to care for a colostomy. Aspects to include in the assessment are: a. Muscle strength and motor coordination b. Memory and reading ability c. Cultural values and beliefs d. Emotional state and possible conflicts

a. Muscle strength and motor coordination Rationale: Psychomotor assessment should include muscle strength, motor coordination, energy level, and sensory acuity. The other factors should also be assessed, but are not part of psychomotor ability.

In most states, directives to physicians, durable power of attorney for health care, and medical power of attorney are included in which legal documents? a. Natural death acts c. Advance care planning b. Allow natural death d. Do Not Resuscitate order

a. Natural death acts in each state have their own requirements. Allow natural death is the new term being used for the Do Not Resuscitate order. Advance care planning is the process of having patients and their families think through their values and goals for treatment and document those wishes as advance directives.

A patient has been taught how to cough and deep breathe. Which evaluation method is most appropriate? a. Return demonstration b. Computer instruction c. Verbalization of steps d. Cloze test

a. Return demonstration To demonstrate mastery of the skill, have the patient perform a return demonstration under the same conditions that will be experienced at home or in the place where the skill is to be performed. Computer instruction is use of a programmed instruction format in which computers store response patterns for learners and select further lessons on the basis of these patterns (programs can be individualized). Computer instruction is a teaching tool, rather than an evaluation tool. Verbalization of steps can be an evaluation tool, but it is not as effective as a return demonstration when evaluating a psychomotor skill. The Cloze test, a test of reading comprehension, asks patients to fill in the blanks in a written paragraph.

When the nurse describes a patient's perceived ability to successfully complete a task, which term should the nurse use? a. Self-efficacy b. Motivation c. Attentional set d. Active participation

a. Self-efficacy Self-efficacy, a concept included in social learning theory, refers to a person's perceived ability to successfully complete a task. Motivation is a force that acts on or within a person (e.g., an idea, an emotion, a physical need) to cause the person to behave in a particular way. An attentional set is the mental state that allows the learner to focus on and comprehend a learning activity. Learning occurs when the patient is actively involved in the educational session

A terminally ill man tells the nurse, "I have never believed there is a God or an afterlife, but now it is too terrible to imagine that I will not exist. Why was I here in the first place?" What does this comment help the nurse recognize about the patient's needs? a. He is experiencing spiritual distress. b. This man most likely will not have a peaceful death. c. He needs to be reassured that his feelings are normal. d. This patient should be referred to a clergyman for a discussion of his beliefs.

a. Spiritual distress may surface when an individual is faced with a terminal illness and it is characterized by verbalization of inner conflicts about beliefs and questioning the meaning of one's own existence. Individuals in spiritual distress may be able to resolve the problem and die peacefully with effective grief work but referral to spiritual leaders should be the patient's choice.

A nurse provides teaching about coping with long-term impaired functions. Which situation serves as the best example? a. Teaching a family member to give medications through the patient's permanent gastric tube b. Teaching a woman who recently had a hysterectomy about her pathology reports c. Teaching expectant parents about physical and psychological changes in childbearing women d. Teaching a teenager with a broken leg how to use crutches

a. Teaching a family member to give medications through the patient's permanent gastric tube Not all patients fully recover from illness or injury. Many have to learn to cope with permanent health alterations. New knowledge and skills are often necessary for patients and/or family members to continue activities of daily living. Teaching family members to help the patient with health care management (e.g., giving medications through gastric tubes, doing passive range-of-motion exercises) is an example of coping with long-term impaired functions. Injured and ill patients need information and skills to help them regain or maintain their levels of health. Some examples of this include teaching a woman who recently had a hysterectomy about her pathology reports and expected length of recovery and teaching a teenager with a broken leg how to use crutches. In childbearing classes, you teach expectant parents about physical and psychological changes in the woman and about fetal development; this is part of health maintenance.

