exam 1 Flashcards
1
Q
Florence Nightingale
A
focused on improving sanitation, temperature, light and well being of the pt; organized the first school of nursing
2
Q
Mary Adelaide Nutting
A
first professor at Columbia teachers college
3
Q
Benners Stages of Nursing Proficiency
A
- Novice
- Advanced Beginner
- Competent
- Proficient
- Expert
4
Q
Communication
A
process of interaction b/w people which symbols are used to create, exchange & interpret messages about ideas, emotions and mind states
5
Q
Intrapersonal
A
with yourself
6
Q
Interpersonal
A
communication b/w you and someone else
7
Q
Small group
A
2 or more people
8
Q
Paralinguistic Communication
A
non-verbal
9
Q
Meta-communication
A
context of the message
10
Q
Nurse-Patient Relationship
A
caring relationship, make sure there is boundaries, facilitate positive change and growth
11
Q
Pre-interaction Phase
A
occurs before meeting the pt
- pre assessment, getting report
12
Q
Orientation phase
A
nurse and pt. meeting, getting to know eachother
13
Q
AIDET
A
A: acknowledge I: introduce D: duration E: explanation T: Thank you
14
Q
Working Phase
A
nurse and pt. work together to solve problems and accomplish goals
ex: gather further data, asking pt preferences, evaluate needs and reassess
15
Q
Termination Phase
A
occurs at the end of the relationship (stay)
ex: summarize goals and objectives
- also at end of shift
16
Q
Therapeutic Communication Techniques
A
using silence, active listening, clarifying techniques, don’t give false hope
17
Q
Non- Therapeutic Communication Techniques
A
false reassurance, telling them not to worry, not listening, bad attitude
18
Q
Assessment
A
- health hx
- subjective & objective info
- diagnostic labs
- family dynamic
- environment
19
Q
Diagnosis
A
- potential problems
- actual problems
20
Q
Goals
A
smart, specific, measurable, attainable, realistic, timely
21
Q
Actions/Interventions
A
plan of care, education, rationale
assess pt’s rx to treatments, ask their input
22
Q
Evaluation
A
was the goal met, what was helpful, what to do better next time
23
Q
Culture
A
pattern of shared attitudes or beliefs, self-definitions, norms
24
Q
Enculturation
A
process by which a person learns norms, values, and behaviors of another culture
ex: HS student from the U.S spends a summer abroad with a family in Sweden
25
Acculturation
process of acquiring new attitudes, roles, customs or behaviors
ex: immigrant from China develops a preference for western food and music
26
Assimilation
process by which a person gives up his or her original identity and develops a new culture culture becoming absorbed into the dominant group
ex: Native American loses his native identity after living in Chicago for 10 years
27
Biculturalism
dual pattern of identification
| ex: woman of christian faith marries a muslim, adopts some Muslim practices, and maintains some christian practices
28
Cultural Awareness
self-examination of ones biases towards other cultures
29
Cultural Knowledge
learning or becoming educated about beliefs and values of other cultures
- health related (treatments)
30
Cultural Skill
Collect Pt. Hx
- ensure language competence, make sure assistances is avliable
Assess Health Literacy
- find out what they know about health/what they want to discuss
Culturally Based Physical Assessment
- ask preference
31
RESPECT MODEL
- what do they call the problem? (ex: not calling it cancer, call it the lump)
- what do you think caused the problem?
- why do you think it started?
- What do you think the sickness does?
- How severe is the sickness?
- What kind of tx's should the pt. recieve
- What are the chief problems of the sickness?
- What does the pt. fear the most?
