N320 Reading + Q's for Quiz 1

C. "Issues of this kind have to be shared with the treatment team and your parents." (Although adolescent patients request confidentiality, issues of sexual abuse, threats of suicide or homicide, or issues that put the patient at risk for harm must be shared with the treatment team and the parents. A threat of this nature must be discussed with the treatment team and the parents. Confidentiality laws do not protect information that would lead to harm to the patient or others)

A 17-year-old patient confides to the nurse that they have been thinking of ways to kill a peer. What response should the nurse give when the patient states, "you have to keep it a secret because its confidential information"? A. "I will keep it a secret, but you and I need to discuss ways to deal with this situation appropriately without committing a crime." B. "Yes, I will keep it confidential. We have laws to protect patients' confidentiality." C. "Issues of this kind have to be shared with the treatment team and your parents." D. "I will have to share this with the treatment team, but we will not share it with your parents."

Minnesota Model of Public Health

1. Consider whether surveillance as an intervention is appropriate for the situation 2. Organize the knowledge of the problem, its natural course of history, and its aftermath 3. Establish clear criteria for what constitutes a case 4. Collect sufficient data from multiple valid sources 5. Analyze the data 6. Interpret and disseminate the data to decision makers 7. Evaluate the impact of the surveillance system

C. "Yes, I will be happy to get any information and history that you can provide." (The friend is a secondary source of information that will be helpful since the patient is not able to give any history or information at this time. Confidentiality laws do not prohibit obtaining information from a secondary source. The friend can provide information and/or history immediately and may be able to relate events that happened just before coming to the hospital. A release would not be necessary to take information about the patient from a secondary source, and a psychotic patient would not be competent to sign a release)

A 26-year-old patient is brought to the emergency room by a friend. The patient is unable to give any coherent history. Which response should the nurse provide when the patient's friend offers to provide information regarding the patient? A. "I'm sorry, but I cannot take any information from you as it would violate confidentiality laws." B. "There is no need for that as I will call his primary care provider to obtain the information we need." C. "Yes, I will be happy to get any information and history that you can provide." D. "Yes, however, we will have to get a release signed from the patient for you to be able to talk with me."

B. Spiritual distress (The client is expressing distress regarding his religion and spiritual well-being. The client could be experiencing ineffective coping, but this does not directly relate to his comment. There is nothing in the client's comment that would lead to the conclusion that the patient is having thoughts of harming himself or experiencing hopelessness)

A 43-year-old client being seen in the mental health clinic states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes the client's comment? A. Ineffective coping B. Spiritual distress C. Risk for self-harm D. Hopelessness

D. community partnerships. (Community partnership is necessary because when there is community partnership lay community members have a vested interest in the success of efforts to improve the health of their community. Most changes must aim at improving community health through active partnerships between community residents and health workers from a variety of disciplines. Partnership, as defined here, is a concept that is as essential for nurses to know and use as are the concepts of community, community as client, and community health)

A Hispanic outreach program works with the nurse in community health to train Hispanic health care workers in providing basic services and education within the local Hispanic community. The concept basic to community-oriented nursing practice that is best described by this intervention is: A. community. B. community client. C. community health. D. community partnerships

D. Report the incident to the client's therapist (The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made)

A client reports to the nurse that once he is released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take? A. None, because no explicit threat has been made. B. Ask the client if he is threatening his wife. C. Call the client's wife and report the threat. D. Report the incident to the client's therapist.

B. Battery (Battery is the harmful, nonconsensual touching of another person. Forceful administration of medication constitutes battery)

A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents A. Assault B. Battery C. Defamation D. Invasion of privacy

C. Nothing may be disclosed that would have been kept confidential before death (Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive. None of the other statements are accurate)

After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual? A. Confidentiality is now reserved to the immediate family. B. Only HIV status continues to be protected and privileged. C. Nothing may be disclosed that would have been kept confidential before death. D. The nurse must confer with the next of kin before divulging confidential, sensitive information.