A client from a homeless shelter who has had minor surgery and has been given an instruction sheet in preparation for discharge is noted to be noncompliant with instructions when dressing for discharge. When asked by the nurse if the instructions were clear, the client said, "I'll read them later, when I have my glasses; besides, I know all that stuff." Based on these behaviors, the nurse may suspect that: a. The client may be unable to read the instructions b. The client is noncompliant c. The client doesn't understand the instructions d. The client is confused

a. The client may be unable to read the instructions Rationale: Clients who can't read may be noncompliant, insist that they know information, or have excuses for not reading the instructions. Behaviors such as these should alert the nurse to the need to further assess literacy.

Priority Decision: The husband and daughter of a Hispanic woman dying from pancreatic cancer refuse to consider using hospice care. What is the first thing the nurse should do? a. Assess their understanding of what hospice care services are. b. Ask them how they will care for the patient without hospice care. c. Talk directly to the patient and family to see if she can change their minds. d. Accept their decision since they are Hispanic and prefer to care for their own.

a. The family may not understand what hospice care is and may need information. Some cultures and ethnic groups may underuse hospice care because of a lack of awareness of the services offered, a desire to continue with potentially curative therapies, and concerns about a lack of minority hospice workers.

A patient had a stroke and must use a cane for support. A nurse is preparing to teach the patient about the cane. Which learning objective/outcome is most appropriate? a. The patient will walk to the bathroom and back to bed using a cane. b. The patient will understand the importance of using a cane. c. The patient will learn how to use a cane. d. The patient will know the correct use of a cane.

a. The patient will walk to the bathroom and back to bed using a cane. Outcomes often describe a behavior that identifies the patient's ability to do something on completion of teaching such as will empty colostomy bag, or will administer an injection. Understand, learn, and know are not behaviors that can be observed or evaluated.

Describe culturally competent care

acknowledge of and respect for cultural differences a willingness to negotiate and compromise when world views differ being aware of ones own values and bias using communication skills to enhance sympathy knowing cultural practices of patients groups regularly seen understanding that all patients are individuals and they may not share the same views as others within their own ethic group

stress

an experience to which a person is exposed through a stimulus or stressor a physical, emotional, or psychological demand that often leads to growth or overwhelms a person and leads to illness

stressors

are tension producing stimuli operating within or on any system frequency, meaning and degree it affects a person varies per individual

denial

avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain

Which action best indicates that learning has occurred? a. A nurse presents information about diabetes. b. A patient demonstrates how to inject insulin. c. A family member listens to a lecture on diabetes. d. A primary care provider hands a diabetes pamphlet to the patient.

b. A patient demonstrates how to inject insulin. Learning is the purposeful acquisition of new knowledge, attitudes, behaviors, and skills. Complex patterns are required if the patient is to learn new skills, change existing attitudes, transfer learning to new situations, or solve problems. A new mother exhibits learning when she demonstrates how to bathe her newborn. A nurse presenting information and a primary care provider handing a pamphlet to a patient are examples of teaching. A family member listening to a lecture does not indicate that learning occurred; a change in knowledge, attitudes, behaviors, and/or skills must be evident.

A nurse is preparing to teach a patient about heart failure. Which environment is best for patient learning? a. A darkened, quiet room b. A well-lit, ventilated room c. A private room at 85 F temperature d. A group room for 10 to 12 patients with heart failure

b. A well-lit, ventilated room The ideal environment for learning is a room that is well lit and has good ventilation, appropriate furniture, and a comfortable temperature. Although quiet is appropriate, a darkened room interferes with the patient's ability to watch your actions, especially when you are demonstrating a skill or using visual aids such as posters or pamphlets. A room that is cold, hot, or stuffy makes the patient too uncomfortable to focus on the information being presented. Learning in a group of six or fewer is more effective than in larger groups and avoids outburst behaviors.

