fundal ch 18 implementing

The nurse is attending a conference on evidence-based practice. Which statement by the nurse indicates further education is needed? "I must conduct research to validate the usefulness of my nursing interventions." "I can learn about evidence-based practice by reading professional nursing journals." "The Agency for Healthcare Research and Quality is a resource for evidence-based practice." "Nursing interventions should be supported by a sound scientific rationale."

"I must conduct research to validate the usefulness of my nursing interventions."

The nurse caring for a client who is recovering after a motor vehicle accident is planning for the client to begin increasing responsibility for self-care. Which would be the nurse's most appropriate strategy? The nurse encourages the client to take a shower instead of receiving a bed bath. The nurse tells the client that recovery is progressing too slowly. The nurse instructs the family to stop performing tasks for the client. The nurse consults with the health care provider to plan an early discharge.

The nurse encourages the client to take a shower instead of receiving a bed bath.

A client with diabetes who has been closely following the prescribed plan of care for over a year is being seen at an outpatient facility. The client has not brought a log of daily glucose checks and tells the nurse, "I haven't been doing them regularly." What is the nurse's most therapeutic statement to the client?] "Should I arrange for a home health nurse to coordinate your care?" "It seems like you are having difficulty with your care regimen." "Should I instruct your family to do the glucose checks for you?" "It is extremely important to your health to strictly follow your plan of care."

"It seems like you are having difficulty with your care regimen."

Which type of nursing intervention is oxygen administration and why is it considered to be so? An independent nursing intervention, because nurses have the necessary skill to administer oxygen An interdependent intervention, because health care providers, nurses, and respiratory therapists have the necessary skill to administer oxygen A dependent nursing intervention, because oxygen is considered a drug that requires a health care provider's order A collaborative nursing intervention, because it is ordered by the respiratory therapist

A dependent nursing intervention, because oxygen is considered a drug that requires a health care provider's order

Which examples of nursing actions involve direct care of the client? Select all that apply A nurse counsels a young family who is interested in natural family planning. A nurse helps a client in hospice fill out a living will form. A nurse massages the back of a client while performing a skin assessment. A nurse arranges for a consultation for a client who has no health insurance. A nurse arranges for physical therapy for a client who had a stroke

A nurse counsels a young family who is interested in natural family planning. A nurse helps a client in hospice fill out a living will form. A nurse massages the back of a client while performing a skin assessment.

The home health nurse caring for a client with limited eyesight notes that the client's route to the bathroom is cluttered. What is the most effective way for the nurse to ensure the client's long-term safety? Assign a home health aide to perform housekeeping duties. Assist the client to identify strategies to promote safety in the home. Remove all the cluttered objects from the pathway to the client's bathroom. Instruct the client about the need to keep the walkway to the bathroom clear.

Assist the client to identify strategies to promote safety in the home; helping the client identify safety strategies will help the client be more independent and will promote safety in the long run. Removing the cluttered objects would be important for the client's immediate safety, but would not help keep the client safe in the long run.

Which task is most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? Bed bath for the newly admitted client who has multiple skin lesions Insertion of a urinary catheter in a client with benign prostatic hypertrophy Preparation of insulin for the diabetic client with an elevated blood glucose level Ambulation of the client with a history of falls for the first time after surgery

Bed bath for the newly admitted client who has multiple skin lesions

A nurse is developing a plan of care for a client and determines appropriate outcomes and interventions for this client. Which variable would be most appropriate for the nurse to address to ensure that the care plan meets the client's needs? Select all that apply. Client's cultural background Client's developmental stage Client's ability to participate Client's socioeconomic status Client's gender

Client's ability to participate Client's developmental stage Client's cultural background Client's socioeconomic status

A client being treated for myasthenia gravis at home tells the nurse, "This medicine is so expensive. I have only been taking half of what the doctor ordered." How would the nurse most effectively meet this client's need? Reinforce to the client and family the necessity of taking all medication as ordered to stabilize the client's condition. Collaborate with other disciplines to determine the best way to meet the client's medication requirements. Instruct the client that some pharmaceutical companies have programs to help with medication expenses. Inform the health care provider of the need to prescribe a less expensive medication for the client's condition.

