Med Surge Exam 1 Flashcards
Which trait is being used by the nurse who says, “I don’t know, but I’ll find out?” Intellectual humility Intellectual courage Intellectual empathy Fair-mindedness
Correct Answer: 1
intellectual humility
Nursing diagnosis or medical diagnosis? Pneumonia Pain Asthma Ineffective airway clearance Anxiety
Pneumonia - Medical Pain - Nursing Asthma - Medical Ineffective airway clearance - Nursing Anxiety - Both
Order the steps in the nursing process. Implement interventions Evaluate outcomes Develop nursing diagnosis Plan care Collect data
Collect data (1) Develop nursing diagnosis (2) Plan care (3) Implement interventions (4) Evaluate outcomes (5)
Identify the questions in the WHAT’S UP? guide.
- W
- H
- A
- T
- S
- U
- P
- Where is it?
- How does it feel?
- Aggravating and alleviating factors?
- Timing?
- Severity?
- Useful other data?
- Patient’s perception of the problem
Nursing Diagnosis
Problem
Etiology
Signs and symptoms
Why Use E B P?
Gold standard of health care
Nurses can give best care possible
E B P Decision Making is defined by
Evaluation of quality Applicability of existing research Patient preferences Costs Clinical expertise Clinical setting
EBP
evidenced based practice
Which of these factors are considered when deciding which evidence to use? Select all that apply. Quality Applicability Nurse convenience Cost Clinical expertise Clinical setting
Correct Answer: 1, 2, 4, 5, 6
Six Steps of E B P: “A S K M M E!”
Step 1
Step 1: Ask the burning question
“Why do we do it that way?”
“How could we do that better?”
Levels of Evidence Quality
One
Two
Three
Four
Level One
Strongest evidence
Systematic reviews of randomized controlled trials
True experimental studies: Factors that could falsely change results controlled as possible
Level One Sources
Joanna Briggs Institute’s Evidence-Based Resources and Cochrane Reviews
Level Two
At least one well-designed randomized controlled trial
Level Three
Evidence obtained from quasi-experimental research studies
Factors that could falsely change the results are not controlled
Less predictive of effectiveness
Level Four
Expert opinion
Weakest level of evidence
Independent nursing interventions does not require
hcp order.
It is under supervision of registered nurse (R N)
the nurse requests the competency evaluated nursing assistant to help the patient with oral care. Which of the following methods requested by the nurse would be most appropriate to achieve evidence-based care?
- instruct the competency evaluated nursing assistant to have the patient rinse the mouth with water after dinner.
- Instruct her to give oral care using oral swabs to clean the teeth and mouth.
- ask her to instruct the patient to use a mouthwash rinse for the oral care.
- explain that oral care is best done by brushing the teeth and tongue with a toothbrush and toothpaste.
4.explain that oral care is best done by brushing the teeth and tongue with a toothbrush and toothpaste.
The nurse is contributing to the plan of care for a patient. In considering appropriate care, the nurse bases the care on which of the following to provide excellent care?
- content taught throughout a nursing educational program
- orientation to the health care agency for new employees
- A nurse’s personal judgment of what is best for each patient.
- Evidence that is evaluated for the health care agency and each patient
- evidence that is evaluated for the health care agency and each patient
A policy and procedure committee is reviewing evidence for a new policy. When considering the evidence, which of the following sources would generally be safest for a health care agency to implement ?
- Joanna Briggs Institute evidence -based resource .
- One randomized controlled trial.
- Four quasi-experimental studies that show similar results.
- The opinion of a national nursing expert on the subject.
1.Joanna Briggs Institute evidence -based resource .
The nurse reads about a research study that affects nursing care and could lead to decreased wound infections. Which of the following actions should the nurse take regarding the information in the study?
- put the information into practice while performing wound care.
- Discuss the research with a trusted coworker, and if the coworker agrees, put the information into practice at work.
- Present the proposed practice change to the policy and procedure committee for evaluation and possible adoption
- Do a journal search to look for similar studies, and if three similar studies are found , incorporate the information into practice.
3.Present the proposed practice change to the policy and procedure committee for evaluation and possible adoption.
A policy and procedure committee is revising the nursing intervention of insertion of a urinary catheter. Where should the committee begin looking for evidence to write an effective policy and procedure on this intervention?
- In current nursing skills textbook’s
- In nursing articles written by national nursing experts based on opinion
- In research articles, preferably systemic reviews of randomized controlled trials
- In the policies and procedures of other nursing facilities
- In research articles, preferably systemic reviews of randomized controlled trials
Nonmaleficence
the obligation to “do no harm”
fidelity
obligation to be faithful to commitments made
beneficence
actions taken will benefit a person
Utilitarianism
utilitarian theory states that actions are judged “right” or “wrong” based purely on their consequences
Deontology
deontology is based on duty, and the normal worth of an action.
