Med Surge Exam 1 (CH 1-5: PP & Vsim)

Factors That Influence Nutrition (5)

Nitrogen balance Hospitalization Physical problems or limitations Limited fixed incomes Medications

increased risk of problems associated with poor nutrition (BMI)

less than 18.5

The statements below reflect interventions to address a person's needs. Arrange each need based on Maslow's hierarchy from most basic to highest level.

Providing nasogastric tube feedings -> Explaining a new procedure -> Referring a patient to a cancer support group -> Encouraging a patient to start a hobby that he or she has always wanted to try

Maslow's Hierarchy of Needs

Physiologic needs -> safety & security -> belongingness & affection -> esteem and self respect -> self actualization

Florence Nightingale

1858 *the goal of nursing is to put patient in the best condition for nature to act upon him"

A home care nurse is preparing a presentation for a group of nursing students about the area of practice. Which statement would the nurse most likely include when describing this practice area? A) "Home care requires that the nurse has an advanced degree in nursing." B) "The major emphasis of care involves accessing community resources." C) "Home care nurses need to have high-level assessment skills." D) "Decision-making is shared among the other health care professionals."

"Home care nurses need to have high-level assessment skills."

A nurse is describing her role as a home care nurse to students. A student asks, "Why do you need such high-level assessment and clinical decision-making skills in this practice?" Which response by the nurse would be most appropriate? A) "The patients I care for usually are much more acutely ill than most patients seen." B) "No other health care professionals are around to confirm my observations." C) "The patient is usually alone in the home and has no one to support him or her." D) "I need to be very alert for changes in patients because I don't have the usual equipment available."

"No other health care professionals are around to confirm my observations."

Which statement by the nurse shows an understanding of the focus of the quality assurance programs developed in the 1980s? A) "The quality assurance programs focus on individual incidents or errors and minimal expectations." B) "The quality assurance programs focus on decreasing the cost of health care for the consumer." C) "The quality assurance programs focus on processes used to provide care and improving those processes." D) "The quality assurance programs focus on coordinating care for patients."

"The quality assurance programs focus on processes used to provide care and improving those processes."

A nurse asks a client with chronic obstructive pulmonary disease (COPD) to breathe in slowly through the nose, taking in a normal breath. Then she asks the client to pucker his lips as if preparing to whistle. Finally, she asks him to exhale slowly and gently through the puckered lips. The nurse recognizes that teaching the client pursed-lip breathing helps the client relax and gain control of dyspnea, reducing feelings of panic. Which of the ANA tenets characteristic of all nursing practice is the nurse demonstrating? Select all that apply. A) Individualized nursing practice B) Use of the nursing process C) A professional work environment D) Interdisciplinary collaboration E) Evidence-based nursing F) Care

- Individualized nursing practice -Care - Use of the nursing process

NANDA

- North American Nursing Diagnosis Association - based on collection and analysis of assessment date - actual or potential health problems - NOT medical diagnosis - collaborative problems

Heathy People 2020

- Reduce or eliminate illness, disability, and premature death among individuals and communities - goals are for over the course of a decade, every decade they come up with a new specific goal

The patient self determination act (1991)

- advanced directive - living will - durable POA - physician orders for life sustaining tx (POLST)

Hoody & Leddy (2010): wellness has 4 components....

1. Capacity to perform to best of ability 2. Ability to adjust, adapt to caring situations 3. reported feeling of well-being 4. Feeling that "everything is together", harmonious

ANA Social Policy Statement

2010 "nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations."

Which of the following best describes the health-illness continuum? A) A person with chronic illness is at the far end of the continuum reflecting illness. B) A person may be considered neither completely healthy or completely ill. C) A person with high-level wellness is free of any disease or infirmity. D) A person on the continuum remains at the point based on his or her initial state of health.

A person may be considered neither completely healthy or completely ill.

Continuous quality improvement (CQI) was identified in the 1990s as a system that would focus on improving quality of care by applying processes. Select all of the processes that apply to CQI. A) Analyzing similar clinical situations to identify repetitive tasks B) Assessing the impact of financial parameters and reimbursement models on patient care delivery C) Reviewing medication errors for individual patients D)Examining different processes that affect patient care

A) Analyzing similar clinical situations to identify repetitive tasks B) Assessing the impact of financial parameters and reimbursement models on patient care delivery D) Examining different processes that affect patient care

Which is an element of nursing as defined by the American Nurses Association?

Alleviating suffering by diagnosing and treating human responses to health problems

A nurse identifies that a patient is unable to identify the correct number of oral medication to take each morning. Which step of the nursing process does this problem involve?

