NUR 2050 Exam 1
Dorsiflexion
Backward bending of the hand or foot. Example: A person's foot is in dorsiflexion when the toes are brought up as though to point them at the knee.
A nurse is discharging a client who was admitted for observation following a motor vehicle accident. The client is a single parent who is living in a new community. What service would be an appropriate referral for this client?
Parish nursing
The nurse is caring for a client with rectal bleeding. The nurse will place the client into which position to facilitate rectal examination?
Sims
Condyloid joint
The oval head of one bone fits into a shallow cavity of another bone; flexion-extension and abduction-adduction can occur (e.g., wrist joint and joints connecting fingers to palm).
anaerobic
capable of living without oxygen
A nurse recommends palliative care for a client who is being discharged following a diagnosis of cancer. What is the chief focus of this type of care
Relief from physical, mental, and spiritual distress
A nurse is providing care to a client recently admitted to the health care facility for treatment of an infection. The client experienced a traumatic brain injury several months ago that resulted in paralysis of both lower extremities and difficulty swallowing and speaking. The client's spouse is the primary caregiver. The client's spouse says to the nurse, "It's been really tough this last month caring for my spouse. Even though I have an aide who comes in to help for a couple of hours a week, I'm just spent, physically and emotionally." A referral for which service would be appropriate?
Respite care
The goals of health care reform include which?
Focusing on cost containment with improved access and quality of services for everyone
The hospital readmission reduction program looks at:
Readmission rates of patients during a 30-day period after discharge.
Rights of Medication Administration
Right medication Right patient Right dosage Right route Right time Right reason Right assessment data Right documentation Right response Right to education Right to refuse
The nurse is caring for a client with hemorrhoids. To facilitate a rectal examination, into which position will the nurse place the client?
Sims
A client has tested positive for methicillin-resistant Staphylococcus aureus after being swabbed on admission to the hospital. Bacterial resistance to antibiotics is an example of:
Survival adaptation
Ball-and-socket joint
The rounded head of one bone fits into a cuplike cavity in the other; flexion-extension, abduction-adduction, and rotation can occur (e.g., shoulder and hip joints).
Circumduction
Turning in a circular motion; combines abduction, adduction, extension, and flexion. Example: Circling the arm at the shoulder, as in bowling or a serve in tennis.
aerobic
requiring oxygen to live and grow
Value-Based Purchasing (VBP)
-A program of the Centers for Medicare & Medicaid Services (CMS) that rewards acute care hospitals with incentive payments for the quality of care they provide to people with Medicare, not just the quantity of procedures performed -Scoring system that includes: 1. Clinical process of care 2. Patient experience of care 3. Outcomes 4. Efficiency -Hospitals excluded from the Inpatient Prospective Payment System (psychiatric, rehabilitation, long term care, children's and cancer) are excluded from VBP
A nurse is teaching a client about the beneficial effects of exercise on his body. Which education point would the nurse include in the plan? Select all that apply
-Exercise increases intestinal tone. -Exercise increases efficiency of the metabolic system. -Exercise increases blood flow to kidneys.
Inpatient Quality Reporting Program (IQR)
-IQR provides CMS with data to help consumers make more informed decisions about their health care 1. Posted on Hospital Compare website Example IQR - 63 measures; examples: 1. Clostridium difficile 2. Incidence of potentially preventable venous thromboembolism 3. Surgical site infections (SSI) 4. Catheter associated urinary tract infection (CAUTI
Joint structure and function
-Limitation in the normal range of motion -Increased joint mobility -Swelling or tenderness in or around the joint -Heat or redness -Crepitation -Deformities -Muscle atrophy, nodules, skin changes -Asymmetry of involvement
"Never Event" medical errors that shouldn't have happened
-Shocking medical errors that should never occur (wrong-site surgery) -Adverse events that are unambiguous (clearly identifiable and measureable) -Serious (resulting in death or significant disability) -Usually preventable In 2007, CMS saidwill not payfor additional cost of these "never events" unless Present on Admission (POA):
A client is admitted with Clostridium difficile (C. difficile) with frequent loose stool and fever. Which action should the nurse implement for this client? Select all that appl
-Start contact precaution protocol and place a sign by the door. -Allocate a vital signs machine for the client's room.
The nurse is caring for several clients with chronic conditions that need to be evaluated for long-term care. After evaluating each client, the nurse determines which client is most appropriate to receive long-term care?
A client who suffered a stroke who has mobility issues and problems completing activities of daily living (ADLs).
Preffered Provider Organization (PPO)
A managed care organization of doctors, hospitals, and other providers who have an agreement with an insurer to provide health care at reduced rates to subscribers. PPO clients do not pay deductibles when using the preferred providers, but can use other providers and pay a higher co-payment as well as a deductible.
When conducting an education program for a group preparing for retirement, the nurse would include information about applying for Social Security benefits and Medicare insurance. The nurse would include in the education that Medicare is a federally funded insurance program which bases the fee for payment on what?
A prospective payment plan based on a predetermined fixed cost
A caregiver asks a nurse to explain respite care. How would the nurse respond? A. "Respite care is a service that allows time away for caregivers." B. "Respite care is a special service for the terminally ill and their family." C. "Respite care is direct care provided to people in a long-term care facility." D. "Respite care provides living units for people without regular shelter."
A. "Respite care is a service that allows time away for caregivers."
Subcutaneous injections
Administered into the adipose tissue layer just below the epidermis and dermis. Various sites used: Outer aspect of the upper arm Abdomen (from below the costal margin to the iliac crests) The anterior aspects of the thigh The upper back The upper ventral or dorsogluteal area
Which government policy addresses penalizing hospitals for readmissions of clients with certain diagnoses within 30 days after discharge?
Affordable care Act
The nurse is providing care to several clients on a medical-surgical unit. For which client's plan of care should the nurse include information regarding extended care?
An older adult client who fell at home and required a hip replacement
Nursing students are reviewing information about health care delivery systems in preparation for a quiz the next day. Which statements describe current U.S. health care delivery practices? Select all that apply. A. Access to care depends only on the ability to pay, not the availability of services. B. The Patient Protection and Affordable Care Act provides private health care insurance to underserved populations. C. Every health insurance plan in the Health Insurance Marketplace offers comprehensive coverage, from doctors to medications to hospital visits. D. The uninsured pay for more than one third of their care out of pocket and are usually charged lower amounts for their care than the insured pay. E. Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do. F. Quality of care can be defined as the right care for the right person at the right time.
C. Every health insurance plan in the Health Insurance Marketplace offers comprehensive coverage, from doctors to medications to hospital visits. E. Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do F. Quality of care can be defined as the right care for the right person at the right time.
