Med-Surge Ch 1: Health Care Delivery and Evidence-Based Nursing Practice
After teaching nursing students about the health-illness continuum, the instructor determines that teaching was successful when the students state which of the following? -"A patient's care must be focused on treating the disease." -"A person can be both healthy and ill at the same time." -"A patient with a disease typically falls on the far end of the continuum." -"A patient with a chronic illness is considered ill."
"A person can be both healthy and ill at the same time" By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a person's state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. Use of the health-illness continuum makes it possible to regard a person as simultaneously possessing degrees of both health and illness. Patient care should not focus just on the treatment of disease; people do have varying degrees of illness, and care should focus on the patient's response to all aspects of nursing care. A patient with a chronic illness or disability may attain a high level of wellness if he or she is successful in meeting health needs within the limits of his or her illness or disability. 6
The World Health Organization defines health as: -"a condition of homeostasis and adaptation." -"reflecting an individual's location along a wellness--illness continuum." -"a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." -"a fluid, ever-changing balance reflected through physical, mental, and social behavior."
"A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity" 5
A nurse asks a client with chronic obstructive pulmonary disease (COPD) to breathe in slowly through the nose, taking in a normal breath. Then she asks the client to pucker his lips as if preparing to whistle. Finally, she asks him to exhale slowly and gently through the puckered lips. The nurse recognizes that teaching the client pursed-lip breathing helps the client relax and gain control of dyspnea, reducing feelings of panic. Which of the ANA tenets characteristic of all nursing practice is the nurse demonstrating? Select all that apply. -Individualized nursing practice Care -Use of the nursing process -A professional work environment -Interdisciplinary collaboration -Evidence-based nursing
-Individualized nursing practice -Care -Use of the nursing process Teaching pursed-lip breathing to a patient with COPD is individualized based on the patient's diagnosis. The nurse demonstrates caring by providing education to support desired patient outcomes. The nurse uses the nursing process of assessment and analysis to determine the need to teach the client pursed-lip breathing. 11
Which of the following best describes the health-illness continuum? -A person with chronic illness is at the far end of the continuum reflecting illness. -A person may be considered neither completely healthy or completely ill. -A person with high-level wellness is free of any disease or infirmity. -A person on the continuum remains at the point based on his or her initial state of health.
A person may be considered neither completely healthy or completely ill Use of the continuum makes it possible to view a person as simultaneously possessing degrees of both health and illness. People with chronic illness or disability may attain a high-level of wellness if they are successful in meeting their health potential withing the limits of their condition. A person's state of health is ever-changing and can fall anywhere along the continuum at any time. High-level wellness does not necessarily mean that a person is free of disease or infirmity. 6
Future healthcare policy in the United States will be significantly affected by a population that is: -aging and becoming more culturally diverse. -becoming skeptical about conventional medicine's reliance on pharmaceuticals and surgery. -becoming more knowledgeable about nutrition and more likely to undertake dietary changes. -aging and includes a higher percentage of people with addictions.
Aging and becoming more culturally diverse The healthcare system will continue to respond to changes in the demographics and cultural diversity of the population. It is predicted that the percentage of people older than 65 years will exceed 20% of the U.S. population by 2030. 6
Which is a goal of case management? -Appropriateness of services -Prescriptive authority -Attainment of fixed price reimbursement -Utilization of the nursing process
Appropriateness of services The goals of care management are to ensure the quality, appropriateness, and timeliness of services as well as to reduce costs. 12
A nurse is caring for a client with HIV and who has been diagnosed with acute pneumonia. Which situation demonstrates an understanding of the nurse's role in the current focus on management of chronic illness and disability? -Teaching the client to avoid crowds -Administering prescribed antibiotics -Making a referral to an HIV support group -Reviewing the client's CD4 count
Teaching the client to avoid crowds Current focus on chronic disease conditions is focused on disease prevention. Teaching the client to avoid crowds encourages the client to take control of his or her health and reduce the risk of exacerbating the pneumonia 9
Which statement is true regarding population demographics? -Homelessness is decreasing. -The culturally diverse population is increasing. -The birth rate is increasing. -Life spans are decreasing.
The culturally diverse population is increasing The population has become more culturally diverse as increasing numbers of people from different national backgrounds enter the country. 6
A student nurse observes a nurse case manager coordinating discharge for a patient diagnosed with congestive heart failure (CHF). Which statement made by the patient indicates to the student that the patient understands the role of the case manager? -"The nurse case manager contacted my insurance company and has arranged for the home health nurse and physical therapist to visit me as soon as I get home." -"The nurse case manager organized my daily nursing care during my hospitalization and arranged for the dietitian to teach me the importance of consuming a diet low in sodium." -"The nurse case manager worked with my physician to coordinate my admission from his office to the hospital." -"The nurse case manager arranged to have a wheelchair waiting to take me to my room. I was so short of breath I could not walk very far."