A nurse is asked about the goal of patient education. What is the nurse's best response? The goal of educating others is to help people a. Meet standards of the Nurse Practice Act. b. Achieve optimal levels of health. c. Become dependent on the health care team. d. Provide self-care only in the hospital.

b. Achieve optimal levels of health. The goal of educating others about their health is to help individuals, families, or communities achieve optimal levels of health. Although all state Nurse Practice Acts acknowledge that patient teaching falls within the scope of nursing practice, this is the nurse's standard, not the goal of education. Patient education helps patients make informed decisions about their care and become healthier and more independent, not dependent. Nurses provide patients with information needed for self-care to ensure continuity of care from the hospital to the home.

Which nursing action is most appropriate for assessing a patient's learning needs? a. Assess the patient's total health care needs. b. Assess the patient's health literacy. c. Assess all sources of patient data. d. Assess the goals of patient care.

b. Assess the patient's health literacy. Because health literacy influences how you deliver teaching strategies, it is critical for you to assess a patient's health literacy before providing instruction. The nursing process requires assessment of all sources of data to determine a patient's total health care needs. Evaluation of the teaching process involves determining outcomes of the teaching/learning process and the achievement of learning objectives, not patient care. Assessing the goal of meeting patient care is the evaluation component of the nursing process.

A patient with heart failure is learning to reduce salt in the diet. When would be the best time for the nurse to address this topic? a. At bedtime, when the patient is relaxed b. At lunchtime while the nurse is preparing the food tray c. At bath time, when the nurse is cleaning the patient d. At medication time, when the nurse is administering patient medication

b. At lunchtime while the nurse is preparing the food tray Appropriate times to talk about food/diet changes during routine nursing care are at breakfast, lunch, and dinner times or when the patient is completing the menu. Many nurses find that they are able to teach more effectively while delivering nursing care. For example, while hanging blood, you explain to the patient why the blood is necessary and the symptoms of a transfusion reaction that need to be reported immediately. In this situation, because the teaching is about food, coordinating it with routine nursing care that involves food can be effective. At bedtime would be a good time to discuss routines that enhance sleep. At bath time would be a good time to describe skin care and how to prevent pressure ulcers. At medication time would be a good time to explain the purposes and side effects of the medication.

A patient with end-stage liver failure tells the nurse, "If I can just live to see my first grandchild who is expected in 5 months, then I can die happy." The nurse recognizes that the patient is demonstrating which of the following stages of grieving? a. Prolonged grief disorder b. Kübler-Ross's stage of bargaining c. Kübler-Ross's stage of depression d. The new normal stage of the Grief Wheel

b. Bargaining is demonstrated by "if-then" grief behavior that is described by Kübler-Ross. Kübler-Ross's stage of depression is seen when the person says "yes me, and I am sad." Prolonged grief disorder is seen when there is a dysfunctional reaction to loss and the individual is unable to move forward after the death of a loved one. In the Grief Wheel model, the new normal stage is when the grief is resolved but the normal state, because of the loss, is not the same as before.

A student nurse learns that a normal adult heartbeat is 60 to 100 beats/minute. In which domain did learning take place? a. Kinesthetic b. Cognitive c. Affective d. Psychomotor

b. Cognitive Cognitive learning includes all intellectual behaviors and requires thinking. In the hierarchy of cognitive behaviors, the simplest behavior is acquiring knowledge. The student nurse acquired knowledge, which is cognitive. Kinesthetic is a type of learner who learns best with a hands-on approach. Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values. Psychomotor learning involves acquiring skills that require integration of mental and muscular activities, such as the ability to walk or to use an eating utensil.

A nurse who is applying behaviorist learning theory offers a block of information on risk factors for heart disease in a straightforward, non-distracting way. What teaching strategies are appropriate for the nurse applying this learning theory to use next? a. Encourage positive teacher-learner relationships, and select multisensory delivery methods b. Give a short test, and provide positive feedback c. Assess clients' developmental and individual learning readiness, and adapt teaching strategies accordingly d. Encourage clients to establish goals, and promote self-directed learning

b. Give a short test, and provide positive feedback Rationale: Nurses applying behaviorist theory should include: careful identification of material to be taught; strategies that avoid distracting information; immediate and repeat testing; positive feedback; and role modeling. Strategies in choice "1" and "3" are consistent with cognitive theory. Strategies in choice "4" are consistent with humanism.

