NU272 Week 6 EAQ Evolve Elsevier: Professionalism, Health, Wellness, Illness, Caring

Which hormone levels peak during a client's sleep? Select all that apply. One, some, or all responses may be correct. o Cortisol o Calcitonin o Thyrotropin o Progesterone o Growth hormone

o Cortisol o Thyrotropin o Growth hormone · Cortisol, thyrotropin, and growth hormone levels peak during sleep. Calcitonin and progesterone hormone levels are not altered during sleep.

A client makes negative comments to the nurse about their hospital stay. Which response by the nurse is correct? o Describe the purpose of different hospital therapies to decrease the client's anxiety. o Explain that becoming so upset does not allow the client to get much-needed rest. o Refocus the conversation on the client's fears, frustrations, and anger about the condition. o Permit the client to release feelings and then leave the room to allow the client to regain composure.

o Refocus the conversation on the client's fears, frustrations, and anger about the condition. · Refocusing the conversation on the client's fears, frustrations, and anger about the condition provides an opportunity for the client to verbalize the feelings underlying the behavior. Describing the purpose of different hospital therapies will have no effect on decreasing the client's anxiety or on allowing ventilation of feelings. Explaining that becoming so upset dangerously blocks the need for rest will not decrease anxiety so that the client can rest. Although allowing release of feelings is therapeutic, leaving denies the client the opportunity for verbalization and discussion.

A registered nurse is teaching a student nurse about factors that influence sleep. Which scenario explained by the registered nurse is an example of a lifestyle factor? o "A client reports trouble falling asleep because of thinking about stress at work." o "A client in the intensive care unit has not slept properly because of noises and disturbances." o "A client who has been taking antidepressants reports drowsiness and lack of sleep." o "A client who works rotating overnight shifts reports fatigue and difficulty sleeping through the night."

o "A client who works rotating overnight shifts reports fatigue and difficulty sleeping through the night." · An individual's lifestyle can influence his or her sleep patterns. Working irregular rotating overnight shifts will throw off a client's biological clock, disrupting sleep. This is an example of a lifestyle factor. When a client reports inadequate sleep due to work stress, this is an example of an emotional stress factor affecting sleep. When a client in the intensive care unit says he or she has not been able to sleep properly because of noises and disturbances, this is an example of an environmental factor affecting sleep. When a client who has been taking antidepressants reports excess drowsiness and lack of sleep, this is an example of a medications and substances factor affecting sleep.

Which key points need to be remembered to maintain health and wellness of a client? Select all that apply. One, some, or all responses may be correct. o "Internal and external variables are considered when planning care for the client." o "The health belief model considers the relationship between a person's health beliefs and health behaviors." o "The health promotion model highlights factors that increase individual well-being and self-actualization." o "Holistic therapies are used by nurses only for pregnancy and pregnancy-related issues to help clients deal with the pain." o "The American Nurses Association (ANA) emphasizes identifying a client's individual needs, prioritizing the needs, and encouraging the client's self-actualization."

o "Internal and external variables are considered when planning care for the client." o "The health belief model considers the relationship between a person's health beliefs and health behaviors." o "The health promotion model highlights factors that increase individual well-being and self-actualization. · The nurse would remember that internal and external variables are considered when planning care for the client. The nurse would know that the health belief model considers the relationship between a person's health beliefs and health behaviors. The nurse would remember that the health promotion model highlights factors that increase individual well-being and self-actualization. Holistic therapies are used by nurses either alone or in conjunction with conventional medicine. It can be used for cancer, pregnancy, and for many complicated diseases. Maslow's hierarchy of needs model emphasizes identifying a client's individual needs, prioritizing the needs, and encouraging the client's self-actualization."

The new nurse is approached by a surveyor from the department of health. The surveyor asks the nurse about the best way to prevent the spread of infection. Which answer by the nurse is correct? o "Let me get my preceptor." o "Wash your hands before and after any client care." o "Clean all instruments and work surfaces with an approved disinfectant." o "Ensure proper disposal of all items contaminated with blood or body fluids."

o "Wash your hands before and after any client care." · The best means to prevent the spread of infection is to break the chain of infection. This is most easily accomplished by the simple act of hand washing before and after all client contact. "Let me get my preceptor" and "Clean all instruments and work surfaces with an approved disinfectant" may be correct, but they are not the best responses for this situation. It is not necessary that all items contaminated with blood or body fluids be disposed.