Assessment

Nursing Process (5)

Assessment -> Diagnosis -> Planning -> implementation -> evaluation

A home care nurse is caring for an older adult with multiple medications after being discharged from the hospital with acute coronary syndrome. Which nursing action best promotes self-management of the medication regimen for this client? A) Assist to identify non-therapeutic medications. B) Assist to identify duplicate medications. C) Call the health care provider for clarification. D) Place the oral medications in a medication organizer.

B) Assist to identify duplicate medications.

A nurse is reading a journal article about the U.S. health care delivery system. When reading this article, which of the following would the nurse expect to find? A) An increased emphasis on disease treatment and cure B) View of a person's state of health as ever-changing C) Diverse cultural backgrounds affecting responses to health care D) Decreased prevalence of disabilities and chronic illnesses E) Increased ethical issues related to technological advancements

B) View of a person's state of health as ever-changing' C) Diverse cultural backgrounds affecting responses to health care E) Increased ethical issues related to technological advancements

Using Maslow's hierarchy of needs, place the following problems in their order of priority. Constipation Helplessness Fear Loneliness Failure to achieve potential

Constipation Fear Loneliness Helplessness Failure to achieve potential

A client is admitted to an acute care facility after having a stroke. The client will require a variety of healthcare services throughout the hospital stay as well as coordination of care prior to discharge. What referral would be a priority for overseeing the client's care? A) Case management B) Physical therapy C) Occupational therapy D) Dietary services

Case management

A client was admitted with a history of ventilator use. The client had been living at home, but her adult children can no longer provide adequate care. What is the rationale for the client's admission to a long-term care facility? A) Clients with conditions that are potentially unstable but without rapid changes may receive care in a long-term acute care facility. B) Clients in stable condition but with the potential for rapid changes may receive care in a long-term acute care facility. C) Clients with rapidly changing conditions but without family members or friends to provide care may receive care in a long-term acute care facility. D) None of the responses is correct.

Clients with conditions that are potentially unstable but without rapid changes may receive care in a long-term acute care facility.

A home care nurse is looking at ways that home care nurses can promote holistic care of the client. What action will the nurse implement in order to accomplish this task? A) Use of natural therapies and alternative medicine B) Encouragement of self-reflection techniques C) Collaboration with an interdisciplinary team D) Concept-based approach to care

Collaboration with an interdisciplinary team

Quality assurance (QA) programs were put into place in the 1980s by the Joint Commission to establish and maintain accountability to the public. These programs are responsible to the public for maintaining certain standards. Choose all of the activities that apply to QA programs. A) Cost of health care services B) Quality delivery of services C) Appropriate standards of care D) Staff-patient ratios for nursing care

Cost of health care services Quality delivery of services Appropriate standards of care

Which of the following best reflects the current trends associated with the elderly population? A) There are more men than there are women in the older population. B) The 65- to 74-year-old age group is the fastest growing segment of the population. C) The percentage of older adults in the population will gradually decrease in the future. D) Conditions affecting elderly women are a major concern due to undertreatment and underdiagnosis.

D) Conditions affecting elderly women are a major concern due to undertreatment and underdiagnosis.

When describing influences on health care delivery, a nurse cites information about current population demographics. Which of the following would be most accurate? A) Increased birth rate B) Fewer school-aged children C) Fewer elderly persons D) More people living in rural areas

Fewer school age children

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?

Improved Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores

A nursing instructor is preparing a class on the changes that have occurred in health care over the past years. Which of the following would the instructor most likely include? A) Increasing cultural diversity of the population B) Static nature of diseases C) Expanding consumer expectations D) Lowered costs for health care E) Reductions in health care staffing F) Restructuring of health care institutions

Increasing cultural diversity of the population Expanding consumer expectations Reductions in health care staffing Restructuring of health care institutions

Nursing students are reviewing the changing patterns of disease. The students demonstrate a need for additional review when they identify which condition as being on the rise? A) Acquired immunodeficiency syndrome B) Tuberculosis C) Pneumonia D) Sexually transmitted infections

Pneumonia

A nurse is preparing a presentation for a local community group addressing the influences on health care delivery. Which of the following would the nurse include in presentation when describing disease patterns? A) Most infectious diseases have been controlled or eradicated. B) The prevalence of chronic illness is decreasing due to the emphasis on healthy living. C) Obesity along with conditions associated with it has become a major health concern. D) People with acute illnesses are considered the largest group of health care consumers.

Obesity along with conditions associated with it has become a major health concern.

A 54-year-old client on a fixed income has had an electrocardiogram (ECG) as part of an annual physical examination. The physician notes an abnormal Q wave on an otherwise unremarkable ECG. What legislation supports the focus on chronic disease prevention, health promotion, and quality, affordable health care for everyone?

