Exam 1 N320 Fundamentals

Question 1

4 modes of Roy’s Adaptation theory

Answer 1

1. Physiologic
2. Self-Concept
3. Role Function
4. Interdependence

Question 2

Roy’s Adaptation Theory
Describe Physiologic Mode

Answer 2

-Physical
-5 basic needs: oxygen, elimination, activity & rest, protection
-4 complex processes: the senses; fluid, electrolyte, & acid base balance; endocrine function
-EX: impaired skin integrity, decreased cardiac output

Question 3

Roy’s Adaptation Theory
Describe Self-Concept Mode

Answer 3

-Beliefs & feelings an individual holds about self
-components: body sensation/body image; personal self including self consistency, self ideal, & moral ethical spiritual self

Question 4

Roy’s Adaptation Theory
Describe Role Function Mode

Answer 4

-Focuses on the roles that the individual occupies in society
-EX: no income coming in & they’re the sole provider for their family, social isolation

Question 5

Roy’s Adaptation Theory
Describe Interdependence Mode

Answer 5

-interactions related to the giving & receiving of love, respect, & value
-EX: loss, grief

Question 6

Describe the nature of clinical judgements in nursing practice

Answer 6

-Clinical judgments made by thinking critically & making sound decisions are the core of professional nursing competence
-it’s the observed outcome of critical thinking & decision making

Question 7

Explain how questioning promotes critical thinking

Answer 7

-it helps nurses face personal biases & examine information for answers & deeper meaning to understand their patients
-when fire critical thinking competencies are applied, the complex & continuous nature of decision making & clinical judgment becomes clear

Question 8

Discuss how reflection improves a nurse’s capacity for making future clinical decisions

Answer 8

When a nurse reflects on the service they give, it helps them identify their mistake & how to improve next time

Question 9

Compare/contrast the 3 levels of critical thinking

Answer 9

1. Basic: the early stage of critical thinking- inexperienced nurse follows guides & trusts older nurses as experts
2. Complex: rely less on experts & instead trust their own decisions (critical thinking & creativity)
3. Commitment: the nurse anticipates when to make choices without assistance from others & accepts accountability for decisions made

Question 10

Explain the importance of problem solving practice

Answer 10

-it requires you to obtain information that clarifies the nature of a person, suggest possible solutions, & by the solution over time to evaluate if it’s effective

Question 11

Describe the processes of inductive & deductive reasoning in decision making

Answer 11

-inductive: moves from reviewing specific data elements to making inferences by forming a conclusion about the related pieces of evidence.. previous experience with the evidence is also considered

-deductive: moves from general to specific. Nurse analyzes facts from a conceptual viewpoint. After collecting data based on conceptual view, the nurse forms an interference & eventually interprets the pts condition with respect to the conceptual view

Question 12

Describe the components of a critical thinking model for clinical decision making

Answer 12

1. Competence- ability to perform nursing skills, cognitive processes that guide nurses in applying nursing process in making accurate clinical judgements
2. Knowledge base- varies on educational experience, nursing education, continuing education courses, & additional college degrees
3. Experience- clinical learning experiences are necessary to acquire decision making skills & to gain competence in performing nursing skills
4. Environment- the context of the pt’s condition & environmental factors, task complexity, time pressure, work setting & interruptions

Question 13

Describe approaches for developing critical thinking skills

Answer 13

Approach critical thinking with confidence, thjnking independently, fairness, responsibility, authority, risk taking, discipline, perseverance, creativity, curiosity, integrity & humility

Question 14

Explain the two steps involved in nursing assessment

Answer 14

• collection of information from a primary source (a pt) & secondary sources (e.g. family, caregiver, friends, health professional, medical record)
  *the interpretation and validation of data to determine whether more data are needed, or the database is complete

Question 15

Describe the 3 types of nursing assessments

Answer 15

1. pt centered interview: conducted during a nursing hx (comprehensive nursing hx)
2. Periodic assessment: conducted during ongoing contact with pts
3. Physical exam (conducted during a nursing hx & at any time a pt presents a symptom)

Question 16

Explain principles to follow in the use of data sources during the assessment

Answer 16

*pt: best sources of information
*Family caregivers & significant other
*health care team
*medical records
*other records & the scientific literature
*nurse’s experience

Question 17

Explain the importance of building a nurse-pt relationship before a formal nursing assessment

Answer 17

-effective communication is foundation for creating nurse-pt relationships that enable pts to tell their stores while nurses understand them.
-helps build trust and nurses will gain more knowledge

Question 18

describe skills to apply when conducting pt interview during nursing hx

Answer 18

-courtesy: greet pts by name they prefer, introduce yourself, ask pts permission to interview if a visitor is present
-comfort: maintain privacy, select quiet room free of distractions, avoid making pt tired
-connection: make good 1st impression, begin w/ open ended questions, be observant, ask if pt needs anything before leaving, respect silence and be open minded
-conformation: at end of interview, ask pt to summarize discussion so there are no uncertainties. tell pt you will FU if you don’t know the answer