32
Emic
insider world view
33
Etic
outsider world view
34
Intersectionality
a model that described the forces, factors and structures that shape and influence life
1. privilege
2. oppression
35
Family Assessment
family-centers approach establishes a working relationship w the pt. and family
- determine pt.'s attitude towards family
- cultural aspects
- discharge planning
36
Macronutrients
kilocalorie containing sources of carbs, proteins, fats
37
Micronutrients
vitamins and minerals
38
Phytochemical's
plant compounds that promote health through antioxidants, anti-inflammatory and immune boosting properties
ex: tomatoes
39
Malnutriton
suboptimal state w/ either insufficient or excessive quantity or quality of macro and micronutrients
40
Sarcopenia
condition of loss of muscle mass and strength
41
Anasarca
generalized edema characterized by fluid overload; due to hypoabuminemia
42
Risk Factors Related to Nutrition
-age, race & ethnicity, genetics, socioeconomic status
43
Basal Metabolic Rate
energy needs at rest to maintain life-sustaining activities for a specific amount of time
44
Resting Energy Expenditure
amount of energy need to consume over 24 hours for the body to maintain internal working activities while at rest
45
Carbohydrates
complex and simple saccharides; main source of energy
46
Proteins
amino acids; necessary for nitrogen balance
47
Fats
calorie-dense
48
Pinocytosis
during absorption, doesn't pass through cell, has to become bound to another cell to get through
49
Metabolism
all biochemical rxns w/in the cells of the body
50
Anabolism
building of more complex biochemical substances by synthesis of nutrients (glycogenesis)
51
Catabolism
breakdown of biochemical substances into smaller substances; occurs during physiological states of negative nitrogen balance (glycogenolysis)
52
Dietary Reference Intakes (DRI's)
acceptable range of quantities of vitamins & minerals for each gender & age group
53
Assessment (nutrition)
- assess pt. nutrition hx
| - food preferences etc
54
Anthropometry
height & weight (BMI)
55
Glucose Measurements
HgA1c blood test; reflects metabolism of carbs; over time
56
Serum Albumin
-measures protein in blood
| Low: protein-calorie malnutrition, inflammation, blood loss, altered fluid status
57
Pre-Albumin
reflects recent protein intake
| Low: more closely related to nutritional status than albumin
58
C-reactive
- identifies inflammation w/ low serum albumin
59
Unsaturated Fats
Monounsaturated: canola, peanut oil, avocados
Polyunsaturated: corn, soybean oils
60
Saturated Fats
fatty beef, butter, cured meats
61
Trans Fats
- worst for you
| ex: French fries, processed foots
62
Clear Liquid Diet
must be see through
| ex: jello, broths
63
Full Liquid Diet
clears, milk products, creams, soups, custards
64
Pureed Diet
soft foots, pureed foods
65
Mechanical Soft Diet
pureed, soft diced foots
66
Soft/Low Residual Diet
low fiber foods
67
High Fiber
fruits, steamed veggies, bran, oatmeal
68
When working with an older adult who is hearing-impaired, the use of which techniques would improve communication?
1. check need for adaptive equipment
2. exaggerate lip movements to help the pt. lip-read
3. give the pt. time to response to questions
4. keep communication short and to the point
5. communicate only through written information
1,3,4
69
Nursings must communicate effectively with the health care team for which of the following reasons?
1. to improve the nurses status with health care team members
2. to reduce the risk of errors to the pt
3. to provide optimum levels of patient care
4. to improve patient outcomes
5. to prevent issues that needed to be reported to outside agencies
2,3,4
70
Motivational interviewing (MI) is a technique that applies understanding a patients values and goals in helping the patient make behavioral changes. When using MI, what outcomes does the nurse expect?
1. gaining an understand of the pt's motivations
2. directing the pt. to avoid poor health choices
3. recognizing the pt.'s strengths and supporting his or her efforts
4. providing assessment data that can be shared with families to promote change
5. identifying differences in pt;s health goals and current behaviors
1,3,5
71
The nurse therapeutically responds to an adult pt. who is anxious by:
1. match the rate of speed to be the same of that as the pt.
2. provide good eye contact
3. demonstrate a calm presence
4. spending time attentively with the pt
5. assuring the pt that all will be well
2,3,4
72
A nurse prepares to contact a patient’s physician about a change in the patient’s condition. Put the following statements in the correct order using SBAR (Situation, Background, Assessment, and Recommendation) communication.
1. “She is a 53-year-old female who was admitted 2 days ago with pneumonia and was started on levofloxacin at 5 PM yesterday. She states she has a poor appetite; her weight has remained stable over the past 2 days.”
2. “The patient reported feeling very nauseated after her dose of levofloxacin an hour ago.”
