NR222: Exam 1

health promotion model focuses on which 3 areas

(1) individual characteristics and experiences (2) behavior-specific knowledge and effect (3) behavioral outcomes, in which the patient commits to or changes a behavior

issues in health care delivery

- Nursing shortage - Competency - Quality and safety in health care (Pay for performance, Patient satisfaction) - Magnet Recognition Program (Nursing-sensitive outcomes) - Nursing informatics & technological advancements - Globalization of Health Care (Vulnerable Populations)

holistic health model

-Attempts to create conditions that promote optimal health -natural healing abilities -ex: meditation, music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery

Impact of Illness on the Patient and Family

-Behavioral and emotional changes -Impact on body image -Impact on self-concept -Impact on family roles -Impact on family dynamics

hospice

-Family centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness -focuses on palliative (non-curable) care

primary care

-Focuses on improved health outcomes -Requires collaboration

continuing care

-For people who are disabled, functionally dependent, or suffering a terminal disease -Available within institutional settings or in the home for example: Nursing centers or facilities, Assisted living, Respite care, Adult day care centers, Hospice

long term care insurance

-Insurance covered for patients under long term care -set cost for unlimited time (2yr minimum)

national priorities partnership

-Promote best practices, prevention, treatment, communication, care coordination, and intervention practices for the leading causes of mortality -Ensure person and family centered care -Make care safer and quality care affordable

restorative care

-Serves patients recovering from an acute or chronic illness/disability -Helps individuals regain maximal function and enhance quality of life -consists of: home health care, rehabilitation, extended care

challenges to health care

-Uninsured patients -Reducing health care costs while maintaining high-quality care for patients -Improving access and coverage for more people -Encouraging healthy behaviors -Earlier hospital discharges result in more patients needing nursing homes or home care

two parts to assessment within the nursing process

-collection and verification of data -analysis of data

health promotion model (HPM)

-defines health as a positive, dynamic state, not merely the absence of disease -directed at increasing a patient's level of well-being

Nursing incorporates health promotion activities, wellness education, and illness prevention activities rather than simply treating illness in three ways:

-immunization programs -routine exercise and good nutrition -physical awareness, stress management, and self responsibility

Maslow's hierarchy of needs

-model that nurses use to understand the interrelationships of basic human needs -basic human need are elements that are necessary for human survival and health

three types of assessment

-patient centered interview during a nursing health history -physical examination -periodic assessment during rounds or administering care

Nursing Centers or Facilities

-provide 24hr intermediate and custodial care -regulated by Omnibus Budget Reconciliation Act -clinical practice must complete MDS and RAIs

inform consent

-right to know, right to revoke -must be free of mental/physical treatment

three parts to diagnosis within the nursing process

-the human response -related factors or the cause of the response -defining characteristics found in the selected patient are the signs/symptoms present that are supporting the diagnosis

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

1

A nurse is conducting a home visit with an older-adult couple. While in the home the nurse weighs each individual and reviews the 3-day food diary with them. She also checks their blood pressure and encourages them to increase their fluids and activity levels to help with their voiced concern about constipation. The nurse is addressing which level of need according to Maslow? 1. Physiological 2. Safety and security 3. Love and belonging 4. Self-actualization

1

A nurse is presenting a program to workers in a factory covering safety topics, including the wearing of hearing protectors when workers are in the factory. Which level of prevention is the nurse practicing? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Quaternary prevention

1

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? 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

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? 1. Quality improvement (QI) 2. Health care patient system 3. Nursing informatics 4. Computerized nursing network

1

Health care reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform? 12 1. Moving from an acute illness to a health promotion, illness prevention model 2. Moving from an illness prevention to a health promotion model 3. Moving from an acute illness to a disease management model 4. Moving from a chronic care to an illness prevention model

1

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. Patient safety 2. Evidence-based practice 3. Patient satisfaction 4. Maintenance of competency

1

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 best describes the role of the nurse in the resolution of ethical dilemmas? 1. To articulate the nurse's 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 on the basis of ethical principles without regard to personally held values or opinions.