Priority Decision: A terminally ill patient is unresponsive and has cold, clammy skin with mottling on the extremities. The patient's husband and two grown children are arguing at the bedside about where the patient's funeral should be held. What should the nurse do first? a. Ask the family members to leave the room if they are going to argue. b. Take the family members aside and explain that the patient may be able to hear them. c. Tell the family members that this decision is premature because the patient has not yet died. d. Remind the family that this should be the patient's decision and to ask her if she regains consciousness.

b. Hearing is often the last sense to disappear with declining consciousness and conversations can distress patients even when they appear unresponsive. Conversation around unresponsive patients should never be other than that which one would maintain if the patients were alert.

A nurse is teaching a patient about the Speak Up Initiatives. Which information should the nurse include? a. The nurse is the center of the health care team. b. If you still do not understand, ask again. c. Ask a nurse to be your advocate or supporter. d. Inappropriate medical tests are the most common mistakes.

b. If you still do not understand, ask again. If you still do not understand, ask again is part of the S portion of the Speak Up Initiatives. Speak up if you have questions or concerns. You (the patient) are the center of the health care team, not the nurse. Ask a trusted family member or friend to be your advocate (advisor or supporter), not a nurse. Medication errors are the most common health care mistakes, not inappropriate medical tests.

A nurse is teaching a patient who has low health literacy about chronic obstructive pulmonary disease (COPD) while giving COPD medications. Which technique is most appropriate for the nurse to use? a. Use complex analogies to describe COPD. b. Include the most important information on COPD at the beginning of the session. c. Ask for feedback to assess understanding of COPD at the end of the session. d. Offer pamphlets about COPD written at the eighth grade level with large type

b. Include the most important information on COPD at the beginning of the session. Include the most important information at the beginning of the session for illiterate patients or patients with a learning disability. Also, use visual cues and simple, not complex, analogies when appropriate. Another technique is to frequently ask patients for feedback to determine whether they comprehend the information. Additionally, provide teaching materials that reflect the reading level of the patient, with attention given to short words and sentences, large type, and simple format (generally, information written on a fifth grade reading level is recommended for adult learners).

A patient is receiving care to manage symptoms of a terminal illness when the disease no longer responds to treatment. What is this type of care known as? a. Terminal care c. Supportive care b. Palliative care d. Maintenance care

b. Palliative care is aimed at symptom management rather than curative treatment for diseases that no longer respond to treatment and is focused on caring interventions rather than curative treatments. "Palliative care" and "hospice" are frequently used interchangeably.

A patient has been taught how to change a colostomy bag but is having trouble measuring and manipulating the equipment and has many questions. What is the nurse's next action? a. Refer to a mental health specialist. b. Refer to an ostomy specialist. c. Refer to a dietitian. d. Refer to a wound care specialist.

b. Refer to an ostomy specialist. Resources that specialize in a particular health need (e.g., wound care or ostomy specialists) are integral to successful patient education. A mental health specialist is helpful for emotional issues rather than for physical problems. A dietitian is a resource for nutritional needs. A wound care specialist provides complex wound care.

The nurse is teaching a client about reducing blood cholesterol levels through dietary management. The most appropriate learning outcome for the teaching would be: a. The client will understand benefits of a low-fat diet for cholesterol reduction b. The client will accurately select low-fat foods from a list of common foods c. The nurse will teach the client about low-fat foods and cholesterol reduction d. The client will list some common low-fat foods

b. The client will accurately select low-fat foods from a list of common foodsRationale: Learning outcomes should state expected client behavior; should reflect an observable, measurable activity; and may have conditions or modifiers stating conditions of performance. Words such as know, understand, feel, and believes are not measurable.

