CH 1 Flashcards
1
Q
Nursing care combines
A
Art and science
2
Q
Nursing care
A
Provide specified care according to standards of practice and follows a code of ethics
3
Q
[from novice to expert]
Novice
A
Beginning nursing student or any nurse entering a situation in which there is no previous level of experience the learner learns via a specific set of rules or procedures, which are usually stepwise and linear.
4
Q
[from novice to expert]
Advanced beginner
A
-some experience in field
-nurse is able to identify meaningful aspects or principles of nursing care.
5
Q
[from novice to expert]
Competent
A
A nurse who has been in the same clinical position for 2 to 3 years.
This nurse is a competent practitioner who is able to anticipate nursing care and establish long range goals.
In this phase the nurse has usually had experience with all types of psychomotor skills required by the specific group of patients.
6
Q
[from novice to expert]
Proficient
A
-A nurse with 2 to 3 years of experience in the same clinical position.
-nurse perceives a patient’s clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation.
-This nurse focuses on managing care as opposed to managing and performing skills.
7
Q
[from novice to expert]
Expert
A
-nurse with diverse experience who has an intuitive grasp of an existing or potential clinical problem.
-nurse is able to zero in on the problem and focus on multiple dimensions of the situation.
-nurse is skilled at identifying patient-centered problems and problems related to the healthcare system or perhaps the needs of the novice nurse.
8
Q
What is ANA?
What is it concerned with?
A
American Nurses Association
The legal aspects of nursing
9
Q
What is the ANA definition of nursing?
A
Nursing incorporates the art and science of caring and focuses on the protection, promotion, and optimization of health and abilities; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassion. Nursing is the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations and recognition of the connection of all humanity.
10
Q
What is the ICN definition of nursing?
A
Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings. Nursing includes the promotion of health; prevention of illness; and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research, participation in sharing health policy and inpatient and health systems management, and education are also key nursing roles.
11
Q
What is the nursing process?
A
Assessment, diagnosis, outcomes identification and planning, implementation and evaluation
12
Q
What are nurses responsibilities in terms of autonomy and accountability?
A
-The initiation of independent nursing interventions without medical orders.
-Collaboration with other healthcare providers to develop the best treatment plan for patient.
-Accountability: professionally and legally responsible for type and quality of nursing care provided, including dependent, independent, and interdependent nursing actions.
13
Q
What is a nurses role as a caregiver?
A
-Help patients maintain and regain health, manage disease and symptoms and attain a maximum level of function and independence through the healing process.
-Restore patient’s emotional, spiritual, and social well-being. Set outcomes and assist them in meeting said outcomes
14
Q
What is a nurse’s role as a patient advocate?
A
To protect patients human and legal rights. Suggesting alternatives to care, securing your patients healthcare rights, and facilitating personal and cultural preferences.
15
Q
What is the role of an advanced practice registered nurse (APRN)?
A
-Independently functioning nurse with a masters or doctorate degree in nursing -advanced education and pathophysiology, pharmacology, and physical assessment; and certification and expertise in a special area of practice.
16
Q
What is a clinical nurse specialist (CNS)?
A
-An APRN who has graduate preparation in nursing
-is an expert clinician in a specialized area of practice.
-Clinical nurse specialists provide diagnosis, treatment, and ongoing management of patients in all healthcare settings.
17
Q
What is a nurse practitioner (NP)?
A
-Provide primary, acute, and specialty health care to patients of all ages and in all types of healthcare settings.
-This care includes assessment, diagnosis, planning, and treatment; monitoring ongoing health status; evaluation of therapy; and health education.
18
Q
What is a certified nurse-midwife (CNM)?
A
-Scope of practice encompasses a full range of primary health care services for women from adolescence beyond menopause.
-The nurse midwife conducts physical examinations; prescribes medication‘s, including controlled substances and contraceptive methods
-admits, manages, and discharges patients; orders and interprets laboratory and diagnostic tests; and orders the use of medical devices.
19
Q
What is a certified nurse-anesthetist (CRNA)?
A
-Advanced education from accredited nurse anesthesia program.
-Practice autonomously and collaboratively.
-Before applying for anesthesia program, must have a one-year critical care or emergency experience.
20
Q
What is a nurse educator?
A
-Responsible for competently educating future nurses
-A nurse educator that educates patients in agency such as personal behaviors that promote healing
– usually a specialized field (ex. certified diabetic nurse educator [CDE])
21
Q
What is a nurse administrator?
A
-Responsible for management of nursing staff and healthcare agency.
-Functions of administrators include budgeting, staffing, strategic planning of programs and services, employee evaluation, and employee development.
22
Q
What is a nurse researcher?
A
-Conducts evidence base practice, performance improvement, and research to improve nursing care and further define and expand the scope of nursing practice
-often works in academic setting, hospital, or independent professional or community service agency.
23
Q
What is a core responsibility of a RN in regards to evidence-based practice?
A
-To make sound clinical judgments.
-identify the patient’s health problems, and know what actions to take.
-uses clinical judgment and critical thinking
-does not rely solely on information gained during education, always searches for the best scientific evidence to apply to recurrent patient health care problems.
24
Q
Who is Florence Nightingale?
What is her role in nursing history?
A
-Establish the first nursing philosophy based on the knowledge of “how to put the body in such a state to be free of disease or to recover from disease“.
-improved the sanitary, nutritional, and basic conditions in battlefield hospitals
-the mortality rate at the barracks hospital in Scutari, turkey, was reduced from 42.7% to 2.2% in six months
25
What is Quality and Safety Education for Nurses (QSEN)?
(QSEN) project:
-preparing future nurses and advanced practice nurses to have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.
26
In the USA who oversees the regulation of the scope of nursing practice?
-In the United States each State Board of Nursing oversees it’s Nurse Practice Act.
-The NPA regulates the scope of nursing practice for the state and protects public health, safety, and welfare.
-The definition of nursing practice published by the ANA is representative of the scope of nursing practice as defined in most states.
27
What us the EHR?