Matching Hospital acquired infections A.An admission to an inpatient hospital within 30 days of a discharge B.Medical error/events that should never occur or could be preventable C.Infections acquired while receiving treatments for another condition D.Undesirable situation or condition that arose during a hospital stay
C.Infections acquired while receiving treatments for another condition
A nurse working for a home health agency is scheduled to evaluate a client with worsening heart failure to determine whether the client is a candidate for the new "Hospital at Home" program. Which statement accurately reflects an outcome for this program?
Clients in the "Hospital at Home" program have been found to require shorter lengths of stay than when admitted to the acute care setting.
Based on the Patient Protection and Affordable Care Act (ACA), nurses are to assume an important new role in health care. Which is an example of this new role?
Collaborating with all agencies to provide for the client's home health needs
The nurse is donning a pair of sterile gloves. The nurse correctly dons the first glove, but inadvertently inserts the thumb and index finger into the thumb hole of the second glove. The glove remains intact. Which action is most appropriate?
Continue to don the glove, then use the other gloved hand to carefully insert the finger into the proper hole.
The nurse performs range of motion exercises on an immobile client to avoid which complication associated with immobility? A.Urinary stasis B.Constipation C.Dependent edema D. Contractures
D. Contractures
A patient who injured the spine in a motorcycle accident is receiving rehabilitation services in a short-term rehabilitation center. The nurse caring for the patient correctly tells the aide not to place the patient in which position? A. Side-lying B. Fowler's C. Sims' D. Prone
D. Prone
The Patient Protection and Affordable Care Act (ACA) was passed in 2010 and aims to provide affordable health care to everyone. Which are goals of the ACA? Select all that apply.
Health care affordability Ability to compare insurance options Accessibility to insurance services Decreased number of uninsured
What is the second line of defense in microbial invasion?
Inflammation
General ease of movement (Physical assessment of mobility status)
Involuntary movements: • Tremors • Tics • Chorea • Athetosis • Dystonia • Fasciculations • Myoclonus • Oral-facial dyskinesias
The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system?
Medicare
Does people pay for Medicare A?
Most do not pay a monthly premium because they or spouse have accrued 40 (10 years) or more quarters of Medicare-covered employment Hospital deductible 2019 = $1,364
Inversion
Movement of the sole of the foot inward (occurs at the ankle)
Eversion
Movement of the sole of the foot outward (occurs at the ankle)
The friend of a long-term care client comes to visit despite having an upper respiratory infection. What health teaching will the nurse share with the visitor?
Please get a mask from the staff upon entry and use a mask along with hand hygiene when visiting to prevent the spread of infection to your friend and others."
A client is admitted to the facility after fracturing a hip. The client has undergone surgery to repair the fracture and is receiving services to promote healing of the surgical site and regain mobility. Which discussion should the nurse have with a member of the interdisciplinary team member to promote the goal of regaining mobility?
Speak with the physical therapist about exercises to strengthen muscles.
A nurse is a member of an interdisciplinary team providing home health care to a client who was discharged home after experiencing a stroke. The client has been receiving services to assist with swallowing. The nurse would collaborate with which member of the team to discuss the client's progress?
Speech therapist
Medicare (Title 18 Social Security Act, 1965)
Subscriber -65 years of age or older -Younger but disabled and qualify after receiving Social Security Disability Insurance (SSDI) for at least 24 months -Person who have end-stage renal disease or amyotrophic lateral sclerosis (ALS) Eligible -U.S. citizen or permanent resident who lived in U.S. at least 5 consecutive years -Meet age or disability requirement If income is low, person may qualify for Medicaid with the Medicare
Supination
The assumption of the supine position. Example: A person is in the supine position when lying on the back; a person's palm is supine when the forearm is turned so that the palm faces upward.
A client diagnosed with lung cancer has been given a prognosis of 3 to 4 months of life. The nurse discusses hospice care with the client and family. Which aspect of the client's health status indicates that hospice care is appropriate?
The client has a life expectancy of less than 6 months
virulence
ability to produce disease
Surgical asepsis is defined as:
absence of all microorganisms.
A nurse is providing care to a client confined to bed. To promote independence while the client is moving in bed and provide the client assistance in moving up in bed, which device would be appropriate?
bed trapeze
range of motion
complete extent of movement of which a joint is normally capable
flaccidity
decreased muscle tone; synonym for hypotonicity
The process of phagocytosis involves:
digestion of microbes by white blood cells.
infection
disease state resulting from pathogens in or on the body
pathogens
disease-producing microorganism
bundles
evidence-based best practices that have proven positive outcomes when implemented together to prevent infection
isometric exercise
exercise in which muscle tension occurs without a significant change in muscle length
isokinetic exercise
exercise involving muscle contractions with resistance varying at a constant rate
antigen
foreign material capable of inducing a specific immune response
antibody
immunoglobin produced by the body in response to a specific antigen
active exercise
joint movement activated by the person
disinfection
process used to destroy microorganisms; destroys all pathogenic organisms except spores
airborne transmission
spreading of microorganisms that are less than 5 mcm when an infected host coughs, sneezes, or talks, or when the organism becomes attached to dust particles
The nurse has been educating the client about how to use a walker safely. The nurse knows that the education has been effective when the client:
steps into the walker when walking.
The nurse is assisting a client with limited mobility to turn in bed. After successfully turning the client to the side, where would the nurse place an additional pillow?
supporting the client's back
Infiltration
the escape of fluid into the subcutaneous tissue. Can be caused by dislodged needle- penetrated vessel wall.
bacteria
the most significant and most commonly observed infection-causing agents
Medicare part B premium
•Standard premium (based on income) •$135.50/month - lowest and what most pay •Pays 80% of health care provider's fee Deductible = $185/year Patient pays 20% of the Medicare approved amount for services after meeting the deductible
Angles of Insertion for Various Injections
--IM 72, 90°. --SQ 45, 90°. --Intradermal 5-15°.
Alignment (Physical assessment of mobility status)
-Abnormal spinal curvatures -Inability to maintain correct alignment independently
A nurse working in a long-term care facility uses proper patient care ergonomics when handling and transferring patients to avoid back injury. Which action should be the focus of these preventive measures? A. Carefully assessing the patient care environment B. Using two nurses to lift a patient who cannot assist C. Wearing a back belt to perform routine duties D. Properly documenting the patient lift
A. Carefully assessing the patient care environment
An immobile postoperative client asks the nurse why it is so important to deep-breathe and cough after surgery. When formulating a response, the nurse incorporates the understanding that retained pulmonary secretions in a postoperative client can lead to which condition? A. Pneumonia B. Hypothermia C. Fluid imbalance D. Pulmonary embolism
A. Pneumonia
A nurse is instructing a patient who is recovering from a stroke how to use a cane. Which step would the nurse include in the teaching plan for this patient? A. Support weight on stronger leg and cane and advance weaker foot forward. B. Hold the cane in the same hand of the leg with the most severe deficit. C. Stand with as much weight distributed on the cane as possible. D. Do not use the cane to rise from a sitting position, as this is unsafe.