A. community as client (When the community is the client, the results of nursing interventions should produce changes that affect the community as a whole, such as reducing the spread of sexually transmitted diseases (STDs). Although the nurse may work with individuals, families or other interacting groups, aggregates, institutions, or communities, or within a population, the resulting changes are intended to affect the whole community. The community health nurse is not providing care to an individual in this circumstance. It would be ideal if there were some form of partnership in this intervention)

A nurse in community health contacts three individuals who have had sexual encounters with an individual recently diagnosed with syphilis. The concept basic to community-oriented nursing practice that is best described by this intervention is: A. community. B. community as client. C. individual as client. D. partnership.

B. change partner. (Content-focused roles often are considered change agent roles, whereas process roles are change partner roles. Change partner roles include enabler-catalyst, teacher of problem-solving skills, and activist advocate. Different roles may be required if the community lacks problem-solving skills or has a history of unsuccessful change efforts. The nurse may have to focus on developing problem-solving capabilities or on making one successful change so that the community becomes empowered to take on the job of promoting change on its own behalf)

A nurse in community health is invited to work with a coalition of churches to address safety concerns for children in the local community. The nurse provides training in problem-solving skills, manages conflict, facilitates the process, and provides expertise in interpreting data. This nurse has chosen the implementation role of: A. change agent. B. change partner. C. group leader. D. data collector.

C. Assist the client in putting on glasses and hearing aid. (A client whose hearing or sight is impaired may have difficulty providing information if these items have been removed from his or her possession. Assisting the client in wearing these assistive devices is the best initial intervention. None of the other options will be as effective in facilitating the interview)

A nurse is about to interview an older client whose glasses and hearing aid were placed in the bedside drawer for safe keeping. Before beginning the interview, which nursing intervention will best facilitate data collection? A. Ask the client if she needs her glasses and hearing aid. B. Give the client her glasses and hearing aid. C. Assist the client in putting on glasses and hearing aid. D. Explain the importance of wearing her hearing aid and glasses.

C. False imprisonment (False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons. None of the other options relate directly to such seclusion)

If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client has experienced which illegal act? A. Battery B. Defamation of character C. False imprisonment D. Assault

C. Fidelity (Fidelity refers to being "true" or faithful to one's obligations to the client. Client abandonment would be a violation of fidelity. None of the other options addressed abandonment)

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated which ethical principle? A. Autonomy B. Veracity C. Fidelity D. Justice

A. community (In most definitions the concept of community includes people, place/time, and function. Nurses in community health practice regularly need to examine how the personal, geographic, and functional dimensions of community shape their nursing practice with individuals, families, and groups. They can use both a conceptual definition and a set of indicators for the concept of community in their practice. The community is first the setting for practice for the nurse practicing health-promotion and disease-prevention interventions with individuals, families, and groups. Second, the community is the target of practice for the public health nurse whose practice is focused on the broader community rather than on individuals)

Migrant workers and their families who reside in a specific mobile home park during the summer months would best be classified as a: A. community. B. group. C. setting of practice. D. target population.

D. "What role does religion play in your life?" (Asking the client to define the role of religion in their life allows for discussion related to the other topics)

The nurse best assesses the client's spiritual life by asking which question? A. "Do you practice a specific religion?" B. "To whom do you turn in times of crisis?" C. "Do you attend church regularly?" D. "What role does religion play in your life?"

A. Refrain from attempting suicide. (Refraining from suicidal attempts is the only outcome that addresses the risk for self-directed violence. The absence of a feeling of powerlessness is not appropriate for the stated nursing diagnosis. The remaining options are interventions)

The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. What is the priority outcome for this client? A. Refrain from attempting suicide. B. Be placed on suicide precautions. C. Attend self-help group daily. D. State absence of feelings of powerlessness.

C. Objective (The mental status exam mostly aids in the collection of objective data)

The mental status examination aids in the collection of what type of data? A. Covert B. Physical C. Objective D. Subjective

A. evaluation phase. (Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. After implementing the intervention, only the accomplishment of objectives and the effects of the intervention activities have to be assessed. The nurse will evaluate whether the objectives were met and whether the intervention activities were effective)

The nurse in community health defines goals and measurable objectives during the planning phase of a community health intervention. This also marks the beginning of the: A. evaluation phase. B. implementation phase. C. needs assessment. D. problem analysis.