Electronic health record, method for documenting and managing patient healthcare information.
28
What is genomics?
Term that describes study of all genes in a person and interactions of these genes with one another and with that person‘s environment.
29
What is continuing education in nursing?
-Continuing education updates your knowledge about the latest research and practice developments
-helps you specialize in a particular area of practice, and teaches you new skills and techniques, all of which are crucial factors to improving patient care.
-Involves formal, organized educational programs offered by universities, hospitals, state nurse associations, professional nursing organizations, and educational and healthcare institutions.
30
What is in-service education?
-An in-service program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other healthcare professionals employed by the institution.
-Often in-service programs are focused on new technology such as how to correctly use the newest safety syringes.
-Many in-service programs are designed to fill required competencies of an organization.
-For example a hospital might offer an in-service program on safe principles for administering chemotherapy or a program on cultural sensitivity.
31
What does a profesional organization do?
-deals with issues of concern to those practicing in the profession.
-Some professional organizations focus on specific areas such as critical care, advance practice, maternal Child nursing, oncology, and nursing research.
-present educational programs and publish journals.
32
Thinking back on a recent clinical experience, which QSEN competencies in knowledge, skills, or attitudes did you use while providing care?
33
What impact do evidence based practice and emergent technologies have on high-quality patient centered care?
Help us provide competent care in line with the most up-to-date research and track patient care as effectively as possible?
34
[ANA standards of nursing]
Assessment
The registered nurse collects patient data and information relative to the healthcare consumers health or the situation
35
[ANA standards of nursing]
Diagnosis
The registered nurse analyzes the assessment data to determine the actual or potential diagnoses, problems, and issues
36
[ANA standards of nursing]
Outcomes identification
The registered nurse identifies expected outcomes for plan individualized to the healthcare consumer or the situation
37
[ANA standards of nursing]
Planning
The registered nurse develops a plan encompassing strategies to achieve expected outcomes
38
[ANA standards of nursing]
Implementation
The register nurse implements the identified plan
Coordination of care: the registered nurse coordinates care delivery.
Health teaching and Health promotion: the registered nurse employs strategies to teach and promote health and wellness.
39
[ANA standards of nursing]
Evaluation
The registered nurse evaluates progress toward attainment of goals and outcomes
40
[ANA standards of nursing]
Ethics
The registered nurse integrates ethics in all aspects of practice
41
[ANA standards of nursing]
Advocacy
The registered nurse demonstrates advocacy and all roles and settings
42
[ANA standards of nursing]
Respectful and equitable practice
The registered nurse practices with cultural humility and inclusiveness
43
[ANA standards of nursing]
Communication
The registered nurse communicates effectively in all areas of professional practice
44
[ANA standards of nursing]
Collaboration
The registered nurse collaborates with healthcare consumers and other key stakeholders
45
[ANA standards of nursing]
Leadership
The registered nurse leads within the professional practice setting and the profession
46
[ANA standards of nursing]
Education
The registered nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking
47
[ANA standards of nursing]
Scholarly Inquiry
The registered nurse integrate scholarship, evidence, and research findings into practice.
48
[ANA standards of nursing]
Quality of Practice
The registered nurse contributes to quality nursing practice
49
[ANA standards of nursing]
Professional Practice Evaluation
The register nurse evaluates one’s own and others’ nursing practice
50
[ANA standards of nursing]
Resource Stewardship
The registered nurse utilizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, and fiscally responsible and avoid waste.
51
[ANA standards of nursing]
Environmental Health
The registered nurse practices in a manner that advances environmental safety and health
52
[QSEN competency]
Patient centered care
-Recognize the patient as source of control and full partner in providing compassionate and coordinated care based on respect for patients preferences, values, and needs
-example involve family and friends in care, integrated understanding of patient, family, community preferences, values.
-Provide patient center care with sensitivity and respect for the diversity of the human experience.
53
[QSEN competency]
Teamwork and collaboration
Function effectively with a nursing in interprofessional team, fostering open communication, mutual respect, and share decision making to achieve high quality patient care
-ex. recognize the contributions of other individuals and groups helping patient/family achieve health goals. Discuss effective strategies for communicating and resolving conflict.
-Participate in designing systems to support effective teamwork
54
[QSEN competency]
Evidence-based practice
-Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare
-example demonstrate knowledge of basic scientific methods appreciate strengths and weaknesses of scientific bases for practice appreciate the importance of regularly reading relevant journals
55
[QSEN competency]
Quality improvement
-Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems.
-Ex. use tool such as flow charts and diagrams to make process of care explicit
-appreciate how unwanted variation and outcomes affects care.
-Identify gaps between local and best practices
56
[QSEN competency]
Safety
-Minimize risk of harm to patients and providers through both a system effectiveness and individual performance
-ex. examine human factors and other basic safety design principles as well as commonly used unsafe practices such as work around and dangerous abbreviations.
-Value own role in preventing errors
57
[QSEN competency]
Informatics
-Use information and technology to communicate, manage knowledge, mitigate error, and support decision-making
-ex. navigate an electronic health record
-protect confidentiality of protected health information in electronic health records
58
You are on the patient safety committee at your hospital. Your assignment is to identify two resources related to safety. One resource must relate to the individual nurse, and the second must relate to the practice and work environment.
59
You are preparing a presentation for your classmates regarding the clinical care coordination conference for a patient with terminal cancer. As part of the preparation, you have your classmates read the Nursing Code of Ethics for professional registered nurses. Your instructor asked the class why this document is important. Which statement best describes this code?
1. Improve self-healthcare
2. Protect the patient confidentiality
3. Ensure identical care to all patients
4. Defines the principles of right and wrong to provide patient care.
4. When giving care, it is essential to provide a specified service according to standards of practice and to follow a code of ethics. The code of ethics is the philosophical ideals of right and wrong that to find the principles who are used to provide care to your patience. It serves as a guide for carrying out nursing responsibilities to provide quality nursing care an ethical obligations of the profession
60
2. A nurse is caring for patient with end stage lung disease. Patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the operation to the family and discusses the patients wishes with them. The nurse is acting as the patient’s:
1. educator
2. advocate
3. caregiver
4. communicator
2. an advocate protects the patients human and legal right to make choices about his or her care. An advocate may also provide additional info to help a patient decide whether or not to except a treatment or find an interpreter to help family members communicate their concerns
61
The nurse spend time with a patient and family reviewing a dressing change procedure for the patient’s room. The patient spouse demonstrates how to change the dressing. The nurse is acting in which professional role?