A. Support weight on stronger leg and cane and advance weaker foot forward.
Which intervention should a nurse plan to incorporate in the care of a surgical client to decrease the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE)? A.Use of intermittent compression devices on the lower extremities B.Administration of heparin intravenously - would only give IV if patient already has a DVT/PE C.Coughing and deep breathing exercises D.Turn patient every 2 hours
A.Use of intermittent compression devices on the lower extremities
An older adult client is admitted into the hospital due to tuberculosis. In addition to standard precautions, which transmission-based precautions should the nurse initiate?
Airborne
The nurse is caring for a client admitted with tuberculosis (TB). What would be the best action by the nurse?
Apply a nonparticulate (N-95) respirator when entering the room
Name of assessment used to measure Older adult dependency
KATZ INDEX OF INDEPENDENCE IN ACTIVITIES OF DAILY LIVING
Abduction
Lateral movement of a body part away from the midline of the body. Example: A person's arm is abducted when it is moved away from the body.
Adduction
Lateral movement of a body part toward the midline of the body. Example: A person's arm is adducted when it is moved from an outstretched position to a position alongside the body.
1.Mrs. Redor, age 55 years, was hospitalized. She takes 5 medications. She is being discharged home. In preparing her discharge, which of the following is least likely to be helpful?
Leave medication brochures by her bed
The nurse must assign a room for a client admitted with endocarditis and methicillin-resistant Staphylococcus aureus (MRSA) in the blood. A client with which diagnosis can share a room with this client?
MRSA in the wound
Opposition
Rotation of the thumb around its long access (movement of the thumb across the palm to touch each fingertip of the same hand).
Two nurses are moving a client up in bed. What motion would the nurses use to counteract the client's weight?
Shift their weight back and forth, from back leg to front leg.
Extension
The state of being in a straight line. Example: A person's cervical spine is extended when the head is held straight on the spinal column.
Injection Volume
The volume of medication varies based on intended site. In general, 1 to 5 mL is the accepted volume range. Deltoid is site used for patients 3 years and older. Deltoid muscle injections should be limited to 1 mL of solution, but up to 2 mL may be administered, depending on the size of the muscle. However, 1-5 mL IM injections are preferably given in the ventrogluteal and vastus lateralis locations due to the size of the muscle. Usually no more than 1mL of solution can be given subcutaneously, larger amounts add to patient discomfort and may predispose to poor absorption
A nurse is providing care to a client who has Salmonella food poisoning. The nurse understands that this pathogen was transmitted by which mechanism?
Vehicle
paralysis
absence of strength secondary to nervous impairment
footdrop
complication resulting from extended plantar flexion
atrophy
decrease in the size of a body structure
What is a benefit of regular exercise over time?
decreased heart rate
A client comes to the emergency department reporting becoming very ill after consuming shrimp and lobster. How will the nurse document this condition?
noncommunicable disease
virus
smallest of all microorganisms; can be seen only by using an electron microscope
The nurse is caring for a client who is on bed rest. After reviewing the image above, which is the most appropriate reason for the nurse to observe this client perform the activity?
"A client can perform this activity to prevent a permanent condition in the feet caused by bed rest."
Which six trends in health care reflect the Institute of Medicine's (IOM) focus?
"The system should be safe, effective, efficient, patient centered, timely, and equitable."
sterilization
(1) the process by which all microorganisms, including spores, are destroyed; (2) surgical procedure performed to render a person infertile
Gastrointestinal: Nursing Diagnosis & Care
*Privacy and positioning *Dietary fiber *Adequate fluids *Pharmacologic agents: stool softeners, bulk formers, laxatives *Bowel program
Joint contractures
-Contractures occur in the skin, the tissues underneath, and the muscles, tendons, ligaments, and joint areas. -They affect range of motion and function in a certain body part. -Flexion or extension and fixation of a joint -Caused by disuse, atrophy, and shortening of muscle fibers
External rotation
A body part turning on its axis away from the midline of the body. Example: A leg is rotated externally when it turns outward at the hip and the toes point away from the midline of the body.
Pivot joint
A ring-like structure that turns on a pivot; movement is limited to rotation (e.g., joints between the atlas and axis of the neck and between the proximal ends of the radius and the ulna at the wrist).
Hinge joint
A spool-like (rounded) surface of one bone fits into a concave surface of another bone; only flexion-extension can occur (e.g., elbow, knee, ankle joints).
risk for disuse syndrome
Affected by: -Level of inactivity -Duration of inactivity -Age -Body weight -Chronic illnesses -Discomfort -Environment
Phlebitis
An inflammation of a vein. Could be from mechanical trauma from the needle/catheter or from chemical trauma from the solution
Orthostatic Hypotension
(Drop in 20 systolic or 10 diastolic, may feel weak and faint) -Decreased ability to equalize blood supply when moving from a lying to a standing position -Causes *Decreased circulating fluid volume *Pooling of blood in the lower extremities *Decreased autonomic response
Gastrointestinal (Constipation)
*Decreased muscle tone *Decreased peristaltic movement *Embarrassment *Ignore the defecation reflex * Neurogenic bowel after spinal cord injury
Respiratory system Nursing Care:
*Exercise and activity *Turn and reposition every 2 hrs. *Deep breathe and cough every 2 hrs. -Incentive spirometer *Encourage fluids *Careful use of narcotics and sedatives *Respiratory assessment to note changes early *Use of oxygen and mechanical ventilation as needed
categories of HAI
-Central‐line Associated Bloodstream Infections (CLABSI) -Clostridium difficile Infections -Catheter‐associated Urinary Tract Infections (CAUTI) -Methicillin-resistant Staphylococcus aureus(MRSA) invasive infections -Surgical Site Infections (SSI)
Inpatient prospective payment system (IPPS).
-Each case is categorized into a diagnosis-related group (DRG). Each DRG has a pre-determined payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG. -Disproportionate share hospital (DSH) adjustment for hospital with a large population of low income patients -Hospitals will incur profit if patient gets discharged early or if the total cost stays under the projected payout.
Major themes of Health Care Reform
-Improving quality and outcomes -Changing payment incentives -Coordinating care -Improving patient centered care/experience -Controlling costs
Hospital Readmission Reduction Program
-Readmission: an admission to an inpatient hospital within 30 days of a discharge from the same or another inpatient hospital -Requires CMS to reduce payments to inpatient prospective payment system (IPPS) hospitalswith excess readmissions
Health and Low Health Literacy
-Seek health care when sicker -Frequently use emergency rooms -Poor understanding and knowledge of chronic conditions -May not effectively participate in preventive care -Higher all-cause mortality risk (Bostock & Steptoe, 2012) -Patient harbors shame which becomes worse when health care personnel become frustrated and angry
Patient Teaching
-Use plain, lay language the person understands -Limit information communicated in a single visit -Be seated at eye level -Use a teach back technique - have patient show or tell you -Critique patient teaching materials
A nurse is conducting a home assessment of a 90-year-old client with a history of several minor strokes that have left the client with a hemiplegic gait. The nurse is particularly concerned about falls. Which activities would help to prevent falls for this client? Select all that apply.
