nursing 1 - week 1 study guide _
A facility is using ___________ nursing care when scientifically sound research data are used to make nursing care decisions. 1) Evidence-based 2) Standardized 3) Individualized 4) Theoretical
Answer: 1) Evidence-based Rationale: Evidence-based nursing care uses solid, scientific data to make decisions about nursing practice.
The parts of a PICOT question are:
Patient problem, Intervention, Comparison intervention, Outcome, and Time.
______________________ nursing care includes activities that are performed in collaboration with other members of the healthcare team and also independently.
contemporary
(t or f) A person who cares for the sick but has not taken the National Council Licensure Examination (NCLEX) can use the title "Nurse."
false Rationale: The title "Nurse" is regulated and can be used only by persons who have completed a nursing program of study and passed the NCLEX.
The four basic components of a nursing theory are...
person, nurse, environment, and health.
the _____________ period (4 to 5 years) children are able to separate from their parents, communicate needs through language, and control bodily functions.
preschool
Florence Nightingale transformed nursing and is associated with which image of the nurse?
professional
_________________ research tells the lived experience of a person or group of people. It is analyzed by examining the words and actions of a small number of participants.
qualitative
_______________ research may be generalized to populations similar to the one studied. It has tight controls and large numbers of participants, and the data are statistically analyzed.
quantitative
_______ ___________ _________ (6 to 12 years) begins to develop relationships outside the home. This leads to increasing confidence and independence.
school aged child
The nurse provides instructions to a parent about what to anticipate during her son's adolescence. Which comment by the parent indicates she understands the instructions? 1) "I know his peers will have more of an influence than I will." 2) "I'm relieved he will finally be able to make good decisions." 3) "I'm sure he will be less inclined to do things with his friends." 4) "I'm glad his growth will slow; the food bills have been huge."
Answer: 1) "I know his peers will have more of an influence than I will." Rationale: Adolescents develop their own personal identity, and they do this by decreasing the attachment to their parents and developing close relationships with peers. The adolescent still lacks common sense and can have poor judgment. Adolescents have a strong need to feel part of a group. There is a growth spurt for both sexes during adolescence.
A young mother of a 1-month-old infant says to the nurse, "My baby can't roll over or sit up. He can raise his head, though, and he looks at me when I talk to him. Is anything wrong?" How should the nurse respond? 1) "No. Babies don't usually roll over until they are about 5 months old." 2) "Probably not. But we can do a Denver Developmental Screening Test to be certain." 3) "Probably not. If he doesn't fall over when you sit him up, he is developing normally." 4) "I don't think so, but we can have the physician examine him to be sure."
Answer: 1) "No. Babies don't usually roll over until they are about 5 months old." Rationale: Development proceeds in a proximodistal pattern, beginning at the center of the body and moving outward. For example, the infant first lifts her head, and later pushes up and rolls over (by about 5 months of age). There is no need to use time and money administering a Denver Developmental Screening Test (DDST); what the mother describes is certainly normal, and the nurse is qualified to make that judgment. Normally, a baby will roll over before she sits alone; it would be very unusual for a 1-month-old to do either. Also, because of proximodistal development, the infant will probably (but not always) roll over before he sits alone. The nurse does not need the physician to answer this mother's question about normal infant development.
Which of the following demonstrates a health restoration activity? Select all that apply. 1) Administering an antibiotic every day 2) Teaching the importance of handwashing 3) Assessing a client's surgical incision 4) Advising a woman to get an annual mammogram after age 50 years
Answer: 1) Administering an antibiotic every day 3) Assessing a client's surgical incision Rationale: Health restoration activities help an ill client return to health. This would include taking an antibiotic every day and assessing a client's surgical incision. Handwashing and mammograms both involve healthy people who are trying to prevent illness.
Which of the following would be the most important health assessment focus for middle adulthood? 1) Cancer screening with the annual health examinations 2) Seeking information about consistent use of seat belts 3) Screening for eating disorders 4) Mental status exam for cognitive changes
Answer: 1) Cancer screening with the annual health examinations Rationale: Chronic diseases, including cancer, are major health problems for adults in the middle years. Habits for seat belt use should have already been established; although it may be important to reinforce seat belt use, the most important assessment is cancer screening. Eating disorders are more common in adolescence. In general, cognitive changes such as memory loss and dementia do not develop until older adulthood.
Which of the following form propositions when linked together, and are considered "building blocks" of theories? 1) Concepts 2) Research data 3) Hypotheses 4) Numbers
Answer: 1) Concepts Rationale: When concepts are linked together, they form propositions that provide the framework for a theory. Research data are used in constructing and testing a theory. Keep in mind that theories can also be started without data, merely by logically linking concepts, perhaps based on a review of the literature. Hypotheses are tested in a research study. They may or may not have been formulated on the basis of a theory. Data in a quantitative study consist of numbers.
A patient who underwent a total abdominal hysterectomy is assisted out of bed as soon as her vital signs are stable. This intervention is most likely being directed by a: 1) Critical pathway 2) Nursing care plan 3) Social worker 4) Traditional care model
Answer: 1) Critical pathway Rationale: This patient's care is most likely being directed by a critical pathway. A critical pathway is a multidisciplinary approach to care that sequences interventions over a length of stay for a given case type, such as total abdominal hysterectomy. Using this model, the patient can be assisted out of bed as soon as her vital signs are stable. Using the traditional model, the nurse would have to obtain a physician's order to assist the patient out of bed after surgery. The nursing care plan guides nursing care but cannot specify when the patient can get out of bed postoperatively without a physician's order. When case management is used, care is coordinated by the case manager across the healthcare setting, but the case manager does not direct each care intervention.
A patient is at risk for dehydration. Because of this, the nurse plans to monitor the patient's intake and output and to check skin turgor every 4 hours. Which of the following processes does this illustrate? 1) Deductive reasoning 2) Inductive reasoning 3) Intuition (inspiration) 4) Data analysis
Answer: 1) Deductive reasoning Rationale: Deduction starts with a general premise (that fluid imbalance may cause dehydration; and that decreased skin turgor is a sign of dehydration); it proceeds to a specific conclusion (that the nurse should monitor intake and output and check skin turgor). Inductive reasoning starts with several pieces of information, from which a pattern is recognized and a conclusion drawn about what it means. Intuition (inspiration) is one way to gain knowledge. It is a "feeling" about something—an inner sense. Data analysis is a step of the research process. In a research report it is the section in which data are reported and, often, statistically analyzed. The nurse in this case is not analyzing data. The nurse made a decision to act, based on knowledge she already had.