Which situation will cause the nurse to postpone a teaching session? (Select all that apply.) a. The patient is mildly anxious. b. The patient is fatigued. c. The patient is asking questions. d. The patient is hurting. e. The patient is febrile (high fever). f. The patient is in the acceptance phase.

b. The patient is fatigued. d. The patient is hurting. e. The patient is febrile (high fever). Any condition (e.g., pain, fatigue) that depletes a person's energy also impairs his or her ability to learn, so the session should be postponed until the pain is relieved and the patient is rested. Postpone teaching when an illness becomes aggravated by complications such as a high fever or respiratory difficulty. A mild level of anxiety motivates learning. When patients are ready to learn, they frequently ask questions. When the patient enters the stage of acceptance, the stage compatible with learning, introduce a teaching plan.

Novice

beginning nursing students

Post traumatic stress disorder

begins when a person experiences, witnesses or is confronted with a traumatic event and responds with intense fear or helplessness -not licensed to treat refer to a professional

crisis intervention

brief psychotherapy specific and narrow focus requires special training in techniques holines -a specific type of brief psychotherapy with prescribed steps

Which situation indicates to the nurse that the patient is ready to learn? a. A patient has sufficient upper body strength to move from a bed to a wheelchair. b. A patient has the ability to grasp and apply the elastic bandage. c. A patient with a below-the-knee amputation is motivated about how to walk with assistive devices. d. A patient has normal eyesight to identify the markings on a syringe and coordination to handle a syringe.

c. A patient with a below-the-knee amputation is motivated about how to walk with assistive devices. Motivation or readiness to learn sometimes results from social task mastery, or physical motives may be involved. Often patient motives are physical. Some patients are motivated to return to a level of physical normalcy. For example, a patient with a below-the-knee amputation is motivated to learn how to walk with assistive devices. Do not confuse readiness to learn with ability to learn. All the other answers are examples of ability to learn because this often depends on the patient's level of physical development and overall physical health. To learn psychomotor skills, a patient needs to possess a certain level of strength, coordination, and sensory acuity. For example, it is useless to teach a patient to transfer from a bed to a wheelchair if he or she has insufficient upper body strength. An older patient with poor eyesight or an inability to grasp objects tightly cannot learn to apply an elastic bandage or handle a syringe.

A toddler is going to have surgery on the right ear. Which teaching method is most appropriate for this developmental stage? a. Encourage independent learning. b. Use discussion throughout the teaching session. c. Apply a bandage to a doll's ear. d. Develop a problem-solving scenario.

c. Apply a bandage to a doll's ear. Use play to teach a procedure or activity (e.g., handling examination equipment, applying a bandage to a doll) to toddlers. Encouraging independent learning is for the middle-aged adult. Use of discussion is for older children, adolescents, and adults, not for toddlers. Use problem solving to help adolescents make choices. Problem solving is too advanced for a toddler.

A nurse is going to teach a patient about hypertension. Which action should the nurse implement first? a. Set mutual goals for knowledge of hypertension. b. Teach what the patient wants to know about hypertension. c. Assess what the patient already knows about hypertension. d. Evaluate the outcomes of patient education for hypertension.

c. Assess what the patient already knows about hypertension. Assessment is the first step of any teaching session, then diagnosing, planning, implementation, and evaluation. An effective assessment provides the basis for individualized patient teaching. Assessing what the adult patient currently knows improves the outcomes of patient education.

The nurse is planning an educational program on cancer detection for a community group. What should be included in the plan to assure that the program will address various learning styles of clients? a. Multicolored posters with bright colors b. Lecture to the group, using many examples c. Audiovisuals, examples, group discussions, and activities d. A game board, with clients matching terms

c. Audiovisuals, examples, group discussions, and activities Rationale: When teaching a group, utilize strategies to address visual, auditory, manipulative, group, and problem-solving types of learners. Using varying techniques and varying activities is a good way to match the varying learning styles of group participants.