-removing clutter from the floor -placing nightlights in the bathroom and hallways -moving the bedroom to the ground floor
Medicare Part B (Medical insurance)
*About 93% of Medicare's beneficiaries are enrolled in Part B *Federal government picks up about 75% of the cost of Part B benefits Covers: Doctor visits, durable medical equipment, home health care, laboratory services, and X-rays, preventive services (i.e., screening for prostate, colon, breast, cervical cancer, glaucoma screening, diabetes screening & self-management, cardiovascular screening, bone mass measurements, flu and pneumonia vaccinations
Thrombus (DVT) Formation- Virchow's Triad
*Changes or injury to vessel wall *Hypercoagulability of the blood -Changes in clotting factors *Venous stasis or slowing of blood -External pressure of the bed against the legs -Lack of motion of the legs -Hypovolemia and increased hematocrit
deep vein thrombosis (DVT)
*Venous thrombosis (DVT) of the deep veins of the lower legs is a major US health problem, affecting 900,000 people annually (CDC 2018) -60,000-100,000 Americans die of DVT/PE deaths per year -50% will have long-term complications *The most serious complication is pulmonary embolism (PE). *DVT/PE: "never event" in acute care 2010
Emphasize patient and family education
-Assess learning needs, motivation, growth and development, culture and ethnicity -Coordinate necessary teaching -Communication skills -Use appropriate educational tools and materials Literacy Evaluate outcomes
Muscle mass, tone, and strength
-Atrophy, hypertrophy -Hypotonicity (flaccidity), spasticity -Paresis or paralysis
Infections occurs as a result of the cyclic process six components
-Infectious agent -Reservoir -Portal of exit -Means of transmission -Portals of entry -Susceptible host
A nurse working in a primary care facility prepares insurance forms in which the provider is given a fixed amount per enrollee of the health plan. What is the term for this type of reimbursement? A. Capitation B. Prospective payment system C. Bundled payment D. Rate setting
A. Capitation
A nurse is providing range-of-motion exercises for a patient who is recovering from a stroke. During the session, the patient complains that she is "too tired to go on." What would be priority nursing actions for this patient? Select all that apply. A. Stop performing the exercises. B. Decrease the number of repetitions performed. C. Reevaluate the nursing care plan. D. Move to the patient's other side to perform exercises. E. Encourage the patient to finish the exercises and then rest. F. Assess the patient for other symptoms.
A. Stop performing the exercises. C. Reevaluate the nursing care plan. F. Assess the patient for other symptoms.
A nurse is assisting a patient who is 2 days postoperative from a cesarean section to sit in a chair. After assisting the patient to the side of the bed and to stand up, the patient's knees buckle and she tells the nurse she feels faint. What is the appropriate nursing action? A. Wait a few minutes and then continue the move to the chair. B. Call for assistance and continue the move with the help of another nurse. C. Lower the patient back to the side of the bed and pivot her back into bed. D. Have the patient sit down on the bed and dangle her feet before moving.
C. Lower the patient back to the side of the bed and pivot her back into bed.
Hospital Acquired condition example
Mom came to hospital and she wasn't turned and now she has a pressure wound and needs to be reported here
1.A nurse discovers that she made a medication error. What should be the nurse's FIRST response?
Asses the patient for any possible side effects of the error
A nurse cares for dying patients by providing physical, psychological, social, and spiritual care for the patients, their families, and other loved ones. What type of care is the nurse providing? A. Respite care B. Palliative care C. Hospice care D. Extended care
C. Hospice care
Flexion
The state of being bent. Example: A person's cervical spine is flexed when the head is bent forward, chin to chest.
Which type of mobility aid would be most appropriate for a client who has poor balance?
a cane with four prongs on the end (quad cane)
The nurse adjusts a client's bed to a comfortable working height in order to turn the client. What would be the nurse's next action?
move the client to edge of the bed opposite the side that client will be turning
indirect contact
personal contact with either a vector, a living creature that transmits an infectious agent to a human, usually an insect; or an inanimate object, called a fomite, such as equipment or countertops
orthopedics
the correction or prevention of disorders of body structures used in locomotion
direct contact
way for organisms to enter the body that involves proximity between the susceptible host and an infected person or a carrier, such as through touching, kissing, or sexual intercourse
The nurse is assessing the developmental level of children in a pediatric clinic. The nurse would be most concerned about which client?
the 24-month-old child who is unable to walk unassisted
droplet transmission
transmission of particles greater than 5 mcm
Matching 1.Never Events A.An admission to an inpatient hospital within 30 days of a discharge B.Medical error/events that should never occur or could be preventable C.Infections acquired while receiving treatments for another condition D.Undesirable situation or condition that arose during a hospital stay
B. Medical error/events that should never occur or could be preventable
The nurse is caring for an older adult with pulmonary tuberculosis. Which precautions will the nurse begin?
airborne
Which are the names of the transmission-based precautions defined by the Centers for Disease Control and Prevention (CDC)? Select all that apply
airborne precautions droplet precautions contact precautions
health care-associated infection (HAI)
an infection that was not present on admission to a health care institution and develops during the course of treatment for other conditions (nosocomial)
host
animal or person on or within which microorganisms live
antimicrobial
antibacterial agent that kills bacteria or suppresses their growth
The nurse is initiating isolation precautions for a client who has chronic Clostridium difficileinfection. What should the nurse be sure to include with these precautions?
be sure that there are gloves of various sizes and gowns for use
A nurse is ambulating a patient for the first time following surgery for a knee replacement. Shortly after beginning to walk, the patient tells the nurse that she is dizzy and feels like she might fall. Place these nursing actions in the order in which the nurse should perform them to protect the patient: A. Grasp the gait belt. B. Stay with the patient and call for help. C. Place feet wide apart with one foot in front. D. Gently slide patient down to the floor, protecting her head. E. Pull the weight of the patient backward against your body. F. Rock your pelvis out on the side of the patient.
c, f, a, e, d, b.
A nurse is caring for a 55-year-old postoperative client. The client returns to the ICU after surgery intubated and mechanically ventilated with a Salem sump nasogastric tube, a Foley catheter, and a PICC line in place. Based on the nurse's knowledge of the most common hospital-acquired infections, which apparatus is most important to remove first?
urinary catheter
paresis
impaired muscle strength or weakness
endogenous
infection in which the causative organism comes from microbial life harbored within the person
A client with a hip fracture is returning to the orthopedic unit, and the orders indicate that the client should be turned by logrolling. Which statement regarding logrolling is correct?
