Exam 3

Question 1

When implementation phase of the nursing process, the nurse performs which of the following first?

1) Carrying out nursing interventions
2) Determining the need for assistance
3) Reassessing the client
4) Documenting interventions

Answer 1

3) Reassessing the client

Question 2

Under what circumstances is it considered acceptable practice for the nurse to document a nursing activity before it is carried out?

1) When the activity is routine
2) When the activity occurs at regular intervals
3) When the activity is to be carried out immediately
4) It is never acceptable

Answer 2

4) It is never acceptable

Question 3

The primary purpose of the evaluating phase of the care planning process is to determine whether:

1) Desired outcomes have been met
2) Nursing activities were carried out
3) Nursing activities were effective
4) Client’s condition has changed

Answer 3

1) Desired outcomes have been met

Question 4

The client has a high priority nursing diagnosis for “Risk for impaired skin integrity” related to the need for several weeks of imposed bed rest. The nurse evaluates the client after one week and finds the skin integrity is not impaired. When the care plan is reviewed, the nurse should perform which of the following?

1) Delete the dx. since the problem has not occurred
2) Keep the dx. since the risk factors are still present
3) Modify the nursing dx. to “Impaired mobility”
4) Demote the nursing dx. to a lower priority

Answer 4

2) Keep the dx. since the R/F still exist

Question 5

If the nurse planned to evaluate the length of time clients must wait for a nurse to respond to a client need reported over the intercom system on each shift, which process does this reflect?

1) Structure evaluation
2) Process Evaluation
3) Outcome Evaluation
4) Audit

Answer 5

2) Process Evaluation

Question 6

Which of the following is true regarding the relationship of implementing to the other phases of the nursing process?

1) The findings from the assessment phase are reconfirmed in the implementing phase
2) After implementing, the nurse moves to the diagnosing phase
3) The nurse’s need for involvement of other health care team members in implementing occurs during the planning phase
4) Once interventions have been completed, evaluating can begin

Answer 6

1) The findings from the assessment phase are reconfirmed in the implementing phase

Question 7

The care plan calls for administration of a medication plus client education on proper diet and exercise for HTN. The nurse finds the pt. BP is still very high. The client is very upset with this finding. Which nursing skill would be most needed?

1) Cognitive
2) Intellectual
3) Interpersonal
4) Psychomotor

Answer 7

3) Interpersonal

Question 8

Which of the following demonstrates appropriate use of guidelines in implementing nursing interventions?

1) No interventions should be carried out w/o the nurse having clear rationale
2) Always follow the primary care provider’s orders exactly, w/o variation
3) Encourage all clients to be as dependent as desired and allow the nurse to perform care for them
4) When possible, give the client options in how interventions should be implemented
5) Each intervention should be accompanied by client teaching

Answer 8

1,4,5

Question 9

Which of the following represents application of the components of evaluating?

1) Goal acheivement must be written as either completely met or unmet
2) Data related to expected outcomes must be collected
3) If the outcome was acheived, conclude that the plan was affective
4) After determining that the outcome was not met, start over with a new nursing care plan

Answer 9

2)Data related to expected outcomes must be collected

Question 10

An element of quality improvement, rather than quality assurance, is which of the following?

1) Focus in on individual outcomes
2) Evaluates organizational structures
3) Aims to confirm that quality exists
4) Plan corrective actions for problems

Answer 10

4) Plan corrective actions for problems

Question 11

What are the steps in the implementing process?

Answer 11

1) Re-assess the client
2) Determine the nurse’s need for assistance
3) Implement Interventions
4) Supervise delegated care
5) Document Nursing activities

Question 12

What are the three types of skills needed for nursing care?

Answer 12

Cognitive, Interpersonal, Technical

Question 13

What are the essential guidelines for preparing and implementing nursing actions and interventions?

Answer 13

1) Base Nursing Interventions off of knowledge, research, and EBP
2) Understand Interventions
3) Adapt Activities to individual client
4) Implement Safe Care
5) Provide Teaching, Support, and Comfort
6) Be Holistic
7) Respect Client Dignity
8) Encourage Client Involvement

Question 14

What are the components of the evaluation process?