A nurse spends time sitting with a dying patient. She holds the patient's hand and prays with her quietly. This action is most clearly an example of whose nursing theory? 1) Jean Watson 2) Imogene King 3) Ida Jean Orlando 4) Martha Rogers
Answer: 1) Jean Watson Rationale: Jean Watson developed the Science of Human Caring theory, which describes caring from a nursing perspective. Imogene King focused her theory on mutual goal setting between the nurse and patient and the process for meeting the goals. Ida Jean Orlando is known for ideas about the nursing process. Martha Rogers developed the Science of Unitary Human Beings theory, which focuses on the betterment of humankind through new and innovative modalities. Her theory stresses the importance of maintaining an environment free of negative energy.
An 80-year-old resident in a long-term-care facility comes to the emergency department with dehydration. The nurse writes a diagnosis of Deficient Fluid Volume related to excessive fluid loss. An individualized nursing goal identified for this client is "The client will maintain urine output of at least 30 mL/hour." Which nursing interventions would directly help achieve or evaluate the stated goal? Choose all that are correct. 1) Measure and record urine output every hour; report an output of less than 30 mL/hour. 2) Monitor skin turgor and moistness of mucous membranes every shift. 3) Administer intravenous (IV) fluids as prescribed. 4) Keep oral fluids within the patient's reach and encourage the patient to drink.
Answer: 1) Measure and record urine output every hour; report an output of less than 30 mL/hour. 3) Administer intravenous (IV) fluids as prescribed. 4) Keep oral fluids within the patient's reach and encourage the patient to drink. Rationale: Measuring and recording urine output allow for direct evaluation of the goal "urine output 30 mL/hour." Administering IV fluids adds fluid to correct dehydration, improves blood flow through the kidneys, and increases urine production. Intake of oral fluids has the same effect. Monitoring skin turgor and monitoring mucous membranes are ways to assess for dehydration, but that intervention does not directly apply to the goal of maintaining urine output. It is aimed at the etiology of this nursing diagnosis, rather than the problem.
Which of the following is true of the Nursing Interventions Classification (NIC)? Select all that apply. 1) NIC interventions can be used in all specialty areas of nursing practice. 2) The American Nurses Association (ANA) has approved it for use. 3) It is used mainly by home health nurses. 4) It is designed primarily for use in hospitals.
Answer: 1) NIC interventions can be used in all specialty areas of nursing practice. 2) The American Nurses Association (ANA) has approved it for use. Rationale: The NIC is on the ANA's list of approved standardized languages. NIC interventions were designed for and are applicable in home, community, and acute care settings. The taxonomy designed specifically for home health is the Clinical Care Classification.
Nurses have the potential to be very influential in shaping healthcare policy. Which of the following factors contributes most to nurses' influence? 1) Nurses are the largest health professional group. 2) Nurses have a long history of serving the public. 3) Nurses have achieved some independence from physicians in recent years. 4) Political involvement has helped refute negative images portrayed in the media.
Answer: 1) Nurses are the largest health professional group. Rationale: Nurses are trusted professionals and the largest health professional group. As such, they have political power to effect changes. If nursing was a small group, there would be little potential for power in shaping policies, even if all the other answers were true. Serving the public, while positive, does not necessarily help nurses to be influential in establishing health policy. Independence from physicians, although positive, does not necessarily make nurses influential in establishing healthcare policy. Refuting negative media, although a worthwhile activity, does not necessarily make nurses influential in establishing healthcare policy.
Which standardized intervention vocabulary was designed specifically for community health nurses? 1) Omaha System 2) Clinical Care Classification 3) Nursing Interventions Classification 4) International Classification for Nursing Practice
Answer: 1) Omaha System Rationale: The Omaha System was designed specifically for community health nurses to use in caring for individuals, families, community groups, or entire communities. The Clinical Care Classification was developed for home healthcare. The Nursing Interventions Classification system is applicable in all settings, including home health and community nursing. The International Classification for Nursing Practice system was designed to describe nursing practice of individuals, families, and communities worldwide.
Which of the following would indicate a 4-year-old child has successfully gone through Erikson's Stage 3 (Initiative versus Guilt)? The child: 1) Refrains from hitting a friend. 2) Plays cooperatively with friends. 3) Is able to develop friendships. 4) Is able to express his feelings.
Answer: 1) Refrains from hitting a friend. Rationale: Stage 3 is Initiative versus Guilt, in which the child becomes responsible for his behavior, develops self-discipline, and is able to manage his impulses. Cooperation and expressing feelings are tasks for Stage 2. Children develop friendships during the preschool age.
All of the following are aspects of the full-spectrum nursing role. Which one is essential for the nurse to do in order to successfully carry out all of the others? 1) Thinking and reasoning about the patient's care 2) Providing hands-on patient care 3) Carrying out physician orders 4) Giving instructions to assistive personnel
Answer: 1) Thinking and reasoning about the patient's care Rationale: A substantial portion of the nursing role involves using clinical judgment, critical thinking, and problem-solving, which directly affect the care the client will actually receive. Providing hands-on care is important; however, clinical judgment, critical thinking, and problem-solving are essential in order to do it successfully. Carrying out physician orders is a small part of a nurse's role; it, too, requires nursing assessment, planning, intervention, and evaluation. Many simple nursing tasks are being delegated to nursing assistive personnel; delegation requires careful analysis of patient status and the appropriateness of support personnel to deliver care. Another way to analyze this question is that none of the options of providing hands-on care, carrying out physician orders, and giving instructions to assistive personnel is required in order for the nurse to think and reason about a client's care; therefore, the answer must be 1.
What health insurance plans are associated with managed care? a. Health maintenance organizations (HMOs) b. Preferred provider organizations (PPOs) c. Point of service (POS) d. All of the above
Answer: D: All of the above Rationale: Managed care insurance plans are based on agreements between the insurance company (managed care organization) and healthcare providers to treat patients for a predetermined, fixed amount. HMOs, PPOs, and POS are types of managed care plans.
