Review questions Flashcards
Health care reform will bring changes in the emphasis of care. Which of the following models is expected from health care reform?
Moving from an acute illness to a health promotion, illness prevention model
Moving from illness prevention to a health promotion model
Moving from an acute illness to a disease management model
Moving from a chronic care to an illness prevention model
Moving from an acute illness to a health promotion, illness prevention model
Which of the following Internet resources available can assist consumers when comparing quality care measures? (Select all that apply.)
WebMD
Hospital Compare
Magnet Recognition Program
Hospital Consumer Assessment of Healthcare
The American Hospital Association’s webpage.
Hospital Compare
Hospital Consumer Assessment of Healthcare
A group of staff nurses notice an increased incidence of medication errors on their unit. After further investigation it is determined that the nurses are not consistently identifying the patient correctly. A change is needed quickly. What type of quality improvement method would be most appropriate?
PDSA
Six Sigma
Rapid-improvement event
A randomized controlled trial
Rapid-improvement event
RIEs are very intense, usually week-long events, in which a group gets together to evaluate a problem with the intent of making radical changes to current processes.
Changes are made within a very short time.
The effects of the changes are measured quickly, results are evaluated, and further changes are made when necessary.
An RIE is appropriate to use when a serious problem such as the increased occurrence of medication errors exists that greatly affects patient safety and needs to be solved quickly.
A nurse is presenting information to a management class of nursing students on the topic of financial reimbursement for achievement of established, measurable patient outcomes. The nurse is presenting information to the class on which topic?
Prospective payment system
Pay for performance
Capitation payment system
Managed care systems
Pay for performance
Pay for performance programs and public reporting of hospital quality data are designed to promote quality, effective, and safe patient care by physicians and health care organizations.
These programs are quality improvement strategies that reward excellence through financial incentives to motivate change to achieve measurable improvements.
A nurse is using data collected from the unit to monitor the incidence of falls after the unit implemented a new fall protocol. The nurse is working in which area?
Quality improvement
Health care patient system
Nursing informatics
Computerized nursing network
Quality improvement
Quality data are the outcome of both QI initiatives. QI is an approach to the continuous study and improvement of the processes of providing health care services to meet the needs of patients and others and inform health care policy. The QI program of an institution focuses on improvement of health care–related processes such as fall prevention.
A nurse is using the Plan-Do-Study-Act (PDSA) strategy to do a quality improvement project to decrease patient falls on a nursing unit. What is the correct sequence for PDSA?
- Bedside change of shift report is piloted on two medical-surgical units
- Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change
- The nursing council develops a strategy for bedside change of shift report
- After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units
1, 3, 2, 4
2, 1, 3, 4
1, 2, 3, 4
3, 1, 2, 4
3, 1, 2, 4
- The nursing council develops a strategy for bedside change of shift report
- Bedside change of shift report is piloted on two medical-surgical units
- Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change
- After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units
Which of the following are examples of the nurse participating in primary care activities? (Select all that apply.)
Providing prenatal teaching on nutrition to a pregnant woman during the first trimester
Assessing the nutritional status of older adults who come to the community center for lunch.
Working with patients in a cardiac rehabilitation program
Providing home wound care to a patient
Teaching a class to parents at the local grade school about the importance of immunizations.
Providing prenatal teaching on nutrition to a pregnant woman during the first trimester
Assessing the nutritional status of older adults who come to the community center for lunch.
Teaching a class to parents at the local grade school about the importance of immunizations.
Primary care activities are focused on health promotion. Health promotion programs contribute to quality health care by helping patients acquire healthier lifestyles. Health promotion activities help keep people healthy through exercise, good nutrition, rest, and adopting positive health attitudes and practices.
Which of the following are characteristics of managed care systems? (Select all that apply.)
Provider receives a predetermined payment for each patient in the program.
Payment is based on a set fee for each service provided.
System includes a voluntary prescription drug program for an additional cost.
System tries to reduce costs while keeping patients healthy.
Focus of care is on prevention and early intervention
Provider receives a predetermined payment for each patient in the program.
System tries to reduce costs while keeping patients healthy.
Focus of care is on prevention and early intervention
Managed care programs have administrative control over primary health care services for a defined patient population. The provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. In this case the managed care organization assumes financial risk in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care. If people stay healthy, the cost of medical care declines. Systems of managed care focus on containing or reducing costs, increasing patient satisfaction, and improving the health or functional status of the individual.
Which of the following nursing activities is provided in a secondary health care environment? (Select all that apply.)
Conducting blood pressure screenings for older adults at the Senior Center.
Teaching a clinic patient with chronic obstructive pulmonary disease purse-lipped breathing techniques.
Changing the postoperative dressing for a patient on a medical-surgical unit.
Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit
Changing the postoperative dressing for a patient on a medical-surgical unit.