3. “Is it possible to make a change in antibiotics, or could we give her a nutritional supplement before her medication?”
4. “The patient started to complain of nausea yesterday evening and has vomited several times during the night.”
4,1,2,3
73
The patient states, “I don’t have confidence in my doctor. She looks so young.” The nurse therapeutically responds: (Select all that apply.)
1. Tell me more about your concern.
2. You have nothing to worry about. Your doctor is perfectly competent.
3. You are worried about your care?
4. You can go online and see how others have rated your doctor. I do that.
5. You should ask your doctor to tell you her background.
1,3
74
The nurse applying effective communication skills throughout the nursing process should: (Place the following interventions in the correct order.)
1. Validate health care needs through verbal discussion with the patient.
2. Compare actual and expected patient care outcomes with the patient.
3. Provide support through therapeutic communication techniques.
4. Complete a nursing history using verbal communication techniques.
4,1,3,2
75
A nurse works with a patient using therapeutic communication and the phases of the therapeutic relationship. Place the nurse’s statements in order according to these phases.
1. The nurse states, “Let’s work on learning injection techniques.”
2. The nurse is mindful of his/her own biases and knowledge in working with the patient with B12 deficiency.
3. The nurse summarizes progress made during the nursing relationship.
4. After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship.
2,4,1,3
76
Which strategies should a nurse use to facilitate a safe transition of care during a patient’s transfer from the hospital to a skilled nursing facility? (Select all that apply.)
1. Collaboration between staff members from sending and receiving departments
2. Requiring that the patient visit the facility before a transfer is arranged
3. Using a standardized transfer policy and transfer tool
4. Arranging all patient transfers during the same time each day
5. Relying on family members to share information with the new facility
1,3
77
The nurse uses silence as a therapeutic communication technique. What are the purposes of the nurse’s silence? (Select all that apply.)
1. Allows the nurse time to focus and avoid saying the wrong thing
2. Prompts the patient to talk when he or she is ready
3. Allows the patient time to think and gain insight
4. Allows time for the patient to drift off to sleep
5. Determines whether the patient would prefer to talk with another staff member
2,3
78
Which of the following is an example of a patient with a health disparity? (Select all that apply.)
1. A patient who has a homosexual sexual preference
2. A patient unable to access primary care services
3. A patient living with a chronic disease
4. A family who relies on public transportation
5. A patient who has had a history of smoking for 10 years
2,3,5
79
A 35-year-old woman has Medicaid coverage for herself and two young children. She missed an appointment at the local health clinic to get an annual mammogram because she has no transportation. She gets the annual screening because her mother had breast cancer. Which of the following are social determinants of this woman’s health? (Select all that apply.)
1. Medicaid insurance
2. Annual screening
3. Mother’s history of breast cancer
4. Lack of transportation
5. Woman’s age
1,4,5
80
. Health care organizations must provide which of the following based on federal civil rights laws? (Select all that apply.)
1. Provide language assistance services at all points of contact free of charge.
2. Provide auxiliary aids and services, such as interpreters, note takers, and computer-aided transcription services.
3. Use patients’ family members to interpret difficult topics.
4. Ensure that interpreters are competent in medical terminology.
5. Provide language assistance to all patients who speak limited English or are deaf.
1,2,4,5
81
A nurse working in a large occupational health clinic knows that many of the workers at her company are marginalized and at risk for poor health outcomes. Which of the following individuals are most likely to be marginalized?
1. Wives of the employees
2. The head supervisors of the company
3. Workers who have a high school education
4. Workers employed for less than a year at the company
3
82
A mother is concerned about her child’s flulike symptoms. You learn from the health assessment that the mother practices use of “hot” and “cold” foods to treat ailments. Which of the following foods do you expect the mother to use to treat her child?
1. Chicken
2. Yogurt
3. Fresh fruits
4. Eggs
4
83
Which explanation provided by the nurse is the most accurate meaning for “providing culturally congruent care”?
1. It fits the patient’s valued life patterns and set of meanings.
2. It is the same set of values as those of the health care team member providing daily care.
3. It holds one’s own way of life as superior to those of others.
4. It redirects the patient to a more socially expected set of values.
1
84
Which statement made by a new graduate nurse about the teach-back technique requires intervention and further instruction by the nurse’s preceptor?