The mother of a toddler asks the nurse when it is safe to place the car safety seat in a forward-facing position. The best response by the nurse is: 1) You can use forward-facing position when the toddler weighs 20 lb. 2) The car safety seat should not be placed in a face-forward position unless the air bags are disabled 3) When the weight and height of the toddler are above the 85th percentile 4) The seat should never be place in a face-forward position because the risk of the child unbuckling the harness
Answer: 1) You can use forward-facing position when the toddler weighs 20 lb. Rationale: The transition point for switching to the forward-facing position is defined by the manufacturer of the car safety seat, but is generally at a body weight of 20 lb (9 kg) and 1 year of age. Car safety seats should be used until the child weighs at least 40 lb.
Which of the following are examples of a health promotion activity? (Select all that apply). 1) Helping a client develop a plan for a low-fat, low-cholesterol diet 2) Disinfecting an abraded knee after a child falls off a bicycle 3) Administering a tetanus vaccination after an injury suffered in a car accident 4) Distributing educational brochures about the benefits of exercise
Answer: 1, 4) Helping a client develop a plan for a low-fat, low-cholesterol diet; Distributing educational brochures about the benefit of exercise. Rationale: Health promotion includes strategies that promote positive lifestyle changes. Disinfecting an abraded knee is a treatment/intervention for an injury. Administering a vaccination is a disease-prevention and treatment activity.
What are two unique characteristics of the scientific method that make it different from other problem-solving methods, such as intuition, trial and error, and so on?
Answer: 1. Objectivity, or self-correction 2. The use of empirical data Rationale: 1. Objectivity, or self-correction. This means that the researcher uses techniques to keep her personal beliefs, values, and attitudes separate from the research process. 2. The use of empirical data. Researchers use their senses to gather empirical data through observation. They attempt to verify the information gathered through a variety of methods so that the research conclusions are based in "reality" rather than on the researcher's beliefs, biases, or hunches.
The nurse is preparing to assess a toddler. To make the assessment go smoothly, before examining the child the nurse should first: 1) Talk to the mother before talking to the child 2) Ask the child about his favorite toy 3) Get the child's height and weight 4) Ask the mother to undress the child
Answer: 2) Ask the child about his favorite toy Rationale: Toddlers have a fear of strangers, so it would be important to establish rapport before examining the child by asking him about his favorite toy. Although talking to the mother before the child prior to a physical assessment does not lead to distrust, the action simply does not contribute to building a rapport with the child. Undressing the child before a trusting relationship is established often creates anxiety in the child, leading to uncooperativeness, fear, or withdrawal. Obtaining the child's height and weight would not help the child feel secure.
A healthy patient tells the nurse that he uses acupuncture and yoga to obtain pain relief and does not take pain medication. The nurse recognizes this as what type of treatment? 1) Rationing 2) Complementary and alternative medicine 3) Tertiary 4) High-technology medicine
Answer: 2) Complementary and alternative medicine Rationale: Complementary and alternative medicine involve treatments and practices that are outside traditional medicine. They include yoga, herbal medications, massage therapy, and acupuncture, to name a few. CAM is becoming more acceptable as alternatives to traditional medicine. Rationing is the limitation of access to or the equitable distribution of resources. Tertiary care occurs during the last stages of life or with long-term rehabilitation. Today's healthcare environment involves more technology and nurses must treat the patient without overreliance on technology.
During adolescence, it would be most important to encourage the teen to eat plenty of: 1) Grains 2) Dairy products 3) Vegetables 4) Fruit
Answer: 2) Dairy products Rationale: Both males and females experience a growth spurt during adolescence. Although the child's diet should include adequate amounts of all the food groups, peak bone mass is attained during this stage, so the child needs to consume adequate calcium, vitamin D, iron, and protein. These nutrients are found in dairy products.
Which nursing intervention is considered an independent intervention? 1) Administering 1 liter of dextrose 5% in normal saline solution at 100 mL/hour 2) Encouraging the postoperative client to perform coughing and deep-breathing exercises 3) Explaining his diet to the client; then communicating the teaching with the dietitian 4) Administering morphine sulfate 2 mg IV to the client with postoperative pain
Answer: 2) Encouraging the postoperative client to perform coughing and deep-breathing exercises Rationale: Encouraging the postoperative client to perform coughing and deep-breathing exercises is an independent nursing intervention. An independent intervention is one that nurses are licensed to prescribe, perform, or delegate based on their skills and knowledge. Administering IV fluid or morphine sulfate is a dependent intervention; it requires an order from a physician or advanced practice nurse but is carried out by the nurse. Explaining to the client how sodium intake affects his heart failure and then communicating the teaching with the dietitian is an interdependent intervention, one that is carried out in collaboration with other healthcare team members.
A nurse has observed that quite a few patients on the unit develop pressure sores while in the agency. The nurse wonders whether there are better preventive measures than are currently being used and wishes to find the best evidence for perhaps changing at least one intervention. What should the nurse do next? 1) Identify a clinical nursing problem. 2) Formulate a PICOT question on the topic. 3) Search the nursing literature. 4) Evaluate the quality of the research in the literature.
Answer: 2) Formulate a PICOT question on the topic Rationale: The first step in finding evidence for an intervention is to identify a clinical nursing problem. However, the scenario indicates that the nurse has already done that. The next step is to formulate a searchable question (a PICOT question). This must be done in order to guide the search of the nursing literature. Then, only after searching the literature, can the nurse evaluate the quality of the research that was found.
Identify five images of nurses that have emerged over time.
Answer: Angel of mercy depicts the nurse as an angelic, serene, compassionate person. Battle-ax image shows the nurse as an unkind, mean-spirited person who lacks compassion for patients. Naughty nurse portrays the nurse as a sex symbol who lacks clinical judgment and critical-thinking skills. Handmaiden image describes the nurse in a submissive role with no autonomy in patient care decisions. Professional image illustrates the nurse as an educated, competent, and caring patient care provider.
A research article describes a multicenter study in which 5,000 healthy patients between the ages of 30 and 65 were given a medication. Effects were observed, which included change in blood pressure with the prescribed drug. Study findings indicate this medication is safe for healthy patients between the ages of 30 and 65 when given for a defined medical condition. What can you most reasonably infer from this information? 1) It was a qualitative study. 2) It was a quantitative study. 3) The study did not use a random sample. 4) The study did not include a broad enough age span.