Doing endotracheal suctioning for a patient on a ventilator in the medical intensive care unit
In secondary care the diagnosis and treatment of illnesses are traditionally the most common services. Secondary services are usually provided in an acute care facility. Critical care units and inpatient medical-surgical units provide secondary and tertiary care.
The nursing staff is developing a quality program. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators (NDNQI) that the nurses can use to measure patient safety and quality for the unit? (Select all that apply.)
Use of physical restraints
Pain assessment, intervention, and reassessment
Patient satisfaction with food preparation
Registered nurse (RN) education and certification
Number of outpatient surgical cases per year
Use of physical restraints
Pain assessment, intervention and reassessment
Registered nurse (RN) education and certification
Physical restraint use, pain management, and RN education and certification are among the reportable nursing sensitive indicators for NDNQI. The other options are not nursing-sensitive indicators.
A community nurse in a diverse community is working with health care professionals to provide for prenatal care for under employed and under insured South African women. Which overall goal of Healthy People 2020 does this represent?
Assess the health care needs of individuals, families, or communities
Develop and implement public health policies and improve access to care
Gather information on incident rates of certain diseases and social problems
Increase life expectancy and quality of life and to eliminate health disparities
Increase life expectancy and quality of life and to eliminate health disparities
By providing prenatal care to this group of women, the nurse improves the birth outcomes for their children and in turn the child’s quality of life. Underinsured represent a health disparity, and Healthy People 2020 aims to decrease this inequity.
Vulnerable populations of patients are those who are more likely to develop health problems as a result of:
Chronic diseases, homelessness, and poverty Incorrect
Poverty and limits in access to health care services
Lack of transportation, dependence on others for care, and homelessness
Excess risks, limits in access to health care services, and dependency on others for care
Excess risks, limits in access to health care services, and dependency on others for care
It is the excess of risks and combination of risk factors that make this population more vulnerable. These vulnerabilities can be associated with the individual’s/community’s social determinants of health or individual health disparities.
Following a community assessment that focused on adolescent health behaviors, the nurse determines that a large number of adolescents smoke and designs a smoking cessation at the youth community center. This is an example of which nursing role:
Educator
Counselor
Collaborator
Case manager
Counselor
To engage a patient to participate in a smoking cessation program or any program that requires changing a behavior requires the nurse to act as a counselor to support the patient in changing that behavior (e.g., in this case a smoking habit). The nurse does not educate the patient about the dangers of smoking but first must actively counsel him or her to decide to change the behavior. Without support and counseling, the smoking cessation education may not be used effectively by the patient.
The nurse in a new community based clinic is requested to complete a community assessment. What is the order for completing this assessment? 1. Structure or locale 2. Social systems 3. Population
1, 3, 2
2, 1, 3
3, 2, 1
3, 1, 2
1) Structure or locale
3) Population
2) Social systems
To begin a community assessment, the structure and geographic boundaries of the community are identified. Look at the structures in the community (e.g., schools, churches, types of residences). Next obtain data about the population and the demographics of the community. Who are the residents of the community, what is the age range, which types of ethnicity are represented? Last, review the social systems in the community.
Using Healthy People 2020 as a guide, which of the following would improve delivery of care to a community? (Select all that apply.)
Community assessment Correct
Implementation of public health policies Correct
Home safety assessment
Increased access to care. Correct
Determining rates of specific illnesses
Community assessment
Implementation of public health policies
Increased access to care
Determining rates of specific illnesses
Improved delivery of health care occurs through assessment of health care needs of individuals, families, and communities; development and implementation of public health policies; improved access to care; and identification of illness rates. For example, assessment includes systematic data collection on the population, monitoring the population’s health status, and accessing available information about the health of the community. Although home assessment, might be valuable to an individual patient, it may not benefit the community as a whole.
Incorrect Feedback:
Improved delivery of health care occurs through assessment of health care needs of individuals, families, and communities; development and implementation of public health policies; improved access to care; and identification of illness rates. For example, assessment includes systematic data collection on the population, monitoring the population’s health status, and accessing available information about the health of the community. Although home assessment, might be valuable to an individual patient, it may not benefit the community as a whole.
A nursing student in the last semester of the baccalaureate nursing program is beginning the community health practicum and will be working in a community based clinic with a focus on asthma and allergies. What is the focus of the community health nurse in this clinic setting? (Select all that apply.)
Decrease the incidence of asthma attacks in the community.
Increase patients’ ability to self-manage their asthma.