A. analyze the community problem (After the identification of the community problem(s), the planning phase of the community-oriented nursing process should begin with an analysis of the problem. During the analysis, the nurse seeks to clarify the nature of the problem, its origins and effects, points at which intervention might be undertaken and interested parties/change agents. Analysis often requires identifying direct and indirect contributing factors, outcomes of the problem, and relationships between problems. Once high-priority problems are identified, relevant goals and objectives are developed, followed by the identification of intervention activities)

The nurse in community health identifies an elder abuse problem related to caregiver stress among families. The nurse further identifies a lack of caregiver support services in the local community. The next step in the community-oriented nursing process would be to: A. analyze the community problem. B. establish priorities. C. establish goals and objectives. D. identify intervention activities.

D. structure (Community health has three dimensions: status, structure, and process. Measures of community health services and resources include service use patterns, treatment data, and provider-to-client ratios. Community health in terms of status, or outcome, is the most well-known and accepted approach; it involves biological, emotional, and social parts. The view of community health as the process of effective community functioning or problem solving is well established. In population-centered practice, the nurse and community seek healthful change together)

The nurse in community health reviews the monthly and year-to-date health service use report for the local community to monitor trends as correlates of the community's health. The nurse is viewing community health through the dimension of: A. partnership. B. process. C. status. D. structure.

B. Request that the client accompany the nurse to the client's room (Least restrictive alternative doctrine requires using the least drastic means of achieving a specific goal. By first attempting to remove the client to a safer location, the nurse is respecting the client's right to treatment that is less restrictive than the other options)

The nurse is caring for an admitted client with a history of becoming aggressive when angry and has caused physical injury to another client and two staff members. When this client begins to demonstrate signs of anger while in the day room what intervention should the nurse implement to address the safety of the milieu? A. Alert security to come to the unit for a show of strength B. Request that the client accompany the nurse to the client's room C. Inform the client that restraints will be used if the behavior continues D. Prepare to administer a prn chemical restraint to the client

B. Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. (The best atmosphere for conducting an assessment is one with minimal anxiety on the patient's part. If a topic causes distress, it is best to abandon the topic at that time. It is important not to pry or push for information that is difficult for the patient to discuss. The use of silence continues to expect the patient to discuss the topic now. Reassurance of confidentiality continues to expect the patient to discuss the topic now)

The nurse is conducting an admission interview with a client who was raped 2 weeks ago. When asked about the rape, the client becomes very anxious and upset and begins to sob. What should be the nurse's response to the client's reaction? A. Push gently for more information about the rape because the information needs to be documented. B. Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. C. Use silence as a therapeutic tool and wait until the client is done sobbing to continue discussing the rape. D. Reassure the client that anything she says to you will remain confidential.

C. Voluntarily (Voluntary admission occurs when the client seeks treatment and is willing to be admitted and agrees to comply with hospital and unit rules. None of the other options meet all these criteria)

The nurse reads the medical record and learns that a client has asked for treatment, agreed to receive treatment, and to abide by hospital rules. The nurse may correctly assume that the client has met the criteria for which type of admission? A. Outpatient B. Emergency C. Voluntarily D. Involuntarily

A. client's own words and actions. (The client should always be considered the primary data source. At times, however, the client will be unable to fulfill this role)

The primary source for data collection during a psychiatric nursing assessment is the A. client's own words and actions. B. client's family and friends. C. client's nonverbal responses. D. client's medical treatment records.

A. Autonomy and beneficence (Autonomy refers to self-determination and beneficence refers to doing good. When a client is restrained or secluded, the need to do good and prevent harm outweighs the client's autonomy)

The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between which ethical principles? A. Autonomy and beneficence B. Advocacy and confidentiality C. Veracity and fidelity D. Justice and humanism

D. windshield survey. (Five useful methods of data collection are informant interviews, participation observation, windshield survey, secondary analysis of existing data, and surveys. Windshield surveys are the motorized equivalent of simple observation. While driving a car or riding public transportation, the nurse can observe many dimensions of a community's life and environment through the windshield. A basic method is participant observation, the deliberate sharing, if conditions permit, in the life of a community. In secondary analysis, the nurse uses previously gathered data, such as minutes from community meetings)

Two nurses in community health schedule a day to ride through a low-income community to better understand the community and what factors affect the health of that community. This direct data collection method is often referred to as: A. composite database. B. participant observation. C. secondary analysis. D. windshield survey.