(the result should not be judged only in terms of it’s consequences)
The nurse is preparing a presentation on factors influencing health care changes. Which of the following would be a factor to include in the presentation? SELECT ALL THAT APPLY
- Decreasing use of evidence
- Increasing older adult population
- Increasing cultural diversity
- population size decline in the United States
- Campaign to stop human trafficking
- Technology advancements
1. 2. 3. 5. 6.
Which of the following actions should the nurse take during admission and throughout a patient’s hospitalization to help ensure payment to the agency for a secondary diagnosis occurrence? SELECT ALL THAT APPLY
- Document patient education related to preventing complications
- document patient refusal of preventative interventions
- document interventions, such as turning and ambulating patients.
- educate patients about methods used to prevent complications
- explain to the patient that participation in preventative interventions is optional
- photograph wounds that are present on admission.
1. 2. 3. 4. 6.
Which of these actions would the nurse correctly interpret as falling within the scope of practice of the licensed practical nurse/licensed vocational nurse? SELECT ALL THAT APPLY
- performing a physical assessment on admission for a critical care patient
- Delegating to a registered nurse
- Ambulating a 1-day postoperative patient.
- Developing the plan of care for a newly admitted surgical patient.
- administering medications to patients in a long-term care facility.
- Obtaining vital signs of patients before medication administration.
3.
5.
6.
the nurse would like to suggest a new method for documenting intake and output to the nurse manager, who uses the autocratic leadership style. To approach the manager, the nurse would recognize that the autocratic leader makes decisions in which of theses ways?
- seeks information from all staff members
- uses own knowledge
- forms focus groups to gather information
- forms a staff committee to provide input
2.
During orientation, a newly hired licensed practical nurse/licensed vocational nurse reviews the agency job description for the position. Which of theses situations would be an appropriate example of a leadership role for this position within the job description?
- consulting with a registered nurse to modify care for an assigned patient
- Performing an annual employee evaluation for a nursing assistant
- Supervising the registered nurse and licensed practical nurse/licensed vocational nurse staff on a surgical unit
- Interviewing a new graduate registered nurse for a staff position
1.consulting with a registered nurse to modify care for an assigned patient
the nurse is caring for an adult patient admitted for an appendectomy who asks the nurse not to disclose any personal health information, including a positive human immunodeficiency virus status. The patient’s mother arrives to visit and asks the nurse to explain why her child must take so many medications. Which of the following responses does the nurse use to apply the principle of veracity?
- “You will have to talk to the health care provider.”
- “the medications are for recovery after a surgical procedure”
- “the medications are to treat an infection”
- “you will need to ask the patient directly about the medications”
4.”you will need to ask the patient directly about the medications”
A patient with cancer who is having chemotherapy has decided to stop receiving it because the patient has accepted mortality. What is the most ethical action by the nurse to address this situation?
- Explain to the patient that it would be silly to stop the last two treatments.
- Explain that this will be reported to a family member.
- Ensure that the patient understands the consequences of discontinuing treatment.
- Ensure that the patient knows that, without treatment death will occur
3.Ensure that the patient understands the consequences of discontinuing treatment.
A patient with terminal cancer has an advance directive indicating that a feeding tube is not to be inserted. After the patient becomes unconscious, the patients family request a feeding tube be inserted. Based on a deontological perspective and supporting the patients autonomy. What action will the nurse anticipate the health care provider will take?
- withhold the feeding tube.
- insert the feeding tube
- order an electroencephalogram to determine if the patient will wake up.
- Place a “Don Not Resuscitate” bracelet on the patients wrist.
- withhold the feeding tube.
The nurse is assisting in the health clinic in offering immunizations for school children. A mother asks the nurse why her children need to be immunized for communicable diseases. The nurse explains that when more children are immunized, more people are protected from the communicable diseases. Which ethical theory supports the nurses’ reply?
- Deontological perspective
- Utilitarian perspective
- Theological perspective
- Automony perspective
2.Utilitarian perspective
A patient in a long-term care facility states her family does not visit very often. She asks the nurse to give her extra medications so she can die. She says that she’s old and no one will mind anyway. What is the nurse’s best response?
- “Now that is just silly! Go to the activity room. They are playing bingo”
- “I’m sorry, but I cannot do that. Do you want to talk about how you are feeling?”
- “I can give you a sedative with lunch so that you can relax more.”
- “my kids don’t visit me often either. I understand how you feel.”
- “I’m sorry, but I cannot do that. Do you want to talk about how you are feeling?”