Answer 14

1) Collect data related to desired outcomes
2) Compare data w/ desired outcomes
3) Related nursing activities to the outcomes
4) Draw conclusions about problem status
5) Continue, modify, or terminate care plan

Question 15

What is Quality Assurance?

Answer 15

An ongoing systemic process designed to evaluate and promote client care.

• Structure
• Process
• Outcome

Question 16

What is Quality Improvement?

Answer 16

A systematic approach that that the intention of improving quality of care opposed to ensuring quality of care

• Identifies and corrects system problems
• Processes, not individuals
• Follows Client care, NOT organizational structure

Question 17

JCAHO

Answer 17

The Joint Commission-
Works to improve safety and quality of care provided to the public through the accreditation of healthcare organizations.

Question 18

CQUIPS

Answer 18

Center for Quality Improvement and Pt. Safety:
Works by-
1) Conducting and supporting user driven research on client safety and health care quality measurement, reporting and improvement
2)Develops and disseminates reports and info on healthcare quality measurement, reporting and improvement
3) Colloborates with stakeholders across healthcare system to implement EBP
4) Assesses it’s own practices to ensure continuous learning and improvment

Question 19

Which of the following is an example of a primary prevention activity?

1) Antibiotic treatment of a suspected UTI
2) Occupational Therapy to assist a client in adapting his or her home environment following a stroke
3) Nutrition Counseling for young adults with a family history of high cholesterol
4) Removal of tonsils for a client with recurrent tonsilitis

Answer 19

3)Nutrition Counseling for young adults with a family history of high cholesterol

Question 20

Which of the following statement is true regarding types of health care agencies?

1) Hospitals provide only acute inpatient services
2) Public Health agencies are funded by governments to investigate and provide health programs
3) Surgery can only be performed inside a hospital setting
4) Skilled nursing, extended care, and long term care facilities provide care for older adults whose insurance no longer covers hospital stays

Answer 20

2) Public Health agencies are funded by governments to investigate and provide health programs

Question 21

In most cases clients must have a primary care provider in order to receive health insurance benefits. If a client is in need of a primary care provider, it is most appropriate for the nurse to recommend which of the following?

1) Family practice physician
2) Physical therapist
3) Case Manager
4) Pharmacist

Answer 21

1) Family practice physician

Question 22

The most significant method for reducing the ongoing increase in the cost of health care in the United States includes controlling which of the following?

1) Number of children according to the family’s income
2) Number of uninsured and underinsured persons
3) Number of physicians and nurses nationwide
4) Competition among drug and medical equipment manufacturers

Answer 22

2) Number of uninsured and underinsured persons

Question 23

A client seeking to control health care costs for both preventative and illness care. Although no systems gurantees exact out of pocket expenditures, the most prepaid and predictable client contribution would be seen with?

1) Medicare
2) An individual fee for service insurance
3) A PPO
4) An HMO

Answer 23

4)An HMO

Question 24

HMO

Answer 24

A Health Maintenance Organization- A group health care agency that provides health maintenance and treatment services to voluntary enrolees A fee is set with regard to the amount/ services provided. It emphasizes client wellness… the healthier the person, the less the services

Question 25

Medicaid

Answer 25

1965- A federal public assistance program paid of general taxes to people who require financial assistance. Paid by federal/state government and provides medical services for the low income.

Question 26

Medicare

Answer 26

1965- Provides a national/ state health insurance for older adults

Question 27

PPO

Answer 27

Preferred Provider organization- a group of providers and health care agencies that provide an insurance company or employer with health services at a discounted rate. Provides clients with a choice of services. Tends to be expensive

Question 28

Primary Prevention

Answer 28

Health and Illness Prevention;
Goal- to decrease the risk to a client of disease/ dysfunction
Approach- general health promotion; protection against specific illnesses.