Use a drawsheet or a friction-reducing sheet to facilitate smooth movement.
exogenous
infection in which the causative organism is acquired from outside the host
iatrogenic
infection that occurs as a result of a treatment or diagnostic procedure
Hospice
is a program of palliative and supportive care services providing physical, psychological, social, and spiritual care for dying people, their families, and other loved ones
Respite care
is a type of care provided for caregivers of homebound ill, disabled, or older adults. The main purpose is to give the primary caregiver some time away from the responsibilities of day-to-day care.
After positioning a client to move from the bed into a wheelchair, how would the nurse stand when helping the client sit up on the side of the bed?
near the client's hip, with legs shoulder width apart and one foot near the head of the bed
Identifying the patient
-Checking the identification bracelet -Validating the patient's name (first identifier) -Validating the patient's identification number, medical record number, and/or birth date (second identifier) -Comparing with the CMAR or MAR -Asking the patient to state his or her name if possible
Purposes of a Medical Record
-Communication -Basis for prescription -Aid in diagnosis -Evidence for continuity and outcomes of care -Research and education -Legal documen
vector
nonhuman carriers—such as mosquitoes, ticks, and lice—that transmit organisms from one host to another
tonus
normal, partially steady state of muscle contraction
Health Insurance Portability and Accountability Act (HIPAA)
-Identifying patient information must be kept confidential (protected health information - PHI) -Policy as to what providers have access to PHI; should be the minimum amount necessary to accomplish the intended purpose -Don't disclose patient information in public areas -Cannot share your password with others -Breaking HIPAA's privacy or security rules can mean either civil or criminal penalties.
The nurse is preparing a sterile field for a procedure in the client's presence. Which is the most appropriate instruction to give the client in this situation?
"I have set up this sterile field for your procedure, so please do not touch anything around the tray."
The nurse is caring for a client who works in a warehouse and has been having low back pain. Which statement by the client indicates the need for more education regarding safe lifting?
"I hold the boxes away from my body so I do not drop them on my feet."
The UAP asks the nurse what hand rolls are used for when providing client care. What is the appropriate nursing response?
"To preserve the client's functional ability to grasp and pick up objects."
A home health nurse is visiting a client who was taught to crutch-walk in the hospital following a knee surgery. The client says, "My armpits are so sore." Which information does the nurse provide?
"Try to bear your weight on your hands, not your armpits."
Medicaid (Established 1965 under Title 19 of Social Services Act)
-Large health insurer in the U.S. -Both state and federal funding (2017) - $600 billion ---The federal gov't paid about 66% with the states picking up 40%. -Created to meet the health care needs of the poor --Eligibility is income based --9 million low income and disabled may have Medicaid and Medicare --Plans differ by state --About 72% are managed care programs; 28% traditional
Quadruple Aim
1. Improved individual patient experience 2. Enhanced population health 3. Reduced healthcare costs 4. Improved the experiences of those in the workforce who provide health care
Three Checks of Medication Administration
1. When the nurse reaches for the container or unit dose package 2. After retrieval from the drawer and compared with the eMAR/MAR, or compared with the eMAR/MAR immediately before pouring from a multidose container 3. Before giving the unit dose medication to the patient or when replacing the multi-dose container in the drawer or shelf
A primary health care provider writes a prescription of "Restraints PRN (as needed)" for a client who has a history of violent behavior. Which action would the nurse take? 1.Ask the health care provider to specify the type of restraint in the prescription. 2.Notify the provider that PRN prescriptions for restraints are unacceptable. 3.Implement the restraint prescription when the client begins to act out. 4.Ensure that the entire staff is aware of the prescription for the restraints.
2. Notify the provider that PRN prescriptions for restraints are unacceptable.
The nurse is providing restraint education to a group of nursing students. Which reason to use restraints is incorrect to teach? 1.To prevent a confused client from pulling out an intravenous (IV) line 2.To prevent an adult client from getting up at night when there is insufficient staffing on the unit 3.To prevent ventilated patient from dislodging the ventilator 4.To keep an older adult client from falling out of bed after a surgical procedure
2.To prevent an adult client from getting up at night when there is insufficient staffing on the unit
A nurse is assessing the extremities of a client who had wrist restraints applied 2 hours ago. Which assessment finding, if present, is of greatest concern? A. The client is able to wiggle the fingers. B. The restraint is secured to the bed's frame. C. The skin of the hand feels cool to the touch and is pale. D. The nurse is able to insert two fingers under the restraints
C. The skin of the hand feels cool to the touch and is pale.
transmission-based precautions
CDC precautions used in patients known or suspected to be infected with pathogens that can be transmitted by airborne, droplet, or contact routes; used in addition to standard precautions
What does medicare cover and NOT cover?
Covers about 50% of the typical person's health care costs Person must pay premiums, deductibles, co-insurance, and co-payments Does not cover - custodial care in a nursing home, annual physical examinations, foot or dental care, vision or hearing tests
Medicare Part A (Hospital Insurance)
Covers inpatient services -Hospital - semiprivate room, meals, drugs, and supplies and care providers -Skilled nursing facility - at least partial coverage for as long as 100 days. Requirements *Needs daily skilled nursing or rehabilitation *Has been hospitalized at least 3 days before entering *Received care within 30 days of hospital discharge
Matching 2.Hospital Acquired Conditions A.An admission to an inpatient hospital within 30 days of a discharge B.Medical error/events that should never occur or could be preventable C.Infections acquired while receiving treatments for another condition D.Undesirable situation or condition that arose during a hospital stay
D.Undesirable situation or condition that arose during a hospital stay
Healthcare Associated Infections (HAI)
HAI: Infections that people acquire while they are receiving treatment for another condition in a healthcare setting Significant because of morbidity and mortality -At any given time, 1 in 20 patients has an infection related to hospital care -Cost billions of dollars per year and result in loss of life Ex. didn't flush the line, didn't care to clean the site
An experienced nurse is teaching a student nurse about the proper use of hand hygiene. Which guideline should the nurse provide to the student?
Hand hygiene is needed after contact with objects near the client.
Which is the primary criterion for admission to a long-term care facility?
Inability to provide self-care
The implementation of diagnosis-related groups (DRGs) by Medicare in 1983 affected hospitals in which way?
Medicare pays only the amount of money preassigned to a treatment for a diagnosis.
During a home care visit to a home-bound older client, the client's spouse, who is the caregiver, verbalizes anger, fatigue, and sleeplessness. Which recommendations by the nurse would be most effective in relieving caregiver role strain?
