NSG 2113 Midterm Flashcards
A nurse is teaching the importance of childhood immunizations to a group of postpartum mothers. This is considered which level of preventive care?
Primary prevention.
Advocating for an increase in welfare incomes is an example of which health promotion strategy?
Building healthy public policy.
(An increase in welfare income requires policy change. Healthy public policy has a positive effect on health. Income is the most influential determinant of health.)
Efforts to decrease obesity by focusing on factors such as household income, food advertising and marketing exemplify which approach to health?
Socioenvironmental.
Which definition of health is the most congruent with a health promotion approach?
The 1984 WHO definition.
Which one of the following best defines health promotion activities?
Activities that enable people to increase control over the determinants of health and thereby improve their health.
The major outcome of the Lalonde Report was its emphasis on which of the following determinants?
Lifestyle.
(The Lalonde Report shifted emphasis from a medical to a behavioural approach to health. Although all of listed options were identified in the document, the area that received the most emphasis was lifestyle and its relationship to health outcomes was lifestyle.)
Which of the following factors would be most improved by an upstream nursing approach to health?
Socioenvironmental risk conditions
(Socioenvironmental risk conditions such as poverty, education, and housing (i.e., social determinants of health) can influence health directly but also indirectly through psychosocial risk factors, behavioural risk factors, and physiological risk factors. “Upstream” approaches include advocating for policies that ensure affordable housing, financial support to patients with low incomes, and safe, fulfilling work environments.)
The belief that health is a societal responsibility is most congruent with which approach to health?
Socioenvironmental.
The statement “To change behaviour, it may be necessary to change more than behaviour” most clearly reflects which approach to health?
Socioenvironmental
Which one of the following documents identifies the role of the private sector in health promotion?
Jakarta Declaration.
Which of the following is the most “upstream” strategy to reduce health disparities due to poverty?
Advocating living wages and income support
Secondary prevention activities are most closely related to which stage of the natural history of disease?
Pathogenesis.
(Secondary prevention activities focus on early detection of disease (pathogenesis stage) to facilitate prompt treatment, such as screening for signs of disease before symptoms occur. Primary prevention activities protect against a disease before signs and symptoms occur (prepathogenesis stage of disease). Tertiary prevention activities occur in the convalescent state of disease and are directed toward minimizing residual disability and helping people to live productively with limitations.)
Providing flexible workplace hours and quality child care at places of employment exemplifies which health promotion strategy?
Creating supportive environments.
Which one of the following statements accurately reflects current working conditions in Canada?
More than one quarter of Canadian workers believe that their workplaces are “unhealthy.”
Which of the following statements accurately reflect the population health promotion model? (Select all that apply.)
The “what” refers to the determinants of health
The “how” identifies the five health promotion strategies from the Ottawa Charter.
The “why” reflects evidence-informed decision making, values, and assumptions.
Which of the following are social determinants of health? (Select all that apply.)
Social exclusion.
Employment security.
Early childhood development.
Which of the following exemplify the health promotion strategy of strengthening community action? (Select all that apply.)
Empowerment of individuals.
Public participation in needs identification.
Participation of community organizations.
Which of the following factors have been identified as strong determinants of health disparities? (Select all that apply.)
Socioeconomic status.
Indigenous identity.
Geographic location.
The nurse found that using tympanic thermometers was quick and easy and yielded temperatures as reliable as those obtained using oral thermometers. This finding represents which of the following?
Evidence-informed practice.
The Canadian social safety net refers to which of the following?
Social programs such as Medicare and employment insurance.
Federal, provincial, and territorial governments have undertaken to reconstruct a health care system that balances current and future political, legal, economic, and social realities. This process has been referred to as which of the following?
Health reform.
Which of the following is the major conclusion of the Romanow Report?
Medicare is sustainable.
(The Romanow report clearly outlined a road map to the future for Canadian health care. Emphasis was on a move to community- and home-based services, increasing primary health care, and modernizing (not rewriting) the Canada Health Act. The report stated unequivocally that Medicare is sustainable.)
The nurse is giving discharge instructions to a client with newly diagnosed diabetes. The nurse discusses with the client what the dietary intake should be. This is an example of which health care service?
