NU142- Chapter 1: Health Care Delivery and Evidence-Based Nursing Practice

A Jewish patient, who adheres to the dietary laws of his faith, is in traction and confined to bed. He needs assistance with his evening meal of chicken, rice, beans, a roll, and a carton of milk. Choose the nursing approach that is most representative of promoting wellness. The nurse:

Prepares the environment and the over-bed table and inspects the contents of the dinner tray. The nurse asks the patient whether he would like to make any substitutions in the foods and fluids he has received.

The nurse is assisting with the development of a program to administer flu shots to a group of senior citizens. What type of prevention does this program reflect?

Primary prevention

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?

Provision of a broad range of direct care to clients

A client is experiencing anorexia related to the adverse effects of cancer treatment. Using Maslow's hierarchy, the nurse identifies this as a reflection of which need?

Physiologic needs

According to Maslow, which category of needs represents the most basic on the hierarchy?

Physiologic needs

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?

"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 statement by the nurse shows an understanding of the focus of the quality assurance programs developed in the 1980s?

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

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?

"Using the term client implies that they are an active partner in nursing 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.

Appraising and enhancing an individual's health-seeking perspective

Which element would be included as a goal of case management?

Appropriateness of services

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?

Ask whether the patient would like to make any substitutions in the foods and fluids received.

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?

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.

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?

Committed to the client, whether an individual, family, group or community, to promote health, safety and individual rights.

health

according to the World Health Organization (2006), a "state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity" (p. 1); often viewed as equivalent to wellness

A nurse with 20 years' experience attends a hospital-required training session and learns a new method for assessing nasogastric (NG) tube placement. During the training the nurse educator provides the nurse with a bibliography of peer-reviewed articles related to NG tube placement. The nurse recognizes the change in procedure developed from which method?

Evidence-based practice

What is the first step in becoming culturally competent?

Exploring one's own cultural beliefs

While interviewing a patient, the nurse notices that the patient is wearing a medallion around his neck. The patient tells the nurse, "It's a medal that everyone in my family wears to protect against cancer." The nurse interprets this statement as most likely reflecting which of the following?

Culture

To address the needs of a chronically ill patient and promote the concept of wellness, a nursing care plan should outline steps to:

Encourage positive health characteristics within the limits of the disease.

Using the concept of the wellness-illness continuum, what would the nurse include in the development of a nursing care plan for a chronically ill patient?

Encourage positive health characteristics within the limits of the specific illness.

Which is not an important reason that nurses utilize research in nursing practice?

Financial obligation

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?

Healthy People 2030

Which is an important role for a nurse in the health care delivery system?

Identifying patient needs and working with patients to address them

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?

Inclusion in the collaborative healthcare team

The Healthy People 2030 initiative targets the improvement of health for all. In addition to eliminating health disparities, what are the broad goals of this plan?

Increasing the quality and length of a healthy life

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?

Interdisciplinary teamwork

A group of nursing students are reviewing the various types of advanced practice nurses. The students demonstrate the need for additional review when they identify which of the following as an advanced practice nurse?

Nurse manager

Which of the following would be categorized as a mid-level practitioner?

Nurse midwives

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?

Nursing interventions that can promote wellness, reduce illness spread, and improve the health status of groups

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:

Obesity

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?

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

A nursing student is preparing for a class presentation addressing the collaborative practice model. Which of the following would the student expect to include?

Participation in decision making that is shared by all involved

The central figure in health care services is the:

Patient

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?

Patient Protection and Affordable Care Act

According to Maslow's hierarchy of human needs, which of the following is the highest level of need(s)?

Self-actualization

According to Maslow's hierarchy of human needs, which of the following is the highest level of need?

Self-actualization

When applying Maslow's hierarchy of needs to patient care, the nurse determines that the patient has reached the ultimate goal indicating integrated human functioning and health when which level is met?

Self-actualization

The nurse is working at an institution that uses a collaborative practice model. Which of the following would most likely be reflected at this institution?

Shared accountability for care

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?

Strong clinical decision-making skills

A client has been admitted in the emergency care unit with conditions of respiratory distress and pneumonia. The client's condition worsens and requires mechanical ventilation. While visiting this client in the hospital, the family observes members of the health care team washing their hands upon entering and leaving the room. By implementing recommended hand hygiene measures, which organization's goals is the health care team supporting?

The Joint Commission

Which statement is true regarding population demographics?

The culturally diverse population is increasing.

A client comes to the clinic and reports being ill for several weeks but does not have insurance and has delayed care. What does the nurse understand about the overall healthcare reform goals that will address issues such as this client?

The goal of healthcare reform is to provide affordable healthcare to more citizens.

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?

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.

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.

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

evidence-based practice (EBP)

a best practice derived from valid and reliable research studies that also considers the health care setting, patient preferences and values, and clinical judgment

pay for performance

a health insurance model that reimburses health care provider groups, hospitals, and health care agencies for either meeting or exceeding metrics that demonstrate that the care and treatments rendered are both cost-efficient and of best quality also known as value-based purchasing

Joint Commission

a nonprofit organization that accredits hospitals and health care organizations

Quality and Safety Education for Nurses (QSEN)

a project whose aim is to develop curricula that prepare future nurses with the knowledge, skills, and attitudes (KSAs) required to continuously improve the quality and safety of the health care system through demonstrating competency in patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics

bundle

a set of three to five evidence-based practices that, when implemented appropriately, can measurably improve patient outcomes

medical-surgical nursing

a specialty area of practice that provides nursing services to patients from adolescence through the end-of-life in hospital medical-surgical units, clinics, ambulatory care units, urgent care centers, home health care agencies, and long-term care facilities

advanced practice registered nurse (APRN)

a title that encompasses certified nurse practitioners (CNPs), clinical nurse specialists (CNSs), certified nurse-midwives (CNMs), and certified registered nurse anesthetists (CRNAs)

patient

a traditional term used to identify someone who is a recipient of health care

A nurse is employed by a community organization engaged in health promotion. In this role, the nurse teaches clients steps they can take toward achieving wellness. The nurse would explain "wellness" to a client as:

an ongoing and intentional effort to achieve the highest potential for total well-being.

National Patient Safety Goals (NPSGs)

areas of patient safety concern identified annually by the Joint Commission that, if rectified, may have the most positive impact on improving patient care and outcomes

core measures

benchmark standards of best practices used to gauge how well a hospital gives care to its patients who are admitted to seek treatment for a specific disease (e.g., heart failure) or who need a specific treatment (e.g., an immunization)

nursing

ccording to the American Nurses Association (2015b), "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations" (p. 1)

interprofessional collaborative practice

employing multiple health professionals to work together with patients, families, and communities to deliver best practices, thus ensuring best patient outcomes

health promotion

focuses on the potential for wellness and targets appropriate alterations in personal habits, lifestyle, and environment in ways that reduce risks and enhance health and well-being

A nurse is a member of which entity within the larger healthcare environment?

healthcare team

wellness

the ability to perform well, adjust and adapt to varying situations, and report feeling well and harmonious

health informatics

the use of health information technology to improve the quality, efficiency, or delivery of health care

telehealth

the use of technology to deliver health care, health information, or health education at a distance

precision medicine

using advances in research, technology, and policies to develop individualized plans of care to prevent and treat disease