Which definition does the World Health Organization (WHO) use to define "health"? o A condition when people are free of disease o A condition of life rather than pathological state o An actualization of inherent and acquired human potential o A state of complete physical, mental, and social well-being

o A state of complete physical, mental, and social well-being · The WHO defines health as a "state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity." Pender, Murdaugh, and Parsons (2011) explains that all people free of disease are not healthy. Pender, Murdaugh, and Parsons (2011) suggest that for many people, health is a condition of life rather than pathological state. Life conditions such as environment, diet, or lifestyle choices can have positive or negative effects on health long before an illness is evident. Pender, Murdaugh, and Parsons (2011) define health as the actualization of inherent and acquired human potential through goal-directed behavior, competent self-care, and satisfying relationships with others.

The nurse realizes that a double dose of insulin was administered to the client by mistake and informs the primary health care provider. Which element of the decision-making process is reflected in the nurse's action? o Authority o Autonomy o Accountability o Responsibility

o Accountability · Accountability means being answerable for one's actions. The nurse's action of admitting the mistake and seeking instructions to correct it indicates accountability. Authority is the legitimate power to give instructions and make final decisions in a situation. Autonomy is freedom of choice and responsibility for the choices. Responsibility indicates the duties and activities that an individual is employed to perform.

Which nursing theory focuses on the client's self-care needs? o Roy's theory o Orem's theory o Watson's theory o Leininger's theory

o Orem's theory · Orem's self-care deficit theory focuses on the client's self-care needs. According to Roy's theory, the goal of nursing is to help a client adapt to changes in physiological needs, self-concept, role function, and interdependent relations during health and illness. Watson's theory of transpersonal caring defines the outcome of nursing activity with regards to the humanistic aspects of life. The major concept of Leininger's theory is cultural diversity, with the goal of nursing care being to provide the client with culturally specific nursing care.

Which organization provides scope and practice guidelines on the roles and responsibilities for nursing and nursing specialties? Select all that apply. One, some, or all responses may be correct. o State Nursing Association o National League of Nursing o American Nurses Association o Academy of Medical Surgical Nurses o Quality and Safety Education for Nurses

o American Nurses Association · The American Nurses Association develops and publishes scope and standards of practice guidelines for nursing and nursing specialties. Many professional organizations have state-level nursing associations, but they do not publish standards and scope of practice. The National League of Nursing is a professional organization related to the education of nurses. The Academy of Medical Surgical Nurses publishes scope and standards of practice for general medical surgical nursing, but not nursing and nursing specialties. Quality and Safety Education for Nurses supports development of the knowledge, skills, and attitudes needed to improve the quality and safety of the health care system.

Which step in the nursing process involves the nurse interviewing a client about a current health problem and taking the client's vital signs? o Planning o Diagnosis o Assessment o Implementation

o Assessment · The scenario is an example of the assessment phase of the nursing process. Assessment involves the collection of comprehensive data pertinent to the client's health. During the planning level of nursing care, the nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. The nurse analyzes the assessment data to determine the diagnoses during the diagnosis level of nursing practice. The nurse implements the health care plan identified for the client during the implementation level of the standards of nursing practice. This level may include administering prescribed medications or health care procedures.

Which is the correct order of steps in the nursing process? o Assessment o Diagnosis o Planning o Implementation o Evaluation

o Assessment o Diagnosis o Planning o Implementation o Evaluation · The first step of the nursing process is assessment, during which the registered nurse (RN) collects comprehensive data pertinent to the client's health. The second step of the process is diagnosis, during which the RN analyzes the assessment data to determine the issues related to the client's health. The third step is outcomes identification and planning, during which the RN identifies expected outcomes for a plan individualized to the client. The plan prescribes strategies and alternatives to attain expected outcomes. The RN then implements the identified plan in the fourth step. In the last step, the RN evaluates the client's progress toward attainment of desired outcomes.

The nurse understands incorporating which interventions would prevent medication errors? Select all that apply. One, some, or all responses may be correct. o Avoid using abbreviations and acronyms. o Minimize the use of verbal and telephone orders. o Try to guess what the client is saying if the language is not understood. o Document each dose of the medication using trailing zeros when recording the dose. o Check three times before giving a medication by comparing the medication prescription and medication profile.

o Avoid using abbreviations and acronyms. o Minimize the use of verbal and telephone orders. o Check three times before giving a medication by comparing the medication prescription and medication profile. · The use of abbreviations is avoided because this action may cause confusion and increase the risk of errors. The use of verbal and telephone orders should be minimized to avoid confusion over drugs that have similar names. Before a medication is administered, the dosage prescription should be checked three times to verify the five rights: right medication, right dose, right time, right route, and right client. The use of trailing zeros should be avoided because it increases the risk of overdose. If the client's language is not understood, a translator's help should be enlisted.