Respite care
A nurse is reading a journal article about how health care delivery in the United States compares with that in other nations in the world. The article goes on to describe areas for which the United States ranks near the bottom in comparison with other nations. The nurse demonstrates understanding of this article by identifying which area as being deficient in the United States when compared with other nations? Select all that
Obesity Heart disease Drug-related deaths Infant mortality
Endurance
Physiologic or psychological inability to tolerate an increase in activity: • Significantly increased pulse, respiration, blood pressure after rest • Shortness of breath, dyspnea • Weakness • Pallor • Confusion • Vertigo • Pain
The nurse uses a small amount of sterile solution from a large, multiuse bottle to moisten gauze in a sterile field. What technique does the nurse use?
Pour the liquid into a sterile container within the sterile field.
The nurse is assisting a client from the bed into a wheelchair. What is a recommended guideline for this procedure?
Raise the head of the bed to a sitting position.
The pediatric nurse is caring for a newborn infant. In which position will the nurse place the infant to sleep?
Suspine
Pronation
The assumption of the prone position. Example: A person is in the prone position when lying on the abdomen; a person's palm is prone when the forearm is turned so that the palm faces downward.
The client is ambulating in the room and walks around a bedside table. What is the bestexplanation for why the client does not bump into the table?
The client is aware of spatial relationships to avoid the table.
Infection occurs when the host is exposed to pathogens. What type of pathogen uses the cell's metabolism, and replicates itself while destroying the cell or changing the cell's genetic makeup?
Virus
The nurses on a busy surgical ward use hand hygiene when caring for postsurgical clients. Which action represents an appropriate use of hand hygiene?
The nurse keeps fingernails less than 1/4 in (0.63 cm) long.
Using proper body mechanics, which motions would the nurse make to move an object?
The nurse uses the internal girdle and a long midriff to stabilize the pelvis and to protect the abdominal viscera when stooping, reaching, lifting, or pulling.
Hyperextension
The state of exaggerated extension. It often results in an angle greater than 180 degrees. Example: A person's cervical spine is hyperextended when looking overhead, toward the ceiling.
Rotation
Turning on an axis; the turning of a body part on the axis provided by its joint. Example: A thumb is rotated when it is moved to make a circle.
nosocomial
something originating or taking place in the hospital (i.e., infection)
endemic
something that occurs with predictability in one specific region or population and can appear in a different geographical location
The nurse is caring for a 76-year-old client who has an unsteady gait. Which method is mostappropriate to assist in transferring?
transfer belt
Intradermal Injections
-Administered into the dermis, just below the epidermis. -Has the longest absorption time of all parenteral routes. -Used for sensitivity tests and local anesthesia. -Body's reaction to the substances is easily visible. -Sites commonly used are the inner surface of the forearm and the upper back, under the scapula. -A 1/4″ to 1/2″, 25- or 27-gauge needle is used and the angle of administration is 5 to 15 degrees. -The dosage given intradermally is small, usually less than 0.5 mL.
Medicare part D- drug coverage
-Beneficiaries pay: average monthly premium = $10-$100 per month; initial deductible = $415 (2019) -Initial coverage limit = usually $3,820 (2019) (called the donut hole; must pay for drugs on own) -Ceiling on out-of-pocket prescription drug expenses of $5,100 (2019); once reached enter catastrophic coverage and pay small percent -Formularies will cover most prescription drugs
Prevent Hospital Readmissions: Considerations for Discharge
-Medications are correct -Treatment matches national guidelines -Make follow-up appointments -Follow up outstanding tests -Arrange post-discharge services -Create a written discharge plan -Inform the patient what to do if problems arise -Educate the patient - be creative -Assess patient understanding -Send discharge summary to primary provider -Reinforce the discharge plan via the telephone
key Health Reform programs
-Patient safety and quality measures 1. Inpatient quality reporting program (IQR) 2. Hospital acquired conditions (HAC) 3. Healthcare associated infections (HAI) Hospital readmissions reduction program -Value-based purchasing (VBP) -Patient centered experience -CMS - Centers for Medicare & Medicaid Services
immobility
-Rendering of a part incapable of being moved -May range from a minor decrease in range of motion to complete loss of motion
Assess the Caregiver
-Roles and responsibilities -Difficulties -Preparedness -Quality of care -Physical and mental health and self-care activities -Existence and involvement of extended family and social support -Relationship between the caregiver and care receiver Cultural background
positions to know
-Sims position- patient lie on their left side, left hip and lower extremity straight, and right hip and knee bent -Trendelenburg position- the body is laid supine, or flat on the back on a 15-30 degree incline with the feet elevated above the head. -Prone position- lies on abdomen, head turned to side. Body is straight (shoulders, head, neck are all in erect position). Helps prevent flexion contractures of hip and knees. Contraindicated in people with spinal problems. -Fowler's position- Semi sitting position; head of the bed is elevated to 45 to 60 degrees- promotes cardiac and respiratory functioning, providing the max space in thoracic cavity. There are variations within the fowler's position- High fowlers, semi fowlers. High fowlers is when the HOB is 90 degrees. In low fowlers the HOB is 30 degrees. -Lateral Recument- Side lying position
Health Maintenance Organization (HMO)
-an organization that provides comprehensive medical care to subscribers for a fixed fee -are prepaid, group-managed care plans that allow subscribers to receive all the medical services they require through a group of affiliated providers. There may be no additional out-of-pocket costs, or subscribers may pay only a small fee, called a copaymen
A nurse is assessing a client's mobility status. What data would the nurse document as normal findings? Select all that apply.
-independent maintenance of correct alignment -head, shoulders, and hips aligned in bed -full range of motion
Which point requires correction regarding the use of restraints? 1.Less restrictive interventions must have been unsuccessful before applying restraints. 2.All other alternatives must have been tried and exhausted before applying restraints. 3.Restraints may be applied to ensure the physical safety of the resident or other residents. 4.A written order for restraints is not required.
4.A written order for restraints is not required.
During the last 8 hours, a nurse cared for a client who had a transurethral prostatectomy. The client has continuous bladder irrigation (CBI) infusing. At the end of the 8 hours, a nurse determines that the client received 3,050 mL of irrigation fluid and that 4,030 mL of fluid was emptied from the urinary drainage bag. The nurse calculates the actual urine output for 8 hours to be _______ mL.
4030-3050=980
Internal rotation
A body part turning on its axis toward the midline of the body. Example: A leg is rotated internally when it turns inward at the hip and the toes point toward the midline of the body.
The postoperative client refuses to do deep breathing, and he refuses to turn while in bed. He informs the nurse that it hurts for him to do both of these things. Which intervention should the nurse perform first?
Assess client's pain level and manage pain accordingly.