C, D, E (Involuntary admission which is court ordered implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently. Neither of the remaining options is accurate assumption regarding an involuntary admission)

What assumption can be made about the client who has been admitted on an involuntary basis? Select all that apply. A. The client can be discharged from the unit on demand of next of kin. B. For the first 48 hours, the client can be given medication over objection. C. The client has failed to agree to fully participate in treatment and care planning. D. The client is a danger to self or others or unable to meet basic needs. E. The commitment was court ordered.

B. Witnessing the informed consent for electroconvulsive therapy from a client

What nursing action supports a client's right to autonomy? A. Spending time with an extremely anxious client B. Witnessing the informed consent for electroconvulsive therapy from a client C. Spending equal amount of one-on-one time with each client on the unit D. Attending an inservice on a newly approved medication

A. Individuals have the right to outcomes that is reflective of their abilities (Outcome criteria are the hoped-for outcomes that reflect the maximal level of patient health that the patient can realistically achieve through nursing interventions. None of the other options accurately describes the guiding principle of outcome planning)

What principle forms the basis of nursing outcome planning? A. Individuals have the right to outcomes that is reflective of their abilities. B. Nursing interventions are designed to solve individuals' problems for them. C. The goal of nursing action is to create a dependency between the client and the caregiver. D. Nurses have the best understanding of client problems and so they direct outcome selection.

B. Problem, related factors, defining characteristics (The components of the nursing diagnosis are problem, related factors, and defining)

What three structural components comprise a nursing diagnosis? A. Problem, outcome, intervention B. Problem, related factors, defining characteristics C. Unmet need, goal, outcome criterion D. Presenting symptom, treatment, goal

B. The client may cause imminent harm to himself or others (A patient may be medicated against his or her will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient's will)

When considering client rights, which client can be legally medicated against his or her wishes? A. The client has accepted the medication in the past. B. The client may cause imminent harm to himself or others. C. The client's primary provider orders the medication. D. The client's mental illness may relate to cognitive impairment.

A. They are assured the same as those for any other citizen (Civil rights are not lost because of hospitalization for mental illness. None of the other statements are accurate when describing the rights of a hospitalized mentally ill client)

When considering the civil rights of persons diagnosed with mental illness and hospitalized for treatment, which statement is true? A. They are assured the same as those for any other citizen B. Their rights are altered to prevent use of poor judgment C. Their rights are always ensured by appointment of a guardian D. Their rights are limited to provision of humane treatment

A. "That judge is going to really regret putting me in here." (The duty to protect is an ethical and legal obligation of health care workers to protect patients from physically harming themselves or others. This duty arises when the patient presents a serious danger to another. While all that statements infer the client's intention to harm, only the correct option is credible since it actually identifies the possible victim)

When considering the duty to warn and protect third parties, which client statement should the nurse report to the treatment team members? A. "That judge is going to really regret putting me in here." B. "All politicians need to be shot." C. "When I'm elected president, I'll make them all pay for doubting me." D. "The man out there who is laughing at me is going to die."

A, B, C, E (Although expense should be considered, interventions are chosen based on being safe, compatible and appropriate, realistic and individualized, and evidence based and not on their economic value)

Which criterion is essential when the nurse plans nursing interventions designed to meet a specific goal? Select all that apply. A. Safe B. Evidence based C. Individualized D. Economical E. Realistic

B. Autonomy (Autonomy refers to self-determination, or the right to make one's own decisions. None of the other options are directly related to the client's right to makes decisions)

Which ethical principle refers to the individual's right to make his or her own decisions? A. Beneficence B. Autonomy C. Veracity D. Fidelity