Health promotion.
The nurse volunteers to take blood pressure measurements after church services. This is an example of which level of health care service?
Illness prevention.
Primary health care refers to which of the following?
An integrated approach to health.
Which of the following is an example of respite care?
Adult day care.
(Day care is an example of respite care because it allows the family to take a break from the responsibilities of caring for a family member. A patient in a nursing home or assisted-living arrangement receives 24-hour care in the facility. Home care is an intermittent service in which only certain tasks are performed.)
A family member asks a nurse what palliative care is. What is the best response by the nurse?
“It is a multidisciplinary approach that allows a person with a terminal illness to be comfortable and maintain independence and dignity.”
(Palliative care is an interdisciplinary end-of-life approach to care, which manages life-threatening or serious illnesses, regardless of age or condition, with the intention of improving quality of life, addressing physical and psychological symptoms, and facilitating a dignified death.)
Which of the following are true regarding provincial and territorial jurisdiction in Canadian health care? (Select all that apply.)
Such jurisdiction aligns services and delivery with Canada Health Act principles
Such jurisdiction determines the location of facilities and staffing.
Such jurisdiction develops and administers its health care insurance plan.
Which of the following are included in the four pillars of primary health care? (Select all that apply.)
- teams
- healthy living
- access
- information
The Canada Health Act guarantees all eligible Canadians health care rooted in which of the following principles? (Select all that apply.)
It is publicly administered.
It is portable.
(The Canada Health Act outlines five principles—public administration, portability, accessibility, universality, and comprehensiveness—by which all Canadian health care is guided.)
Which of the following statements about evidence-informed practice are true? (Select all that apply.)
Evidence-informed practice assists nurses in meeting standards of practice.
Evidence-informed practice helps nurses to solve dilemmas in the clinical setting.
Evidence-informed practice requires nurses to review and critique research and practise findings.
Which of the following historical factors contributed to the model of health care in Canada? (Select all that apply.)
Urbanization.
The Great Depression.
Physician payment and autonomy issues.
The five levels of health care include which of the following? (Select all that apply.)
REHABILITATIVE
CURATIVE
(The five levels of health care are promotive, preventive, curative, rehabilitative, and supportive. Assisted living is one type of supportive health care; public health is both promotive and preventive.)
Which of the following statements are true? (Select all that apply.)
Home care and community-based services are becoming increasingly important in the Canadian health care system.
E-health is both a potential challenge and an opportunity within the Canadian health care system.
Nursing’s metaparadigm includes which of the following?
Person, health, environment or situation, and nursing.
Which of the following statements about prescriptive theories is accurate?
They reflect practice and address specific phenomena.
A theory is a set of concepts, definitions, relationships, and assumptions that does which of the following?
Explains a phenomenon.
There is a contemporary move toward addressing nursing as a science or as evidence-informed practice. This suggests which of the following?
Theories will be tested to describe or predict patient outcomes.
To practise in today’s health care environment, nurses need a strong scientific knowledge base in nursing and other disciplines, such as the physical, social, and behavioural sciences. This relates to which of the following?
Interdisciplinary theories.
Which theories describe an orderly process beginning with conception and continuing through death?
Developmental theories.
Maslow’s hierarchy of needs is useful to nurses, who must continually prioritize a patient’s nursing care needs. The most basic or first-level needs include which of the following?
Air, water, and food.
Leininger’s theory of cultural care diversity and universality specifically addresses which of the following?
Caring for patients from diverse cultures.
As an art, nursing relies on knowledge gained from practice and reflection on past experiences. As a science, nursing relies on which of the following?
Scientifically tested knowledge
A theory is a set of concepts, definitions, relationships, and assumptions or propositions to explain a phenomenon. What is the purpose of the components of a theory?
To describe, explain, predict, and prescribe interrelationships among the concepts that define the phenomenon.
Nursing theories focus on the phenomena of nursing and nursing care. Which of the following is true of phenomena?
They are aspects of reality that can be consciously sensed or experienced.
Which types of theories are broad and complex?
Grand theories.
Which of the following theories address specific phenomena or concepts and reflect practice?
A middle-range theory.