1

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

1

When designing a plan for pain management for a postoperative patient, the nurse assesses that the patient's 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

When taking care of patients, a nurse routinely asks if they take any vitamins or herbal medications, encourages family members to bring in music that the patient likes to help the patient relax, and frequently prays with her patients if that is important to them. The nurse is practicing which model? 1. Holistic 2. Health belief 3. Transtheoretical 4. Health promotion

1

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

1, 2, 3

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

1, 2, 3, 4

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

1, 2, 4

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.) 1. Use of physical restraints 2. Pain assessment, intervention, and reassessment 3. Patient satisfaction with food preparation 4. Registered nurse (RN) education and certification 5. Number of outpatient surgical cases per year

1, 2, 4

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. 5. Providers are exempt from fidelity to people with drug addiction because addiction reflects a lack of personal accountability. 6. If a new drug is discovered that cures a disease but at great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it.

1, 2, 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.

1, 2, 5

Which of the following are examples of a nurse participating in primary care activities? (Select all that apply.) 1. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2. Assessing the nutritional status of older adults who come to the community center for lunch 3. Working with patients in a cardiac rehabilitation program 4. Providing home wound care to a patient 5. Teaching a class to parents at the local grade school about the importance of immunizations

1, 2, 5

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

1, 3, 4

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

1, 4

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

1, 4, 5

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

1, 4, 5

A male patient has been laid off from his construction job and has many unpaid bills. He is going through a divorce from his marriage of 15 years and has been seeing his pastor to help him through this difficult time. He does not have a primary health care provider because he has never really been sick and his parents never took him to a physician when he was a child. Which external variables influence the patient's health practices? (Select all that apply.) 1. Difficulty paying his bills 2. Seeing his pastor as a means of support 3. Age of patient (46 years) 4. Stress from the divorce and the loss of a job 5. Family practice of not routinely seeing a health care provider

1, 5

Health Services Pyramid

1. population based health care services 2. clinical preventive services 3. primary health care 4. secondary health care 5. tertiary health care

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

1b, 2d, 3c, 4a

Match the examples with the professional nursing code of ethics: a. Advocacy b. Responsibility c. Accountability d. Confidentiality 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 patient's request. 4. You tell your patient that you will return in 30 minutes to give him his next pain medication.

1d, 2c, 3a, 4b

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

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? 1. "My small company will now have to offer the 75 employees health insurance or pay a penalty." 2. "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." 3. "I signed up for the state health insurance exchange before the designated deadline to make sure I had health insurance." 4. "Since I have now been diagnosed with diabetes, my health insurance plan cannot charge me higher premiums."

2

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

2

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? 1. Prospective payment system 2. Pay for performance 3. Capitation payment system 4. Managed care systems

2

A patient comes to the local health clinic and states: "I've noticed how many people are out walking in my neighborhood. Is walking good for you?" What is the best response to help the patient through the stages of change for exercise? 1. "Walking is OK. I really think running is better." 2. "Yes, walking is great exercise. Do you think you could go for a 5-minute walk next week?" 3. "Yes, I want you to begin walking. Walk for 30 minutes every day and start to eat more fruits and vegetables." 77 4. "They probably aren't walking fast enough or far enough. You need to spend at least 45 minutes if you are going to do any good."

2

After a class on Pender's health promotion model, students make the following statements. Which statement does the faculty member need to clarify? 1. "The desired outcome of the model is health-promoting behavior." 2. "Perceived self-efficacy is not related to the model." 3. "The individual has unique characteristics and experiences that affect his or her actions." 4. "Patients need to commit to a plan of action before they adopt a health-promoting behavior."

2

As part of a faith community nursing program in her church, a nurse is developing a health promotion program on breast self-examination for the women's group. Which statement made by one of the participants is related to the individual's perception of susceptibility to an illness? 1. "I have a door hanging tag in my bathroom to remind me to do my breast self-examination monthly." 2. "Since my mother had breast cancer, I know that I am at increased risk for developing breast cancer." 3. "Since I am only 25 years of age, the risk of breast cancer for me is very low." 4. "I participate every year in our local walk/run to raise money for breast cancer research."