Answer: 2) It was a quantitative study. Rationale: Quantitative research uses large enough numbers of subjects that are often randomly selected so the results can be generalized to a similar population to those studied. It uses numbers to report data. Qualitative research focuses on individual experience and usually involves only a few participants (subjects); unlike quantitative research, the focus is not on generalizing the results to wider populations. There is no information in the scenario to indicate whether or not the sample was random. And finally, with only the information in the scenario, you cannot judge whether the age group tested was appropriate; that would depend on the purpose of the study and the medication used.
Which of the following is the most prevalent major health problem for young adults? 1) Cancer 2) Obesity 3) Eating disorders 4) Cardiovascular disease
Answer: 2) Obesity Rationale: Obesity has increased drastically in adults. Of course, some cancers do occur in young adults; however, cancer and cardiovascular disease become major concerns in middle adulthood. Eating disorders are a problem more typical of adolescence. They are not widespread in adults. They may occur in young adults but are not as prevalent as obesity.
Which statement pertaining to Benner's practice model for clinical competence is true? 1) Progression through the stages is constant, with most nurses reaching the proficient stage. 2) Progression through the stages involves continual development of thinking and technical skills. 3) The nurse must have experience in many areas before being considered an expert. 4) The nurse must have experience in many areas before being considered an expert.
Answer: 2) Progression through the stages involves continual development of thinking and technical skills. Rationale: Movement through the stages is not constant. Benner's model is based on integration of knowledge, technical skill, and intuition in the development of clinical wisdom. The model does not mention experience in many areas. Nurses reach the stages based on their individual abilities; thus, one cannot give definitive time frames for reaching the stages.
How is qualitative research different from quantitative research? Qualitative research: 1) Is more valid when large numbers of participants are studied 2) Reports data in the form of words 3) Is less useful than quantitative research 4) Requires careful attention to methods and techniques
Answer: 2) Reports data in the form of words Rationale: Qualitative data are primarily reported in the form of words, not numbers. Qualitative research focuses on individual experience and usually involves only a few participants (subjects); unlike quantitative research, the focus is not on generalizing the results to wider populations. Qualitative methods are scientific and legitimate. All types of research require careful attention to methods for collecting, analyzing, and reporting data findings; therefore, this feature cannot be used to differentiate between qualitative and quantitative approaches.
Which of the following best explains why it is difficult for the profession to develop a definition of nursing? 1) There are too many different and conflicting images of nurses. 2) There are constant changes in healthcare and the activities of nurses. 3) There is disagreement among the different nursing organizations. 4) There are different education pathways and levels of practice.
Answer: 2) There are constant changes in healthcare and the activities of nurses. Rationale: The conflicting images of nursing make it more important to develop a definition; they may also make it more difficult but not to the extent that constant change does. Healthcare is constantly changing and with it come changes in where, how, and what nursing care is delivered. Constant changes make it difficult to develop a definition. Although different nursing organizations have different definitions, they are similar in most ways. The different education pathways affect entry into practice, not the definition of nursing
What is the error in the following nursing order: "7-21-15—Using 2 persons, assist the patient from bed to chair 3 times per day. Jerry Xeno, RN"? 1) There is no action verb. 2) There are no times or limits. 3) Nurses do not need to sign nursing orders. 4) The order is too long and complex.
Answer: 2) There are no times or limits. Rationale: The action verb is assist. Although the order includes instructions to use 2 persons to assist the patient out of bed, and to do that 3 times per day, it needs further clarification with regard to times and limits. That is, it does not say when to get the patient out of bed (e.g., every 8 hours, once per shift), and it does not say how long the patient is to remain in the chair. Nurses do need to sign nursing orders for accountability. The order is not too long and complex; in fact, it needs more information.
The student nurse asks her preceptor why the patient is being discharged 2 days after surgery when he still needs wound care and help with basic hygiene. The preceptor should educate the student nurse on which concept? 1) Preferred Provider Organizations (PPOs) 2) Health Maintenance Organizations (HMOs) 3) Diagnosis-Related Groups (DRGs) 4) Point of Service (POS)
Answer: 3) Diagnosis-Related Groups Rationale: Discharge planning begins on admission. A diagnosis-related group is a prospective reimbursement system. Insurance companies will reimburse hospitals on a per-case flat rate determined by patient groups (DRGs). Hospitals will lose money if the patient's hospital costs are greater than the amount reimbursed. Therefore, a patient's length of stay corresponds with the reimbursement rate. The patient will be discharged and followed up by home healthcare nurses.
In preparing to teach parents about their school-age children, the nurse should be aware of which of the following considerations? A. Increased mobility increases the risk for falls. B. Increased excursions increase the risk of accidents. C. Decreased motor skills are typical of this stage. D. The child may have difficulty adjusting to increased autonomy.
Answer: B. Increased excursions increase the risk of accidents. Rationale: School-age children are involved in increasing activities outside the home or away from the family. They have increased educational needs for accident and safety awareness. Fall risk related to increased motility refers to toddlers, reduced motor skills occurs in older adults, and adjusting to autonomy refers to adolescents.
The NSNA is the professional organization for which of the following? a. Newly licensed nurses b. Student nurses c. Licensed practical nurses d. Certified nursing assistants
Answer: B. Student nurses
A mother and father have brought their school-age child to the emergency department with injuries that cause the nurse to suspect child abuse. The nurse wishes to assess further for abuse and neglect. Which of the following should the nurse do? 1) Interview the parents together and the child separately. 2) Have one parent in the room to reassure the child during the interview. 3) Interview the child and each parent separately. 4) Request that a sexual assault nurse examiner interview the family members.
Answer: 3) Interview the child and each parent separately. Rationale: Interviewing each family member separately allows the suspected victim more freedom to express concerns. An abused person may be afraid to talk with the abuser present and may even support the abuser's version of events. If two adults accompany a child, the situation still does not allow such freedom, because it may be that one of the adults is abusing both the partner and child. The nurse should separate the caregivers and child to be certain they all tell the same story. A SANE is needed to perform the physical examination only if sexual abuse is suspected from the interview.