Which type of theory tests the validity and predictability of nursing interventions?
A prescriptive theory
The nursing diagnosis phase is part of the nursing process. What is the purpose of this phase?
It allows the nurse to apply theory to practice in a reliable manner
The nursing process is an example of an open system. Which of the following statements defines an open system?
An open system interacts with the environment by exchanging information.
Evidence-informed nursing practice is the end result of which of the following?
Theory-generating and theory-testing research.
You are a nurse researcher interviewing senior oncology nurses, asking them to describe how they deal with the loss of a patient. The analysis of the interviews yields common themes describing the nurses’ grief. This is an example of which type of study?
Qualitative study.
An operating room nurse is talking with colleagues during a meeting. She asks, “I wonder if we would see fewer wound infections if we used chlorhexidine instead of povidone-iodine to clean the skin of our surgical patients? What does the P represent in this example of a PICOT question?
Surgical patients.
(Surgical patients are the patient population of interest (P) in the PICOT (patient population, intervention, comparison, outcome, time) question. The intervention is the cleaning of the skin, and the comparison of interest is between chlorhexidine use and povidone-iodine use. Operating room nurses are not an element of the PICOT question.)
A nurse researcher is designing an exercise study that involves 100 patients who attend a wellness clinic. As the patients come to the clinic, each has a choice as to whether he or she wants to be in the new exercise program or remain in the traditional program. The nurse plans to measure the patients’ self-report of exercise before and 6 months after the program begins. What factor might influence the results of this study in an unfavourable way?
Sampling method.
(Because the patients at the clinic are allowed their choice of the traditional versus the new exercise program, the sampling in this study is not random sampling.)
The foundation of research is which of the following?
Scientific method
A researcher gives a subject full and complete information about the purpose of a study. This is an example of which of the following?
Informed consent.
A new nurse on an orthopedic unit is assigned to care for a patient undergoing skeletal traction. The nurse asks a colleague, “What is the best practice for cleaning pin sites in skeletal traction?” This question is an example of which of the following?
Knowledge-focused trigger.
The nurses on a medical unit have seen an increase in the number of pressure injuries developing in their patients. The nurses decide to initiate a quality improvement project with the plan, do, study, act (PDSA) model. Which of the following is an example of the “do” step of that model?
Implement a new skin care protocol on all medical units.
The nurse researcher obtains informed consent from participants in a study primarily for which reason?
To ensure that the study subjects understand their roles in the study.
Which of the following is a priority goal for nursing research?
Improving patient care.
A clinical nurse develops a better way to secure an intravenous access device in a patient and wants to see whether it would benefit other patients. Which of the following should be the first step in initiating a study?
Review current literature related to the clinical problem.
The nurse researcher who obtains new knowledge regarding a procedure can most effectively share the information with the nursing profession by doing which of the following?
Communicating the research findings in a professional journal.
(Publication of research results provides other nurses with the scientific background of the study before they apply its findings in practice. Study subjects and setting should be similar in order to replicate a study. Nurses should not change from accepted to unproven ways of providing care without careful research and collaboration with colleagues. Experimenting with new nursing measures is inappropriate and may place a patient at risk.)
Nurses who are new to practice can best contribute to nursing research by doing which of the following?
Assisting with data collection.
A nurse manager wants to determine how well a new policy is working in the clinical area. Which of the following would be appropriate to use?
Evaluation research
The nurse involved in scientific research effectively analyzes the information collected and determines a course of nursing action by doing which of the following?
Using critical thinking.
A nurse manager is researching the effects of staff shortages on job satisfaction among new graduates. Which of the following would be the most effective way to gather data?
By interviewing staff nurses on the unit regarding their perceptions
Which of the following could be a barrier to nursing research?
Shortage of professional nursing staff.
Reflective journal writing is a tool used by the nurse. What is the purpose of this tool?
To help the nurse identify how previously learned knowledge can be applied in the future.
A patient tells the nurse, “I’m not happy with the way my bath was done this morning. The technician just seemed to be in a hurry and did not wash my back like I asked.” The nurse decides to talk with the technician to learn his side of the story as well. What is the nurse exhibiting?
Fairness.