1. Educator
2. Advocate
3. Caregiver
4. Communicator
1. The nurses is demonstrating the role of educator and exhibits concepts and facts about health, describes the reason for routine care activities, demonstrates procedure such as home care activities, reinforces learning or patient behavior, and evaluate patient progress and learning through return demonstration.
62
Examination for RN licensure is the same in every state in the United States. This examination:
1. Guarantees safe nursing care for all patients
2. Insures standard nursing care for all patients
3. Provides the minimal standard of knowledge for an RN in practice
4. Guarantees standardize education across all pre-licensure program
3. RN candidates must pass the NCLEX-RN to attain licensure. Regardless of educational preparation, exam for RN licensure is exactly the same in every state in the US
63
Contemporary nursing requires that the nurse have knowledge and skills for a variety of professional roles and responsibilities. Which of the following are examples of these roles and responsibilities? (Select all that apply)
1. Caregiver
2. Autonomy
3. Patient advocate
4. Health promotion
5. Genetic counselor
1, 2, 3, 4 each of these roles or skills and clues activities for the professional nurse. Each of these is used in direct care or are part of professionalism that guys nursing practice.
64
6. Match the advanced practice nurse specialty with the statement about the role
1. Clinical nurse specialist
2. Nurse anesthetist
3. Nurse practitioner
4. Nurse midwife
A. Provides independent care, including pregnancy and gynecological services
B. Expert clinician in a specialized area practice such as adult diabetes care
C. Provides comprehensive care, usually in a primary care setting, directly managing the medical care of patients who are healthy or have chronic conditions
D. Plans and delivers anesthesia and pain management to patients across the lifespan
Clinical nurse specialist: expert clinician in a specialized area of practice that as adult diabetes care. The role statements describe the activities performed of the role of the advanced practice nurse specialty. Typically see hospitalized patients with a specific type of illness or health problem.
Nurse anesthetist: provides car services under the supervision of an anesthesiologist. The role state describe the activities performed in the role of the advance practice nurse specially. Care for patients during surgical experience and administer anesthesia during pregnancy.
Nurse practitioner: provides comprehensive care, usually in a primary care setting, directly managing the medical care patients were healthy or have chronic conditions. The role statements describe the activities performed on the role of the advanced practice nurse specialty. Care for patients who are healthy or have minor acute or stable chronic conditions.
Nurse midwife: provides independent care, including pregnancy and gynecological services. The role statements describe the activities performed in the role of the advanced practice nurse specialty
65
7. Healthcare reform will bring changes and emphasis of care. Which of these models is expected from healthcare reform?
1. Moving from an acute illness to a Health promotion, illness prevention model
2. Moving from an illness prevention to a Health promotion model
3. Moving from hospital-based to community-based care
4. Moving from an acute illness to a disease management models
1. Healthcare reform also affects how healthcare is delivered there is a greater emphasis on health promotion, disease prevention, and management of illness
66
The nurse manager meets with the registered nursing staff about an increase in urinary tract infections in patients with a Foley catheter. The staff work together to review the literature on catheter-associated urinary tract infections (CAUTIs), identifies at-risk patients, and establishes new catheter care practices. This is an example of which QSEN competency?
1. Patient-centered care
2. Safety
3.Team work and collaboration
4. Quality improvement
3. This is an example of the competency of teamwork and collaboration. This competency focuses on the nurse functioning effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality pt care.
67
A critical care nurse is using a new research-based intervention to correctly position patients who are on ventilators to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which QSEN competency?
1. Patient-centered care
2. Evidence-based practice
3.Teamwork and collaboration
4. Quality improvement
2. The use of a research intervention to improve patient care brings the evidence-based practice gained from the research to the bedside
68
The nurses on an acute care medical floor notice an increase in pressure injury formation in their patients. A nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure injury risk. The second uses a new assessment instrument to identify at-risk patients. Given this information, the nurse consultant exemplifies which career?
1. Clinical nurse specialist
2. Nurse administrator
3. Nurse educator
4. Nurse researcher
4. The nurse researcher investigates problems to improve nursing care and to further define and expand the scope of nursing practice. He or she often works in an academic setting, hospital, or independent professional or community service agency.
69
Summary
• Nursing standards provide the guidelines for implementing and evaluating nursing care.
• Changes in society, such as health care reform, changing demo- graphic patterns, increases in the medically underserved popula- tion, and increased consumerism, affect the practice of nursing.
• A nurse may take multiple professional career paths, such as ad- vanced practice, nurse educator, research, and administration, to advance within the discipline.
• Nurses are increasingly aware of the role of politics and its influ- ence on the health care system. As a result, nurses are more aware of the profession’s influence on health care policy and practice.
• Advances in nursing’s scientific knowledge base and the application of evidence-based practice have improved patient care and patient outcomes.
• Although nursing programs are available for professional registered nurse (RN) education, all programs should adhere to educational standards established by a professional nursing organization.
• Professional nursing organizations have an impact on educational standards and certifications, specialty practice, consumerism, and patient advocacy.
70
Critical thinking
Synthesis of analysis, knowledge and experience
71
Code of Ethics
Formal statement that delineates a professions guidelines for ethical behavior. Set standards or expectations for the professional to achieve.
72
An 18-year-old is in the ER with fever and cough. The nurse obtains her vital signs, listens to her lungs and heart sounds, determines her level of comfort, and collects blood and sputum samples for analysis. Which standard of practice is performed?