A nurse caring for patients in a primary care setting submits paperwork for reimbursement from managed care plans for services performed. Which purpose best describes managed care as a framework for health care? A. A design to control the cost of care while maintaining the quality of care B. Care coordination to maximize positive outcomes to contain costs C. The delivery of services from initial contact through ongoing care D. Based on a philosophy of ensuring death in comfort and dignity
A. A design to control the cost of care while maintaining the quality of care
Matching Re-admission rates A.An admission to an inpatient hospital within 30 days of a discharge B.Medical error/events that should never occur or could be preventable C.Infections acquired while receiving treatments for another condition D.Undesirable situation or condition that arose during a hospital stay
A. An admission to an inpatient hospital within 30 days of a discharge
A nurse researcher keeps current on the trends to watch in health care delivery. What trends are likely included? Select all that apply. A. Globalization of the economy and society B. Slowdown in technology development C. Decreasing diversity D. Increasing complexity of patient care E. Changing demographics F. Shortages of key health care professionals and educators
A. Globalization of the economy and society D. Increasing complexity of patient care E. Changing demographics F. Shortages of key health care professionals and educators
A nurse is preparing an exercise program for a patient who has COPD. Which instructions would the nurse include in a teaching plan for this patient? Select all that apply. A. Instruct the patient to avoid sudden position changes that may cause dizziness. B. Recommend that the patient restrict fluid until after exercising is finished. C. Instruct the patient to push a little further beyond fatigue each session. D. Instruct the patient to avoid exercising in very cold or very hot temperatures. E. Encourage the patient to modify exercise if weak or ill. Recommend that the patient consume a high-carb, low-protein diet.
A. Instruct the patient to avoid sudden position changes that may cause dizziness. D. Instruct the patient to avoid exercising in very cold or very hot temperatures.
Nurses provide care to patients as collaborative members of the health care team. Which roles may be performed by the advanced practice registered nurse? Select all that apply. A. Primary care provider B. Hospitalist C. Physical therapist D. Anesthetist E. Midwife F. Pharmacist
A. Primary care provider D. Anesthetist E. Midwife
The medical/surgical nurse watches a student nurse prepare a sterile field. Which of the following actions, if performed by the student nurse, requires further instruction? A. The student nurses places the sterile drape, then turns to grab a packaged set of sterile gloves from the table behind her. B. The student nurses' hands, once in the sterile gloves, do not go above her head or below her waist. C. The student nurse drops the sterile gauze into the sterile field from a 6 inch height D. The student nurse performs hand hygiene prior to putting on sterile glove
A. The student nurses places the sterile drape, then turns to grab a packaged set of sterile gloves from the table behind her.
The nurse has admitted a client to the postoperative unit following a bowel resection and is providing postoperative health education on coughing and deep breathing. What does the nurse explain to the client about why these actions are important? A.If you continue to breathe shallowly or cough ineffectively, this can lead to atelectasis and pneumonia. B.If you continue to breathe shallowly or cough ineffectively, this can lead to deep vein thrombosis (DVT) by preventing poor oxygen exchange in the cardiac and peripheral circulatory system. C.If you continue to breathe shallowly or cough ineffectively, this can lead to dizziness, falling, or an inability to ambulate because of shortness of breath. D.If you continue to breathe shallowly or cough ineffectively, this can lead to respiratory obstructive disease
A.If you continue to breathe shallowly or cough ineffectively, this can lead to atelectasis and pneumonia.
Gait and posture (Physical assessment of mobility status)
Abnormalities of gait and posture: • Spastic hemiparesis • Scissors gait • Steppage gait • Sensory ataxia • Cerebellar ataxia • Parkinsonian gait • Gait of old age • Use of assistive devices for ambulation
A nurse is providing health care to patients in a health care facility. Which of these patients are receiving secondary health care? Select all that apply. A. A patient enters a community clinic with signs of strep throat. B. A patient is admitted to the hospital following a myocardial infarction. C. A mother brings her son to the emergency department following a seizure. D. A patient with osteogenesis imperfecta is being treated in a medical center. E. A mother brings her son to a specialist to correct a congenital heart defect. F. A woman has a hernia repair in an ambulatory care center.
B A patient is admitted to the hospital following a myocardial infarction. C A mother brings her son to the emergency department following a seizure. F. A woman has a hernia repair in an ambulatory care center.
A nurse is assisting a postoperative patient with conditioning exercises to prepare for ambulation. Which instructions from the nurse are appropriate for this patient? Select all that apply. A. Do full-body pushups in bed six to eight times daily. B. Breathe in and out smoothly during quadriceps drills. Place the bed in the lowest position or use a footstool for dangling. C. Dangle on the side of the bed for 30 to 60 minutes. D. Allow the nurse to bathe the patient completely to prevent fatigue. E. Perform quadriceps two to three times per hour, four to six times a day.
B, C, F
A nurse is using the Katz Index of Independence in Activities of Daily Living (ADLs) to assess the mobility of a hospitalized patient. During the patient interview, the nurse documents the following patient data: "Patient bathes self completely but needs help with dressing. Patient toilets independently and is continent. Patient needs help moving from bed to chair. Patient follows directions and can feed self." Based on this data, which score would the patient receive on the Katz index? A. 2 B. 4 C. 5 D. 6
B. 4
A nurse caring for patients in a pediatrician's office assesses infants and toddlers for physical developmental milestones. Which patient would the nurse refer to a specialist based on failure to achieve these milestones? A. A 4-month-old infant who is unable to roll over B. A 6-month-old infant who is unable to hold his head up himself C. An 11-month-old infant who cannot walk unassisted D. An 18-month-old toddler who cannot jump
B. A 6-month-old infant who is unable to hold his head up himself
A nurse is caring for a patient who is on bed rest following a spinal injury. In which position would the nurse place the patient's feet to prevent footdrop? A. Supination B. Dorsiflexion C. Hyperextension D. Abduction
B. Dorsiflexion
A nurse working in a pediatric clinic provides codes for a patient's services to a third-party payer who pays all or most of the care. This is an example of what mode of health care payment? A. Out-of-pocket payment B. Individual private insurance C. Employer-based group private insurance D. Government financing
B. Individual private insurance
A patient has a fractured left leg, which has been casted. Following teaching from the physical therapist for using crutches, the nurse reinforces which teaching point with the patient? A. Use the axillae to bear body weight. B. Keep elbows close to the sides of the body. C. When rising, extend the uninjured leg to prevent weight bearing. D. To climb stairs, place weight on affected leg first.
B. Keep elbows close to the sides of the body.
A nurse is caring for patients in a primary care center. What is the most likely role of this nurse based on the setting? A. Assisting with major surgery B. Performing a health assessment C. Maintaining patients' function and independence D. Keeping student immunization records up to date
B. Performing a health assessment
A nurse is caring for a patient in a long-term care facility who has had two urinary tract infections in the past year related to immobility. Which finding would the nurse expect in this patient? A. Improved renal blood supply to the kidneys B. Urinary stasis C. Decreased urinary calcium D. Acidic urine formation
B. Urinary stasis
Which statement by the patient indicates the development of a deep vein thrombosis? (swelling, warmth, A."My legs itch." B."My left leg is swollen compared to my right." C."The skin on my legs is dry and scaly." D."My left leg feels cool when I touch it."