Question 29

Secondary Prevention

Answer 29

Diagnosis and Treatment;
Goal- To alleviate disease and prevent further disability
Approach- Early detection; intervention
*Mammogram

Question 30

Tertiary Prevention

Answer 30

Rehabilitation, Health Restoration, and Palliative Care;
Goal- To minimize disability associated with chronic illness/ irreversible disease
Approach: Restorative Activities to attain optimal level of functioning

Question 31

The ANA’s Health System Reform agenda(2008) included which of the following?

1) Primary Health care should be based in acute care hospitals
2) A minimum standard of health care for all persons should be paid for completely with public funds
3) Case Management should be focused on clients with enduring health care needs
4) Essential services should be initiated simultaneously to avoid gaps

Answer 31

3) Case Management should be focused on clients with enduring health care needs

Question 32

The Pew Commission competencies for future practitioners included the need for providers to become skilled in which of the following?

1) Use of technology
2) Emphasizing practice in tertiary settings
3) Traditional clinical approaches
4) Making decisions for incompetent clients

Answer 32

1) Use of technology

Question 33

Which of the following is characteristic of nursing care provided in community based health?

1) Clients are primarily those with identified illnesses
2) Clients are individuals in groups according to their geographic commonalities
3) Care is paid for by the community as a whole rather than by the individual
4) All clients are case managed

Answer 33

2) Clients are individuals in groups according to their geographic commonalities

Question 34

When performing collaborative health care, the nurse must implement which of the following?

1) Assume a leadership role in directing the health care team
2) Rely on the expertise of the other health care team members
3) Be physically present for the implementation of all aspects of the care plan
4) Delegate decision making authority to each health care provider

Answer 34

2) Rely on the expertise of the other health care team members

Question 35

The nurse concludes that effective discharge planning has been conducted when the client states which of the following?

1) As soon as I get home, the nurse will come out, look at where I live and see what kind of care I will need
2) All I need are my meds and a ride home. Then I’m ready for discharge
3) When I visit my doctor in 10 days, they’ll show me how to change my bandages
4) I have the phone numbers of the home care nurse and the therapist who will visit me at home tomorrow

Answer 35

4) I have the phone numbers of the home care nurse and the therapist who will visit me at home tomorrow

Question 36

6) A large disaster in a community resulted in the destruction of many family homes and many individuals were injured. The assistance of the community health nurses and home health nurses is needed. The home health nurse is most likely to perform which of the following?
1) Provide a safe water supply
2) Monitor for communicable diseases
3) Establish communication and support systems
4) Assess and treat individual clients

Answer 36

4) Assess and treat individual clients

Question 37

What is the Cognitive Domain?

Answer 37

“The Thinking domain”- 6 intellectual abilities and thinking processes 1) Knowledge 2) Comprehension 3) Application 4) Analysis 5) Synthesis 6) Evaluation
Bloom’s Taxonomy (1956)

Question 38

What the Affective Domain?

Answer 38

The “Feeling domain”- Is divided into categories that specify the degree of a person’s depth of emotional responses to tasks. Includes emotional and social goals such as feelings, interests, attitudes, and appreciations.

Question 39

What is the psychomotor domain?

Answer 39

“The Skill domain”- Fine and gross motor skills

Question 40

Nurses applying the behaviorist theory will:

Answer 40

• Arrange an environment that desires elicit desired response
• Provide sufficient time practice
• Repetition
• Opportunity for trial and error
• Select teaching strategies that avoid distracting information

Question 41

Nurses applying the cognitive theory will:

Answer 41

• Provide social, emotional, physical environment conducive to learning
• Select multi sensory teaching strategies
• Adapt teaching to developmental stages
• Target different learning styles
• Assess individual’s readiness to learn

Question 42

Nurses applying humanism will:

Answer 42

• Convey empathy in the nurse-client relationship
• Encourage the learner to establish goals and promote self-directed learning
• Encourage active learning serving as a facilitator, mentor or resource for the learner
• Use active learning strategies to assist the client in adopting new behaviors
• Expose the learner to new relevant information and ask appropriate questions to encourage the learner to seek answers

Question 43

Which learning activity reflects Bloom’s affective domain?