(Fairness involves analyzing all viewpoints to understand the situation completely before making a decision. Curiosity gives the critical thinker the motivation to continue to ask questions and learn more. Risk taking involves trying different ways to solve problems.)
The surgical unit has initiated the use of a pain rating scale to assess the severity of patients’ pain during their postoperative recovery. The nurse assigned to a patient can look at the pain flow sheet to see the patient’s pain scores over the last 24 hours. Use of the pain scale is an example of adherence to which intellectual standard?
Consistency.
During the day, the nurse spends time instructing a patient in how to self-administer insulin. After discussing the technique and demonstrating an injection, the nurse asks the patient to try it. After the patient makes two attempts, it is clear that the patient does not understand how to prepare the correct dose. The nurse discusses the situation with the charge nurse and asks for suggestions. This is an example of which of the following?
Problem solving.
A nurse uses the institution’s procedure manual to confirm how to insert a Foley catheter. Which level of critical thinking is the nurse using?
Basic critical thinking.
(At the basic level of critical thinking, a learner trusts the experts and follows a procedure step by step. Complex critical thinkers analyze and examine choices more independently. Commitment is the third level of critical thinking in which the person anticipates the need to make choices without assistance from others. The scientific method is a process of problem solving.)
The nurse refers to a patient’s postsurgical written plan of care, noting that the patient has a drainage device that is collecting wound drainage. The surgeon is to be notified when drainage in the device exceeds 100 mL for the day. The nurse carefully notes the amount of drainage currently in the device. This is an example of which of the following?
Assessment.
The nurse asks a patient how she feels about impending surgery for breast cancer. Before initiating the discussion, the nurse reviewed information about loss and grief in addition to therapeutic communication principles. Which critical thinking component is involved in the nurse’s review of the literature?
Knowledge application.
Before performing a procedure for the first time at a new agency, what does the nurse do?
Reads about the procedure in the policy and procedure manual.
Which of the following is the most accurate information to give a nurse during change-of-shift reporting?
Patient reports sharp pain in left anterior knee
On entering a patient’s room during change-of-shift rounds, the nurse notice that the patient and spouse have their backs turned to each other, and both have their arms folded across their chests. Which of the following is the best action for the nurse to take at this time?
Ask the patient and spouse if they need some time alone right now.
The nurse is assessing the urinary history of a middle-aged married woman. The nurse asks her if she gets up to go to the bathroom at night. She replies, “Yes.” What other question should the nurse ask?
“Is there something that is causing you to get up at night?”
(Perhaps the patient’s husband is getting up in the middle of the night because of a prostate problem, and this is why she is awakened. The nurse should not assume nocturia without further assessment questions.)
A patient with diabetes mellitus who takes daily insulin injections is scheduled for surgery the next day. The patient is to take nothing by mouth after midnight. The nurse questions whether insulin should be given the morning of surgery. This is an example of which of the following?
Scientifically based clinical judgement.
The patient is a 65-year-old overweight woman with multiple medical diagnoses, including diabetes mellitus type 2, hypertension, and residual right-sided weakness that resulted from a previous cerebrovascular accident. What tool should be used to plan her care?
Concept map
(A concept map is a visual representation of patient problems and interventions that shows their relationships to each other and allows easy synthesis of data about the patient.)
A patient newly admitted to the hospital begins to have chest pain. Before calling the physician, the nurse should gather what additional data? (Select all that apply.)
Pain intensity. Location of the pain. Character of the pain. Radiation of the pain. Meaning of pain to the patient. Family history of myocardial infarctions.
Pain intensity. Location of the pain. Character of the pain. Radiation of the pain. Meaning of pain to the patient.
(The nurse should gather the data the physician will need to determine whether the chest pain represents a myocardial infarction. Family history is important in comprehensive pain assessment; however, taking time to obtain this information is inappropriate in this critical situation.)
What is the purpose of assessment?
To establish a database concerning the patient.
The nurse asks a patient, “Ms. Neil, describe for me your typical diet over a 24-hour day. What foods do you prefer? Have you noticed a change in your weight recently?” This series of questions would probably occur during which phase of a patient interview?
Working.
During data clustering, the nurse performs which of the following tasks?