B."My left leg is swollen compared to my right."
Saddle joint
Bone surfaces are convex on one side and concave on the other; movements include flexion-extension, adduction-abduction, circumduction, and opposition (e.g., joint between the trapezium and metacarpal of the thumb).
A nurse is caring for a patient who is hospitalized with pneumonia and is experiencing some difficulty breathing. The nurse most appropriately assists him into which position to promote maximal breathing in the thoracic cavity? A. Dorsal recumbent position B. Lateral position C. Fowler's position D. Sims' position
C. Fowler's position
A nurse is caring for a patient who has been hospitalized for a spinal cord injury following a motor vehicle accident. Which action would the nurse perform when logrolling the patient to reposition him on his side? A. Have the patient extend his arms outward and cross his legs on top of a pillow. B. Stand at the side of the bed in which the patient will be turned while another nurse gently pushes the patient from the other side. C. Have the patient cross his arms on his chest and place a pillow between his knees. D. Place a cervical collar on the patient's neck and gently roll him to the other side of the bed.
C. Have the patient cross his arms on his chest and place a pillow between his knees.
standard precautions
CDC precautions used in the care of all patients regardless of their diagnosis or possible infection status; this category combines universal and body substance precautions
A new nurse is considering getting a job in either an acute care setting or a home care setting. Which statement about these care settings is most accurate?
Clients play a large role in helping themselves in the home care setting
Nurses in various health care settings provide services to prevent the fragmentation of care that is occurring as a health care trend in today's society. What role of the nurse is most important in preventing this effect?
Coordinator of care
A school nurse is conducting a program for the parents about common childhood illness. Which information do parents need to know about preventing childhood illness?
Early infection treatment is needed to prevent the spread of infection.
A nurse has an older adult home care client who lives alone with no family nearby. On a recent visit, the nurse notices that his clothes are very loose, and he has difficulty letting the nurse leave when the visit is ending. After talking with him, the nurse learns that he has not been cooking for himself and he can't get to the grocery store easily. What service could the nurse suggest as an immediate response until a long-term plan can be formed?
Enroll the client in Meals on Wheels
Gliding joint
Flat surfaces of the bone slide over one another; flexion-extension and abduction-adduction can occur (e.g., carpal bones of wrist and tarsal bones of feet).
Plantar flexion
Flexion of the foot. Example: A person's foot is in plantar flexion in the footdrop position.
The nurse conducting a hand hygiene in-service determines that the participants need additional education when they state that the use of an alcohol-based hand rub is appropriate in which situation?
When hands are visibly soiled
Medicare Part A (Home Health &Hospice coverage)
Home health care -If needed less than 7 days per week and not to exceed 21 days -Unable to leave the house without significant effort (home bound) Hospice - person with 6 months or less to live -Time of service can be renewed
Hospital Acquired Conditions (HAC)
Hospital Acquired Conditions: an undesirable situation or condition that affects a patient and that arose during a stay in a hospital or medical facility. Examples. -Pressure Ulcer/Injury Stage 3 and 4 -Surgical site infection ‐ orthopedic, bariatric, CABG -Vascular catheter‐associated infection -Blood incompatibility- -Catheter associated UTI- cloudy/clamsy -Object left in surgery -Falls - specific trauma -Poor glycemic control -Air embolism -DVT/PE post‐oporthopedic-
Patient Centered Experience/Patient's Perspective
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (also available for home health care) -Nurse communication -Doctor communication -Hospital staff responsiveness -Pain management -Medication communication -Hospital cleanliness and quietness -Discharge information -Overall hospital rating
Which is the acute care setting for people who are too ill to care for themselves at home, are severely injured, or require surgery?
Hospitals
asepsis
absence of disease-producing microorganisms; using methods to prevent infection
The nurse is caring for a client who has been placed in strict isolation. Which nursing action is appropriate?
Remove fresh fruit from the room.
Which action is the best example of a nurse donning/removing protective equipment properly?
Removing respirator after leaving client's room
Criteria for Choosing Equipment for Injections
Route of administration Viscosity of the solution Quantity to be administered Body size Type of medication
personal protective equipment (PPE)
gloves, gowns, masks, and protective eye gear designed to minimize or prevent the health care worker's exposure to infectious material
spasticity
increased muscle tone
A nurse is taking stock of the equipment in the room of an older adult client with pneumonia who has been on parenteral nutrition for a long time. Which equipment can transmit infection to older adult clients?
indwelling catheter
Parish nursing
is an expanding area of specialty nursing practice that emphasizes holistic health care, health promotion, and disease-prevention activities. It combines professional nursing practice with health ministry, emphasizing health and healing within a faith community -reach out to those most vulnerable, such as older adults, those who have suffered a loss or change, single parents, and children
passive exercise
manual or mechanical means of moving the joints
isotonic exercise
movement in which muscles shorten (contract) and move
reservoir
natural habitat for the growth and multiplication of microorganisms
parasites
organism that lives on or in a host and relies on it for nourishment
When assisting a client from the bed into a wheelchair, the nurse assesses the client for signs of dizziness. For what adverse condition is the nurse assessing in the client?
orthostatic hypotension
contractures
permanently contracted state of a muscle
fungi
plant-like organisms (molds and yeasts) that can cause infection
A nurse is preparing to turn a client who is unable to mobilize independently. Which action bestensures the safety of both the client and the nurse?
positioning a friction-reducing sheet under the client to facilitate movement
ergonomics
practice of designing equipment and work tasks to conform to the capability of the worker and providing a means for adjusting the work environment and work practices to prevent injuries
patient care ergonomics
practice of designing equipment and work tasks to conform to the capability of the worker in relation to patient care
medical asepsis
practices designed to reduce the number and transfer of pathogens; synonym for clean technique
surgical asepsis
practices that render and keep objects and areas free from microorganisms; synonym for sterile technique
colonization
presence of an organism residing in an individual's body but with no clinical signs of infection
The nurse is caring for a client with multiple areas of skin breakdown on the back. In which position will the nurse choose to place the client to improve arterial oxygenation?
prone
isolation
protective procedure designed to prevent the transmission of specific microorganisms; also called protective aseptic techniques and barrier techniques
The nurse is caring for a client who is on bed rest and was just turned to the left side. Which action should the nurse take next to decrease the risk of impaired skin integrity?
pull the shoulder blade forward and out from under the client
A nursing student is donning sterile gloves to perform routine tracheostomy care for a client. Which behavior by the student would require immediate intervention from the instructor?
reaches down to the bed to pick up a sterile drape