A nurse is teaching an older adult patient about strokes. Which teaching technique is most appropriate for the nurse to use? a. Use a pamphlet about strokes with large font in blues and greens. b. Speak in a high tone of voice to describe strokes. c. Begin and end each teaching session with the most important information about strokes. d. Provide specific information about strokes in frequent, large amounts.

c. Begin and end each teaching session with the most important information about strokes. Begin and end each teaching session with the most important information when teaching older adult patients. Also, if using written material, assess the patient's ability to read and use information that is printed in large type and in a color that contrasts highly with the background (e.g., black 14-point print on buff-colored paper). Avoid blues and greens because they are more difficult to see. Speak in a low tone of voice (lower tones are easier to hear than higher tones). Provide specific information in frequent, small (not large) amounts for older adult patients.

Prior to beginning a teaching session on self-care of a colostomy, the nurse will assess the client's readiness to learn by assessing: a. Client's recognition of a need to learn, and belief that learning will lead to self-care ability b. Client's knowledge and previous experience with colostomies c. Client's pain and comfort levels, and willingness to learn d. Client's cognitive and sensory abilities

c. Client's pain and comfort levels, and willingness to learn Rationale: Readiness involves both willingness to learn and ability to learn at a specific time. Pain or discomfort may make it difficult for a client to learn, and must be addressed prior to teaching. The other factors should be assessed as well, but are not indicative of readiness.

A nurse is teaching a culturally diverse patient about nutritional needs. What must the nurse do first before starting the teaching session? a. Obtain pictures of food. b. Get an interpreter. c. Establish a rapport. d. Refer to a dietitian.

c. Establish a rapport. Establishing a rapport is important for all patients, especially culturally diverse patients, before starting teaching sessions. Obtaining pictures of food, getting an interpreter, and referring to a dietitian all occur after rapport is established.

A nurse is teaching a group of healthy adults about the benefits of flu immunizations. Which purpose of patient education is the nurse fulfilling? a. Restoration of health b. Coping with impaired functions c. Promotion of health and illness prevention d. Health analogies

c. Promotion of health and illness prevention As a nurse, you are a visible, competent resource for patients who want to improve their physical and psychological well-being. In the school, home, clinic, or workplace, you promote health and prevent illness by providing information and skills that enable patients to assume healthier behaviors. Injured and ill patients need information and skills to help them regain or maintain their level of health; this is referred to as restoration of health. Not all patients fully recover from illness or injury. Many have to learn to cope with permanent health alterations; this is known as coping with impaired functions. Analogies supplement verbal instruction with familiar images that make complex information more real and understandable. For example, when explaining arterial blood pressure, use an analogy of the flow of water through a hose.

A nurse wants the patient to begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning? a. Lecture b. Demonstration c. Role play d. Question and answer session

c. Role play Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values. Role play and discussion (one-on-one and group) are effective teaching methods for the affective domain. Lecture and question and answer sessions are effective teaching methods for the cognitive domain. Demonstration is an effective teaching method for the psychomotor domain.

After a teaching session on taking blood pressures, the nurse tells the patient, "You took that blood pressure like an experienced nurse." What type of reinforcement did the nurse use? a. Material b. Activity c. Social d. Entrusting

c. Social Three types of reinforcers are social, material, and activity. When a nurse works with a patient, most reinforcers are social and are used to acknowledge a learned behavior (e.g., smiles, compliments, words of encouragement). Examples of material reinforcers include food, toys, and music. Activity reinforcers rely on the principle that a person is motivated to engage in an activity if he or she has the opportunity to engage in a more desirable activity after completion of the task. The entrusting approach is a teaching approach that provides the patient the opportunity to manage self-care. It is not a type of reinforcement.

The nurse has offered a diabetic education program. What is the best indication of client compliance with a diabetic treatment plan? a. The client expresses a desire to learn about diabetes treatment. b. The client can list foods that are not allowed on a diabetic diet. c. The client willingly learns about diabetes treatment and follows the treatment plan. d. The client is able to discuss diabetes treatment and passes a test on program content with a score of 90%.

c. The client willingly learns about diabetes treatment and follows the treatment plan. Rationale: Evaluation of compliance involves evaluating the extent to which the client recognizes and accepts the need to learn, and then follows through with appropriate behavior. Clients may learn the educational material and still not be compliant.