How can the nurse evaluate the effectiveness of communication with a client? o Client feedback o Medical assessments o Health care team conferences o Client's physiological responses

o Client feedback · Feedback permits the client to ask questions and express feelings and allows the nurse to verify client understanding. Medical assessments do not always include nurse-client relationships. Team conferences are subject to all members' evaluations of a client's status. Nurse-client communication should be evaluated by the client's verbal and behavioral responses.

According to the nursing process, which would the nurse do after administering pain medication to a postoperative client? o Administer nonpharmacological comfort measures. o Inform the health care provider of the nursing action. o Create a care plan that addresses the client's pain level. o Determine whether the pain medicine relieved the client's pain.

o Determine whether the pain medicine relieved the client's pain. · After implementation of a nursing action (administration of pain medication), the nurse must evaluate the intervention's effectiveness. Administering nonpharmacological comfort measures is a different intervention and does not occur as a result of the pain medication. The nurse does not need to inform the provider of the nursing action. The nurse creates a plan of care before administering the pain medication, not after.

Which carative factor is involved in creating a healing environment at all levels, physical and nonphysical, according to Watson's theory of transpersonal caring? o Promoting transpersonal teaching-learning o Promoting and expressing positive and negative feelings o Developing a helping, trusting, human caring relationship o Providing for a supportive, protective, and/or spiritual environment

o Developing a helping, trusting, human caring relationship · The carative factor of providing for a supportive, protective, and/or spiritual environment is related to creating a healing environment at all levels, physical and nonphysical. The carative factor of promoting transpersonal teaching-learning is related to learning together while educating the client to acquire self-care skills. The carative factor of developing a helping, trusting, and human caring relationship is related to learning to develop and sustain helping, trusting, and authentic caring relationships through effective communication with the client.

An older client is apprehensive about being hospitalized for the first time. Which intervention is correct for the nurse to perform to limit the client's stress? o Use the client's first name. o Visit with the client frequently. o Explain what the client can expect. o Listen to what the client has to say.

o Explain what the client can expect. · Explaining procedures and routines should decrease the client's anxiety about the unknown. The nurse would not confuse roles of professional and friend; the client should be called by an appropriate title (Mr., Miss, Ms., Mrs., etc.) unless the client requests otherwise. The nurse would not confuse the role of professional with that of being a friend; "visiting" has a social connotation. Although listening to the client is therapeutic, this does not change the fact that the hospital environment is strange to the client and the client needs information.

The nurse hears these sounds while auscultating a client's heart. Which abnormal sound would the nurse document for this client? o Systolic murmur o Third heart sound (S3) o Fourth heart sound (S4) o Pericardial friction rub

o Fourth heart sound (S4) · The fourth heart sound (S4) is low-pitched sound; it is heard in late diastole, just before the first heart sound (S1). This is an extra heart sound that can be best heard with the bell of the stethoscope. Systolic murmurs are turbulent sounds that occur between the first and second (S2) heart sounds. The third heart sound (S3) is a low-pitched diastolic sound heard just after S2. Pericardial friction rubs are typically heard in both systole and diastole and occur because of movement of the heart in contraction and relaxation.

Which is an example of an independent nursing intervention? o Preparing a client for endoscopy o Coordinating with an x-ray technician for imaging o Starting an intravenous line for a blood transfusion o Keeping edematous lower extremities elevated on pillows

o Keeping edematous lower extremities elevated on pillows · Independent nursing interventions do not require a prescription from another health care professional. Keeping edematous lower extremities elevated on pillows can be initiated by the nurse and does not need a prescription. Preparing a client for endoscopy, coordinating with an x-ray technician for imaging, and starting an intravenous line for a blood transfusion are dependent nursing interventions.