"The nurse case manager contacted my insurance company and has arranged for the home health nurse and physical therapist to visit me as soon as I get home." A nurse case manager coordinates care between nurses, other health care personnel, and insurance companies. Nurse case managers coordinate patient care from the time of hospital admission to the time of discharge and often after discharge from an acute care setting. Care coordination provided by the nurse care manager is not episodic. 12
Which statement by the nurse shows an understanding of the focus of the quality assurance programs developed in the 1980s? -"The quality assurance programs focus on individual incidents or errors and minimal expectations." -"The quality assurance programs focus on decreasing the cost of health care for the consumer." -"The quality assurance programs focus on processes used to provide care and improving those processes." -"The quality assurance programs focus on coordinating care for patients."
"The quality assurance programs focus on processes used to provide care and improving those processes" 8
A nurse is preparing a presentation for a local community group about health, wellness, and illness. When describing the concept of wellness, which of the following features would the nurse include? Select all that apply. -Performing to one's best ability -Being completely without illness -Feeling that everything is together -Being able to adjust and adapt -Experiencing a feeling of well-being
-Performing to one's best ability -Feeling that everything is together -Being able to adjust and adapt -Experiencing a feeling of well-being 6
The nurse is practicing in a community-based setting. What outcomes may be achieved by the nurse's community interventions? (Select all that apply.) -Promote wellness. -Reduce the spread of disease. -Improve the health status of the community. -Prevent hospital-acquired illness. -Promote the financial health of the community.
-Promote wellness. -Reduce the spread of disease. -Improve the health status of the community. 15
Which element would be included as a goal of case management? -Appropriateness of services -Prescriptive authority -Attainment of fixed-price reimbursement -Utilization of the nursing process
Appropriateness of services The goals of care management are to ensure the quality, appropriateness, and timeliness of services as well as to reduce costs 12
A patient who adheres to the dietary laws of Judaism is in traction and confined to bed. The patient needs assistance with the evening meal of chicken, rice, beans, a roll, and a carton of milk. Which nursing approach is most representative of promoting wellness? -Remove items from the overbed table to make room for the dinner tray. -Push the overbed table toward the bed so that it will be within the patient's reach when the dinner tray arrives. -Ask a family member to assist the patient with the tray and the overbed table, then straighten the area in an attempt to provide a pleasant atmosphere for eating. -Ask whether the patient would like to make any substitutions in the foods and fluids received.
Ask whether the patient would like to make any substitutions in the foods and fluids received 6
The American Nurses Association's Code of Ethics provides practice guidelines, based on universal moral principles, for all nurses. Which statement reflects the nurse's primary commitment within this framework? -Committed to the client, whether an individual, family, group or community, to promote health, safety and individual rights. -Responsible for enhancing the profession of nursing practice, working within its set parameters. -Has the duty to follow every health care practitioner order. -Expected to maintain competence and professional development.
Committed to the client, whether an individual, family, group or community, to promote health, safety and individual rights. The nurse's primary commitment is always to the client, whether as an individual, family, group, or community. The nurse serves as the advocate or spokesperson for the client, who frequently does not understand the complexity of his or her illness or disease and is unaware of treatment modalities and outcomes of care. 11
Which is a primary task of nursing research? -Determining nursing diagnoses -Decreasing overall operating costs for the health care system -Contributing to the scientific base of nursing practice -Managing the care of an entire caseload of patients
Contributing to the scientific base of nursing practice 8
Which of the following would least likely impact health care delivery and nursing? -Growth in the population -Cultural diversity -Increased consumer knowledge -Decline in genetic focus
Decline in genetic focus Factors impacting health care delivery and nursing include growth in the population, increasing cultural diversity, increased consumer knowledge, and advances in technology and genetics. 6
A nursing instructor is describing to a class the various roles that nurses assume. The instructor determines that teaching has been effective when the students identify which of the following as the focus of the nursing researcher role? -Achievement of patient outcomes through direct intervention -Provision of cost-effective, high-quality nursing care -Establishment of a scientific basis for action -Promotion of health through screening and early detection
Establishment of a scientific basis for action The primary task of nursing research is to contribute to the scientific basis of nursing practice. While achievement of patient outcomes through direct intervention can be affected by information gained through nursing research, this is not the focus of nursing research 12
