172.4 Ethical and patient safety

The nurse is assessing a client diagnosed with chronic bronchitis who has been experiencing an increase in dyspnea. The client lives within 2 blocks of a factory that emits pollution into the air. In light of this information, the nurse is primarily concerned with:

Identifying a correlation between the pollution and the clients increased dyspnea

A nurse working with clients at or below the poverty level recognizes that the life expectancy of these clients is lower than the general population because of: (select all that apply.)

Inadequate nutritional diets High-risk work environment Hazardous living environments Addictive and abusive lifestyles

The student nurse is investigating different types of practice settings. In looking at community health nursing, the student recognizes that it:

Includes direct care and services to subpopulations

One of the overall goals of Healthy People 2010 is to:

Increase life expectancy

Nurses are caring for clients from a variety of cultures primarily as a result of:

Increased ease of travel and mobility

The Goldmark Report concluded that:

Increased financial support should be provided for nursing education

Nurses need to be aware of current trends in the health care delivery system in order to respond in educational preparation and practice. A major trend that is influencing nursing practice today is:

Increased incidence of chronic disease processes

Changes in recent population demographics that have impacted the delivery of nursing care include the following: (Select all that apply.)

Increased life expectancy Decreasing rural population Expanding urban settlement

A client had a surgical procedure with spinal anesthesia. The client's blood pressure was 122/78 mm Hg 30 minutes ago and is now 138/60 and the client reports nausea. What action vey the nurse is best?

Notify the primary health care provider

The best example of the impact of the womens movement on health care is:

Women subjects to be included in all appropriate health research projects

Nurses have the opportunity to work in a wide variety of health care agencies around the world. The practice setting where the majority of nurses continue to work is:

Acute care

To facilitate change within a community, the nurse working as an effective change agent should:

Work with clients and groups to select alternative health care sites and treatments

A client has a recurrence of gastric cancer and is crying. What response by the nurse is most appropriate?

Would you tell me what you are feeling now?

The nurse is teaching a client who has been treated for acute gastritis. What statement by the client indicates a need for further teaching?

"I will only take ibuprofen once in a while when I really need it."

A nurse is giving a client instructions for showering the night before surgery. What instruction is most appropriate?

"Use the prescribed solution and wash the area where you will have surgery very thoroughly."

Which of the following educational activities is an example of in-service education?

A program on new cardiac medications provided at a local hospital

Which one of the following clients from a vulnerable population currently appears to be at the greatest risk?

A substance abuser who shares drug paraphernalia

In the ANA Standards of Professional Performance, which one of the following is a specific measurement criterion for The nurses decisions and actions on behalf of clients are determined in an ethical manner?

Acts as client advocate

A homeless client has presented in the ED with a bacterial infection in a hand wound. The nurse has cleansed and dressed the wound, and an initial dose of an antibiotic has been administered. the client will need the antibiotic prescription filled and a dressing change in 3 days. In order to ensure that the client will receive the appropriate follow-up care, the nurse must first act as the clients:

Advocate

Levels of prevention are used by the nurse to provide a framework or guide for nursing interventions. Focus is based on the clients needs and the care or service that is provided. An example of a true health promotion service is a(n):

Aerobic dance class

A postoperative client has just been admitted to the postanesthesia care unit (PACU). What assessment by the PACU nurse takes priority?

Airway

A group that lobbies at the state and federal level for advancement of nursings role, economic interest, and health care is the:

American Nurses Association

To obtain a certification in a specialty area, the nurse will have to complete:

An examination and the minimum practice requirements

As a community health nurse assisting the client and family with nutritional needs the nurse should first:

Ask the client and family what they think they should eat

A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best?

Assess the client for anxiety

The perioperative nurse manager and the postoperative unit manager are concerned about the increasing number of surgical infections in their hospital. What action by the managers is best?

Audit charts to see if the Surgical Care Improvement Project (SCIP) outcomes were met.

A postoperative client vomited. After cleaning and comforting the client, which action by the nurse is most important?

Auscultate lung sounds.

A community nurse has identified a need for educational programming among the residents of an assistive living facility dealing with osteoarthritis. The best example of such programming is:

Be an informed consumerdont fall for false arthritis cures.