1. Diagnosis
2. Evaluation
3. Assessment
4. Implementation
3. Assessment is the collection of comprehensive data pertinent to the patient’s health and the situation.
73
The nurse spend time with the patient and family review in the dressing change procedure for the patient’s wound. The patient’s spouse demonstrates how to change the dressing. The nurse is acting in which professional role?
1. Educator
2. Advocate
3. Caregiver
4. Case manager
1. The nurse is demonstrating the role of educator. An educator explains concepts and facts about health, describes the reason for routine care activities, demonstrates procedures such as home care activities, reinforces learning or patient behavior, and evaluate the patient’s progress in learning through return demonstration.
74
How does knowledge of Genomics affect patient treatment decisions?
Genomics describes the study of all the genes in a person, as well as the interactions of those genes with each other and with that persons environment. Genomics info allows HC providers to determine how genomics changes contribute to patient conditions and influence treatment decisions.
75
Which of the following Internet resources can help consumers compare quality care measurements? (Select all that apply)
1. WebMD
2. Hospital Compare
3. Magnet Recognition Program
4. Hospital Consumer Assessment of Healthcare
5. The American Hospital Association‘s webpage
2, 4. Both of these are internet sites that collect patient data to document hospitals quality of care and patient satisfaction. WebMD is an Internet source that is disease/condition specific. The Magnet Recognition Program is a hospital initiated recognition that assesses the quality of nursing care and patient safety.
76
You are on the patient safety committee at your hospital. Your assignment is to ID two sources related to safety. One resource mass relate to the individual nurse, and the second most relate to the practice at work environment.
The ANA website is www.nursingworld.org. Sources for individual nurses are HealthyNurseTM, needle safety, and safe patient handling (http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse). A source for regarding safe practice environments is Nursing Practice and Work Environment, which includes bullying and lateral violence and safe staffing (http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse).
77
Mrs. Langman is in the hospital recovering from hip replacement surgery. Her surgery involved insertion of a new type of hip replacement prosthesis and new postsurgical care. The advanced practice registered nurse (APRN) is preparing her discharge medication and reb prescriptions. The staff nurse is preparing to transfer Mrs. Langman to a rehab facility. The nurse educator is conducting bedside rounds to explain the new prosthesis and related postop care.
a. Discuss the roles of the staff nurse, APRN, and nurse educator.
b. What is the educational preparation for each role?
a. A staff nurse provides direct care for a group of patients in a health care setting. This practice is guided by the standards of professional practice and the agencies practice philosophy. An advanced practice registered nurse is the most independently functioning nurse. He or she has a master's degree in nursing; advanced education in pathophysiology, pharmacology, and physical assessment; and certification and expertise in a specialized area of practice. A nurse educator works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments. Nurse educators need experience in clinical practice to provide them with practical skills and theoretical knowledge. A faculty member in a school of nursing educates students to become professional nurses. Nursing faculty members are responsible for teaching current nursing practice, trends, theory, and necessary skills in laboratories and clinical settings.
b. Staff nurses have basic education and NCLEX licensure. Advanced practice registered nurses have master's degree preparation and advance practice certification. Nurse educators have a master's or doctoral degree in nursing.
78
Interprofessional collaboration is increasing as a result of ______________?
- More complex needs associated with chronic diseases
- Increasing complexity of skills required to deliver care
- Knowledge required to provide comprehensive care to patients
- Increasing specialization within health professions
79
Interprofessional Collaboration
- Is a complex process that is formed between two or more people from various professional fields to achieve common goals for a patient
80
Nurse's Role in Interprofessional Collaboration
- Communicate patient needs to all members of the healthcare team
- Clarify priorities
- Ensure continuum of care
81
Interprofessional team-based care:
- "Care delivered by intentionally created, usually relatively small work groups in healthcare who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients (e.g. rapid, responsive teams, palliative care," Interprofessional Education Collaborate (2016)
82
T/F: Interprofessional collaboration critical to the delivery of, safe patient care, and the creation of as positive work culture for practitioners.
True
83
Interprofessional collaboration involves all professionals bringing different points of view to the table to __________, __________, and __________ complex patient problems together, providing integrated and cohesive patient care.
- identify, clarify, and solve
84
How can interprofessional collaboration be accomplished?
- Can be accomplished through referrals to or consultations with other health care specialist and through patient care conferences involving members of all healthcare disciplines
85
What is critical for interprofessional collaboration?
- Open communication, cooperation, trust, mutual respect, and understanding of team members roles and responsibilities are critical for a successful interprofessional collaboration
86
Principles of Patient-Centered Care
-Respect for patients' values, preferences, and expressed needs
-Coordination and integration of care
-Information, communication, and education
-Physical comfort
-Emotional support and alleviation of fear and anxiety
-Involvement of family and friends
-Transition and continuity (where are they going when they leave the hospital)
-Access to care
87
What are the four steps of SBAR?
- Situation
- Background
- Assessment
- Recommendation/Request
88
Check Backs
- Restate what the person said to verify understanding by all team members
89
Call Outs
- Shout out important information for all team members to hear at one time
90
Delegation
- Process of transferring a task/activity to UAP (unlicensed assistive personnel)
- The nurse is always accountable for the task/activity delegated!
91
Supervision
- Guidance or direction, evaluation, and follow-up to ensure a task/activity is performed appropriately and safely
- Examples: Turning and positioning, Vital signs, Intake and output measurements
92
T/F Building an empowered nursing team begins with the nurse executive
- True
- Transformational leadership
93
QSEN Building Competence in Patient-Centered Care
Nathan, a new graduate nurse, Is assigned to care for a patient who had surgery yesterday for cancer. The plan is for the patient to be discharged home in two days. Identify strategies that Nathan can use to meet his patient's expectations.
- Answer: Nathan knows that meeting patient expectations is part of delivering patient-centered care. He first asks the patient about his expectations for his hospitalization but also for discharge. He also discusses to what extent the patient wants to be involved in decision making. Nathan can talk with the case manager/discharge planner regarding the patient concerns related to discharge. Nathan can work with the case manager/discharge planner to ensure that the patient has the resources and equipment needed for home care.