Organizing cues into patterns that lead to identification of nursing diagnoses.
What type of interview technique is the nurse using when the nurse asks the question, “Do you have pain or cramping?”
Closed-ended questioning.
Which of the following is subjective information to be entered in the patient’s medical record?
Pain intensity 8 out of 10.
(Pain is purely a subjective phenomenon. Although the pain intensity rating is an objective number, it depends on the patient’s report. The other options are objective data.)
Which of the following is objective information to be recorded in the patient’s medical record?
Voided 250 mL of clear yellow urine.
Which of the following is an open-ended question the nurse might use when interviewing a patient?
“What do you mean when you say, ‘I don’t feel quite right’?”
The nurse asks the patient whether he or she has any allergies. This is an example of which of the following?
Health history data.
The nursing assessment is which phase of the nursing process?
First.
Which of the following defines a nursing diagnosis?
A clinical judgement about individual, family, or community responses to actual and potential health problems or life processes.
The nurse reviews data regarding a patient’s pain symptoms, comparing the defining characteristics of acute pain with those of chronic pain. The patient’s pain has lasted a few weeks. In the end, the nurse selects Acute pain as the correct nursing diagnosis. This is an example of avoiding which type of error?
Error in data clustering.
Which of the following is one purpose of using standard formal nursing diagnostic statements?
To facilitate understanding of patient problems by different health care providers.
The nursing diagnosis Readiness for enhanced communication is an example of which of the following?
Wellness nursing diagnosis.
The nursing diagnosis Hypothermia is an example of which of the following?
Actual nursing diagnosis.
In the examples given below, which nurse is acting to avoid a data collection error?
The nurse who assesses the edema in a patient’s lower leg is unsure of its severity and asks a co-worker to check it with her.
“Unhappy and worried about health” is not a scientifically based nursing diagnosis, and it can lead to error in which of the following
Diagnostic label.
After establishing a nursing diagnosis of Acute pain, the nurse develops which appropriate patient-centred goal?
Reducing pain intensity to the level of a patient rating of 3 or below during the patient’s hospital stay.
In a review of systems, asking about the last time a patient had a tuberculosis (TB) skin test is a question that would fit under which of the following categories?
Lower respiratory system.
(TB affects the lower respiratory system, not the upper respiratory system. A TB skin test is not a laboratory test. There is no immunization vaccine against TB.)
The nurse is assigned to a patient who has returned from the recovery room after surgery for a colorectal tumour. After an initial assessment, the nurse anticipates the need to monitor the patient’s abdominal dressing, intravenous (IV) infusion, and drainage tubes. The patient is in pain and will not be able to eat or drink until intestinal function returns. The nurse will have to establish priorities of care in which of the following situations?
The patient’s vital signs change, showing a drop in blood pressure.
The nurse has set a time limit for expected outcomes. What is the purpose of establishing such a time frame?
Indicate when the patient is expected to respond in the desired manner.
A patient-centred goal is a specific and measurable behaviour or response that reflects which of the following?
The patient’s highest possible level of wellness and independence in function.
Which of the following is an example of an expected outcome statement in measurable terms?
Patient will report pain intensity of less than 4 on a scale of 0 to 10.
The nurse anticipates that a right-handed patient with a fractured right arm will require assistance with activities of daily living. What skill is the nurse demonstrating?
Cognitive skill.
(The nurse is using sound judgement and clinical decisions to provide individualization of care. A decision is made without direct interaction with the patient but is based on knowledge about the patient. No psychomotor skill is involved in this decision-making process. There is no such thing as a behavioural skill.)
Which of the following characteristics of a goal is missing from the statement “Patient will ambulate daily”?
Measurable
Interdisciplinary care plans represent which of the following?
Contributions of all disciplines in caring for the patient
Environmental factors heavily affect a patient’s care. The nurse’s first concern for the patient includes which of the following?
Safety
Assessment data must be descriptive, concise, and complete. In performing an assessment, the nurse should do which of the following? (Select all that apply.)
Include subjective data from the patient.
Perform a thorough physical examination.
Use interpersonal and cognitive skills.
What techniques encourage a patient to tell his or her full story? (Select all that apply.)