A nurse has taught a patient about healthy eating habits. Which learning objective/outcome is most appropriate for the affective domain? a. The patient will state three facts about healthy eating. b. The patient will identify two foods for a healthy snack. c. The patient will verbalize the value of eating healthy. d. The patient will cook a meal with low-fat oil.

c. The patient will verbalize the value of eating healthy. Affective learning deals with expression of feelings and acceptance of attitudes, opinions, or values. Having the patient value healthy eating habits falls within the affective domain. Stating three facts or identifying two foods for a healthy snack falls within the cognitive domain. Cooking falls within the psychomotor domain.

rationalization

check with others reason why something is just as good or better

A nurse is assessing the ability to learn of a patient who has recently experienced a stroke. Which question/statement will best assess the patient's ability to learn? a. "What do you want to know about strokes?" b. "On a scale from 1 to 10, tell me where you rank your desire to learn." c. "Do you feel strong enough to perform the tasks I will teach you?" d. "Please read this handout and tell me what it means."

d. "Please read this handout and tell me what it means." A patient's reading level affects ability to learn. Reading level is often difficult to assess because patients who are functionally illiterate are often able to conceal it by using excuses such as not having the time or not being able to see. One way to assess a patient's reading level and level of understanding is to ask the patient to read instructions from an educational handout and then explain their meaning. Asking patients what they want to know identifies previous learning and learning needs and preferences; it does not assess ability to learn. Motivation is related to readiness to learn, not ability to learn. Just asking a patient if they feel strong is not as effective as actually assessing the patient's strength

Which statement indicates that the nurse has a good understanding of teaching/learning? a. "Teaching and learning can be separated." b. "Learning is an interactive process that promotes teaching." c. "Learning consists of a conscious, deliberate set of actions designed to help the teacher." d. "Teaching is most effective when it responds to the learner's needs."

d. "Teaching is most effective when it responds to the learner's needs." Teaching is most effective when it responds to the learner's needs. It is impossible to separate teaching from learning. Teaching is an interactive process that promotes learning. Teaching consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills.

A client presents with the following: recent medical diagnosis of congestive heart failure, four new medications, and reduced activity levels due to shortness of breath. The most appropriate nursing diagnosis based upon this information is: a. Health-Seeking Behavior (exercise and activity) related to desire to improve health status b. Noncompliance with medical treatment plan related to lack of energy for activity c. Risk for ineffective coping related to deficient knowledge d. Deficient Knowledge (medication) related to inexperience with newly ordered therapy

d. Deficient Knowledge (medication) related to inexperience with newly ordered therapy Rationale: Deficient Knowledge is used as a diagnostic label when the client is seeking health information or the nurse has identified a learning need. The area of deficiency should be included in the diagnosis.

A nurse is teaching the staff about nursing and teaching processes. Which information should the nurse include regarding the teaching process? During the teaching process, what should the nurse do? a. Assess all sources of data. b. Identify that it is the same as the nursing process. c. Perform nursing care therapies. d. Focus on a patient's learning needs.

d. Focus on a patient's learning needs. The teaching process focuses on the patient's learning needs and willingness and capability to learn. Nursing and teaching processes are not the same. All the rest are components of the nursing process: Assess all sources of data and perform nursing care therapies.

End-of-life palliative nursing care involves a. constant assessment for changes in physiologic functioning. b. administering large doses of analgesics to keep the patient sedated. c. providing as little physical care as possible to prevent disturbing the patient. d. encouraging the patient and family members to verbalize their feelings of sadness, loss, and forgiveness.

d. In assisting patients with dying, end-of-life care promotes the grieving process, which involves saying goodbye. Physical care is very important for physical comfort but assessment should be limited to essential data related to the patient's symptoms. Analgesics should be administered for pain but patients who are sedated cannot participate in the grieving process.