94
Which activity performed by a nurse is related to maintaining competency in nursing practice?
1. Asking another nurse about how to change the settings on a medication pump
2. Regularly attending unit staff meetings
3. Participating as a member of the professional nursing council
4. Attending a review course in preparation for a certification examination
- 4. Attending a review course in preparation for a certification examination
- Maintaining ongoing competency is a nurse's responsibility. Earning certification in a specialty area is one mechanism that demonstrates competency. Specialty certification has been shown to be positively related to patient safety.
95
Which of the following are examples of a nurse participating in primary care activities? (Select all that apply)
1. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester
2. Assessing the nutritional status of older adults who come to the community center for lunch
3. Working with patients in a cardiac rehabilitation program
4. Providing home wound care to a patient
5. Teaching a class to parents at the local grade school about the importance of immunizations
- 1,2,5 Primary care activities are focused on health promotion. Health promotion programs contribute to quality health care by helping patients acquire healthier lifestyles. Health promotion activities help keep people healthy through exercise, good nutrition, rest, and adopting positive health attitudes and practices.
96
Which of the following statements is true regarding Magnet status recognition for a hospital?
1. Nursing is run by a Magnet manager who makes decisions for nursing units
2. Nurse in Magnet hospitals make all the decisions on the clinical units.
3. Magnet is a term that is used to describe hospitals that are able to hire the nurses they need.
4. Magnet is a special designation for hospitals that achieve excellence in nursing practice.
- 4. Magnet® status is a process and review that hospitals go through that shows achievement of excellence in nursing practice. The designation is given by the American Nurses Credentialing Center and focuses on demonstration of quality patient care, nursing excellence, and innovations in professional practice.
97
Which of the following nursing activities is provided in a secondary healthcare environment?
1. Conducting blood pressure screenings for older adults at the senior center
2. Teaching a patient with chronic obstructive pulmonary disease pursed-lipped breathing techniques at an outpatient clinic
3. Changing the postoperative dressing for a patient on a medical- surgical unit
4. Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit
-3. In secondary care the diagnosis and treatment of illnesses are traditionally the most common services. Secondary services are usually provided in an acute care setting. Inpatient medical-surgical units provide secondary care. Critical care units provide tertiary care.
98
A nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an appropriate goal for restorative care?
1. Patient will be able to walk 200 feet without shortness of breath.
2. Wound will heal without signs of infection.
3. Patient will express concerns related to return to home.
4. Patient will identify strategies to improve sleep habits.
- 1. Restorative interventions focus on returning patients to their previous level of function or on reaching a new level of function limited by their illness or disability. The goal of restorative care is to help individuals regain maximal functional status and to enhance quality of life through promotion of independence.
99
Which of the following describe characteristics of an integrated healthcare system? (Select all that apply)
1. The focus is holistic.
2. Participating hospitals follow the same model of healthcare delivery.
3. The system coordinates a continuum of services.
4. The focus on healthcare providers is finding a cure for patients.
5. Members of the healthcare team link electronically to use the EMR to share the patient's healthcare record.
- 1, 3, 5. Integrated health care systems are shifting to more holistic approaches to health care. At the core of this shift is provision of a coordinated continuum of services for enhancing the health status of defined populations. There is no single model for an integrated health care system. Two types of integrated health care delivery systems are common: an organizational structure that follows economic imperatives and a system that supports an organized care delivery approach. Patient-centered medical home care is an example; members of the care team are linked by information technology, electronic health records, and system-best practices to ensure that patients receive care when and where they need it, and how they want it
100
The school nurse has been following a nine-year-old student who has shown behavioral problems in class. The student acts out and does not follow teacher instructions. The nurse plans to meet with the students family to learn more about social determinants of health that might be affecting the student. Which of the following factors would be appropriate for this type of assessment? (Select all that apply)
1. The student's seating placement in the classroom
2. The level of support parents offer when the student completes homework
3. The level of violence in the family's neighborhood
4. The age at which the child first began having behavioral problems
5. The cultural values about education held by family
- 2, 3, 5. Social determinants include social support, exposure to crime and violence, and culture. The nurse should learn the child's age at which behavioral problems appeared, but this is not a social determinant. Seating placement is not a social determinant but could be a factor if the child has visual or other physical problems.
101
A nurse is assigned to care for 82-year-old patient who will be transferred from the hospital to a rehabilitation center. The patient and her husband have selected the rehabilitation center closest to their home. The nurse learns that the patient will be discharged in three days and decides to make the referral on the day of discharge. The nurse reviews the recommendations for physical therapy and applies the information to fall prevention strategies in the hospital. What discharge planning action by the nurse has not been address correctly?
1. Patient and family involvement in referral
2. Timing of referral
3. Incorporation of referral discipline recommendations into plan of care
4. Determination of discharge date
- 2. The nurse must make the referral as soon as possible. The other elements of discharge planning, including knowing the discharge date, involving the patient and family in decision-making, and incorporating the referral discipline's recommendations for the patient's care are part of discharge planning.
102
A nurse newly hired at a community hospital learns about intentional hourly rounding during orientation. Which of the following are known evidence-based outcomes from intentional rounding? (Select all that apply)
1. Reduction in nurse staffing requirements
2. Improved patient satisfaction
3. Reduction in patient falls
4. Increased costs
5. Reduction in patient call light use
- 2, 3, 5. Intentional rounding is an evidence-based practice used in an increasing number of hospitals today. Studies have shown that intentional rounding can reduce patient falls and call light use and improve patient satisfaction scores. Proactive problem solving can occur when using intentional rounding. Education for patients helps them understand the importance of this practice.
103
Which of the following are common barriers to effective discharge planning? (Select all that apply)
1. Ineffective communication among providers
2. lack of role clarity among healthcare team
3. Sufficient number of hospital beds to manage patient volume
4. Patient's long-term disabilities
5. The patient's cultural background
- 1, 2. Barriers to effective discharge planning include ineffective communication, lack of role clarity among health care team members, and lack of resources. The presence of long-term disability is not a barrier but a characteristic of some patients who need greater discharge planning. A patient's cultural background is not a barrier unless you do not consider cultural factors in planning for discharge
104
Using Healthy People 2020 as a guide, which of the following would improve delivery of care to a community? (Select all that apply.)
