Exam 1 Flashcards
A nurse is caring for a client who is in an acute care facility. The nurse should recognize that the clients care required clinical reasoning when it is complicated by which of the following factors? (SATA)
A. Complex clinical situations
B. Ongoing client and family concerns
C. Cost of health care
D. Decreased need for advanced health care practitioner intervention
E. Availability of computerized medical records
A & B
A charge nurse is planning to discuss factors that can influence the clinical decision-making process in client care with a newly licensed nurse. Which of the following factors should the charge nurse include? (SATA)
A. Appropriate delegation B. Cost of client care C. Available resources D. Awareness of client status E. Support from other staff
C, D, & E
A nurse asks a client to rate their current level of pain using a scale of 0-10 after administering pain medication 30 min ago. Which of the following steps of the nursing process is the nurse performing?
Evaluation
A nurse is caring for a client who has been wheezing. The nurse asks an assistive personnel to use a stethoscope and listen to the clients lung sounds to determine if their wheezing has improved. This is an example of?
Delegation of the wrong task
A nurse at an urgent care clinic is auscultating the lungs of a client who reports a cough and shortness of breath. Which of the following steps of the nursing process is the nurse using?
Assessment
A charge nurse is preparing to discuss critical thinking skills with a group of newly licensed nurses. Which of the following skills should the nurse plan to include in the discussion? (SATA)
A. Inspection B. Implementation C. Inference D. Creativity E. Inductive reasoning
C, D, & E
A nurse is reviewing methods created to assist nurses in using evidence-based practice. Which of the following is a NCSBN model that can assist the nurse with critical thinking and decision making?
Clinical judgment
A nurse is developing a goal for a client to ambulate with assistance at least once by the end of the shift. The nurse should identify that this is an example of which of the following steps of the nursing process?
Planning
A nurse is providing teaching about performing blood glucose checks to a client who has a new diagnosis of diabetes mellitus. Which action indicates the nurse is using the affective domain of learning?
Ask the client how they feel about checking their blood glucose levels
A nurse is providing teaching to a client who has a new prescription for eye drops. Which of the following teaching strategies is an example of using the psychomotor domain of learning?
Ask the client to teach-back about how to use the medication.
A nurse is caring for a client who has impaired cognition and has begun taking a new medication. Which action should the nurse take during client education?
Direct the education to the caregivers as well as the client.
A nurse is preparing a low-stimulus environment for an educational session on smoking cessation. What should the nurse implement?
Set the thermostat to a comfortable temperature (learning is best achieved in a private, low-stimulus environment. A low-stimulus environment provides good ventilation, adequate lighting, a comfortable temperature, and a decreased noise level)
A nurse is teaching a client about how to perform daily blood pressure readings at home. Which of the following statements by the client is an example of the teach-back method of learning?
“Let me show you how I will take my blood pressure at home each day.”
A nurse is preparing for a teaching session with a client who has pernicious anemia. What should the nurse identify as part of the implementation step of the teaching process?
Use demonstration to teach the client about vitamin B12 injections.
A nurse is planning a 30-min group education class. What action should the nurse plan to take to address various learning styles related to the domains of learning?
Provide games, discussion, and question-and-answer
A nurse is using a question-and-answer session to teach a client about a dietetic diet. What outcome is an example of cognitive learning?
The client understands a diabetic meal plan
A nurse reviewing the goals of client education with a newly licensed nurse. Which of the following information should the nurse include? (SATA)
A. Improvement of health B. Provide knowledge about an illness or injury C. Relevance D. Health promotion E. Motivation
A, B, & D
A nurse is reviewing a client’s plan of care. “The client will ambulate 20 feet using a walker” is the desired outcome. Which aspect of SMART goal should the nurse identify as missing from the outcome?
Timed
A nurse is reviewing information about client education with a newly licensed nurse. Which information should the nurse include as the focus of client education?
Empowering clients to be accountable for self-care
A nurse is providing teaching to a client who has a recent diagnosis of pancreatic cancer. The nurse is using strategies in the affective domain of learning. Which client statement is part of the affective domain?
A. “I have been crying a lot since I learned about my diagnosis. Im worried about everything.”
B. “I am learning how to take my blood pressure so I can check it at home every day.”
C. “I understand I may lose weight because I may not feel like eating much.”
D. “I will take my pain medication on a schedule to prevent my pain from becoming severe.”
A. “I have been crying a lot since I learned about my diagnosis. I’m worried about everything.”
A nurse is planning a smoking cessation program for a client. Which of the following actions is a component of SMART outcome goals?
A. Providing a reward for accomplishing the outcome
B. Providing motivation to accomplish the outcome
C. Providing a time frame to accomplish the outcome
D. Providing demonstration on how to complete the outcome
C. Providing a time frame to accomplish the outcome
A nurse is assessing a client’s health literacy prior to providing education. Which of the following actions should the nurse take? (SATA)
A. Ask questions regarding the clients health care needs and concerns
B. Obtain a health history
C. Assess the clients education level
D. Perform a physical assessment
E. Use medical terminology when education the client
A, B, & C
A nurse is assessing a postoperative client prior to a teaching session. The nurse notes that the client is grimacing and restless. Which barrier to learning is the client exhibiting?
Physical discomfort
A nurse is orienting a newly licensed nurse to the unit. Which statement by the newly licensed nurse indicates an understanding of the importance of documentation of client education?
A. “Client documentation can decrease hospital reimbursement.”
B. “Client documentation can decrease the need to re-evaluate the clients educational needs.”
C. “Client documentation can increase staffing and services.”
D. “Client documentation can increase liability?
C. “Client documentation can increase staffing and services.”
A nurse is participating in a question-and-answer session with a client. Which domain of learning uses this type of client education?
Cognitive domain
A nurse is providing teaching to a client who speaks a different language than the nurse. Which action should the nurse take?
A. Ask the clients family member to translate
B. Request a medical interpreter to be present
C. Ask another nurse on the unit to translate
D. Provide the client with only written materials
B. Request a medical interpreter to be present.
A nurse educator is planning an in-service for staff nurses about psychomotor client teaching strategies. Which activates require the use of gross motor skills? (SATA)
A. A client walking with crutches
B. A client using a manual wheelchair
C. Administering an intradermal injection to a client
D. Opening a clients medication bottle
E. Applying an adhesive bandage to a clients finger
A & B