Patient Protection and Affordable Care Act

A nurse is preparing a presentation for a local community group about health, wellness, and illness. When describing the concept of wellness, which of the following features would the nurse include? Select all that apply. A) Performing to one's best ability B) Being completely without illness C) Feeling that everything is together D) Being able to adjust and adapt E) Experiencing a feeling of well-being

Performing to one's best ability Feeling that everything is together Being able to adjust and adapt Experiencing a feeling of well-being

A nurse is interested in obtaining additional education to become a nurse practitioner and is reviewing various course programs. Which of the following would the nurse expect to find? A) Specialty in a circumscribed area of care B) Primarily acting as a educator for clients and families C) Provision of a broad range of direct care to clients D) Practice most often in acute care settings

Provision of a broad range of direct care to clients

The nurse working in the clinic has had several incidences of positive chlamydia cultures return in women with pelvic pain. The nurse understands that early diagnosis and treatment are essential measures in which to reduce contagion and limit the complications related to this infection. What type of prevention will the nurse use when these infections are treated?

Secondary

A group of students are reviewing information on the roles of a nurse. The students demonstrate understanding of the information when they identify which activity as associated with the nurse's role as a leader? A) Supervision of unlicensed assistive personnel B) Identification of a problem related to patient care C) Client education about a disease condition D) Development of a plan of care for a client

Supervision of unlicensed assistive personnel

A nurse is caring for a client who has HIV and who has been diagnosed with acute pneumonia. Which situation demonstrates an understanding of the nurse's role in the current focus on management of chronic illness and disability? A)Teaching the patient to avoid crowds B)Administering prescribed antibiotics C) Making a referral to an HIV support group D) Reviewing the patient's CD4 count

Teaching the patient to avoid crowds

What is the primary basis for growth in home care nursing?

The discharge of patients who are more critically ill Ch1 pg7

An advanced practice registered nurse (APRN) specializing in adult-gerontology has accepted a new position in a different state. Which governing body does the APRN need to consult to verify prescriptive authority in the new state?

The new states board of nursing

Changes in population demographics over the next 40 years will significantly affect the delivery of health care services. Select the one change that will have the most impact on the practice of nursing. A) Immigration patterns will result in a more diverse population. It is projected that, by 2030, more than 20% of Americans will be immigrants. B) Hispanics will become the largest minority group in the United States, constituting about 29% of the population. C) The non-Hispanic, white population will reach 47%. D) The number of adults over age 65 will double in size.

The number of adults over age 65 will double in size.

A client receives dialysis four times a week at a dialysis center. Which type of care is provided at a dialysis center? A) ambulatory care B) home care C) intermediate care D) long-term acute care

ambulatory

Deontologic theory

formalist theory

Restraints protocol

must have orders every 24 hours and chart every hour

patient vs client

patient is from latin term "to suffer" client is from latin term "to lean"

hospice care

patients in last 6 months of life

When functioning in the practitioner role, the nurse would be involved in which of the following? Select all that apply. A) Providing direct care B) Collaborating with other disciplines C) Collecting data for an investigation D) Prescribing medications E) Teaching clients and families

providing direct care collaborating with other disciplines teaching clients and families

A nurse educator is teaching about the various disciplines of community-based nursing. Which discipline will not be included when teaching about community-based care? A) Community health nursing B) Hospice nursing C) Public health nursing D) Home health nursing

public health nursing

Which of the following are considered the primary concepts of community-based nursing? Select all that apply. A) Self-care B) Preventive care within the context of culture and community C) Focus on cure over care D) Use of non-Western treatments E) Cost containment

self care preventative care wishing the context of culture and community

Which of the following would least likely impact health care delivery and nursing? A) Growth in the population B) Cultural diversity C) Increased consumer knowledge D) Decline in genetic focus

D) decline in genetic function

Which patient age groups is currently one of the fastest growing age groups in the population?

85 and older

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 contacted my insurance company and has arranged for the home health nurse and physical therapist to visit me as soon as I get home." B)"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." C) "The nurse case manager worked with my physician to coordinate my admission from his office to the hospital." D)"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."

"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."

A client in an acute care facility is assigned a case manager to oversee and coordinate care. What important function does a case manager have? A) Provide early, thorough discharge planning. B) Make sure the client is administered medications. C) Provide care to the client who is terminally ill and has less than 6 months to live. D) Make home visits to see that the client is taken care of after discharge.

A) Provide early, thorough discharge planning.

Which order of activities is accurate when making a home visit? A) Review agency policies regarding visits, ask permission to enter home, perform hand hygiene, and document care provided. B) Confirm need for visit with referring agency, park away from the home, perform hand hygiene, and document teaching and client response to teaching. C) Call client to arrange time for visit, perform hand hygiene, ask permission to enter home, bring only required equipment into the home. D) Investigate the neighborhood before the visit, leave a message telling the client the time and nature of the nurse's visit, ask permission to enter the home, and include client behaviors in charting outcomes.