Hildegard Peplau was a nursing theorist whose major contribution to nursing was: 1) Transcultural nursing 2) Health promotion 3) Nurse-patient relationship 4) Holistic comfort
Answer: 3) Nurse-patient relationship. Rationale: Hildegard Peplau was a psychiatric nurse who showed that developing a relationship with psychiatric patients made their treatment more effective. From her work, she developed the Theory of Interpersonal Relations, which focuses on the nurse-patient relationship. This theory is in use every day in nursing.
Which of the following aspects of nursing is essential to defining it as both a profession and a discipline? 1) Established standards of care 2) Professional organizations 3) Practice supported by scientific research 4) Activities determined by a scope of practice
Answer: 3) Practice supported by scientific research Rationale: The ANA has developed standards of care, but they are unrelated to defining nursing as a profession or discipline. Having professional organizations is not included in accepted characteristics of either a profession or a discipline. A profession must have knowledge that is based on technical and scientific knowledge. The theoretical knowledge of a discipline must be based on research, so both are scientifically based. Having a scope of practice is not included in accepted characteristics of either a profession or a discipline.
According to Maslow's Hierarchy of Needs, which patient need should the nurse address first? 1) Protecting the patient against falls 2) Protecting the patient from an abusive spouse 3) Promoting sleep and rest in the critically ill patient 4) Promoting self-esteem after a body image change
Answer: 3) Promoting sleep and rest in the critically ill patient Rationale: According to Maslow's Hierarchy of Needs, basic physiological needs should be met first. They include the need for rest, food, air, water, temperature regulation, elimination, sex, and physical activity. Therefore, the nurse should address the critically ill patient's need for rest first.
Which nurse is most clearly using evidence-based practice? One who uses an intervention: 1) He read about in a study in a nursing research journal 2) From the agency's critical pathway in the electronic health record 3) Published in the clinical practice guidelines of a national organization 4) That is individualized to meet a specific patient need
Answer: 3) Published in the clinical practice guidelines of a national organization Rationale: Clinical practice guidelines provide the best evidence because they are usually developed by scientists and qualified healthcare professionals after a thorough review and evaluation of the available evidence for an intervention. An individual study published in a nursing journal can provide some applicable evidence; however, it might not be as scientifically sound as a body of studies of the same intervention. Critical pathways are not always evidence based. The nurse should always individualize interventions, as needed, to meet specific patient needs; however, this answer does not state that the intervention being individualized has any basis in evidence.
According to Fowler's Theory of Faith Development, the faith expressed by someone during which stage reflects a drawing together of stories, values, and beliefs? 1) Mythic-literal faith 2) Individuative-reflective faith 3) Synthetic-conventional faith 4) Intuitive-projective faith
Answer: 3) Synthetic-conventional faith Rationale: This stage begins in early adolescence. This coincides with Piaget's stage of formal operations. The faith expressed by someone at this stage reflects a drawing together of stories, values, and beliefs that have been learned over time into a unified whole.
The patient says to the Charge Nurse, "I have a great group of nurses. The RN and UAP are all very attentive to my care needs and work very well together." Which nursing model of care is this unit following? 1) Team nursing 2) Case method nursing 3) Functional nursing 4) Primary nursing
Answer: 3) Team nursing Rationale: With team nursing, an RN or LVN is paired with a NAP. The pair is then assigned to render care for a group of patients. In case method nursing, one nurse cares for one patient during the entire shift. Private duty nursing is an example of this care model. This nursing unit is following the functional nursing model of care in which care is partitioned and assigned to a staff member with the appropriate skills. For example, the NAP is assigned vital signs, and the LVN is assigned medication administration. When the primary nursing model is used, one nurse manages care for a group of patients 24 hours a day, even though others provide care during part of the day.
According to developmental norms, at what age does the greatest increase in height occur? 1) 1 to 3 years 2) 4 to 5 years 3) 6 to 11 years 4) 12 to 18 years
Answer: 4) 12 to 18 years Rationale: Twelve- to 18-year-old females grow 2 to 8 inches, and males grow 4 to 12 inches. Growth is about 3 inches for children during years 1 to 3 and 4 to 5. Growth is about 2 inches during the sixth and up to the 12th year.
Which of the following is a collaborative intervention? 1) Rubbing patient's back to facilitate relaxation 2) Measuring the patient's blood pressure 3) Assessing the patient's educational needs related to discharge 4) Administering prescribed medications to a patient
Answer: 4) Administering prescribed medications to a patient Rationale: Administering medications requires a physician's order and pharmacist to dispense; it is therefore a collaborative intervention for the nurse. The other options are independent nursing actions.
List the five components of a nursing order.
Answer: Date, subject, action verb, times and limits, signature
The nurse is planning to discuss the psychosocial challenges of middle adulthood with a community group. Which of the following should be included in the discussion? 1) There is an unavoidable decline in health in middle adulthood. 2) There are significant age-related body changes that affect health. 3) Work is more challenging because the productive years have passed. 4) Along with raising children, there is often the concern of aging parents.
Answer: 4) Along with raising children, there is often the concern of aging parents. Rationale: Middle adults often have competing demands of raising children and caring for aging parents along with the demands of a job. There is not a noticeable decline in health, although energy levels may decline. There are some age-related changes (loss of skin turgor, muscle tone, etc.), but they are not as significant as they are during older adulthood, and as a rule they do not affect health. During middle adulthood, a person is usually at the peak of his career, but it is also the peak of creativity.
The nurse assesses her patient to determine whether his condition has changed since her assessment 4 hours earlier. What process is the nurse using? 1) Critical thinking 2) Reciprocity 3) Problem-solving 4) Clinical judgment
Answer: 4) Clinical judgment Rationale: Clinical judgment involves observing, comparing, contrasting, and evaluating the client's condition to determine whether the patient's condition has changed. The nurse must know what to expect based on the patient's condition and treatment regimen. The nurse then uses critical thinking to analyze the information and determine options for care. Reciprocity is used by nurses licensed in one state to obtain a license to practice nursing in another state.
A patient has a diagnosis Impaired Walking related to knee pain secondary to arthritis. The nurse has written the following set of nursing orders for that diagnosis. Provide passive range of motion to the affected knee 3 times per day. Assist the patient to walk to the bathroom and at least 3 times per day. Which of the following is a valid criticism of this set of orders? The orders 1) Are too long and complex. 2) Do not address the etiology of the nursing diagnosis. 3) Do not address the problem side of the nursing diagnosis. 4) Should not include the words "secondary to arthritis."
