Chapter 1 Health care delivery & Evidence based Nursing
According to Maslow, which category of needs represents the most basic on the hierarchy? A.) Physiologic needs B.) Self-actualization C.) Safety and security D.) Sense of belonging
Answer: A.) Physiologic needs
Which of the following delineates actions that are legally permitted for a particular profession based on specific educational qualifications A.) Scope of practice B.) Job description C.) Code of ethics D.) Occupational Health and Safety Administration (OSHA)
Answer: A.) Scope of practice
According to the Centers for Disease Control (CDC, 2006), this chronic illness has tripled in occurrence since 1980: A.) Cancer of the breast B.) Autism C.) Diabetes D.) End-stage renal disease
Answer: C.) Diabetes
Which of the following would NOT be categorized as a mid-level practitioner? A.) Nurse midwives B.) Nurse practitioners C.) Nursing assistants D.) Certified registered nurse anesthetists
Answer: C.) Nursing assistants
When functioning in the practitioner role, with which of the following would the nurse be involved? Select all that apply. - Providing direct care - Educating the patient and family - Coordinating with other disciplines - Implementing timely investigations of problems - Helping patients navigate through the complex health system
Answer: - Providing direct care - Educating the patient and family - Coordinating with other disciplines Rationale: In the practitioner role, the nurse helps patients meet their needs by using direct interventions, teaching patients and family members to perform care, and coordinating and collaborating with other disciplines to provide needed services. The researcher role involves implementing timely investigations of problems. A specialized role, the clinical nurse leader, helps patients navigate through complex health systems.
Which is not an important reason that nurses utilize research in nursing practice? A.) Validation B.) Dissemination C.) Replication D.) Financial obligation
Answer: D.) Financial obligation
The nurse is providing a program at the local YMCA about stress-reduction techniques combined with a 1-mile walk around the indoor track once a week. What does this type of program address for the community? A.) Health maintenance B.) Illness prevention C.) Early detection of illness D.) Health promotion
Answer: D.) Health promotion
Which of the following best reflects the rationale for evidence-based practice? A.) A means to ensure quality care B.) A process for accreditation C.) A method for determining reimbursement D.) A way to establish accountability
Answer: A.) A means to ensure quality care
Although nurse practice acts may vary state by state, all recognize several basic principles supporting the legal parameters for all registered nurses. Select the activity that falls under the scope of nursing practice. A.) Appraising and enhancing an individual's health-seeking perspective B.) Changing a patient's health care treatment plan C.) Diagnosing pathology based on the patient's response to treatment D.) Prescribing a physical therapy program to treat a flare-up of a chronic condition
Answer: A.) Appraising and enhancing an individual's health-seeking perspective
Which element would be included as a goal of case management? A.) Appropriateness of services B.) Prescriptive authority C.) Attainment of fixed-price reimbursement D.) Utilization of the nursing process
Answer: A.) Appropriateness of services
A nurse in a primary care physician's office has a 73-year-old female client who is interested in learning things she can do to maintain movement and flexibility while coping with osteoporosis. In what situation would this client still be considered healthy even though she has been diagnosed with a chronic disease? A.) Clients with a chronic illness can still achieve a high quality of life within the limits of the illness if they are physiologically stable and mentally healthy. B.) Clients with a chronic illness can never be considered healthy. C.) Clients with a chronic illness can be considered healthy only if they carefully follow their health care provider's advice regarding medications, activity, and diet. D.) Clients with a chronic illness are considered healthy only until the point at which primary body systems begin to lose function.
Answer: A.) Clients with a chronic illness can still achieve a high quality of life within the limits of the illness if they are physiologically stable and mentally healthy.