What is the first step in becoming culturally competent? -Exploring one's own cultural beliefs -Visiting as many cultures as possible -Maintaining eye contact at all times -Using touch as a method of maintaining rapport
Exploring one's own cultural beliefs Exploring one's own cultural beliefs and how they might conflict with the beliefs of the patients being cared for is the first step toward becoming culturally competent. Specific areas to be considered when providing care include the amount of space and distance needed to feel comfortable, eye contact, attitudes related to time, the use of touch, observance of civil and religious holidays, and the cultural meanings associated with food. 6
After teaching a group of students about health, wellness and illness, a nursing instructor determines that additional instruction is necessary when the students identify which of the following as a component of wellness? -Performing to the best of one's ability -Reporting a feeling of well-being -Adjusting to varying situations -Feeling together about one part of life
Feeling together about one part of life Wellness involves being proactive and involved with self-care activities aimed toward a state of physical, psychological, and spiritual well-being. It includes the capacity to perform to the best of one's ability; the ability to adjust and adapt to varying situations; a reported feeling of well-being; and a feeling that "everything is together" and harmonious. 6
A nurse is a member of which entity within the larger healthcare environment? -healthcare team -healthcare delivery system -health maintenance organization -physician hospital organization
Healthcare team The healthcare team includes nurses, physicians, pharmacists, psychologists, social workers, healthcare administrators, and various other health professionals, such as physical therapists. 12
The National Center for Health Statistics uses data from healthcare agencies to issue quarterly and annual reports on performance related to goals for improving the health of the U.S. population. Which initiative is targeted with improving the health of all Americans? -Healthy People 2030 -The Joint Commission -Agency for Healthcare Research and Quality -Quality Indicators
Healthy People 2030 The Healthy People 2030 campaign provides an overall action plan to improve the health and quality of life of people living in the United States. The initiative includes leading health indicators for measuring the overall health of the U.S. population. 7
The nurse is collecting data at the clinic from a new client who is being seen for an employee physical. The client informs the nurse that both parents have a history of high blood pressure and his father had a stroke at age 52 years. The nurse discusses diet and exercise programs that may benefit the client. What is the nurse displaying with this information? -Early detection -Health maintenance -Health promotion -Illness prevention
Illness prevention Illness prevention involves identifying risk factors such as family history of hypertension or diabetes and reducing the effects of risk factors on one's health 6
A 75-year-old client had surgery for a hip fracture yesterday. The client is under stress as a result of pain, sleep deprivation, and the hospital environment. The nurse caring for the client implements a proactive approach to pain management. Pain-management plans include communicating frequently to establish an acceptable pain rating, conducting hourly pain assessments, and evaluating the client's pain control hourly. In addition to improved patient outcomes, how else might the hospital benefit from the nurse's actions? -Improved Hospital Consumer Assessment of Healthcare -Providers and Systems (HCAHPS) survey scores -Additional funding from the Institute for Healthcare Improvement (IHI) -Continued accreditation from The Joint Commission Improved Quality and Safety Education for Nurses (QSEN) survey scores
Improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) The HCAHPS survey measures patients' satisfaction with the quality of the nursing care they receive, including their satisfaction with their communication with nurses, the responsiveness of hospital staff, the quietness of the environment, their pain management, communication about their medications, and their discharge information. 9
Students are reviewing information about community health nursing. The students demonstrate understanding of the term "community-oriented nursing practice" by describing it as which of the following? -Nursing interventions that can promote wellness, reduce illness spread, and improve the health status of groups -Nursing care directed to specific client groups with identified needs, usually related to illness -Provision of primary care services, often with care being provided to underserved populations -Nursing care of clients with complex needs who are discharged from acute care institutions early in the recovery process
Nursing interventions that can promote wellness, reduce illness spread, and improve the health status of groups Community-based nursing and home health care is directed toward specific client groups with identified needs, which usually relate to illness, injury, or disability, resulting most often from advanced age or chronic illness. Community nursing centers are nurse managed and provide primary care, often to underserved populations. 12
A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which of the following would the nurse include in presentation when describing disease patterns? -Most infectious diseases have been controlled or eradicated. -The prevalence of chronic illness is decreasing due to the emphasis on healthy living. -Obesity along with conditions associated with it has become a major health concern. -People with acute illnesses are considered the largest group of health care consumers.