2

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 agreement about a definition of usefulness exists 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

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

2

Which statement made by a nurse shows that the nurse is engaging in an activity to help cope with secondary traumatic stress and burnout? 1. "I don't need time for lunch since I am not very hungry." 2. "I am enjoying my quilting group that meets each week at my church." 3. "I am going to drop my gym membership because I don't have time to go." 4. "I don't know any of the other nurses who met today to discuss hospital-wide problems with nurse satisfaction."

2

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

2

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. 301 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

Which of the following are symptoms of secondary traumatic stress and burnout that commonly affect nurses? (Select all that apply.) 1. Regular participation in a book club 2. Lack of interest in exercise 3. Difficulty falling asleep 4. Lack of desire to go to work 5. Anxiety while working

2, 3, 4, 5

The nurse assesses the following risk factors for coronary artery disease (CAD) in a female patient. Which factors are classified as genetic and physiological? (Select all that apply.) 1. Sedentary lifestyle 2. Mother died from CAD at age 48 3. History of hypertension 4. Eats diet high in sodium 5. Elevated cholesterol level

2, 3, 5

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

2, 4

What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in 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

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

2, 4, 1, 5, 3

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 29correctly. A change is needed quickly. What type of quality improvement method would be most appropriate? 1. PDSA 2. Six Sigma 3. Rapid-improvement event (RIE) 4. A randomized controlled trial

3

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

3

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

3

A patient had surgery for a total knee replacement a week ago and is currently participating in daily physical rehabilitation sessions at the surgeon's office. In what level of prevention is the patient participating? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Quaternary prevention

3

A patient registered at the local fitness center and purchased a pair of exercise shoes. The patient is in what stage of behavioral change? 1. Precontemplation 2. Contemplation 3. Preparation 4. Action

3

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? 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 gives you a list of physicians and hospitals from which you can choose. 4. This is a fee-for-service plan in which you can choose any physician or hospital.

3

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

3

Based on the transtheoretical model of change, what is the most appropriate response to a patient who states: "Me, stop smoking? I've been smoking since I was 16!" 1. "That's fine. Some people who smoke live a long life." 2. "OK. I want you to decrease the number of cigarettes you smoke by one each day, and I'll see you in 1 month." 3. "I understand. Can you think of the greatest reason why stopping smoking would be challenging for you?" 4. "I'd like you to attend a smoking cessation class this week and use nicotine replacement patches as directed."

3

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

3

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 a patient's self-worth. 2. Nurses have a scope of practice that encourages their presence during ethical discussions. 3. Nurses develop a relationship with 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 in an acute care hospital are attending a unit-based education program to learn how to use a new pressure-relieving device for patients at risk for pressure ulcers. This is which type of education? 1. Continuing education 2. Graduate education 3. In-service education 4. Professional Registered Nurse Education

3

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 principle, 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 obscured or deleted all patient identifiers? 1. Yes, because patient privacy would not be violated since 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 on the basis of other comments that you make online about his or her condition and your place of work 4. No, because the principle of justice requires you to allocate resources fairly

3

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

3

Which activity shows a nurse engaged in primary prevention? 1. A home health care nurse visits a patient's home to change a wound dressing. 2. A nurse is assessing risk factors of a patient in the emergency department admitted with chest pain. 3. A school health nurse provides a program to the first-year students on healthy eating. 4. A nurse schedules a patient who had a myocardial infarction for cardiac rehabilitation sessions weekly.

3

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. Place the steps in 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.

3, 1, 2, 4

Using the Transtheoretical Model of Change, order the steps that a patient goes through to make a lifestyle change related to physical activity. 1. The individual recognizes that he is out of shape when his daughter asks him to walk with her after school. 2. Eight months after beginning walking, the individual participates with his wife in a local 5K race. 3. The individual becomes angry when the physician tells him that he needs to increase his activity to lose 30 lbs. 4. The individual walks 2 to 3 miles, 5 nights a week, with his wife. 5. The individual visits the local running store to purchase walking shoes and obtain advice on a walking plan.