1. Community assessment
2. Implementation of public health policies
3. Home safety assessment
4. Increased access to care
5. Determining rates of specific illnesses
1, 2, 4, 5
105
A community health nurse is working in a clinic with a focus on asthma and allergies. What is the primary focus of the community health nurse in this clinic setting? (Select all that apply.)
1. Decrease the incidence of asthma attacks in the community
2. Increase patients' ability to self-manage their asthma
3. Treat acute asthma in the hospital
4. Provide asthma education programs for the teachers in the local schools
5. Provide scheduled immunizations to people who come to the clinic
1, 2, 4
106
The nurse caring for a refugee community identifies that the children are undervaccinated and the community is unaware of resources. The nurse assesses the community and determines that there is a health clinic within a 5-mile radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources. Which of the following practices is the nurse providing? (Select all that apply.)
1. Raising awareness about community resources for the children
2. Teaching the community about health promotion and illness prevention
3. Promoting autonomy in decision making about health practices
4. Improving the health care of the community's children
5. Participating in professional development activities to maintain nursing competency
1, 2, 4
107
What factor results in vulnerable populations being more likely to develop health problems?
1. The ability to use available resources to find housing
2. Adequate transportation to the grocery store and community clinics
3. Availability of others to help provide care
4. Limited access to health care services
4
108
What factor results in vulnerable populations being more likely to develop health problems?
1. The ability to use available resources to find housing
2. Adequate transportation to the grocery store and community clinics
3. Availability of others to help provide care
4. Limited access to health care services
Physical environment
109
A community health nurse conducts a community assessment focused on adolescent health behaviors. The nurse determines that a large number of adolescents smoke. Designing a smoking cessation program at the youth community center is an example of which nursing role?
1. Educator
2. Counselor
3. Collaborator
4. Case manager
2
110
A nurse in a community health clinic reviews screening results from students in a local high school during the most recent academic year. The nurse discovers a 10% increase in the number of positive tuberculosis (TB) skin tests when comparing these numbers to the previous year. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community nurse was acting in which nursing role(s)? (Select all that apply.)
1. Epidemiologist
2. Counselor
3. Collaborator
4. Case manager
5. Caregiver
1, 3
111
A nursing student is giving a presentation to a group of other nursing students about the needs of patients with mental illnesses in the community. Which statement by the student indicates that the nursing professor needs to provide further teaching?
1. "Many patients with mental illness do not have a permanent home."
2. "Unemployment is a common problem experienced by people with a mental illness."
3. "The majority of patients with mental illnesses live in long-term care settings."
4. "Patients with mental illnesses are often at a higher risk for abuse and assault."
3
112
The nurse in a new community-based clinic is requested to complete a community assessment. Order the steps for completing this assessment.
1. Structure or locale
2. Social systems
3. Population
1, 3, 2
113
The public health nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2020. Most of the immigrant population do not have a primary care provider, nor do they participate in health promotion activities; the unemployment rate in the community is 25%. How does the nurse determine which goals need to be included or updated? (Select all that apply.)
1. Assess the health care resources within the community.
2. Assess the existing health care programs offered by the county health department.
3. Compare existing resources and programs with Healthy People 2020 goals.
4. Initiate new programs to meet Healthy People 2020 goals.
5. Implement educational sessions in the schools to focus on nutritional needs of the children.
1, 2, 3
114
1. The components of the nursing metaparadigm include:
1. Person, health, environment, and theory.
2. Health, theory, concepts, and environment.
3. Nurses, physicians, health, and patient needs.
4. Person, health, environment, and nursing.
4. Person, health, environment, and nursing
115
Theory is essential to nursing practice because it: (Select all that apply.)
1. Contributes to nursing knowledge.
2. Predicts patient behaviors in situations.
3. Provides a means of assessing patient vital signs.
4. Guides nursing practice.
5. Formulates health care legislation.
6. Explains relationships between concepts.
1. Contributes to nursing knowledge.
2. Predicts patient behaviors in situations.
.4. Guides nursing practice.
.6. Explains relationships between concepts.
116
A nurse ensures that each patient's room is clean; well ventilated; and free from clutter, excessive noise, and extremes in temperature. Which theorist's work is the nurse practicing in this example?
1. Henderson
2. Orem
3. King
4. Nightingale
4
117
The nurse is caring for a patient admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. The nurse assumes responsibility for bathing and feeding the patient until the patient can begin performing these activities. The nurse in this situation is applying the theory developed by:
1. Johnson.
2. Orem.
3. Roy.
4. Peplau.
2
118
Match the following types of theory with the appropriate description.
1. Middle-range theory
2. Shared theory
3. Grand theory
4. Practice theory
a. Very abstract; attempts to describe nursing in a global context
b. Specific to a particular situation; brings theory to the bedside
c. Applies theory from other disciplines to nursing practice
d. Addresses a specific phenomenon and reflects practice
1. Middle-range theory
d. Addresses a specific phenomenon and reflects practice
2. Shared theory
c. Applies theory from other disciplines to nursing practice
3. Grand theory
a. Very abstract; attempts to describe nursing in a global context
4. Practice theory
b. Specific to a particular situation; brings theory to the bedside
119
Match the following descriptions to the appropriate grand theorist.
1. King
2. Henderson
3. Orem
4. Neuman
a. Based on the theory that focuses on wellness and prevention of disease
b. Based on the belief that people who participate in self-care activities are more likely to improve their health outcomes
c. Based on 14 activities, the belief that the nurse should assist patients with meeting needs until they are able to do so independently
d. Based on the belief that nurses should work with patients to develop goals for care
1. King
d. Based on the belief that nurses should work with patients to develop goals for care
2. Henderson
c. Based on 14 activities, the belief that the nurse should assist patients with meeting needs until they are able to do so independently
3. Orem
b. Based on the belief that people who participate in self-care activities are more likely to improve their health outcomes
4. Neuman
a. Based on the theory that focuses on wellness and prevention of disease
120
Which of the following statements related to theory-based nursing practice are correct? (Select all that apply.)