What is the first step in becoming culturally competent? A.) Exploring one's own cultural beliefs B.) Visiting as many cultures as possible C.) Maintaining eye contact at all times D.) Using touch as a method of maintaining rapport
Answer: A.) Exploring one's own cultural beliefs
The National Center for Health Statistics uses data from healthcare agencies to issue quarterly and annual reports on performance related to goals for improving the health of the U.S. population. Which initiative is targeted with improving the health of all Americans? A.) Healthy People 2030 B.) The Joint Commission C.) Agency for Healthcare Research and Quality D.) Quality Indicators
Answer: A.) Healthy People 2030
The nurse educator is planning a teaching session for nursing students related to the treatment and management of gestational diabetes. The nurse educator arranges for a dietitian, pharmacist, and physician assistant to participate in the lesson plan. Which professional nurse competency is the nurse educator demonstrating? A.) Interdisciplinary teamwork B.) Patient-centered care C.) Evidence-based practice D.) Quality improvement measures
Answer: A.) Interdisciplinary teamwork
Which of the following would be categorized as a mid-level practitioner? A.) Nurse midwives B.) Nursing assistants C.) Registered nurse D.) Licensed practical nurse
Answer: A.) Nurse midwives Rationale: Mid-level practitioners are educated and regulated by the state boards of nursing. They include, among others, nurse practitioners (NPs), nurse midwives, and certified registered nurse anesthetists (CRNAs). Nursing assistants, registered nurses, and licensed practical nurses are not considered mid-level practitioners.
Students are reviewing information about community health nursing. The students demonstrate understanding of the term "community-oriented nursing practice" by describing it as which of the following? A.) Nursing interventions that can promote wellness, reduce illness spread, and improve the health status of groups B.) Nursing care directed to specific client groups with identified needs, usually related to illness C.) Provision of primary care services, often with care being provided to underserved populations D.) Nursing care of clients with complex needs who are discharged from acute care institutions early in the recovery process
Answer: A.) Nursing interventions that can promote wellness, reduce illness spread, and improve the health status of groups
The central figure in health care services is the: A.) Patient B.) Nursing assistant C.) Nurse D.) Physician
Answer: A.) Patient
According to Maslow's hierarchy of needs, which of the following is the lowest-level need? A.) Physiological needs B.) Safety and security C.) Sense of belonging and affection D.) Esteem and self-respect
Answer: A.) Physiological needs
A client who has no health insurance asks if there is any chance that they will benefit from healthcare reform. What should the nurse tell the client about the goal of the Patient Protection and Affordable Care Act? A.) The goal of the Patient Protection and Affordable Care Act is to provide affordable healthcare to U.S. citizens who previously had no access to health insurance. B.) The Patient Protection and Affordable Care Act applies only to people who are eligible for Medicaid, so it will not apply to the client's situation. C.) The Patient Protection and Affordable Care Act applies only to people who are eligible for Medicare, so it will not apply to the client's situation. D.) The goal of the Patient Protection and Affordable Care Act is to provide affordable healthcare to U.S. citizens who have at least three dependents.
Answer: A.) The goal of the Patient Protection and Affordable Care Act is to provide affordable healthcare to U.S. citizens who previously had no access to health insurance.
Which strategy would a nurse likely discuss with a client as part of health promotion? A.) making positive dietary changes B.) evaluating the merits of various diagnostic procedures C.) locating a therapist for a child with emotional problems D.) determining how often blood glucose levels should be monitored at home
Answer: A.) making positive dietary changes
After teaching nursing students about the health-illness continuum, the instructor determines that teaching was successful when the students state which of the following? A.) "A patient's care must be focused on treating the disease." B.) "A person can be both healthy and ill at the same time." C.) "A patient with a disease typically falls on the far end of the continuum." D.) "A patient with a chronic illness is considered ill."
Answer: B.) "A person can be both healthy and ill at the same time."