1) Administering an injection
2) Accepting the loss of a limb
3) Inserting a catheter
4) Learning how to read

Answer 43

2)Accepting the loss of a limb

Question 44

Which is the best method of helping a client newly diagnosed with diabetes to learn the dietary requirements associated with the disease?

1) Provide a videotape that addresses the dietary requirements associated with the disease
2) Ask a nutritionist to visit the client to present information and handouts about diabetic diet
3) Ask the client to make a list of her favorite foods and how to work them into her diet
4) Have the client attend a group meeting for clients with diabetes to discuss their adaptation to this chronic health condition

Answer 44

2) Ask a nutritionist to visit the client to present information and handouts about diabetic diet

Question 45

A nurse is scheduling a teaching situation. Which client is most ready to learn?

1) a 45 yr. old man who was just informed of a cancer dx.
2) a 3 yr. old child whose parents are reading a story book about going to the hospital
3) a 60 yr. old female who just received her ABD pain medication 5 min. ago
4) a 70 yr. old male recovering from a stroke who has just returned from physical therapy

Answer 45

2) a 3 yr. old child whose parents are reading a story book about going to the hospital

Question 46

How can the nurse best assess the client’s style of learning?

1) Ask the client how they best learn
2) Use a variety of teaching strategies
3) Observe the client’s interactions with others
4) Ask family members

Answer 46

1) Ask the client how they best learn

Question 47

A 74 year old client who takes multiple medications tells the nurse, “I have no idea why I take this yellow pill” What is the best nursing diagnosis for this client?

1) Deficient knowledge
2) Health-seeking behavior
3) Deficient knowledge(Medication Information)
4) Noncompliance

Answer 47

3) Deficient knowledge(Medication Information)

Question 48

A client is scheduled to have a diagnostic procedure. Which questions by the nurse will most likely produce a ‘teachable moment”?

1) Have you ever had this procedure before?
2) What are your concerns about this procedure?
3) What would you like to know about this procedure
4) Are you prepared for this procedure?
5) What have you heard about this procedure?

Answer 48

2) What are your concerns about this procedure?
3) What would you like to know about this procedure?
5) What have you heard about this procedure?

Question 49

A client needs to learn to self-administer insulin injections. Which statements reflect possible low literacy skills?

1) I will read the information later- I’m too tired right now
2) I’ve watched my brother giver his own shots. I know how to do it
3) Just show my wife
4) Do you have a video showing how I should give myself the shot?
5) I don’t understand this section of the handout

Answer 49

1) I will read the information later- I’m too tired right now
2) I’ve watched my brother giver his own shots. I know how to do it
3) Just show my wife
4) Do you have a video showing how I should give myself the shot?

Question 50

A primary care provider admitted a client experiencing hypertensive crisis because of the failure to take his prescribed medications. To determine learning needs, which client assessment by the nurse would have the highest priority:

1) Age
2) Perception of the effects of HTN
3) Ability to purchase needed medications
4) Support system

Answer 50

3) Ability to purchase needed medications

Question 51

A client has a learning outcome of “Select foods that are low in fat content” Which statement reflects that the client has met this learning outcome?

1) I understand the importance of maintaining a lowfat diet
2) I feel better about myself now
3) See how I revised my favorite recipe to be lower in fat
4) Since changing my diet, my husband is also losing weight

Answer 51

3) See how I revised my favorite recipe to be lower in fat

Question 52

A client’s learning outcome is “Client will verbalize medication name, purpose, and appropriate precautions.” Which documented statement reflects evidence of learning?

1) Taught name, purpose, and precautions for the new cardiac meds., seemed to understand
2) Written info about the medication provided and reviewed, correct responses were given to follow-up questions
3) Written information read to client, stated he would read it when he got home
4) Asked questions about the new medication satisfied with infomation

Answer 52

2)Written info about the medication provided and reviewed, correct responses were given to follow-up questions