3, 1, 5, 4, 2

Which of the following nursing activities is provided in a secondary health care environment? 1. Conducting blood pressure screenings for older adults at the Senior Center 2. Teaching a clinic patient with chronic obstructive pulmonary disease purse-lipped breathing techniques 3. Changing the postoperative dressing for a patient on a medical-surgical unit 4. Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit

3, 4

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

4

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

4

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

4

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

4

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 patient 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

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

4

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

4

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? 1. Implementing the new skin care protocol on all medicine units 2. Reviewing the data collected on patients cared for using the protocol 3. Reviewing the quality improvement reports on the six patients who developed ulcers over the last 3 months 4. Based on findings from patients who developed ulcers, implementing an evidence-based skin care protocol

4

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

4

Which activity performed by a 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. Attending a review course in preparation for a certification examination

4

Which of the following statements 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

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

4

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: You as the nurse are accountable for the well-being of this patient. 2. Respect for autonomy: This patient's autonomy will be violated if he does not receive the liver transplant. 3. Ethics of care: The caring thing that a nurse could provide this patient is resources for a liver transplant. 4. Justice: The greatest question in this situation is how to determine the just distribution of resources.

4, 2, 3, 1

Ethical dilemmas often arise over a conflict of opinion. Reliance on a predictable 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 could 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

nursing process

A critical thinking process that professional nurses use to apply the best available evidence to caregiving and promoting human functions and responses to health and illness.

Preffered Provider Organization (PPO)

A managed care organization of doctors, hospitals, and other providers who have an agreement with an insurer to provide health care at reduced rates to subscribers. PPO clients do not pay deductibles when using the preferred providers, but can use other providers and pay a higher co-payment as well as a deductible.

dilemmas

A situation where a difficult choice has to be made

illness

A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired

health

A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity

health promotion

Activities such as routine exercise and good nutrition that help patients maintain or enhance their present level of health and reduce their risk of developing certain diseases.

ADPIE

Assessment Diagnosis Planning Implementation Evaluation

manager

Coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or agency

Professional standards review organizations (PSROs)

Created to review the quality, quantity, and cost of hospital care provided through Medicare and Medicaid

Accountable care organizations (ACOs)

Developed to coordinate medical care, strives to ensure that patients receive the right care at the right time, without duplication of services or incidence of medical errors

internal variables influencing health beliefs

Developmental Stage, Intellectual Background, Perception Background, Emotional Factors, Spiritual Factors

secondary and tertiary care

Diagnosis and treatment of disease provided by Hospital emergency departments, urgent care centers, critical care units, and inpatient medical-surgical units

Prospective Payment System (PPS)

Eliminated cost-based reimbursement and grouped patients into diagnosis-related groups (DRGs)

Florence Nightingale

Established sanitary nursing care units. Founder of modern nursing. began professional education of nursing.

health care reform

Facilitated access to care for millions of uninsured Americans

Mary Nutting

First Nursing professor at Columbia Teachers College. Helped move nursing into universities.

Mary Mahoney

First professionally trained African American nurse; brought cultural diversity and respect

secondary prevention

Focuses on those who have health problems or illnesses and are at risk for developing complications or worsening conditions

caregiver

Helps patients maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process

medicare part A

Inpatient coverage, home health, hospice

illness behavior

Involves how people monitor their bodies and define and interpret their symptoms

assisted living

Long-term care setting Home environment Greater resident autonomy No fee caps

medicare part C

Medicare Advantage

The point of the ethical practice is an agreement to reassure the public that in all ways the health care team not only 300works to heal patients but agrees to do this in the least painful and harmful way possible. This principle is commonly called the principle of ________?