Answer: 4) Do not address the etiology (knee pain) of the nursing diagnosis. Rationale: Although nursing interventions sometimes flow from the problem side of a diagnosis, there must always be some interventions that address the etiology of the diagnosis. Otherwise, the nurse is merely treating the symptoms, rather than removing factors that contribute to the problem. In this instance, if the patient's pain is treated, the diagnosis of Impaired Walking may no longer exist. These orders are not too long and complex. Also, it is acceptable to include a medical diagnosis, such as arthritis, if it aids in understanding the patient's problem and if it is preceded by the words "secondary to."
A nurse has an educational background that prepares her to manage research projects. Which nursing degree does this nurse most likely hold? 1) Associate degree 2) Baccalaureate degree 3) Master's degree 4) Doctoral degree
Answer: 4) Doctoral degree Rationale: Doctorally prepared nurses are specifically educated to become nurse researchers.
What is wrong with this nursing order? "3/10/2015. Provide measures to relieve anxiety at every patient contact. J. King, RN" 1) Lacks a target time 2) Does not contain a verb 3) Should not be signed 4) Is vaguely worded
Answer: 4) Is vaguely worded Rationale: The nursing order is vaguely worded and is not individualized. It should specify which measures to use to relieve the patient's anxiety. Goals, not nursing interventions, need target times. In this order, provide is not an action verb. Nursing orders should be signed, so that is not an error.
Most nurses see nursing as focusing on the entire person and his response to cellular changes. This global perspective of nursing is known as a nursing: 1) Framework 2) Theory 3) Model 4) Paradigm
Answer: 4) Paradigm Rationale: A paradigm is a worldview or an ideology. It is the most global conceptual framework of a discipline. The nursing paradigm includes the entire person and his whole-person responses to changes in his cells and organs. A conceptual framework is a set of concepts that are related to form a whole or pattern. A model is a symbolic representation of a framework or concept—a diagram, graph, picture, drawing, or physical model. Models are developed to promote understanding of concepts. In a theory, the relationships among the concepts are described in more detail and assumptions are stated.
A 34-year-old patient who suffered a stroke has right-sided weakness and impaired mobility. Which facility will the patient be sent to after discharge from the hospital? 1) Assistive living 2) Behavioral health center 3) Independent living facility 4) Rehabilitation center
Answer: 4) Rehabilitation center Rationale: Rehabilitation centers employ respiratory therapists, physical therapists, speech-language pathologists, occupational therapists, nurses, and other healthcare providers to treat stable patients who require additional treatment. The patient will, at the least, require physical therapist and occupational therapy. Physical therapists help patients regain muscle functioning and mobility. Occupational therapists help patients regain function and independence.
Which of the following nursing activities is a direct-care intervention? 1) Consulting with the nurse practitioner about a patient's medication 2) Telephoning the physician when a pain medication is not relieving the patient's pain 3) Checking and stocking the unit's resuscitation cart daily 4) Sitting with a patient who is anxious about his upcoming surgery
Answer: 4) Sitting with a patient who is anxious about his upcoming surgery Rationale: Direct-care interventions are performed through interaction with the patient (e.g., patient teaching). Indirect-care interventions are performed away from the patient but on behalf of the patient or a group of patients.
Why does a clinical practice guideline provide better support for an intervention than does a single study?
Answer: A clinical practice guideline provides better support because it includes more data and multiple studies. A single study may have included only a few patients and may not be reliable because of that or for other methodological reasons. Considering many studies removes some of the bias.
Which of the following is not a characteristic of young adults? A. Problem-solving skills are reduced and motor skills are slower. B. There is a strong need to achieve intellectually. C. Physical maturation is complete. D. Work, intimacy, and parenting are priorities.
Answer: A. Problem-solving skills are reduced and motor skills are slower. Rationale: In the young adult, thought processes and mental abilities are well established. Young adulthood is usually the healthiest stage of a person's life.
According to the American Nurses Association standards of practice, which of the following are you expected to do as a registered nurse? Choose all correct answers. A. Plan a study and choose the research design and methods. B. Formulate the hypothesis for a study planned by the lead researcher on a project. C. Use current research in planning nursing care. D. Use evidence-based interventions specific to a patient's problem.
Answer: C and D Rationale: Nurses who have master's and doctoral degrees are responsible for designing and conducting research. The ANA standards of practice require nurses with a basic level of preparation to find and use research in planning and implementing patient care.
Lydia, an 85-year-old woman, expresses concerns about her living situation. She lives alone, has very few friends, and has no immediate family in the city. She has felt sad and lonely and has not been eating well. Using Maslow's Hierarchy of Needs to prioritize her care needs, which of the following would be the initial focus of care? A. Safety B. Love C. Physiological D. Self-esteem
Answer: C. Physiological Rationale: Maslow's hierarchy flows in order of priority as follows: physiology, safety, love, self-esteem, and finally self-actualization.
In what stage do the psychosocial developmental aspects striving for individuality, exploring one's abilities, and associative play occur? A. Toddler B. Infant C. Preschool D. Adolescent
Answer: C. Preschool Rationale: Adolescents are striving for identity, toddlers for autonomy, and infants for trust.
In preparing a patient education plan for an adolescent, the nurse should consider which of the following? A. Adolescents are faced with special concerns about their occupation. B. Family relationships are of minimal importance at this developmental stage. C. The intense privacy needs of adolescents may impede their learning about their healthcare. D. Adolescents are concerned with performance and academic expectations, which may impede their learning about their healthcare.
Answer: C. The intense privacy needs of adolescents may impede their learning about their healthcare. Rationale: Adolescents are struggling with issues of independence and identity, which can increase their need for privacy, creating some barriers to learning.
List three skills or types of knowledge that nurses need for determining nursing interventions.
Answer: Clinical judgment Critical thinking Past experience Answers might also include theoretical, practical, personal, and ethical knowledge; psychomotor and nursing process skills.
Why does a clinical practice guideline provide better support for an intervention than does an agency's critical pathway?