A. A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately (AMS discharges are sometimes used when the patient does not agree with the provider, as long as the patient is not a danger to himself or herself or to others. The patient with dementia and the patient who is actively suicidal would pose a safety risk and would be not allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member's opinion doesn't impact an AMA discharge)

Which hospitalized patient should the nurse identify as being a candidate for the appropriate use of a release from hospitalization known as against medical advice (AMA)? A. A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately B. A 75-year-old patient with dementia who demands to be allowed to go back to his own home C. A 21-year-old actively suicidal patient who wants to be discharged to home and do outpatient counseling D. A 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care

D. Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating" (This diagnosis contains all the required components: problem statement, related factors, and defining characteristics)

Which nursing diagnosis for a psychiatric client is correctly structured and worded? A. Hopelessness related to severe chronic depression B. Spiritual distress as evidenced by client stating "God has abandoned me because I'm a bad person" C. Defensive coping related to lack of insight associated with illicit drug use D. Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating"

A, C, D (In community-oriented practice, the nurse and community seek healthful change together. Their common goal involves an ongoing series of health-promoting changes rather than a fixed state. The most effective means of completing healthy changes in the community is through this same partnership. Nurses who have a community orientation are often considered unique because of their target of practice)

Which of the following best support the concept of community-oriented nursing practice? Select all that apply. A. Direct nursing care of individuals with tuberculosis (TB) B. Hospice home care for a terminally ill individual and family C. Nursing interventions to stop elder abuse D. Nutrition education programs for teenagers and their families E. Wound care for a homebound individual

D. "We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment." (Some of the purposes of the assessment interview are to establish rapport, learn more about the presenting issues, and form mutual goals and a plan for treatment. The other options do not appropriately explain the assessment purpose)

Which response should the nurse provide a client who asks, "Why you need to conduct an assessment interview"? A. "I need to find out more about you and the way you think in order to best help you." B. "The assessment interview lets you have an opportunity to express your feelings." C. "You are able to tell me in detail about your past so that we can determine why you are experiencing mental health alterations." D. "We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment."

C. Right to informed consent (Before being given medication, the client should be fully informed about the reason for, the expected outcomes of, and any side effects of the medication. The client has the right to refuse medication. If, in a nonemergency situation, he is given medication after refusing it, his right to informed consent has been violated)

Which right of the client has been violated if he is medicated without being asked for his permission? A. Right to dignity and respect B. Right to treatment C. Right to informed consent D. Right to refuse treatment

C. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator (Discussing a patient's information in public places where it may be overheard is a violation of a patient's confidentiality. The other options describe appropriate interactions for patient continuity of care and support of the treatment plan by the health care team)

Which scenarios describe a HIPAA violation associated with a nurse's behavior? A. An ED (Emergency Department) nurse gives the intensive care unit nurse a client report from a telephone at the nurse's station. B. A nurse on the medical-surgical floor calls a patient's primary care provider to obtain a list of current medications. C. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. D. A nurse on the psychiatric unit gives discharge information to the counseling office regarding a client's outpatient treatment.

D. Nursing Outcomes Classification (NOC) (The Nursing Outcomes Classification is a publication used as a resource across the United States. It is a standardized list of nursing outcomes that gives nurses a way to evaluate the effect of nursing interventions. That is not the function of any of the other options)

Which tool can the novice nurse might refer to when writing nursing outcomes? A. North American Nursing Diagnosis Association (NANDA) B. Joint Commission (formally JCAHO) C. Nursing Interventions Classification (NIC) D. Nursing Outcomes Classification (NOC)

B. data generation (Data generation in a community health assessment is the process of developing data that do not already exist through interaction with community members, individuals, families, and groups. This type of data includes community knowledge and beliefs, values, goals, perceived needs, norms, problem-solving processes, power, leadership, and influence structures. This activity parallels the assessment phase of the nursing process. Data gathering is the process of obtaining existing, readily available data. Data interpretation is conducted in the analysis phase. All of the steps will assist the nurse in problem identification)

While conducting a community health assessment, a nurse in community health meets with local religious leaders to understand the values, norms, perceived needs, and influence structures within the community. This process of data collection can best be described as: A. data gathering. B. data generation. C. data interpretation. D. problem identification.