Active listening.
Back-channelling.
Use of open-ended questions.
The nurse has gathered the following assessment data about a patient. Which of these cues form a pattern? (Select all that apply.)
Patient is restless.
Respirations are 24 breaths per minute and irregular.
Patient reports feeling short of breath.
(The rapid irregular breathing, complaints of shortness of breath, and restlessness are part of a pattern indicating that the patient may be experiencing hypoxia because all are signs and symptoms characteristic of this condition. The other information, although important, is not related to hypoxia.)
Which of the following are defining characteristics for the nursing diagnosis of Impaired urinary elimination? (Select all that apply.)
Nocturia.
Frequency.
Urinary retention.
When determining a patient’s ability to perform instrumental activities of daily living, which of the following skills does the nurse assess? (Select all that apply.)
Ability to take medications.
Ability to write cheques.
Ability to cook meals.
(The correct options are skills that allow the patient to live independently in society. They may or may not be performed on a daily basis. The other options are activities of daily living._
A manager is reviewing the nurses’ notes in a patient’s medical record. She finds the following entry: “Patient is difficult to care for, refuses suggestion for improving appetite.” Which of the following directions should the manager give to the staff nurse who entered the note?
Enter only objective and factual information about the patient.
A patient tells the nurse, “I have stomach cramps and feel nauseated.” This is an example of which type of data?
Subjective.
As the nurse enters the patient’s room, the nurse notices that he is anxious to say something. The patient quickly exclaims, “I don’t know what’s going on; I can’t get an explanation from my doctor about the results of my test. I want something done about this.” Which of the following is the most appropriate documentation of the patient’s emotional status?
The patient stated that he felt frustrated by the lack of information he has received regarding his diagnostic tests.
Patients frequently request copies of their medical records. The nurse understands that which of the following is correct?
Patients have the right to read their records.
Accurate entries are an important characteristic of good documentation. Which of the following charting entries is most accurate in the way it is written?
Patient ambulated 15 m and back down hallway with assistance from nurse, heart rate 88 and regular before exercise, 94 and regular after exercise.
Which of the following represents a breach of confidentiality and privacy?
A nurse telephones the patient’s church to have the patient’s name placed on a prayer list.
Which of the following is one purpose of the patient’s medical record?
Education and research
(The purposes of keeping a medical record include communication, legal documentation, financial billing, education, research, and auditing–monitoring. An effective way to learn the nature of an illness and the individual patient’s response to it is to read the patient’s record. It is a valuable educational tool. Research may also be conducted on the basis of data collected from medical records. Different types of permissions must be secured before patient records are reviewed for any kind of research or data analysis. Change-of-shift reports are not part of the medical record. Incident reports are documented in a record that is not part of the patient’s medical record. Procedure guidelines are found in procedure manuals, not in the patient’s medical record.)
Which of the following is a guideline for legally sound documentation?
If an order is questioned, record that clarification was sought
(If the nurse carries out an order known to be incorrect, the nurse is just as liable for prosecution as is the physician. Therefore, the nurse should clarify the order with the physician and document having done so. All entries should be recorded legibly and in black ink. Black ink is more legible when records are photocopied or transferred to microfilm. To increase accuracy and decrease unnecessary duplication, care activities should be documented at the time they are performed. The nurse should not erase, apply correction fluid, or scratch out errors made while recording because it makes the charting illegible and may create the appearance that the nurse was attempting to hide or deface a record. A single line should be drawn through the error, the word error should be written above it, and the nurse should sign his or her name or initials. Then the note can be recorded correctly.)
Which of the following is the best example of quality documentation?
6-cm incision on right lower quadrant, edges pink and well approximated with sutures; no drainage noted.
When a nurse follows the SOAP method of charting, the information the nurse would record under “O” would be which of the following?
Right foot is red with +4 pitting edema and capillary refill less than 3 seconds.
Which of the following is a method of charting in which the nurse writes a progress note only when the standardized statement on the form is not met?
Charting by exception.
Why are critical pathways a valuable tool in patient care?
They provide members of the health care team with a way to document their contributions to the patient’s total plan of care.