Question 19

explain communication approaches to use during the working phase of a pt centered interview

Answer 19

-this phase fathers accurate, relevant, & complete info about pt’s condition
-ask pt to describe what they know about their health problems & health care expectations
-don’t rush to an opinion, don’t rush pt
-verbal cues pts express will help you stay focused
-organize your time with pt & focus on priority areas to assess

Question 20

explain how to maintain professionalism during hx taking

Answer 20

-have caring approach, look at pt- not the computer
-ask pt to explain why them came here & listen
- ask open ended questions & speak at reasonable pace

Question 21

identify components of nursing health hx

Answer 21

-biographical info such as age, gender, address, insurance, occupation, marital status
-chief concern
-pt expectations
-illness/health concerns
-past health hx and family hx
-psychosocial hx & spiritual health
-review of systems (subjective data)
-observation of pt behavior

Question 22

describe elements of assessment process

Answer 22

-collect data, recognizing & confirming cues that begin to form picture of pt health care problems/needs
-clinical inference: occurs before you determine pts problems (interpretation of the cues/collection of data which involves clinical judgement)

Question 23

nursing diagnosis vs. medical diagnosis vs. collaborative problem diagnosis

Answer 23

1. nursing diagnosis- clinical judgment made by RN to describe pt’s response or vulnerability to health conditions or life events that RN can treat
2. medical diagnosis- identification of disease condition based on specific assessment of physical signs/symptoms , pt’s medical hx, & results of tests/procedures
3. collaborative problem- requires BOTH medical & nursing interventions to treat

Question 24

describe importance of having standardized language of nursing diagnoses

Answer 24

ppl can understand across all disciplines and care settings

Question 25

describe the diagnostic reasoning process

Answer 25

data cluster is a set of signs/symptoms found during assessment that help you group them. compare a pt's data with info that's consistent w/ nominal healthy patterns

Question 26

describe components of a nursing diagnostic statement

Answer 26

-diagnostic label/diagnosis: name of nursing diagnosis approved by NANDA, ICNP, or any other system used in your institution that offers definitions for each diagnosis -related factors: a pt's response to a health problem is related to conditions that caused or influenced the response -major assessment findings: optional, further clarity can be added

Question 27

explain the difference between finding data patterns & data interpretation

Answer 27

-patterns: critically organizing all data elements into patterns called data clusters -interpretation: placing labels on data patterns/clusters to identify a pt's response to health care problem

Question 28

how to form a nursing diagnosis statement

Answer 28

Each type of diagnosis is different -Problem focused diagnosis has 3 parts; diagnostic label, related factors, major defining characteristics -Risk nursing diagnosis has 2 parts; diagnosis and associated risk factors ("as evidenced by") -health promotion diagnosis has 2 parts; diagnosis. level and defining characteristics/assessment findings

Question 29

identify sources of nursing diagnostic errors

Answer 29

during data collection, analysis of data clusters/patterns, & interpretation in choosing a nursing diagnostic statement

Question 30

explain the relationship of planning to nurse diagnosis

Answer 30

planning is a conscious process that occurs quickly (automatic) when nurses are familiar with pt's diagnoses & have experience in observing how pts respond to interventions

Question 31

discuss criteria used in priority setting

Answer 31

priorities are based on pt's current condition and desired outcomes, NOT ordering of list of care tasks

Question 32

discuss the difference between a goal and expected outcome

Answer 32

Expected outcomes: use SMART -Specific, measurable, attainable, realistic, timed nursing goals are specific expected outcomes related to nursing diagnosis EX: goal is oral health, expected outcome is knowledge of infection management/self care oral hygiene

Question 33

discuss difference between independent vs dependent nursing interventions

Answer 33

independent- nurse initiates in response to nursing diagnosis without supervision dependent- requires an order from provider

Question 34

discuss benefits of nursing care plans

Answer 34

-promotes continuity of care/better communication bc it informs all providers about a pts needs/interventions. -reduces risk of incomplete, incorrect, inappropriate care

Question 35

describe consultation process

Answer 35

seek expertise of a specialist to identify ways to handle specific problems in pt management or planning/implementing therapies

Question 36

explain process of inter professional collaboration

Answer 36

complex process involving 2+ people from various professional fields to achieve common outcomes for pt

Question 37

explain the relationship between nursing interventions & nursing's scope of practice

Answer 37

-nursing intervention depends on the nurse's scope of practice! -nursing scope of practice describes what a nurse is licensed to perform