A student nurse observes a nurse case manager coordinating discharge for a patient diagnosed with congestive heart failure (CHF). Which statement made by the patient indicates to the student that the patient understands the role of the case manager? A.) "The nurse case manager arranged to have a wheelchair waiting to take me to my room. I was so short of breath I could not walk very far." B.) "The nurse case manager contacted my insurance company and has arranged for the home health nurse and physical therapist to visit me as soon as I get home." C.) "The nurse case manager organized my daily nursing care during my hospitalization and arranged for the dietitian to teach me the importance of consuming a diet low in sodium." D.) "The nurse case manager worked with my physician to coordinate my admission from his office to the hospital."
Answer: B.) "The nurse case manager contacted my insurance company and has arranged for the home health nurse and physical therapist to visit me as soon as I get home."
Which of these roles would be considered an expanded nursing role? A.) Certified nurse's aide (CNA) B.) Certified nurse practitioner (CNP) C.) Respiratory therapist D.) Social worker
Answer: B.) Certified nurse practitioner (CNP)
To address the needs of a chronically ill patient and promote the concept of wellness, a nursing care plan should outline steps to: A.) Inform the patient about all the possible complications of the disease process. B.) Encourage positive health characteristics within the limits of the disease. C.) Restrict most activities to protect the patient from additional deterioration. D.) Encourage activity, beyond the scope of tolerance, to prevent progressive deterioration.
Answer: B.) Encourage positive health characteristics within the limits of the disease.
A 75-year-old client had surgery for a hip fracture yesterday. The client is under stress as a result of pain, sleep deprivation, and the hospital environment. The nurse caring for the client implements a proactive approach to pain management. Pain-management plans include communicating frequently to establish an acceptable pain rating, conducting hourly pain assessments, and evaluating the client's pain control hourly. In addition to improved patient outcomes, how else might the hospital benefit from the nurse's actions? A.) Additional funding from the Institute for Healthcare Improvement (IHI) B.) Improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores C.) Continued accreditation from The Joint Commission D.) Improved Quality and Safety Education for Nurses (QSEN) survey scores
Answer: B.) Improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores
A nursing student is preparing for a class presentation addressing the collaborative practice model. Which of the following would the student expect to include? A.) A discussion of a centralized organizational structure B.) Participation in decision making that is shared by all involved C.) Accountability that is primarily attributed to the patient D.) Nurses and physicians playing major roles in clinical decisions
Answer: B.) Participation in decision making that is shared by all involved
A 54-year-old client on a fixed income has had an electrocardiogram (ECG) as part of an annual physical examination. What legislation supports the focus on chronic disease prevention, health promotion, and quality, affordable health care for everyone? A.) Building a Safer Health System Act B.) Patient Protection and Affordable Care Act C.) A New Health System for the 21st Century Bill D.) Healthcare Research and Quality Improvement Bill
Answer: B.) Patient Protection and Affordable Care Act
Which statement is true regarding population demographics? A.) Homelessness is decreasing. B.) The culturally diverse population is increasing. C.) The birth rate is increasing. D.) Life spans are decreasing.
Answer: B.) The culturally diverse population is increasing.
The nurse informs the administrative assistant that a client is expected to come in for lab work. The administrative assistant inquires about why the nurse refers to the individual as a client. What is the best response by the nurse? A.) "We should refer to everyone as a client. They pay for our service." B.) "That's how the physician wants us to refer to them." C.) "Using the term client implies that they are an active partner in nursing care." D.) Using the term client is more respectful that using the term patient.
Answer: C.) "Using the term client implies that they are an active partner in nursing care."
The American Nurses Association's Code of Ethics provides practice guidelines, based on universal moral principles, for all nurses. Which statement reflects the nurse's primary commitment within this framework? A.) Responsible for enhancing the profession of nursing practice, working within its set parameters. B.) Has the duty to follow every health care practitioner order. C.) Committed to the client, whether an individual, family, group or community, to promote health, safety and individual rights. D.) Expected to maintain competence and professional development.
Answer: C.) Committed to the client, whether an individual, family, group or community, to promote health, safety and individual rights.