1. Nursing theory differentiates nursing from other disciplines.
2. Nursing theories are standardized and do not change over time.
3. Integrating theory into practice promotes coordinated care delivery.
4. Nursing knowledge is generated by theory.
5. The theory of nursing process is used in planning patient care.
6. Evidence-based practice results from theory-testing research.
1, 3, 4, & 6
121
8. A nurse is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following theories?
1. Roy
2. Watson
3. Johnson
4. Benner
1
122
9. Using Maslow's hierarchy of needs, identify the priority for a patient who is experiencing chest pain and difficulty breathing.
1. Self-actualization
2. Air, water, and nutrition
3. Safety
4. Esteem and self-esteem needs
2
123
10. Which of the following categories of shared theories would be most appropriate for a patient who is grieving the loss of a spouse?
1. Biomedical
2. Leadership
3. Psychosocial
4. Developmental
3
124
1. Match the components of PICO using the question "Does the use of guided imagery compared with standard care decrease the postoperative pain in hospitalized adolescents?"
_____ (P) Patient/population
A. Adolescents receiving standard care
_____ (I) Intervention
B. Decreased postoperative pain
_____ (C) Comparison
C. Hospitalized adolescents
_____ (O) Outcome
D. Guided imagery
C, D, A, B
125
Place the steps of the EBP process in the appropriate order.
1. Critically appraise the evidence you gather.
2. Ask the clinical question in PICOT format.
3. Evaluate the outcomes of the practice decision or change.
4. Search for the most relevant and best evidence.
5. Cultivate a spirit of inquiry.
6. Integrate the evidence.
7. Communicate the outcomes of the EBP change.
5, 2, 4, 1, 6, 3, 7
126
A nurse is reading a research article discussing a new practice to decrease the incidence of catheter-associated urinary tract infections. One section of the article describes who was studied and how the data were collected to answer the research questions and hypotheses. What section of the research article is currently being read?
1. The literature review
2. The data analysis
3. The methods
4. The implications for practice
3
127
4. A nurse implements an EBP change that teaches patients the importance of taking their diabetes medications correctly and regularly on time using videos streamed on the Internet. The nurse measures the patients' behavioral outcome from the practice change using which type of measurement?
1. Measuring the patient's weight
2. Chart auditing teaching sessions
3. Observing patients viewing the videos
4. Checking patients' blood sugars
4
128
5. A patient in the intensive care unit experiences a sentinel event related to central-line catheter care that resulted in serious injury. What performance improvement model should the unit use to identify errors that led to the sentinel event?
1. Six Sigma
2. Root cause analysis
3. PDSA
4. Balanced scorecard
2
129
Which of the following are outcomes measurements? (Select all that apply.)
1. A nurse teaches a patient how to administer an injection and then observes the patient do a return demonstration.
2. A nurse implements a new pain-management protocol and checks patients' charts to confirm whether interventions are being provided.
3. A nursing unit adopts a set of strategies for reducing pressure injuries, and the UPC members use direct observation of the skin to measure incidence of pressure injuries.
4. A nursing unit implements a new fall-prevention protocol and checks the monthly performance data for incidence of falls on the unit.
5. A nursing unit implements a patient rounding program, and the charge nurse watches the assistive personnel to see whether hourly rounding is being done on patients.
1, 3, & 4
130
7. The nurses on a medical unit have seen an increase in the number of pressure injuries developing in their patients. The nurses decide to initiate a performance improvement project using the PDSA model. Which of the following is an example of "Plan" from that model?
1. Orienting patients to the unit's practice of hourly rounding on patients
2. Reviewing the incidence of pressure injuries on patients cared for using the protocol
3. Based on findings from patients who developed injuries, implementing an evidence-based skin care protocol on all units
4. Meeting with all disciplines to develop a multidisciplinary approach for reducing pressure injuries
4
131
The nurse is using the QSEN competency of EBP when working with the unit council to initiate a change related to pain management. Which behaviors demonstrate the nurse practicing behaviors associated with EBP? (Select all that apply.)
1. Initiating plan for self-development as a team member
2. Reading original research related to pain management
3. Demonstrating effective use of strategies to reduce risk of harm to self or others
4. Valuing EBP as critical to the development of pain management guidelines for the unit
5. Describing to the unit council reliable sources for locating clinical guidelines
6. Applying technology and information management tools to support safe processes of care
2, 4, & 5
132
Nurses in a community clinic are conducting an EBP project focused on improving the outcomes of children with asthma. The PICO question asked by the nurses is "In school-aged children, does the use of an electronic gaming education module versus educational book improve the usage of inhalers?" In the question, what is the "O"?
1. School-aged children
2. Educational book
3. Use of inhalers
4. Electronic gaming education
3
133
10. During an EBP committee meeting, a nurse discussed two systematic integrative reviews related to the use of prepackaged bath kits versus the standard use of bath basins. What level of evidence is the nurse presenting?
1. Level I
2. Level II
3. Level IV
4. Level VI
1
134
A patient in labor has been brought to the certified nurse midwife (CNM). Which interventions should the CNM undertake in this situation?
Conduct the labor.
Care for the newborn.
135
The nurse conducts health awareness training programs at a community center. What kind of action is this?
Primary prevention
136
What is true about the general practice of advance practice registered nurses?
Function independently.
137
The nurse is working with a young childbearing family who has one child with a congenital heart disease. The parents are trying to determine the risks of a second child being born with congenital heart disease. Which information is important in assisting the parents in this decision?
Genomics.
138
A 50-year-old patient is admitted with acute exacerbation of asthma. The patient is treated with bronchodilators and oxygen therapy. The patient is clinically stable and is planned for discharge. The nurse teaches the patient about deep breathing exercises. The nurse has initiated these exercises to improve the patient's lung capacity. Which professional behavior is the nurse showing?