The nurse is assisting with the end-of-life care of a client. Which activity is performed when the nurse views family as context? o Assess the resources available to the family. o Meet the client's family's comfort and nutritional needs. o Meet the client's comfort, hygiene, and nutritional needs. o Determine the family's need for rest and their stage of coping.

o Meet the client's comfort, hygiene, and nutritional needs. · When viewing family as context, the nurse mainly focuses on the client's comfort, hygiene, and nutritional needs. Family as context means focusing on the health and development of a client. When viewing family as a system, the nurse mainly focuses on assessing the resources available to the family. Family as a system includes both family as context and family as a client. When viewing family as a client, the client's family comfort and nutritional needs are focused on, and the nurse determines the family's needs for rest and their stage of coping.

Which points about nursing care and nursing practice have been accurately stated? Select all that apply. One, some, or all responses may be correct. o Nursing theories help describe, explain, predict, and/or prescribe nursing care measures. o Expertise in nursing is a result of clinical experience, and substantial knowledge is not required. o The scientific work used in developing theories expands the scientific knowledge of the profession. o Nursing theories offer inadequate rationales for how and why nurses perform specific interventions and for predicting client behaviors and outcomes. o The expertise required to interpret clinical situations and make clinical judgments is the essence of nursing care and the basis for advancing nursing practice and nursing science.

o Nursing theories help describe, explain, predict, and/or prescribe nursing care measures. o The scientific work used in developing theories expands the scientific knowledge of the profession. o The expertise required to interpret clinical situations and make clinical judgments is the essence of nursing care and the basis for advancing nursing practice and nursing science. · Nursing theories help describe, explain, predict, and/or prescribe nursing care measures. The scientific work used in developing theories expands the scientific knowledge of the profession. The expertise required to interpret clinical situations and make clinical judgments is the essence of nursing care and the basis for advancing nursing practice and nursing science. Expertise in nursing is a result of clinical experience as well as knowledge. Nursing theories offer well-grounded rationales for how and why nurses perform specific interventions and for predicting client behaviors and outcomes.

Which sleep pattern would the nurse recognize as normal in preschoolers? o Daytime naps are very common among preschoolers. o On average, a preschooler sleeps about 12 hours a night. o Partial awakening leading to sleeplessness is common among preschoolers. o About 30% of sleep time in preschoolers is spent in non-rapid eye movement sleep (NREM).

o On average, a preschooler sleeps about 12 hours a night. · The average preschooler sleeps about 12 hours a night. By the age of 5, children rarely take daytime naps except in cultures in which a siesta is the custom. Partial awakening followed by a normal return to sleep is normal in preschoolers. About 30% of an infant's sleep time is in the rapid eye movement sleep (REM) cycle.

Which statement(s) are true regarding delegation? Select all that apply. One, some, or all responses may be correct. o The delegatees are accountable for effective client care. o Open lines of communication must occur between delegator and delegatee. o Delegation occurs only when at least two people are involved in a mutual work situation. o The delegation potentials are significantly lower when caregivers such as unlicensed nursing personnel (UNP) are partnered. o Delegation involves sharing activities with other health team members who have the authority to accomplish the work.

o Open lines of communication must occur between delegator and delegatee. o Delegation occurs only when at least two people are involved in a mutual work situation. o Delegation involves sharing activities with other health team members who have the authority to accomplish the work. · Open lines of communication between delegator and delegatee help eliminate any misunderstanding regarding delegated tasks. Delegation occurs only when at least two people are involved in a mutual work situation; one who has the authority to perform specific tasks and the other who holds accountability for the task being performed. Delegation involves sharing activities with others who have appropriate authority to accomplish the work. When delegating a task to delegatee, the delegator retains accountability for effective client care by ensuring that the task is completed by the right person and that the person is supervised appropriately. The delegation potentials are significantly higher when caregivers such as UNPs are partnered.

Place in order the priority of care based on Maslow's hierarchy. o Physiological needs o Psychological security o Social relationships o Self-esteem needs o Self-actualization needs

o Physiological needs o Psychological security o Social relationships o Self-esteem needs o Self-actualization needs · Maslow's hierarchy of needs include five levels of priority. The first level includes physiological needs such as air, water, and food. The second level includes safety and security needs, which involve physical and psychological security. The third level contains love and belonging needs, including friendship and social relationships. The fourth level encompasses esteem and self-esteem needs, which involve self-confidence, usefulness, achievement, and self-worth. The final level is the need for self-actualization, the state of achieving one's full potential and having the ability to solve problems and cope realistically with life situations.