(Critical pathways are multidisciplinary care plans that include patient problems, key interventions, and outcomes expected within an established time frame. Critical pathways promote integration of information so that each discipline has access to notes written by others. Nurses are not the only ones who use the critical pathway. The nurse and other team members, such as physicians, dietitians, social workers, physiotherapists, and respiratory therapists, use the same critical pathway to monitor the patient’s progress. The use of critical pathways does reduce duplication and the amount of charting. Variances are unexpected outcomes, unmet goals, and interventions not specified within the critical pathway time frame. A variance is not something the physician develops but rather an outcome for the patient. A variance is the situation in which the activities on the critical pathway are not completed as predicted or the patient does not meet the expected outcomes. A variance can be positive or negative.)
Which of the following is one advantage of standardized care plans?
They establish clinically sound standards of care for similar groups of patients.
A nursing instructor is helping a student nurse with discharge planning for a patient. The instructor realizes that further education is needed when the student nurse says which of the following?
“I really can’t start discharge planning until the physician writes the discharge orders.”
The nurse is giving a change-of-shift report. Which of the following is the most appropriate report statement?
“David Jackson, in 121-1, a 92-year-old patient of Dr. Able, is here with pneumonia. He is receiving oxygen at 2 L per nasal cannula. He has crackles in his right lower lobe, clear rest. He can get up with assistance of one. He has been coughing up thick, yellow-tinged sputum after his breathing treatments. He gets them every 6 hours. His next treatment will be at 0800.”
A patient is complaining of pain at 0400 hours. The nurse telephones Dr. Rice and receives an order for oxycodone hydrochloride, 5 mg, one tablet every 4 hours as needed. It is wise for the nurse to do which one of the following?
Repeat the prescribed order back to the physician.
According to the guidelines, quality documentation and reporting should be which of the following? (Select all that apply.)
The five guidelines call for documentation and reporting to be factual, accurate, complete, current, and organized.
According to the World Health Organization what is the best definition of health?
Involving the total person and the environment
Accountability is a critical aspect of nursing care. Which of the following is an example of a specific decision-making process of accountability?
Evaluating patient outcomes after implementing care
How is the idea of a theory best explained?
A purposeful set of assumptions that identify relationships between concepts
A nurse has provided care to a patient. Which entry should the nurse document in the patient’s record?
Left abdominal incision 5 cm in length without redness, edema or drainage
The R in SBAR stands for:
Recommendation
A patient comes to the clinic and asks the nurse for an explanation of the Medicare system. What is the best response?
Canada’s national health insurance system
What is the primary purpose of registration laws for the nursing profession?
To protect the public against unqualified and incompetent practitioners
Vulnerable populations include patients who are more likely than others to develop health problems as a result of what?
Exposure to excessive risk
Risk factors can be placed into the following interrelated categories: genetics, environment, age and lifestyle. The presence of any of these risk factors means which of the following.
The chances of getting the disease is increased
What are characteristics of critical thinking?
Considering what is important in a given situation
In caring for patients, it is essential for the nurse to realize that evidence-informed decision-making is which of the following?
Dependent on patient value and expectations
The nurse needs to complete all of the following tasks. Which task does the nurse perform first?
Notify the health care provider of the decreased level of consciousness of the patient who had a stroke yesterday.
The charge nurse on a surgical unit is doing staff assignments for the 3:00 to 11:00 shift. Which of the following patients should the charge nurse assign to the licensed practical nurse?
The patient who had a vaginal hysterectomy two days ago.
(The patient who had a vaginal hysterectomy should be the most stable of these patients and should require the least amount of nursing assessment. A registered nurse (RN) should be responsible for the patient being discharged, especially if teaching needs to be done. An RN should also care for the patient who had a laryngectomy because the procedure was done fairly recently and life-threatening complications can arise, as well as for the patient who underwent mastectomy because the surgery occurred only this morning.)
Which type of care management approach entails coordination of health care services for patients and their families while streamlining costs and maintaining quality?
Case management.
(Case management is the management approach that coordinates health care services for patients and their families while streamlining costs and maintaining quality. Total patient care is the original care model in which an RN directs all care for a patient. In team nursing, an RN leads a team of nurses and technicians to provide care. In primary nursing, an RN directs implementation of the care plan for each patient.)