A nurse on the postsurgical inpatient unit is observing a client perform leg exercises. What action by the client indicates a need for further instruction?

Bends both knees, pushes against the bed until calf and thigh muscles contract

The postanesthesia care unit (PACU) charge nurse notes vital signs on four postoperative clients. Which client would the nurse assess first?

Client with a respiratory rate of 6 breaths/min

The nurse recognizes which of the following as the largest contributing factor for the rise in the need and use of home care?

Clients are more acutely ill when discharged from the acute care facility.

A nurse assesses a client in the preoperative holding area and finds brittle nails and hair, dry skin turgor, and muscle wasting. What action by the nurse is best?

Consult the primary health care provider about a dietitian referral.

When assessing members of a vulnerable population, the community health nurse should realize that the primary need is to:

Create a comfortable, nonthreatening environment.

A client has a great deal of pain when coughing and deep breathing after abdominal surgery despite having pain medication. What action by the nurse is best?

Demonstrate how to splint the incision.

The nurse assists the client in a health promotion activity that also reduces the cost of health care delivery when:

Discussing exercise and nutrition

An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best?

Do not have the client sign the consent and call the primary health care provider.

A client who had a partial gastrectomy 3 days ago begins to experience vertigo, sweating, and tachycardia about 30 minutes after eating breakfast. What postoperative complication would the nurse suspect?

Dumping syndrome

The nurse is caring for a client who has frequent gastric pain and dyspepsia. Which procedure would the nurse expect for the client to make an accurate diagnosis?

Esophagogastroduodenoscopy (EGD)

The twentieth century is recognized for which of the following nursing concepts?

Formalized university-based nursing education

The postoperative nurse is caring for a client who reports feeling "something popped" after vomiting. What action by the nurse is best?

Gather sterile non adherent dressings

Which of the following statements best reflects Nightingales nursing philosophy on health maintenance and restoration?

Have any clients developed a nosocomial infection last month?

Contemporary nursing practice is based on knowledge generated through nursing theories. Florence Nightingales theory introduced the concept that nursing care focuses on:

Health maintenance and restoration

In 1893 Lillian Wald and Mary Brewster made significant contributions to the nursing profession through their work involving the:

Henry Street Settlement in New York

A new perioperative nurse is receiving orientation to the surgical area and learns about the Surgical Care Improvement Project (SCIP) goals. What major areas do these measures focus on? (Select all that apply.)

Infection prevention Thromboembolism prevent Correct hair removal

The nurse is best able to provide quality care that benefits both client and family by:

Integrating the science and art of nursing into the practice

Which of the following statements by the home health nurse best reflects client advocacy in response to the clients concern over the expense of the therapy?

Lets call the regional dialysis center and explore options for reducing the cost of your home dialysis.

A nurse is caring for a client who has chronic renal failure. The nurse states, We will do everything possible to return you to the optimum level of self-care possible. In coordinating an approach to best meet the needs of this client, the nurse is fulfilling the role of:

Manager

A nurse moves from Seattle to Boston and begins working in a hospital. The most important factor for the nurse to consider when moving to another state is the:

Massachusetts Nurse Practice Act

The minimum educational requirement for a nurse practitioner is:

Master in nursing

A postoperative client has respiratory depression after receiving morphine for pain. Which medication and dose does the nurse prepare to administer?

Naloxone 0.4 to 2mg

Nursing education programs in the United States may seek voluntary accreditation by the appropriate accrediting commission council of the:

National League for nursing

The human rights movement most directly impacts nursing practice because:

Nurses act as advocates for all clients

In assessing the structure of the community in order to identify the needs of its population, the nurse will focus on:

Observing locations where services, such as water sanitation, are provided

A client is receiving Dilantin to prevent seizure activity. To which allied health care professional should the nurse refer this client in order to minimize the challenges this condition creates?

Occupational therapist

A nurse works on the postoperative floor and has four clients who are being discharged tomorrow. Which one has the greatest need for the nurse to consult other members of the health care team for postdischarge care?

Older adult who lives alone at home despite some memory loss.