Collaborate with other disciplines to determine the best way to meet the client's medication requirements

A client in the last stages of pancreatic cancer tells the nurse, "I am tired of fighting. I am ready to die." What is the nurse's best action? Research other treatment options available for the client. Ask if the client would like to speak with a spiritual adviser. Collaborate with other disciplines to plan end-of-life care for the client. Remind the client that positive thoughts are essential for recovery.

Collaborate with other disciplines to plan end-of-life care for the client

A client has terminal cancer and the primary care provider has ordered a diagnostic imaging test. The client does not want the test performed so the nurse agrees to dialogue with the primary care provider on the client's behalf. The nurse's actions are what type of intervention? Supportive Coordination surveillance technical

Coordination

A nurse is administering metformin to a client who has a new onset of diabetes mellitus type 2. Which step should the nurse consider a priority on the nursing care plan? Monitor for noncompliance. Monitor for lactic acidosis Administer B12 injections Restrict intake of foods and fluids.

Monitor for lactic acidosis; Because an action is being carried out, this is the implementation step of the nursing process. Following the administration of medication, the nurse should monitor the client for lactic acidosis as well as side effect

The emergency room (ER) has a strict protocol regarding intramuscular (IM) injection technique. A nurse working in the ER has learned of a new technique to decrease pain with IM injections from the nursing literature and would like to use it. What is the most appropriate way for the nurse to implement the technique? Ask the ER health care provider to order IM injections with the new technique Petition to change the protocol based on the new evidence.

Petition to change the protocol based on the new evidence.

Which action is a responsibility of the nurse in the nurse-nurse team relationship? Provide creative leadership to make the nursing unit a challenging place to work. Intervene to promote healthy family functioning through education and advocacy. Communicate nursing's perspective regarding the client and family. Challenge the client to develop self-care abilities that promote health.

Provide creative leadership to make the nursing unit a challenging place to work.

The client is about to have blood drawn before seeing the health care provider. The spouse, while smiling and holding the client's hand, states, "Here comes the blood sucker. It is going to hurt bad." This statement is an example of which type of intervention? Select all that apply. Psychosocial Supportive Physical Coordinating Technical

Psychosocial Supportive Physical

A nurse in the intensive care unit (ICU) has been assigned to care for a client who was seriously injured during a gang rape. The nurse was raped 6 months ago and fears being too upset to care for the client properly. How should the nurse deal with the assignment? Recognize the nurse's own limitations and ask for another nurse to be assigned. Recognize that the nurse may be faced with this issue again and care for the client. Recognize the nurse's own limitations and ask another nurse to assist if the nurse becomes too emotional. Recognize the issue and care for the client to the best of the nurse's ability.

Recognize the nurse's own limitations and ask for another nurse to be assigned

Which tasks can the nurse appropriately delegate to the unlicensed assistive personnel (UAP)? Select all that apply Administer routine oral medications. Assist the client to the bedside commode. Assess the client's need for education. Record the client's intake and output. Assess the client's risk for pressure injuries.

Record the client's intake and output. Assist the client to the bedside commode

The client has a diagnosis of Risk for Injury related to falls. How would the nurse know if the intervention was successful The client verbalizes risks for injury. The client calls for assistance to get out of bed. The client is free of falls. The client is taught safety precaution

The client is free of falls.

A client who has been in a vegetative state for years is scheduled for an elective surgery. The nurse is questioning whether the procedure is necessary. What is the nurse's appropriate first action? The nurse should address the concern with the hospital attorney. The nurse should address the concern with the surgeon. The nurse should address the concern with the client's family. The nurse should address the concern with the hospital ethics committe

The nurse should address the concern with the surgeon

What are the goals of the research that is behind the Nursing Outcomes Classification (NOC) system? Select all that apply To communicate nursing to non-nurses To evaluate the validity and usefulness of the classification in clinical field testing To teach decision making To define and test measurement procedures for the outcomes and indicators To ensure appropriate reimbursement for nursing services To identify, label, and validate nursing-sensitive client outcomes and indicators

To identify, label, and validate nursing-sensitive client outcomes and indicators To evaluate the validity and usefulness of the classification in clinical field testing To define and test measurement procedures for the outcomes and indicators