The nurse is making a referral to physical therapy for a client who has had a hip replacement and is going to be discharged in 2 days. The nurse understands that physical therapy as part of the client's plan of care includes the client in what discipline? A.) A discipline unto themselves B.) Inclusion in the administrative team C.) Inclusion in the collaborative healthcare team D.) Inclusion in the supervisory team
Answer: C.) Inclusion in the collaborative healthcare team
A nurse, working in a health clinic, treats a variety of conditions on a daily basis. One disorder that is rapidly increasing and is the leading cause of secondary morbidity is: A.) Kidney disease B.) Coronary heart disease C.) Obesity D.) Pneumonia
Answer: C.) Obesity
How should the registered nurse be responsive to the changing health care needs of society? A.) Focus care on the traditional disease-oriented approach to patient care, because hospitalized patients today are more acutely ill than they were 10 years ago. B.) Learn how to delegate discharge planning to ancillary personnel so that registered nurses can spend their time managing the "high-tech" equipment needed for patient care. C.) Place increasing emphasis on wellness, health promotion, and self-care, because the majority of Americans today suffer from chronic debilitative illness. D.) Stress the curative aspects of illness, especially the acute, infectious disease processes.
Answer: C.) Place increasing emphasis on wellness, health promotion, and self-care, because the majority of Americans today suffer from chronic debilitative illness.
According to the American Nurses Association (1995), the advanced practice registered nurse is distinguished from other registered nurses according to scope of practice. Select the activity that would distinguish the advanced practice nurse from other RNs. A.) Interprets health care provider orders B.) Develops nursing care plans C.) Prescribes medications D.) Reports abnormal test results
Answer: C.) Prescribes medications
A local college is having a career-day seminar for student nurses. Booths from various agencies and facilities have been set up. One of the students approaches the booth of a home care agency and asks the nurse there about what is required to become a home care nurse. Which of the following would the nurse incorporate into the response? A.) Need for at least a master's degree in nursing B.) Specialization in a specific area of practice C.) Strong clinical decision-making skills D.) Expert case management abilities
Answer: C.) Strong clinical decision-making skills Rationale: A nurse working in home care needs advanced knowledge and skills in general nursing practice with an emphasis on community health and acute medical-surgical nursing. The home care nurse also needs high-level assessment, critical thinking, and decision-making skills in a setting where other health care professionals are not available to validate observations, conclusions, and decisions. Home care nurses provide "high-tech, high-touch" care to people with acute health care needs. A master's degree is not necessary. Clinical nurse specialists practice within a specific or specialized area of care and are ideal case managers, because they have the educational background and clinical expertise to organize and coordinate services and resources to meet patients' health care needs cost-effectively and efficiently.
What is the primary focus of the nurse advocacy role in managing a clinical pathway? A.) Continuity of care B.) Cost-containment practices C.) Effective utilization of services D.) A patient's progress toward desired outcomes
Answer: D.) A patient's progress toward desired outcomes
A patient who adheres to the dietary laws of Judaism is in traction and confined to bed. The patient needs assistance with the evening meal of chicken, rice, beans, a roll, and a carton of milk. Which nursing approach is most representative of promoting wellness? A.) Remove items from the overbed table to make room for the dinner tray. B.) Push the overbed table toward the bed so that it will be within the patient's reach when the dinner tray arrives. C.) Ask a family member to assist the patient with the tray and the overbed table, then straighten the area in an attempt to provide a pleasant atmosphere for eating. D.) Ask whether the patient would like to make any substitutions in the foods and fluids received.
Answer: D.) Ask whether the patient would like to make any substitutions in the foods and fluids received. Rationale: Wellness involves being proactive and being involved in self-care activities aimed toward a state of physical, psychological, and spiritual well-being. With this in mind, health care providers must aim to promote positive changes that are directed toward health and well-being. The sense of wellness has a subjective aspect that addresses the importance of recognizing and responding to patient individuality and diversity in health care and nursing. Although all of the actions listed would promote the patient's comfort, addressing the patient's religious dietary needs is most representative of promoting wellness.