While administering medications, the nurse realizes he has given the wrong dose of medication to a patient. The nurse acts by completing an incident report and notifying the patient’s physician. The nurse is exercising which of the following?
Accountability: is to the answerability of individuals for their actions. Authority is the legitimate power to give command and make final decisions. Responsibility is concerned with the duties and actions that an individual is employed to perform. Decision making is the process of critically appraising information and generating a conclusion.
Many managers distribute biweekly newsletters describing ongoing unit or health care agency activities and post minutes of committee meetings in an accessible location for all staff to read. This is an example of which of the following?
Staff communication.
(Staff communication occurs through vehicles such as newsletters and practices such as making meeting notes accessible. Nursing practice councils may or may not communicate with staff. Nurse–physician collaborative practice is a model, as is interdisciplinary collaboration.)
During the morning rounds, the nurse assesses the condition of a patient who underwent major open-heart surgery 2 days earlier. The patient complains of lower leg pain at the site where the vein graft was removed. The nurse finds that the intravenous (IV) infusion is being delivered at the appropriate rate but that only 100 mL remains in the bag. An order exists for the IV infusion to continue. What is the nurse’s first-order priority?
Administer an analgesic to the patient to treat the leg pain.
(Pain is always a first-order priority. If 100 mL of solution remains in the infusion bag, the nurse has a small window of time to focus on replacing the IV bag, which can be done after the pain medication is administered. The nurse should verify pharmacy deliveries while obtaining the new IV bag. Wound healing instruction can be instituted after action has been taken on the higher priority issues.)
A patient is experiencing an anxiety attack. What is the priority of this patient’s nursing need?
High (first-order) priority.
(High (first-order) priority issues are those that create an immediate threat to a patient’s survival and safety. An anxiety attack is such a high-priority issue because of the safety aspect. Issues of intermediate (second-order) priority are those that do not have a potential to cause immediate harm. Issues of low (third-order) priority and nonemergency priority are those that may or may not be related to the acute phase of the patient’s illness and can wait until other problems have been addressed.)
The nurse checks on a patient who was admitted to the hospital with pneumonia. The patient has been coughing profusely and has required nasotracheal suctioning. The patient is febrile and is receiving an IV infusion of antibiotics. The patient asks the nurse for a bath because of profuse perspiring. Which task does the nurse delegate to the nursing assistant working with her today?
Administering a bed bath
Which of the following tasks is appropriate for an RN to delegate to the nursing assistant?
Measuring vital signs for a patient who is having an abdominal CT scan later in the morning.
Which of the following team members is essential for empowering a nursing team?
Nurse executive.
(Without the nurse executive’s involvement in the organization, it is unlikely that anyone will advocate for the values and goals of nursing. The team members named in the other options are important but are not essential for the nursing team to move forward.)
In what way is the interprofessional collaborative practice model unique?
It ensures that health care providers can practise to the full potential of their role and competencies.
(The interprofessional collaborative practice model is used by nursing teams and other health care providers who are members of the interprofessional team. The entire health care team, not just one provider, is accountable for the care delivered to the patient. The focus is on the patient, not on any health care provider.)
A staff nurse has concerns about a procedural aspect of patient care. What is the most effective way for the nurse to ensure that this concern is addressed?
Discuss concerns with the unit manager.
Which of the following statements represents a nurse-sensitive outcome?
The patient ate 50% of lunch.
(The patient’s intake is a nurse-sensitive outcome that can be achieved as a result of nursing care. Family visitation shows a family focus. The inability of a patient to report pain intensity indicates a problem, not an outcome. Completing patient education indicates the completion of an intervention, not the attainment of an outcome.)
The five rights of delegation include which of the following?
Right task, circumstances, person, communication, and supervision
The nurse instructs an unregulated care provider (UCP) to change the central line dressing of a patient after the patient finishes lunch. This is an example of violating which of the five “rights” of delegation? (Select all that apply.)
Task.
Person.
(UCPs are not qualified to change central line dressings. This is an inappropriate delegation of a task to this person.)
What is the purpose of assessment?
To establish a database concerning the patient.