Autonomy.
139
A pregnant patient is diagnosed with a minor vaginal infection. Which nursing domain involves providing independent care for women during normal pregnancy, including labor, delivery, and care for the newborn?
Certified Nurse Midwife (CNM)
140
What did Mary Adelaide Nutting contribute to the development of nursing as a profession?
Ensured affiliation of nursing education with universities.
Was the first professor of nursing at Columbia University Teachers College.
141
A 50-year-old patient is admitted with acute exacerbation of asthma. The patient is treated with bronchodilators and oxygen therapy. The patient is clinically stable and is planned for discharge. Who is responsible for teaching the patient about managing asthma at home?
The nurse educator.
142
The nurse is teaching a patient with diabetes how to self-administer subcutaneous insulin. Which key element should the nurse keep in mind before teaching the patient about health care principles?
Match the teaching with the patient's capabilities.
143
Which roles and responsibilities should every nurse be expected to fill?
Caregiver.
Autonomy and Accountability.
Patient Advocate.
Health Promotion.
144
A patient with lung cancer is emotionally, economically, and socially disturbed. What is the role of the nurse as a caregiver?
Manage the disease and symptoms.
Help the patient establish and achieve goals.
Implement measures to restore emotional and social well-being.
145
The nurse is caring for an older-adult couple in a community-based assisted living facility. During the family assessment, the nurse notes that the couple has many expired medications and multiple medications for their respective chronic illnesses. They indicate that they go to two different health care providers. The nurse begins to work with the couple to determine what they know about their medications and helps them decide on one care provider rather than two. This is an example of which competency for QSEN?
Safety
146
The nurse with specialized nursing skills is capable of identifying both patient-centered problems and problems related to the health care system. According to Benner, which specialist nurse possesses such skills?
Expert nurse
147
The nurse is planning to obtain a master's degree in nursing. Which role can the nurse with a master's degree in nursing fulfill?
Nurse educator.
Nurse administrator.
Advanced practice registered nurse.
Nurse researcher.
148
Certain cultural groups in the United States are disproportionately affected by infectious diseases such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Which factors increase the risk for HIV and AIDS?
Expectations about behavior by men or women in the culture.
Communication patterns and language practiced by the culture
149
Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. What are the responsibilities of the nurse as a patient educator?
Explain concepts and facts about health to patients.
Teach the patient to self-administer insulin injections.
150
The nurse is learning about the global nursing shortage that has led to fewer nurses in the workplace. Which essential skills should the nurse learn to ensure professional and efficient patient management?
Patient education.
Time management.
Compassionate care.
Therapeutic communication.
151
The nurse is learning about the effects of health care reform. Which type of actions should the nurse perform in response to health care reform?
Revise practice standards.
Change nursing education.
Explore new methods of providing care.
152
The nurse is learning about the standards of nursing practice. Which activities are part of the practice of implementation?
Educating patients for health awareness.
Using therapeutic procedures for patient care.
Providing consultation to enhance patient care.
153
A patient with asthma approaches a primary care center for management of the illness. What is the role of the nurse practitioner during the patient's visit for primary care?
Provide direct medical care.
Provide comprehensive care.
Establish a collaborative provider-patient relationship.
154
The nurse has many roles to perform. Which activities are included in the direct caregiving role?
Implements postoperative exercises for a patient who recently had surgery.
Provides measures that restore a patient's emotional, spiritual, and social well-being.
155
Nurses at a community hospital are in an education program to learn how to use a new pressure-relieving device for patients at risk for bed sores. This is an example of which type of education?
Inservice education.
156
An elderly patient has been put on a potentially toxic drug for treatment of arthritis. The patient and family have expressed concern about the drug. What is the role of the nurse in this particular situation?
Provide information so the patient can decide whether to accept the treatment or refuse.
157
A patient sprained her ankle. The nurse instructs the patient to keep the leg elevated and applies cold compresses on the affected ankle. Which standard of practice is the nurse performing?
Implementation
158
Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. What are the responsibilities of the nurse as a patient educator?
Explain concepts and facts about health to patients.
Teach the patient to self-administer insulin injections.
159
Nurses at a community hospital are in an education program to learn how to use a new pressure-relieving device for patients at risk for bed sores. This is an example of which type of education?
Inservice education
160
Nursing is important in providing safe, patient-centered health care to the global community. Which statements are true about the nursing practice?
Nursing practice helps shape health policy and health systems management.
Nursing practice involves collaborative care of sick individuals of all ages, families, groups, and communities.
Nursing practice involves helping a dying patient find relief from pain.
Nursing practice involves interpreting clinical situations and making complex decisions based on knowledge and experience.
161
The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. The nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Which career does the nurse consultant exemplify?
nurse researcher
162
The nurse educator is preparing to teach a group of nursing students about nursing interventions for managing bioterrorism. Which topics should the nurse include in the teaching plan? Select all that apply.
Decontamination methods.
Evidence-based research on vaccines.
163
The nurse educator is delivering a lecture on nursing as a profession to a group of nursing students who have recently joined the baccalaureate nursing degree course. The nurse is explaining the nursing processes by giving examples. Which examples should the nurse give while explaining nursing assessment? Select all that apply.
Recording body temperature two hours after administering antipyretic medication.
Asking the patient about hygiene and sanitation in the patient's community.
Identifying the signs of respiratory distress in a hospitalized patient.
164
The nurse practitioner is assessing a patient who has been admitted for congestive cardiac failure. The nurse suspects a pulmonary pathology and asks for a chest x-ray to confirm the findings. Which standard of practice is the nurse performing?
Prescriptive authority
165
The nurse is caring for a patient whose daughter wishes to pursue a career in nursing. She wants to enroll in a program that is of short duration and makes her eligible to take the nursing licensure exam. Which educational program should the nurse recommend to this student?
Associate degree program in nursing
166
The senior nurse is explaining to the nurse who holds an associate degree in nursing about next steps in advanced nursing education. Which educational options should be included?
Bachelor of Science in Nursing
Bachelor of Nursing