Nonmaleficence

Clara Barton

Nurse during the Civil War; founder of the American Red Cross

interview techniques

Observation Open-ended questions Leading questions Back channeling Direct closed-ended questions

tertiary prevention

Occurs when a defect or disability is permanent or irreversible

Lillian Wald and Mary Brewster

Opened the Henry Street Settlement, focusing on the health needs of the poor

medicare part D

Prescription drug coverage

adult day care centers

Provide a variety of health and social services to specific patient populations who live alone or with family in the community

prevenative care

Reduces and controls risk factors for disease

respite care

Respite care provides short-term relief or "time off" for people providing home care to an individual who is ill, disabled, or frail.

Utilization review (UR) committees

Review admissions, diagnostic testing, and treatments ordered by physicians who cared for patients receiving Medicare

processing an ethical dilemma

Step 1: Ask if this is an ethical dilemma. Step 2: Gather all relevant information. Step 3: Clarify values. Step 4: Verbalize the problem. Step 5: Identify possible courses of action. Step 6: Negotiate the outcome. Step 7: Evaluate the action.

Sources of data collection

The patient, family, health care team, medical records, scientific literature, and nursing experience

primary prevention

True prevention that lowers the chances that a disease will develop

internal variables

a person's developmental stage, intellectual background, perception of functioning, and emotional and spiritual factors

external variables

a person's health beliefs and practices include family practices, socioeconomic factors, and cultural background

value

a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior

State Children's Health Insurance Program (SCHIP)

a public health insurance program, jointly funded by the federal and state governments, that provides health insurance coverage for children whose families meet income eligibility standards

denotology

actions stated as right or wrong on the basis of their "right-making characteristics"

Action stage

actively engaging in strategies to change behavior

positive health behaviors

activities related to maintaining, attaining, or regaining good health and preventing illness

illness prevention

activities such as immunization programs protect patients from actual or potential threats to health

code of ethics helps settle about practice and behavior; including______, responsibility, accountability, and ________

advocacy and confidentiality

fidelity

agreement to keep promises

preventative ethics

aims to interrupt potential ethical problems before they develop

Quality improvement (QI)

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

Performance Improvement (PI)

an organization analyzes and evaluates current performance and uses the results to develop focused improvement actions

who is covered under medicaid

assisted care to low income patients

Nonmaleficence

avoidance of harm or hurt

health behaviors

behaviors undertaken by people to enhance or maintain their health

justice

being fair

risk factors

characteristics or behaviors that increase the likelihood of developing a medical disorder or disease examples: -Genetic and physiological factors -age -environment -lifestyle

valadation

compression of data with another source to determine data accuracy

Contemplation stage

considering a change within the next 6 months

four communication skills for patient interview

courtesy, comfort, connection, confirmation

health promotion model

describes the multidimensional nature of persons as they interact within their environment to pursue health

concept mapping

develops critically thinking skills by understanding the relationships that exist among patient problems

varacity

devotion to the truth

Medicare prospective reimbursement system is based on payment calculated from ________ assignment

diagnoses related group (DRG)

medical diagnosis

disease or medical condition

diagnosis-related groups (DRGs)

each group has a fixed reimbursement amount with adjustments based on case severity, rural/urban/regional costs, and teaching costs

communicator

essential to the nurse-patient relationship; it allows you to know your patients including their strengths, weaknesses, and needs

issues

ethical problems in which a choice must be made

external variables influencing health beliefs

family practices, socioeconomic and psychological factors, cultural background

casuistry

focuses on an intimate understanding of particular situation

autonomy

freedom from external control or influence; independence

Examples of risk factors are:

generic and physiological factors, age, environment, lifestyle

health belief model

helps you understand factors influencing patients perceptions, beliefs, and behavior to plan care that will help maintain or restore health and prevent illness

nursing diagnosis

human response to actual or potential health problems and life process

negative health behaviors

include practices actually or potentially harmful to health

Globalization

increasing connectedness of words economy, culture, and technology

the focuses of health promotion model

individual characteristics and experiences, behavior-specific knowledge and affect, and behavioral outcomes