Question 38

explain benefits of standard nursing interventions

Answer 38

-allows nurses to deliver the most clinically effective care to improve pt outcomes -captures pt care info that can be shared across disciples/care settings to make it easier to measure quality of care/support ongoing research

Question 39

describe implications for use of standard care bundles

Answer 39

-interventions when implemented together can result in better pt outcomes than doing it individually -improve quality of care, prevents complications

Question 40

describe the association between critical thinking and selecting nursing interventions

Answer 40

critical thinking helps nurses select the right nursing intervention for pt and rule out possible errors

Question 41

explain a nurse's role in the implementation process

Answer 41

to reassess the pt before a procedure, review nursing care plan (possible revision), organize resources, prevent complications, implement the interventions correctly

Question 42

explain how a nurse balances organizational & pt priorities in time management

Answer 42

-be aware of agency's goals of efficiency and cost -provide timely, safe, efficient care -time management

Question 43

describe how nurses anticipate/prevent complications

Answer 43

know the risks, be knowledgable of pt's condition, adapt your choice of interventions depending on the situation... CRITICAL THINKING IS KEY TO PREVENT COMPLICATIONS!

Question 44

define 2 implementation skills as they relate to direct and indirect nursing interventions

Answer 44

1. cognitive skills; ensure no nursing action is automatic, it needs to be thoughtful and pt centered 2. interpersonal communication skills; develop trust, express care, and communicate clearly to pt 3. psychomotor skills; requires cognitive and motor actives.. access your level of competency, obtain resources to ensure pt has safe treatment

Question 45

describe relationship between critical thinking and evaluation

Answer 45

critical thinking- influences nurse's workplace performance and reflects ability to resolve a pts problem evaluation- final step of nursing process that determines a pt's condition after nursing interventions were delivered

Question 46

explain difference between evaluative measures and assessment

Answer 46

-evaluative measures are at the end; after nursing interventions -assessment starts the very first time you meet pt before intervention

Question 47

explain relationship among goals of care, expected outcomes, and evaluative measures when evaluating nursing care

Answer 47

they work together to determine how pt is going/how care plan is being effective

Question 48

explain how evaluation reveals errors or omissions in care

Answer 48

evaluation involves observation skills, critical thinking, intellectual standards, knowledge, & reflection to see errors so changes can be made

Question 49

compare constitutional, civl, & criminal law

Answer 49

-constitutional law: devised from federal & state constitutions -civil law: statutory law that protects right of individuals & provides for fair & equitable treatment when civil wrongs or violations occur -criminal law: statutory law that protects society & provides punishment for crimes defined by municipal, state, & federal legislation

Question 50

describe scope of nursing practice & standards of nursing care

Answer 50

-scope of nursing practice defines nursing & reflects the values of the nursing profession -the standard of nursing care reflects the knowledge & skill ordinarily possessed/used by nurses to perform within the scope of practice. (derived from health care Laws, guidelines, professional organizations, evidence based nursing, citizen advocacy groups)

Question 51

define the standard of proof required to establish a nurse's negligence

Answer 51

it's the degree to which the evidence must show that a duty of care was violated, resulting in harm to the pt

Question 52

examples of federal statues that affect nursing practice

Answer 52

-PPACA (pt protection & affordable care act) ; later changed to Affordable Care Act (ACT) that has 4 themes including consumer rights/protection, affordable health care, increase access to care & quality of care that meets the need of pts ; it's intended to reduce overall medical costs -EMTALA (emergency medical treatment & active labor act) ; prohibits transfer of pts from private to public hospitals without appropriate screening & stabilization to prevent pt dumping -HIPPA (health insurance portability & accountability act) ; provides rights to pts & protects employees -HITECH (health information technology act) ; privacy regarding technology, never post pt info on social media -ADA (Americans w/ disability act) ; protects right of ppl w/ physical or mental disabilities -MHPAEA (mental health parity & addiction equity act) ; requires health insurance companies to provide coverage for mental health substance use disorder -PSDA (pt self determination act) ; requires healthcare institutions to provide written info to pts concerning their rights to make dickens about their care including right to refuse treatment & to formulate an advance directive -UAGA (uniform anatomical gift act) ; provides foundation for national organ donation system -OBRA (omnibus budget reconciliation act) ;focuses on pt rights, quality of life/care, physical environment in which pts live ; addresses the use of physical & chemical restraint use

Question 53

analyze under what circumstances a pt can be chemically or physically restrained

Answer 53

-when they want to ensure physical safety of pt or other pts -when less restrictive interventions are unsuccessful -when only on the written order of a health care provider

Question 54

explain what a nurse's witnessing of a pt's informed consent indicates

Answer 54

it indicates that the pt voluntarily gave consent, the pt's signature is authentic, & the pt appears to be competent to give consent