The nurse is caring for a team of patients. Which of the following practice guidelines does the nurse follow to ensure appropriate patient care is provided? Select All That Apply
- An institutions policy
- A national organizations code of ethics
- state practice laws for nurses
- National association nursing standards
- Local nursing standards
- An institutions policy
- state practice laws for nurses
- Local nursing standards
The nurse provides nursing care to prevent liability. Which of theses actions would the nurse take to prevent liability? Select All That Apply
- Breach the duty of care.
- Document accurately.
- Follow current nursing practice standards.
- Protect patient rights.
- Pursue continuing education.
- Utilize organizational policies
- Document accurately.
- Follow current nursing practice standards.
- Protect patient rights.
- Pursue continuing education.
- Utilize organizational policies
Which action does the health insurance portability and accountability act 1996 require the nurse to take while caring for patients?
- Maintain continuing nursing education credit hours
- ensure the privacy of patients protected health information .
- limit nursing work hours to no more than 35 hours per week
- avoid membership in a union or collective bargaining agreement unit.
2.ensure the privacy of patients protected health information .
The nurse is collecting data on a patient in a health care clinic. Which of the following observed data contributes to the suspicion a patient is a victim of human trafficking and not safe? Select All That Apply
- physical bruising and marks
- below normal weight range
- emotionally depressed
- personal identification available upon request
- unmanaged chronic health issues
- excellent health history
- physical bruising and marks
- below normal weight range
- emotionally depressed
- unmanaged chronic health issues
The nurse recognizes that which of these factors are influencing health care changes? Select all that apply. Technology Evidence-based practice Non-resistant infectious organisms Nursing informatics Decreasing older population Increasing cultural diversity
1, 2, 4, 6
The nurse is preparing to administer medications. Which methods should the nurse implement to reduce medication errors? Select all that apply. Use no interruption zones. Stop prep to round with physician. Wear bright-colored vests. Avoid interrupting others. Talk with patient during med prep.
1, 3, 4
The nurse uses which ethical principle when carrying out the patient’s wishes? Autonomy Beneficence Fidelity Nonmaleficence
Correct Answer: 3
The nurse cares for a suspected human trafficking victim. The nurse would use which of these to report the suspicion? Select all that apply.
Call a code blue
Facebook
U.S. Department of Homeland Security Tip Line
Local law enforcement
National Human Trafficking Resource Center Hotline
Twitter
Correct Answer: 3, 4, 5
What action can the nurse take legally under the Health Insurance Portability and Accountability Act of 1996 (H I P A A)? Select all that apply.
Share details of patient care on social media.
Keep patient health information confidential.
Take pediatric patient photo with cell phone.
Access laboratory reports of a relative.
Post x-rays on social media.
Report coworker access of an employee health record.
2, 6
Adapting to a new culture while maintaining elements of one’s culture of origin is called: Cultural assimilation Acculturation Cultural awareness Cultural diversity
Acculturation
Which is the most prominent value in Western medicine? Spiritual focus Tradition Balance with nature Research base
Research base
Which interpreter is best to use with an ill patient who has limited English proficiency? Patient’s child Patient’s parent Patient’s friend Hospital employee
Hospital employee
What are actions the nurse can take to provide spiritual care for patients? Select all that apply. Provide religious counseling. Follow patients’ cues. Be aware of one’s own spirituality. Ask how the patient is coping. Turn on religious programming.
Follow patients’ cues.
Be aware of one’s own spirituality.
Ask how the patient is coping.
intellectual courage
look at other points of view even when you may not agree with them at first
intellectual autonomy
think about what you observe and determine for yourself whether it is safe
independent nursing actions
teaching, counseling, and bedside care
dependent nursing
nursing interventions hat require a direct order from a physician
role of LVN/LPN v. RN
LVN/LPN- bedside care
RN- Administers nursing services
The acronym ASKME
Ask, Search, thinK, Measure, Make it happen, and Evaluate
Health literacy
an individuals capacity to obtain, process, and understand basic health information. (affects the ability to make the best informed health decisions)
QSEN
(Quality and safety education for nurses project)
focuses on nursing education that promotes the continual improvement of quality and safety in patient care.
Hospital-acquired Conditions and present-on-admission reporting(POA)
nurses must carefully assess and document patient conditions that are POA to show that they did not occur during hospitalization
Human trafficking and the nurses role
obtain education of trafficing
identify physical and psychological symptoms
discuss suspicions with clinical team
Indicators of human trafficking
signs of abuse
malnourishment
minimal or no medical history
Autocratic(leadership style)
the leader determines the goals and plans for achieving the goals
mandatory reporting
required to report known or suspected abuse of a person to state authorities. (older adults, children, and those with mental or developmental disabilities)
define and name examples of never events
will cause a person harm or death
concepts related to culture
cultural sensitivity, awareness, and competence
Gerontological issues in the future
by 2050 39.1% of America’s aging population will be a minority or ethnic group
Veracity
the virtue of truthfulness