1. “After teaching a patient how to use an inhaler, I need to use the teach-back technique to test my patient’s technique.”
2. “The teach-back technique is an ongoing process of asking patients for feedback.”
3. “Using teach-back will help me identify explanations and communication strategies that my patients will most commonly understand.”
4. “Using pictures, drawings, and models can enhance the effectiveness of the teach-back technique.”
1
85
Which statement made by a new graduate nurse about the teach-back technique requires intervention and further instruction by the nurse’s preceptor?
1. “After teaching a patient how to use an inhaler, I need to use the teach-back technique to test my patient’s technique.”
2. “The teach-back technique is an ongoing process of asking patients for feedback.”
3. “Using teach-back will help me identify explanations and communication strategies that my patients will most commonly understand.”
4. “Using pictures, drawings, and models can enhance the effectiveness of the teach-back technique.”
1
86
A family includes a mother, a stepfather, two teenage biological daughters of the mother, and a biological daughter of the father. The father’s daughter just moved home following the loss of her job in another city. The family is converting a study into a bedroom and is in the process of distributing household chores. Nursing assessment reveals all members of the family think that their family can adjust to lifestyle changes. This is an example of family:
1. Diversity.
2. Durability.
3. Resiliency.
4. Configuration.
3
87
A mother and her two children are homeless and enter a free health care clinic. Which statements most likely describe the effects of homelessness on this family? (Select all that apply.)
1. The children have stability in their education.
2. The family members may have symptoms of malnutrition, such as anemia.
3. The family is at a low risk for experiencing violence.
4. The children are at higher risk for developing ear infections.
5. All family members may have mental health issues.
2,4,5
88
A nurse is caring for a 66-year-old patient who lives alone and is receiving chemotherapy and radiation for a new cancer diagnosis. He is unable to care for himself because of severe pain and fatigue. He moves into his 68-year-old brother’s home so his brother can help care for him. Which assessment findings indicate that this family caregiving situation will be successful? (Select all that apply.)
1. Both the patient and his brother attend church together regularly.
2. The brothers are living together and enjoy eating the same foods.
3. Other siblings live in the same city and are willing to help.
4. The patient and his brother have a close network of friends.
5. The patient has obsessive-compulsive disorder and has difficulty throwing away possessions.
1,3,4
89
A family is facing job loss of the father, who is the major wage earner, and relocation to a new city where there is a new job. The children will have to switch schools, and his wife will have to resign from the job she enjoys. Which of the following contribute to this family’s hardiness? (Select all that apply.)
1. Family meetings
2. Established family roles
3. New neighborhood
4. Willingness to change in time of stress
5. Passive orientation to life
1,2,4
90
A patient who is newly diagnosed with breast cancer states, “Although I am really scared about what is going to happen to me, I know my family will learn from this experience, and we will be stronger in the end.” What term does the nurse use in the patient’s 133medical record to describe the characteristic displayed in this statement?
1. Resiliency
2. End-of-life care
3. Family functioning
4. Family’s culture
1
91
A hospice nurse is caring for a family that is providing end-of-life care for their grandmother, who has terminal breast cancer. The nurse focuses on symptom management for the grandmother and on helping the family with developing coping skills. This approach is an example of which of the following?
1. Family as context
2. Family as patient
3. Family as a system
4. Family as structure
2
92
A 7-year-old child was recently diagnosed with asthma. A nurse is providing education to the child and her parents about the treatment and management of asthma and changes they need to make in their home environment to promote her health. Which statement made by the parents requires follow-up by the nurse?
1. “We have made an appointment to talk with the school nurse about the change in our child’s health.”
2. “We forgot to give our daughter her medications before bedtime, so we made a list of her medications to help us remember.”
3. “We have worked out a schedule to check on her before and after school.”
4. “We have not been spending time with our parents because we are so busy taking care of our daughter.”
4
93
A family consisting of a grandparent, two adults, and three school-age children just immigrated to the United States. They come to a community wellness center to establish health care. Which of the following questions does the nurse ask to assess the family’s function? (Select all that apply.)