A) Review agency policies regarding visits, ask permission to enter home, perform hand hygiene, and document care provided.

While engaging in community-based nursing, the nurse would focus on which of the following as a primary concept of care? Select all that apply. A) Self-care B) Prevention C) Continuity of care D) Collaboration E) Health screening

A) Self-care B) Prevention C) Continuity of care D) Collaboration

Students are comparing and contrasting the roles and functions of nurse practitioners and clinical nurse specialists. The students demonstrate understanding of these roles when they identify which of the following as associated with nurse practitioners? Select all that apply. A) Collaboration with other disciplines B) Direct care provision C) Prescribing of medications D) Counseling of patients and families E) Consultation with nursing staff

A) collaboration with other disciplines B) direct care provision C) prescribing of meds

When functioning in the practitioner role, with which of the following would the nurse be involved? Select all that apply. A) Providing direct care B) Educating the patient and family C) Coordinating with other disciplines D) Implementing timely investigations of problems E) Helping patients navigate through the complex health system

A) providing direct care B) educating the patient and family C) coordinating with other disciplines

A certified nurse practitioner (CNP) working in the emergency department (ED) provides advanced cardiac life support (ACLS) to a client experiencing asystole. The CNP knows epinephrine is the first medication to be administered immediately after intravenous (IV) access. When the client remains in asystole the nurse knows to administer atropine. Which care planning tool is the nurse using to provide patient care?

Algorithm

A nurse is using an evidence-based practice tool to plan care for a patient with acute abdominal pain who is admitted to the health care facility. Which tool would the nurse most likely expect to use? A) Care map B) Multidisciplinary action plan C) Clinical guideline D) Algorithm

Algorithm Ch 1 pg 9

A nurse is interviewing for prospective employment in a managed care organization. When considering this type of health care delivery system, which of the following would be most important for the nurse to keep in mind? Select all that apply. A) Reimbursement for services is highly variable. B) Payment rates are usually determined after care is provided. C) Precertification for procedures is required. D) The choice of providers for services is often limited. E) Services are primarily limited to inpatient facilities. F) Utilization review is a key factor to determine cost-effectiveness.

C) Precertification for procedures is required. D) The choice of providers for services is often limited. F) Utilization review is a key factor to determine cost-effectiveness.

A client is going to be in a subacute care unit for approximately 30 days. The client will require frequent assessments and periodic review of the client's progress. What role will the registered nurse have in the care of this client? A) The RN will provide direct care for the client. B) The RN will ensure that the client eats 100% of the meals. C) The RN will order the various treatments for the client. D) The RN will coordinate the client's care.

D) The RN will coordinate the client's care.

nurse preparing a presentation about the practice of nursing for a group of first-year nursing students plans to incorporate the American Nurses Association phenomena of care. Which of the following would the nurse include? Select all that apply. A) Emotions B) Lifespan changes C) Decision making D) Self-care E) Culture F) Ethics

Emotions Lifespan changes Decision making Self-care

Quality Assurance (QA) focuses on which of the following?

Individual incidents or errors and minimal expectations

The registered nurse has a responsibility to practice nursing according to the Social Policy Statement (2003) of the American Nurses Association (ANA). What definition by the ANA best describes the role of registered nurses? A) To diagnose and treat medical conditions B) To prescribe medications in order to treat a variety of medical conditions C) To prevent illness and maintain health D) To diagnose and treat the human responses to health and illness

To diagnose and treat the human responses to health and illness

A public health nurse describes the role of the nurse in public health to a group of community stakeholders during a budget meeting. Which category of care will the nurse place public health nursing? A) Community-oriented nursing B) Community-based nursing C) Specialty population nursing D)Comprehensive population nursing

community oriented

Teleologic theory

consequentialism (the doctrine that the morality of an action is to be judged solely by its consequences.)

A nursing student asks an instructor to explain what roles are involved in community health nursing. Which of the following would the instructor include? Select all that apply. A)Epidimiologist B) Case manager C) Visiting nurse D) Financial consultant E) Emergency services advisor

epidemiologist case manager visiting nurse

Which is not an important reason that nurses utilize research in nursing practice? A) Validation B) Dissemination C) Replication D) Financial obligation

financial obligation

Overweight (BMI)

greater than 25

Obese (BMI)

greater than 30

High Waist circumference for females

greater than 35 inches - High waist circumferences put patients at risk for diabetes, dyslipidemia, hypertension, heart attack, and stroke

High waist circumference for male

greater than 40 in

A nursing student is reviewing a class lecture on quality assurance (QA) and continuous quality improvement (CQI) programs. The student demonstrates understanding of the material when identifying which of the following as a component of QA? A) Individual incidents of patient care B) Analysis of conditions affecting patient care C) Processes involved in patient care D) Changes to improve quality of patient care

individual incidents of patient care