passive strategies of health promotion

individuals gain from the activities of others without acting themselves

cue

information you obtain through use of the senses

Maintenance stage

maintaining a changed behavior

Preparation stage

making small changes

what is one confidentiality issue with adolescents

mandatory reporting laws must be reported

federal government pays for ______________ and created professional standards review organizations (PSROs)

medicare/medicaid

Precontemplation stage

no intention of changing behavior

diagnosis

nurse analyzes the assessment data to determine the diagnoses or issues

assessment

nurse collects comprehensive data to pertinent to the patient's health and/or the situation

objective data

observations or measurements of a patient's health status

moral distress

occurs when a nurse knows the ethically correct action to take but feels powerless to take that action

Mother Bickerdyke

organized ambulance services and walked abandoned battlefields at night, looking for wounded soldiers.

three phases of an interview

orientation and setting an agenda, working phase-collecting assessment or nursing health system, terminating and interview

Patient Protection and Affordable Care Act

passed in 2010, focuses on the major goals of increasing access to health care services for all, reducing health care costs, and improving health care quality.

nursing-sensitive outcomes

patient outcomes and select nursing workforce characteristics that are directly related to nursing care

subjective data

patient's verbal descriptions of their health problems

chronic illness

persists, usually longer than 6 months, is irreversible, and affects functioning in one or more systems. Patients often fluctuate between maximal functioning and serious health relapses that may be life threatening

health beliefs

person's ideas, convictions, and attitudes about health and illness. They may be based on factual information or misinformation, common sense or myths, or reality or false expectations

medicare part B

physician services, outpatient hospital services, durable medical equipment, and other services and supplies covered

health services pyramid

population based health care services, clinical preventative services, primary health care, secondary health care, tertiary health care

Managed Care Organization (MCO)

preventative measures and treatment to specific groups

6 health care settings and services

preventative, primary, secondary, tertiary, restorative, continuing

pay for performance

programs and public reporting of hospital quality data are designed to promote quality, effective, and safe patient care

confidentiality

protection of patients personal health information

capitation

providers receive a fixed amount per patient or enrollee of a health care plan

managed care

providers receive predetermined capitalized payment for each patient enrolled

present illness or health concerns you could use the acronym PQRST

provokes quality radiate severity time

competency emphasizes importance of _________

public service, health of communities, and ethically responsible behaviors

utilitarianism

relies on the application of a certain principle

accountability

responsible professionally and legally for the type and quality of nursing provided, ability to answer for one's own actions

acute illness

reversible, has a short duration, and is often severe. The symptoms appear abruptly, are intense, and often subside after a relatively short period

Utilization Review (UR) Committees

review the admissions and identify and eliminate overuse of diagnostic and treatment services ordered by physicians caring for patients on Medicare

professional standards review organizations (PSROs)

review the quality, quantity, and cost of hospital care

advocacy

support of a particular cause

Beneficence

taking positive actions to help others

quality of life

the degree of overall satisfaction that a person gets from life, central to discussions about end-of-life care

health promoting behavior

the desired behavioral outcome and the end point in the HPM. Health-promoting behaviors result in improved health, enhanced functional ability, and better quality of life at all stages of development

feminist ethics

the nature of relationships to guide participants in making difficult decisions

ethics

the study of principles about what is right and wrong, fair and unfair

the institute of medicine guides nurses to transform by

training, achieve higher levels of education, build partnerships with physicians, and improve information infrastructure

the _________ describes a series of changes through which patients progress for successful behavior change rather than simply assuming that all patients are in an action stage

transtheoretical model of change

Patient-centered medical home (PCMH)

uses technology, teamwork, and effective communication with patients to make care culturally sensitive and accessible, gather clinical data, promote patient participation in decision making, and monitor patient outcomes

responsibility

willingness to respect obligations and follow through on promises

educator

you explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient's progress in learning

patient advocate

you protect your patient's human and legal rights and provide assistance in asserting these rights if the need arises

inference

your judgment or interpretation of the cues