Answer: Critical pathways may not always be evidence based, but clinical practice guidelines are always evidence based. Critical pathways are developed by the agency's practitioners, who may be reluctant to change some of the traditional practices that they believe to be effective. Also, some institutions may omit interventions they do not consider to be cost effective.
What type of custodial care activities can the RN assign to the NAP? a. Assisting the patient with grooming b. Walking the stable patient c. Changing the patient's wound dressing d. A and B only
Answer: D. A and B only Rationale: The NAP can provide custodial care that consists of helping patients with activities of daily living such as bathing, grooming, eating, and toileting. The NAP works under the direction/supervision of the RN.
Which of the following activities is a nurse/physician collaborative intervention for Joan R.? (Assume that all the interventions are appropriate.) A. Rubbing the patient's back to facilitate relaxation B. Encouraging the patient to discuss her fears about surgery C. Assessing the patient's educational needs related to discharge D. Administering medication to reduce fever and offering Joan up to 500 mL of fluid per shift
Answer: D. Administering medication and offering fluids Rationale: Reducing the patient's fever helps to conserve body fluids, and increasing her fluid intake by mouth will supplement the IV fluids. Administering medications and IV fluids are physician orders that require nursing judgment when implementing.
Joan R., a 65-year-old woman, was brought to the hospital by her husband. He reported that "she has barely eaten this week, been very quiet, and complains of dizziness, nausea, and a severe headache." Her medical diagnosis includes dehydration. The doctor orders IV fluids at 150 mL/hr. Nursing care includes assessing vital signs every 4 hours, monitoring fluid intake and output, and providing sips of water as tolerated. Which of the following describes the interventions to treat her fluid deficit? A. Physician prescribed B. Nursing prescribed C. Nurse/client prescribed D. Collaborative
Answer: D. Collaborative Rationale: Joan is experiencing a problem that requires collaborative care. There will be primary provider-prescribed interventions, such as IV fluids and medication. She will also benefit from nursing interventions, such as offering sips of water, monitoring body temperature, and administering medication as prescribed.
Which of the following is not an essential component of a nursing theory? A. Environment B. Nurse C. Person D. Holistic care
Answer: D. Holistic care Rationale: Holistic care is not the fourth component of a nursing theory; health is.
In the United States, the practice of nursing is regulated by which of the following? a. ANA's Code for Nurses With Interpretive Statements b. ANA's Nursing's Social Policy Statement c. ANA's Standards for Nursing Practice d. State nurse practice acts
Answer: D. State nurse practice acts Rationale: Each state's nurse practice act defines and regulates the scope and practice of nursing within the state. State nurse practice acts legally define nursing and are the laws that regulate the scope of practice for all levels of nursing within a state. The ANA Code for Nurses and Nursing's Social Policy Statement and Standards "provide a means by which a profession clearly describes the focus of its activities, the recipients of service, and the responsibilities for which its practitioners are accountable" (ANA, 1998, p. vii). Standards are guidelines that the profession develops to promote the delivery of quality care by competent professionals.
When developing patient care plans, it is important to remember that nursing orders include which of the following? A. Outcomes B. Theories C. Collaborative problems D. Strategies
Answer: D. Strategies Rationale: Strategies are the activities for enacting the nursing interventions, whereas collaborative problems are developed in the diagnostic phase. Outcomes are the goals to be achieved with intervention. Theories are the frameworks we use as a knowledge base to develop our plans of care.
To be considered a discipline, a profession must have a _____________________ that has theoretical and practical boundaries.
Answer: Domain of knowledge Rationale: The theoretical boundaries of a healthcare profession are the questions that arise from clinical practice and are then investigated through research. The practical boundaries are the current state of knowledge and research in the field. To be considered a discipline, a profession must have a domain of knowledge that has both theoretical and practical boundaries (Meleis, 1991).
Nursing research studies have little effect on the quality of care.
Answer: False
General systems theory describes human systems as closed and dynamic. True False
Answer: False Rationale: Human systems are open and dynamic.
Orem's theory focuses on how the nurse and family can meet the patient's needs. True False
Answer: False Rationale: Orem's theory focuses on the patients' ability to meet their own needs and on the nurse and/or family assisting as required by patients' self-care deficits.
The purpose of nursing care is to achieve the goals of__________, illness prevention, __________, and end-of-life care.
Answer: Health promotion, health restoration
__________ nursing practice considers a client, the family, and the community.
Answer: Holistic
According to the American Nurses Association, nursing is the diagnosis and treatment of ____________________________________________.
Answer: Human responses to actual and potential health problems Rationale: In 1980, the ANA defined nursing as the diagnosis and treatment of human responses to actual and potential health problems. This definition continues to be the nursing profession's standard.
In the NIC system, what is the difference between interventions and activities?
Answer: Interventions are broad, general, two- or three-word labels (names); they are the standardized part of the language. Activities are the more specific actions the nurse performs in carrying out the intervention; they are not standardized.
Name and describe three standardized intervention vocabularies recognized by the ANA.
Answer: NIC. Consists of 542 interventions with associated activities. Can be used in all specialties. Does not include nursing diagnoses and patient outcomes. Clinical Care Classification (CCC). Designed for home healthcare. Has 198 interventions; also includes diagnoses and outcomes. Omaha System. Designed for community health. Includes diagnoses and outcomes. Has 63 "targets" for intervention that you combine with four "categories" to make the intervention statement.
Whose theory is based on self-care abilities?
Answer: Orem's theory
five stages of nursing competence
Answer: Stage 1: Novice. This phase begins with the onset of education. The novice is receptive to education and is learning the rules. Stage 2: Advanced Beginner. After considerable exposure to clinical situations, performance improves and the nurse begins to recognize elements of a situation. The result is progression to the advanced beginner stage. Stage 3: Competence. After several years of practice, this stage is achieved. Competent performers have gained additional experience and wrestle with more complex concerns. They are able to handle their patient load and prioritize situations. They are also more involved in their caregiving role and may be emotionally involved in the clinical choices made. Stage 4: Proficient. Proficient nurses are a resource for newer nurses. They are able to see the "big picture," coordinate services, forecast needs, and plan intuitively as well as consciously. Stage 5: Expert. Expert nurses are able to see what needs to be achieved and how to do it. They trust in and use their intuition. They have expert skills and are often consulted when others need advice or assistance.