Question 55

list the elements needed to establish negligence & malpractice

Answer 55

1. professional duty owed to the pt 2. breach (did not carry out) of such duty 3. injury caused by the breach 4. resulting damages

Question 56

determine nursing actions most often associated w/ a breach of nursing practice

Answer 56

-failure to follow the standard of care -failure to communicate abnormal assessment date -failure to document care & evaluation of care -failure to act as the pt's advocate -failure to follow policies & procedures

Question 57

identify proactive measures nurses can take to help reduce their legal risks

Answer 57

-identify potential hazards/risks & eliminate them before harm occurs

Question 58

identify the purposes of a health record

Answer 58

-health care documentation consists of all info entered into health record, which may be electronic, paper, or combination of both formats -nursing documentation systems should reflect current standards of nursing practice & minimize risk of errors ; documentation systems need to be flexible enough allow members of health care to efficiently document & retrieve clinical data, track pt outcomes, facilitate continuity of care

Question 59

discuss the relationship between documentation & financial reimbursement for health care

Answer 59

-documentation: key communication strategy that produces a written account of pertinent pt data, clinical decisions, interventions, & pt responses in a health record -financial reimbursement: insurance companies look at documentation to determine payment or reimbursement for health care services (Ex: HACs - hospital acquired condition such as pressure injuries, falls, catheter associate UTIs, CLABSIs -central line associated blood stream infections) **diagnosis-related groups (DRGs) = classifications based on pts primary & secondary medical diagnosis that are used as the basis for establishing Medicare reimbursement for pts provided by health care agencies

Question 60

discuss legal guidelines for documentation

Answer 60

-don't document retaliatory or critical comments about a pt or care provided by another healthcare professional, don't document opinions -correct all errors promptly, record all facts, protect the security of your password for computer documentation -avoid using generalized empty phrases such as "status unchanged" or "had a good day" -document only for yourself, document discussions you had with providers to seek clarification regarding order in question -begin each entry w/ time & date, end w/ signature & credentials, don't erase/scratch out errors while recording (only do single line through & write "error" with your signature, date) -don't leave blanks in nurse's progress note, record all written entries legibly using black ink, no pencils/felt pens/erasable ink

Question 61

identify ways to maintain the confidentially of heath care record data

Answer 61

-auto sign off -a firewall: combination of hardware/software that protects private network resources from outside hackers, network damage, theft, misuse of information -a password: collection of alphanumeric characters & symbols that a user types into a computer sign-on screen before accessing a program after the entry & acceptance of an access code or username

Question 62

describe guidelines for quality documentation

Answer 62

-5 important characteristics: factually accurate, current, organized, complete **achieve these by sticking to the facts, writing in short sentences, using simple/short words, avoid us of jargon or abbreviations

Question 63

identify appropriate & inappropriate use of abbreviations in health care documentation

Answer 63

Do not use: -U for unit, write out "unit" instead -IU for international unit, write it out instead -Q.D, QD, q.d., qd (daily), QOD, qod (every other day)... write out "daily" or "every other day" instead -trailing zeros or lack of leading zeros -MS, MSO4, MgSO4... write out morphine sulfate & magnesium sulfate instead

Question 64

describe the different methods used in record keeping

Answer 64

-Flow sheets: graphic records that are organized by body system & navigated using the computer mouse w/ a series of tabs & rows -narrative documentation: story-like format, traditionally used by nurses/health care providers to record pt assessment, clinical decisions, & care provided -PIE: P for nursing problems or diagnosis, I for interventions that will be used to address the problem, E for nursing evaluation -focus charting: uses DAR.. D for date (subjective or objective), A for action/nursing intervention, R for response of the pt -SOAP note: used by all heath care disciplines .. S for subjective, O for objective, A for assessment, P for plan

Question 65

identify elements to include when documenting a pts discharge plan

Answer 65

-clear/concise description in pts language -step by step description of how to perform a procedure -detailed list of all prescribed meds -precautions to follow when performing self care or procedures -pts restrictions -review signs/symptoms to report to provider it it comes up at home -list names/phone numbers of health care providers -unsolved problems -actual time of discharge, mode of transpiration, who accompanied the pt

Question 66

describe elements to include in the documentation of telephone conversations w/ providers

Answer 66

-only authorized staff receive & record telephone & verbal orders -identify pt info -use clarifying questions to avoid misunderstandings -document TO (telephone order or verbal order) -read back of all orders prescribed to health care provider & document TORB (telephone order read back) -follow agency policies -healthcare provider cosigns

Question 67

medication: Warfarin (Coumadin)

Answer 67

-blood thinner -oral, prevents blood clots -vit k is an antagonist -monitor through proton

Question 68

medication: Heparin

Answer 68

-blood thinner -IV/Sub Q, injectable -protamine sulfate is an antagonist