Which statement best describes the nurse's role as an advocate? o Protects the client's human and legal rights and helps assert these rights o Helps the client maintain health, manage disease, and attain highest level of independence o Explains concepts about health, describes reasons for routine care, and demonstrates procedures such as self-injections o Establishes an environment for collaborative client-centered care to provide safe, quality services

o Protects the client's human and legal rights and helps assert these rights · The nurse's role as advocate is to protect the client's human and legal rights and provide assistance in asserting these rights if the need arises. The nurse acts on behalf of the client. The role of caregiver is to help the client maintain and regain health, manage disease and symptoms, and attain a maximal level of function and independence through the healing process. The role of educator is carried out by explaining concepts and facts about health, describing reasons for routine care activities, demonstrating procedures such as self-injections, reinforcing learning or client behavior, and evaluating the client's progress in learning. The role of manager involves establishing an environment for collaborative client-centered care to provide safe, quality care with positive client outcomes.

Which nursing interventions would the nurse implement to promote sleep for a client in a health care setting? Select all that apply. One, some, or all responses may be correct. o Restrict visitors. o Reduce lighting. o Provide activities during the day. o Decrease the sounds of the infusion alarms. o Increase the dosage of pain prescriptions at night.

o Reduce lighting. o Provide activities during the day. · To promote sleep in the health care setting, the nurse can reduce the lighting because bright lights disrupt sleep and reduce the melatonin level, which promotes sleep. Inactivity and boredom can lead to napping during the day and evening, which can disrupt sleep. There is no indication visitors are disrupting sleep, and if they are arriving at night, the nurse discusses this with the client before restricting the visitors. All alarms should be left at an audible level, because they are a mechanism of alert to the nurse in emergency situations. Increasing the dosage of pain prescriptions when not indicated may interfere with sleep. Prescriptions commonly used to treat pain, especially opioids, alter sleep and place the individual at risk for sleep-disordered breathing.

What does appropriate delegation do for a health care organization? Select all that apply. One, some, or all responses may be correct. o Reduces stress o Decreases trust o Reduces client care o Decreases time efficiency o Improves treatment outcomes

o Reduces stress o Improves treatment outcomes · Delegation requires empowerment of the delegatee to accomplish the task and, therefore, sharing functions reduces stress. As functions are distributed, it improves treatment outcomes. Appropriate delegation increases trust between the delegator and the delegatees, increases client care, and increases time efficiency.

Which professionals in a health care organization can be delegators? o Assistants o Technicians o Registered nurses o Client care associates

o Registered nurses · Registered nurses are professionals in a health care organization who can be delegators. The registered nurses allocate a portion of work related to client care to other individuals. Assistants, technicians, and client care associates in a health care organization can be delegatees.

Which characteristic indicates that nursing is a profession? o Trained to perform specific tasks o Required to follow a code of ethics o Required to have a collection of specific skills o Has limited autonomy in decision-making and practice

o Required to follow a code of ethics · Nursing is a profession because it follows a code of ethics, which is the philosophical ideals of right and wrong that defines the principles the nurse uses to care for the clients. Nursing is not just a collection of specific skills performed by a trained individual. The nurse is expected to act professionally by administering quality client-centered care in a safe, conscientious, and knowledgeable manner. Nursing is a profession because nurses have autonomy in decision-making and practice in accordance with the state and federal laws and regulations. Nursing is a profession because its members must not only possess basic nursing education but extended education to explore new methods of health care.

A teenager begins to cry while talking with the nurse about the problem of not being able to make friends. Which is the correct therapeutic nursing intervention? o Sitting quietly with the client o Telling the client that crying is not helpful o Suggesting that the client play a board game o Recommending how the client can change this situation

o Sitting quietly with the client · Sitting quietly with the client conveys the message that the nurse cares and accepts the client's feelings; this helps establish trust. Telling the client that crying is not helpful negates feelings and the client's right to cry when upset. Distraction (suggesting that the client play a board game) closes the door on further communication of feelings. After a trusting relationship has been established, the nurse can help the client explore the problem in more depth.

Which approach is a comforting approach that communicates concern and support? o Touch o Listening o Knowing the client o Providing a positive presence

o Touch · Touch is a comforting approach that involves reaching out to clients to communicate concern and support. Listening is a critical component of nursing care and is necessary for meaningful interactions with clients. Knowing the client comprises both the nurse's understanding of a specific client and his or her subsequent selection of interventions. Providing presence is a person-to-person encounter that conveys closeness and a sense of caring.