1. “What does your family do to keep members healthy?”
2. “How does your family usually make decisions?”
3. “What health services are available in your neighborhood?”
4. “Which rituals or celebrations are important for your family?”
5. “Is there a lot of crime in your neighborhood?”
6. “How many parks are there in your community?”
1,2,4
94
A married couple has three children. The youngest child just graduated from college and is moving to a different city to take a job. The other two children left the home several years ago. Both of their parents are older and are beginning to need help to maintain their home. What assessment questions will help the nurse determine the family’s functioning? (Select all that apply).
1. Which transitions or changes in your family are you currently experiencing?
2. Are your children having any problems that are affecting your family right now?
3. Describe a recent family conflict and how your family resolved it.
4. What coping strategies do you typically use as a family?
5. Who is involved in helping care for your parents?
2,3,5
95
During a visit to a family clinic, a nurse teaches a mother about immunizations, the use of car seats, and home safety for an infant and toddler. Which type of nursing interventions are these?
1. Restorative
2. Health promotion
3. Acute care
4. Growth and development
2
96
The nurse is caring for a patient who has just had a near-death experience (NDE) following a cardiac arrest. Which intervention by the nurse best promotes the spiritual well-being of the patient after the NDE?
1. Allowing the patient to discuss the experience
2. Referring the patient to pastoral care
3. Having the patient talk to another patient who had an NDE
4. Offering to pray for the patient
1
97
Which statement made by a patient who is recovering after recently experiencing third-degree burns shows connectedness?
1. “My pain medicine helps me feel better.”
2. “I know I will get better if I just keep trying.”
738
3. “I see God’s grace and become relaxed when I watch the sun set at night.”
4. “I feel so much closer to God after I read my Bible and pray.”
4
98
A nurse is caring for a patient who is Muslim and has diabetes. Which of the following items does the nurse need to remove from the meal tray when it is delivered to the patient?
1. Small container of vanilla ice cream
2. A dozen red grapes
3. Bacon and eggs
4. Garden salad with ranch dressing
3
99
A 44-year-old male patient has just been told that his wife and child were killed in an auto accident while coming to visit him in the hospital. Which of the following statements are assessment findings that support a nursing diagnosis of Spiritual Distress related to loss of family members? (Select all that apply.)
1. “I need to call my sister for support.”
2. “I have nothing to live for now.”
3. “Why would my God do this to me?”
4. “I need to pray for a miracle.”
5. “I want to be more involved in my church.”
2,3
100
A patient has just learned she has been diagnosed with a malignant brain tumor. She is alone; her family will not be arriving from out of town for an hour. The nurse has been caring for her for only 2 hours but has a good relationship with her. What is the most appropriate intervention for support of her spiritual well-being at this time?
1. Make a referral to a professional spiritual care adviser.
2. Sit down and talk with the patient; have her discuss her feelings and listen attentively.
3. Move the patient’s Bible from her bedside cabinet drawer to the top of the over-bed table.
4. Ask the patient whether she would like to learn more about the implications of having this type of tumor.
2
101
A nurse is preparing to teach an older adult who has chronic arthritis how to practice meditation. Which of the following strategies are appropriate? (Select all that apply.)
1. Encourage family members to participate in the exercise.
2. Have patient identify a quiet room in the home that has minimal interruptions.
3. Suggest the use of a quiet fan running in the room.
4. Explain that it is best to meditate about 5 minutes 4 times a day.
5. Show the patient how to sit comfortably with the limitation of his arthritis and focus on a prayer.
2,3,5
102
A nursing student is developing a plan of care for a 74-year-old-female patient who has spiritual distress over losing a spouse. As the nurse develops appropriate interventions, which characteristics of older adults should be considered? (Select all that apply.)
1. Older adults do not routinely use complementary medicine to cope with illness.
2. Older adults dislike discussing the afterlife and what might have happened to people who have passed on.
3. Older adults achieve spiritual resilience through frequent expressions of gratitude.
4. Have the patient determine whether her husband left a legacy behind.
5. Offer the patient her choice of rituals or participation in exercise.
3,4,5
103
A nurse used spiritual rituals as an intervention in a patient’s care. Which of the following questions is most appropriate to evaluate its efficacy?