Identify five factors that influence the prioritization of nursing problems.
Answer: The patient's condition New data from reassessment Time and resources available for the nursing interventions The nurse's level of expertise and experience in assessment and setting priorities Feedback from the patient, family, or other healthcare workers Evidence base
A nurse is in the process of generating and selecting nursing interventions for a patient. Number the following steps in the order in which they should occur. 1) Choose the best interventions for the patient. 2) Identify several interventions or actions. 3) Review the desired patient outcomes. 4) Review the nursing diagnosis. 5) Individualize standardized interventions to meet the patient's unique needs.
Answer: The steps should be done in the following order: 4, 3, 2, 1, 5 Rationale: The process of generating and selecting interventions occurs in the following order: 1) Review the nursing diagnosis. 2) Review the desired patient outcomes. 3) Identify several interventions or actions. 4) Choose the best interventions for the patient. 5) Individualize standardized interventions to meet the patient's unique needs. Interventions flow from diagnoses and outcomes. Many interventions may be available for a patient problem; select the ones that are best for the patient. If you are using standardized plans of care, protocols, and so forth, you will need to individualize standardized interventions to meet the patient's unique needs.
Explain how theory influences your choice of nursing interventions.
Answer: Theories influence your perspective: what you notice, what you consider to be a problem, how you define a problem, and what you choose to do about it.
Implementation refers to the action phase of the nursing process in which nursing care is provided.
Answer: True
Maslow's theory is based on a hierarchy of human needs. True False
Answer: True
Nurses manage collaborative problems using nursing and physician-prescribed interventions.
Answer: True
Nursing theory should be based on reliable and valid data. True False
Answer: True Rationale: All theories should be based on data that have been tested and found to be reliable and valid.
A conceptual framework contains abstract concepts and propositions. True False
Answer: True Rationale: Conceptual frameworks are more abstract than theories.
True or False: Informed consent requires the written consent of a study participant._______
Answer: True Rationale: Consent must usually be obtained from every participant in a study. It is obtained by discussing what is expected of the person, providing written information on the project to participants, and obtaining the participant's written consent to be a subject.
Nursing interventions are performed for the purpose of assessing health status, preventing and treating illness or disease, and promoting health.
Answer: True Rationale: Nursing interventions are actions based on clinical judgment and nursing knowledge. They are performed for the purpose of assessing health status, preventing and treating illness or disease, and promoting health.
(Complete this statement.) Nursing research is based on the ____________________ method.
Answer: scientific Rationale: Nursing research is based on the scientific method. It is the process in which the researcher, through use of senses, systematically collects observable, verifiable data to describe, explain, or predict events.
In Maslow's theory, ___________ is the need to develop one's maximum potential.
Answer: self-actualization
(Complete this statement.) A 23-year-old athlete decides to donate bone marrow for a child who requires a bone marrow transplant to fight leukemia. According to Maslow's later work, this athlete is fulfilling his need for ____________________.
Answer: self-transcendence Rationale: Self-transcendence is the drive to connect to something beyond oneself and to help others recognize their potential. Donating bone marrow to someone to improve his or her life fulfills the need for self-transcendence.
___________ ________________ are nurse-initiated treatments—those that nurses perform or delegate based on their knowledge and skills.
Independent interventions
Identify two outside forces that influence the nursing profession.
National economy, consumers, direct-to-consumer marketing, the women's movement, collective bargaining
Describe a five-step process for generating and choosing nursing interventions.
Review the nursing diagnosis. Nursing orders should flow from the etiology and sometimes from the problem side of the diagnosis. Review the desired patient outcomes. Outcomes suggest nursing strategies that are specific to the individual patient. Identify several interventions/actions. Identify those that might achieve the desired outcomes for the nursing diagnosis. Choose the best interventions for this patient. Choose those expected to be most effective in helping to achieve client goals. Individualize the standardized interventions. They should be structured to meet the unique needs of the patient.
the ____________ period (6 to 12 years) begins to develop relationships outside the home. This leads to increasing confidence and independence.
adolescent
Developmental theories help nurses identify what to expect _________ , _________, _________ and ___________ from patients at various ages.
behaviorally, cognitively, socially, and morally
Between ___________ and ______________, infants develop a sense of trust when the caregiver provides the child with love, warmth, and food.
birth, first year
Critical adaptations at birth include the establishment of respirations and independent _____________, _____________ and the production of __________.
circulation, thermoregulation, urine
growth begins at the time of conception and continues for 10 lunar months until birth.
fetal
Theory provides the _________ for nursing knowledge, gives direction to nursing practice, and guides the future direction of nursing research.
foundation
state whether the following is Health promotion, Illness prevention or Health restoration -Activities that foster the highest state of well-being of the recipient
health promotion
state whether the following is Health promotion, Illness prevention or Health restoration -Activities that foster a return to health for those already ill
health restoration
state whether the following is Health promotion, Illness prevention or Health restoration -Focus on avoidance of disease
illness prevention
_____________ __________________ (40 to 65 years) is a time when people balance aspirations with reality. It is often a time when the needs of children diminish whereas the needs of aging parents increase.
middle adulthood
______________________________ are laws that regulate nursing practice at the state level.
nurse practice acts
include such activities as teaching, counseling and emotional support, referral, physical care, and environmental management.
nursing interventions
__________ ___________, written on the nursing care plan, consist of the detailed instructions for performing nursing interventions.
nursing orders
Nurses use ________________ as an evidence-based framework for their nursing practice.
theories
_______________ help nurses (1) find meaning in their experiences of nursing; (2) organize their thinking around pertinent ideas; and (3) develop new, evidence-based ideas and insights into the work they do.
theories
A ___________ contains highly concrete and specific concepts and propositions. A. Theory B. Hypothesis C. Research project D. Conceptual framework
theory
___________ period (12 to 36 months) is the time when the child explores the environment and attempts to become autonomous.
toddler
(t or f) Managed care models of insurances (HMOs, PPOs, POS, IDNs) reduce cost by reimbursing providers at discounted, predetermined rates and limiting the consumers' choice of providers.
true
(t or f) Growth and development occur across the life span in a predictable pattern.
true
the _______ ____________ (20 to 40 years) leaves home and begins to function as an independent person.
young adult