A client who is doing a return demonstration of how to change a wound dressing to the leg contaminates the dressing after appropriately cleansing the wound. The best nursing response is to: a. Say, "You have done this all wrong! Let me show you again." b. Remove the dressing, cleanse the wound again, and apply a new dressing c. Say and do nothing to avoid upsetting the client d. Say, "You did a good job of cleansing the wound. Let's look at ways to best put the dressing on."

d. Say, "You did a good job of cleansing the wound. Let's look at ways to best put the dressing on." Rationale: Clients need positive feedback on performance to enhance learning. Positive feedback can include praise, positively worded corrections, and suggestions of alternate methods. Negative feedback is often viewed as punishment, and may cause the client to avoid the nurse or refuse to participate further.

A nurse teaches a patient with heart failure healthy food choices. The patient states that eating yogurt is better than eating cake. In this situation, which element represents feedback? a. The nurse b. The patient c. The nurse teaching about healthy food choices d. The patient stating that eating yogurt is better than eating cake

d. The patient stating that eating yogurt is better than eating cake Feedback should show the success of the learner in achieving objectives (i.e., the learner verbalizes information or provides a return demonstration of skills learned). The nurse is the sender. The patient is the receiver. The teaching is the message.

Priority Decision: A patient in the last stages of life is experiencing shortness of breath and air hunger. Based on practice guidelines, what is the most appropriate action by the nurse? a. Administer oxygen. b. Administer bronchodilators. c. Administer antianxiety agents. d. Use any methods that make the patient more comfortable.

d. There currently are no clinical practice guidelines to relieve the shortness of breath and air hunger that often occur at the end of life. The principle of beneficence would encourage any of the options to be tried, based on knowing that whatever gives the patient the most relief should be used.

A deathly ill patient from a culture different than the nurse's is admitted. Which question is appropriate to help the nurse provide culturally competent care? a. "If you die, will you want an autopsy?" b. "Are you interested in learning about palliative or hospice care?" c. "Do you have any preferences for what happens if you are dying?" d. "Tell me about your expectations of care during this hospitalization."

d. Using the open-ended statement to seek information related to the patient's and family's perspective and expectations will best guide the plan of care for this patient. This will open the discussion about palliative or hospice care and preferences for end-of-life 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 impt. Which of the following best describes this code? 1. improves self-health care 2. protects patients confidentiality 3. ensures identical care to all patients 4. defines the principles of right and wrong to provide patient care

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.

Describe ethical dilemma

existing when the right thing to do is not clear. Resolution requires the negotiation of differeing values among involving in the dilemma They can cause distress and controversy for both patients and caregivers

disassociation

experiencing a subjective sense of numbing and a reduced awareness of one's surroundings inappropriate feelings in certain situations like crying at a funeral

situational crises

external sources such as a job change, a motor vehicle crash, a death, or severe illness

Eustress

good stress that motivates

Continuing education

involves formal, organized educational programs offered by universities, hospitals, state nurse associates, professional nursing organizations, and educational and health care institutions

Critical thinking skills

• Ability to interpret clinical situations and make complex decisions • Based on fact, experience and standards of care • Reasoned thinking • Open to alternatives • Ability to reflect

Florence Nightingale

• Established the first nursing philosophy • Book "Notes on Nursing: what it is and what it is not" 1860 • First nurse epidemiologist Statistician • Implemented methods to improve sanitation and ultimately reduced illness, infection and mortality • Opened the first formal, fully organized nursing training school

Trends in Nursing

• Evidence-Based Practice • Quality and Safety: National safety goals, Quality and Safety Education for Nurses (QSEN) • Emerging Technologies • Genomics: Study of all genes • Perception of Nursing • Impact of nursing on politics and health policy

6 KSA's (knowledge, skills and attitudes)

• Patient centered care • Teamwork and Collaboration • Evidenced-Based Practice • Quality Improvement • Safety • Informatics

Code of ethics

•Philosophical ideals of right and wrong that define principles used to provide care; It is important for you to incorporate your own values and ethics into your practice.