1. Do you feel the need to forgive your wife over your loss?
2. What can I do to help you feel more at peace?
3. Did either prayer or meditation prove helpful to you?
4. Should we plan on having your family try to visit you more often in the hospital?
3
104
The nurse is caring for a 50-year-old woman visiting the outpatient medicine clinic. The patient has had type 1 diabetes since age 13. She has numerous complications from her disease, including reduced vision, heart disease, and severe numbness and tingling of the extremities. Knowing that spirituality helps patients cope with chronic illness, which of the following principles should the nurse apply in practice? (Select all that apply.)
1. Pay attention to the patient’s spiritual identity throughout the course of her illness.
2. Select interventions that you know scientifically support spiritual well-being.
3. Listen to the patient’s story each visit to the clinic, and offer a compassionate presence.
4. When the patient questions the reason for her long-time suffering, try to provide answers.
1,3
105
The nurse is caring for a client with pneumonia, who has severe malnutrition. The nurse should assess the patient for which of the following assessment findings? (Select all that apply.)
1. Heart disease
2. Sepsis
3. Hemorrhage
4. Skin breakdown
5. Diarrhea
2,3,4
106
The nurse is evaluating the recent lab results for a patient. Which labs are the best indicators for malnutrition? (Select all that apply.)
1. Serum total protein
2. Potassium
3. Lipids
4. Albumin
5 Serum BUN
1,5
107
The nurse is caring for a client with dysphagia and is feeding her a pureed chicken diet when she begins to choke. What is the priority nursing intervention?
1. Suction her mouth and throat.
2. Turn her on her side.
3. Put on oxygen at 2 L nasal cannula.
4. Stop feeding her.
4
108
A client who is receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus. What should be the nurse’s priority action?
1. Have the patient turn on the left side and perform a Valsalva maneuver.
2. Clamp the intravenous (IV) tubing to prevent more air from entering the line.
3. Have the patient take a deep breath and hold it.
4. Notify the health care provider immediately.
1
109
A patient is receiving both parenteral (PN) and enteral nutrition (EN). When would the nurse collaborate with the health care provider and request a discontinuation of parenteral nutrition?
1. When 25% of the patient’s nutritional needs are met by the tube feedings
2. When bowel sounds return
3. When the central line has been in for 10 days
4. When 75% of the patient’s nutritional needs are met by the tube feedings
4
110
A client is receiving an enteral feeding at 65 mL/hr. The gastric residual volume in 4 hours was 125 mL. What is the priority nursing intervention?
1. Assess bowel sounds.
2. Raise the head of the bed to at least 45 degrees.
3. Continue the feedings; this is normal gastric residual for this feeding.
4. Hold the feeding until you talk to the primary care provider.
3
111
Which action can a nurse delegate to assistive personnel (AP)?
1. Performing glucose monitoring every 6 hours on a patient
2. Teaching the client about the need for enteral feeding
3. Administering enteral feeding bolus after tube placement has been verified
4. Evaluating the client’s tolerance of the enteral feeding
1
112
Which statement made by the parents of a 2-month-old infant requires further education by the nurse?
1. “I’ll continue to use formula for the baby until he is at least a year old.”
2. “I’ll make sure that I purchase iron-fortified formula.”
3. “I’ll start feeding the baby cereal at 4 months.”
4. “I’m going to alternate formula with whole milk, starting next month.”
4
113
A nurse sees an assistive personnel (AP) perform the following intervention for a patient receiving continuous enteral feedings. Which action would require immediate attention by the nurse?
1. Fastening tube to the gown with new tape
2. Placing client supine while giving a bath
3. Monitoring the client’s weight as ordered
4. Ambulating patient with enteral feedings still infusing
2
114
A patient is receiving total parenteral nutrition (TPN). What are the primary interventions the nurse should follow to prevent a central line infection? (Select all that apply.)
1. Change the dressing using sterile technique.
2. Change TPN containers every 48 hours.
3. Change the TPN tubing every 24 hours.
4. Monitor glucose levels to watch and assess for glucose intolerance.
5. Elevate head of the bed 45 degrees to prevent aspiration.
1,3