A contractual agreement between a hospital and a corporation to pay the health care expenses of the corporations employees is an example of a(n):

PPO-A preferred provider organization (PPO)

A client has arrived in the inpatient postoperative unit. What action by the inpatient nurse takes priority?

Participating in hand-off report

A client has a nasogastric (NG) tube as a result of an upper gastrointestinal (GI) hemorrhage. What comfort measure would the nurse remind assistive personnel (AP) to provide?

Performing frequent oral care

The nurse working in a free clinic is caring for a homeless client diagnosed with paranoid schizophrenia who has reported that, I hurt my foot running away from them. It hurts so bad I can hardly walk now. On assessment the nurse notices bruising on the clients back, arms, and thighs, a red rash on both neck and face, and poor personal hygiene, in addition to edema of the left ankle. The nurse should first realize that this client is at risk for:

Physical abuse and assault

The client is being discharged from an acute care facility following a total hip replacement. She will need follow-up for her rehabilitation and exercise plan. In addition to a home health care nurse, what referral should be discussed?

Physical therapist

A preoperative nurse is reviewing morning laboratory values on four clients waiting for surgery. Which result warrants immediate communication with the surgical team?

Potassium: 2.9 mEq/L (2.9 mmol/L)

Regulatory interventions were initiated to reduce the rise in health care costs. These interventions include:

Prospective payment systems

The nurse working in a free clinic often utilized by Hispanic immigrants is assessing a client who reports a cough and malaise. The client is hearing impaired, speaks very little English and is currently living in a homeless shelter. The nurses primary concerns should be the clients:

Risk for tuberculosis

Which of the following activities reflect the nurses role in health promotion and wellness? (Select all that apply.)

Screening the local homeless population for head lice Monitoring blood pressures at a community health fair Consulting a teenage mother on breast-feeding techniques Providing literature on smoking cessation to client families

A registered nurse (RN) is watching a new nurse change a dressing and perform care around a Penrose drain. What action by the new nurse warrants intervention?

Securing the drain's safety pin to the sheets

A nurse is planning interventions for the clients of a homeless shelter. Which of the activities represents a primary level intervention regarding sexually transmitted diseases?

Sex education for teenage residents

A postoperative nurse is caring for a client who received a neuromuscular blocking agent during surgery. On assessment the nurse notes the client has weak hand grasps. What assessment does the nurse conduct next?

Signs of oxygenation

A client with peptic ulcer disease is in the emergency department and reports gastric pain that has gotten much worse over the last 24 hours. The client's blood pressure when lying down is 112/68 mm Hg and when standing is 98/52 mm Hg. What action by the nurse is most appropriate?

Start a large-bore IV with normal saline

There are many types of health care delivery agencies. An example of a secondary level care agency is a:

State-owned psychiatric hospital

The postanesthesia care unit (PACU) nurse is caring for an older client following a lengthy surgery. The client's pulse is 48 beats/min which is 20 beats/min lower than the preoperative baseline. What assessment does the nurse make next?

Temperature

A client with a history of a gastrointestinal disorder eats a well-balanced diet that keeps his GI symptoms suppressed. Which level of prevention corresponds to his dietary management?

Tertiary prevention

In looking at the nineteenth century, the growth of professional nursing was stimulated by:

The Civil War

A nurse is discussing the need to use a specific cleansing agent when redressing an infected hand. The client prefers using, plain old soap and water. The nurse knows that the primary factor that will affect client compliance is:

The clients acceptance of the need for the specialized care

Which of the following clients is a concern for the community health nurse? (Select all that apply.)

The homeless woman with a history of congestive heart failure The child of itinerant workers who has a developed asthma A client diagnosed with HIV who recently lost her insurance

A postoperative client has an abdominal drain. What assessment by the nurse indicates that goals for the priority client problems related to the drain are being met?

There is no redness, warmth, or drainage at the insertion site.

The nurse is caring for a client who has been diagnosed with peptic ulcer disease. For which complication would the nurse monitor?

Upper gastrointestinal (GI) bleeding

Risk for injury during client transfer is minimized most effectively by:

Use of evidence-based techniques

A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team?

Use of multiple herbs and supplements