Obesity along with conditions associated with it has become a major health concern. 6
A nursing student is preparing for a class presentation addressing the collaborative practice model. Which of the following would the student expect to include? -A discussion of a centralized organizational structure -Participation in decision making that is shared by all involved -Accountability that is primarily attributed to the patient -Nurses and physicians playing major roles in clinical decisions
Participation in decision making that is shared by all involved 13
A 54-year-old client on a fixed income has had an electrocardiogram (ECG) as part of an annual physical examination. What legislation supports the focus on chronic disease prevention, health promotion, and quality, affordable health care for everyone? -Patient Protection and Affordable Care Act -Building a Safer Health System Act -A New Health System for the 21st Century Bill -Healthcare Research and Quality Improvement Bill
Patient Protection and Affordable Care Act The Patient Protection and Affordable Care Act, also known as the ACA, supports access to quality, affordable health care, improved access to innovative and preventive health care programs and therapies, and expanded insurance coverage. 8
A client is experiencing anorexia related to the adverse effects of cancer treatment. Using Maslow's hierarchy, the nurse identifies this as a reflection of which need? -Esteem and self-respect -Safety and security -Physiologic needs -Belongingness and affection
Physiologic needs Difficulties involving a loss of appetite would most likely indicate a nutritional problem, reflecting Maslow's physiologic needs 5
How should the registered nurse be responsive to the changing health care needs of society? -Focus care on the traditional disease-oriented approach to patient care, because hospitalized patients today are more acutely ill than they were 10 years ago. -Learn how to delegate discharge planning to ancillary personnel so that registered nurses can spend their time managing the "high-tech" equipment needed for patient care. -Place increasing emphasis on wellness, health promotion, and self-care, because the majority of Americans today suffer from chronic debilitative illness. -Stress the curative aspects of illness, especially the acute, infectious disease processes.
Place increasing emphasis on wellness, health promotion, and self-care, because the majority of Americans today suffer from chronic debilitative illness 12
Nursing students are reviewing the roles that a nurse may assume. The students demonstrate understanding of the information when they identify which of the following as characteristic of the research role? -Achieving patient outcomes through direct intervention -Assuming responsibility for unlicensed assistive personnel -Replicating findings to further the science of nursing -Promoting health through screening and early detection
Replicating findings to further the science of nursing 12
A nurse is caring for a patient who is experiencing fear, anxiety, and feelings of powerlessness after receiving a diagnosis of cancer. The nurse develops a teaching plan focusing on the patient's diagnosis and treatment options to promote the patient's sense of control over the situation. Using Maslow's Hierarchy of Human Needs, which of the following categories is the nurse attempting to meet? -Esteem and self-respect -Safety and security -Physiology -Belongingness and affection
Safety and security 5
Which of the following delineates actions that are legally permitted for a particular profession based on specific educational qualifications -Scope of practice -Job description -Code of ethics -Occupational Health and Safety Administration (OSHA)
Scope of practice Scope of practice is used to delineate actions that are legally permitted for a particular profession, based on specific educational qualifications. 11
The nurse is working at an institution that uses a collaborative practice model. Which of the following would most likely be reflected at this institution? -Centralized organizational structure -Physician as the primary decision-maker -Isolated participation from the patient -Shared accountability for care
Shared accountability for care A collaborative practice model involves nurses, physicians, and ancillary health personnel functioning within a decentralized organizational structure, collaboratively making clinical decisions. Collaborative practice is further enhanced with integration of the health or medical record and with joint reviews of patient care records. The collaborative model promotes shared participation, responsibility, and accountability in a health care environment. 9
Which tool is often used by case managers? -Service cost measurement -Bottom line -Outcome criteria -Standards of care
Standards of care 9
A client has been admitted in the emergency care unit with conditions of respiratory distress and pneumonia. The client's condition worsens and requires mechanical ventilation. While visiting this client in the hospital, the family observes members of the health care team washing their hands upon entering and leaving the room. By implementing recommended hand hygiene measures, which organization's goals is the health care team supporting? -The Joint Commission -The National Council of State Boards of Nursing (NCSBN) -Institute of Medicine (IOM) -Agency for Healthcare Research and Quality (AHRQ)
The Joint Commission One of The Joint Commission National Patient Safety Goals (NPSGs) prioritizes the reduction of health care-associated infections. The NCSBN prioritizes matters related to public health, safety, and welfare, including the development of licensing examinations in nursing. The IOM emphasis relates to ensuring that patient care is safe, effective, patient centered, timely, efficient, and equitable. The AHRQ highlights patients' satisfaction with care. 8
An advanced practice registered nurse (APRN) specializing in adult-gerontology has accepted a new position in a different state. Which governing body does the APRN need to consult to verify prescriptive authority in the new state? -The new state's boards of nursing -The new state's APRN Advisory Committee -The National Council of State Boards of Nursing (NCSBN) -The new employers' board of directors
The new state's boards of nursing 12