Treat acute asthma attack in the home care setting
Provide asthma education programs for the teachers in the local schools
Provide scheduled immunizations to people who come to the clinic
Decrease the incidence of asthma attacks in the community
Increase patient’s ability to self-manage their asthma
Provide asthma education programs for the teachers in the local schools
All of these activities improve the level of health and quality of life for patients in this community. Asthma self-management controls symptoms and improves a patient’s quality of life. Assessing for and preventing risks and educational programs improve the level of health within a community. The example here was asthma, but managing chronic diseases in the community improves the overall level of health of that community. Community-based nursing care takes place in community settings such as the home or a clinic, where the focus is on the needs of the individual or family (e.g., immunization). It involves the safety needs and acute and chronic care of individuals and families and enhances their capacity for self-care.
The nurse caring for a Bosnian community identifies that the children are undervaccinated and the community is unaware of resources. The nurse assesses the community and determines that there is a health clinic within a 5-mile radius. The nurse meets with the community leaders and explains the need for immunizations, the location of the clinic, and the process of accessing health care resources. Which of the following practices is the nurse providing? (Select all that apply.)
Providing community resources for the children
Teaching the community about health promotion and illness prevention
Promoting autonomy in decision-making about health practices
Improving the health care of the community’s children
Participating in professional development activities to maintain nursing competency
Providing community resources for the children
Teaching the community about health promotion and illness prevention
Improving the health care of the community’s children
Providing community resources for the children will help the community identify potential clinics for vaccination and well-baby and child examinations. By teaching the community about relevant illnesses, you increase the level of awareness not only about the disease but also about methods of treatment. As the community becomes more informed about the illness, prevention, and treatment methods, the health of the community increases.
Which of the following are major public health problems commonly affecting older adults? (Select all that apply.)
Substance abuse
Confusional states
Financial limitations
Communicable diseases
Acute and chronic physical illnesses
Substance abuse
Confusional states
Financial limitations
Acute and chronic physical illnesses
The older-adult population frequently has restricted or fixed income levels and a higher percentage of chronic and physical illnesses. The management of these illnesses further depletes the financial resources of the older-adult population, further increasing their risks for health problems.
The nurse in a community health clinic noticed an increase in the number of positive tuberculosis (TB) skin tests from students in a local high school during the most recent academic year. After comparing these numbers to the previous years, 10% increase in positive tests was found. The nurse contacts the school nurse and the director of the health department. Together they begin to expand their assessment to all students and employees of the school district. The community health nurse was acting in which nursing role(s)? (Select all that apply.)
Epidemiologist
Counselor
Collaborator
Case manager
Caregiver
Epidemiologist
Collaborator
Initially when the nurse noticed an increase in the number of positive TB skin tests, she was comparing current data with previous data to track positive skin test rates. Once the increase was noted, she collaborated with the school nurse and other members of the health department to determine the impact of the increased TB skin testing.
On the basis of an assessment, the nurse identifies an increase in the immigrant population group in the community. How would the nurse determine some of the health needs of this population? (Select all that apply).
Identify what the immigrant population views as the two most important health needs.
Apply information from Healthy People 2020
Determine how the population uses available health care resources
Determine which health care agencies will accept immigrant populations
Identify perceived barriers for health care
Identify what the immigrant population views as the two most important health needs.
Apply information from Healthy People 2020
Determine how the population uses available health care resources
Identify perceived barriers for health care
All of these impact the health care needs of this population. It is necessary to identify their priorities and try to meet them and to apply information from reliable guidelines such as Healthy People 2020. How or if a population uses available health care resources or the perceived barriers for health care is important. These elements help identify factors that promote or impede health care for this group. Determining which health care agencies accept immigrant populations doesn’t address health care needs of this population.
The public health nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2020. In the immigrant community, most of the population does not have a primary care provider, nor do they participate in health promotion activities; the unemployment rate in the community is 25%. How does the nurse determine which goals need to be included or updated? (Select all that apply.)
Assess the health care resources within the community
Assess the existing health care programs offered by the county health department
Compare existing resources and programs with Healthy People 2020 goals
Initiate new programs to meet Healthy People 2020 goals.
Implement educational sessions in the schools to focus on nutritional needs of the children.
Assess the health care resources within the community
Assess the existing health care programs offered by the county health department
Compare existing resources and programs with Healthy People 2020 goals
The nurse must first assess for existing health care resources and educational programs in existence. Then the nurse must compare these resources and programs with Healthy People 2020 goals. These processes determine if any new goals need to be added or updated.
The components of the nursing metaparadigm:
Person, health, environment, nursing
A nurse ensures that each patient’s room is clean, well ventilated, and free from clutter, excessive noise, and extremes in temperature. Which theorist’s work is the nurse practicing in this example?
Nightingale
Nightingale’s environmental theory directs the nurse to manipulate the environment to promote rest and healing.
The nurse is caring for a patient admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. The nurse assumes responsibility for bathing and feeding the patient until the patient is able to begin performing these activities. The nurse in this situation is applying the theory developed by:
Orem
When applying Orem’s self-care deficit theory, the nurse continually assesses the patient’s ability to perform self-care and intervenes as needed to ensure that physical, psychological, sociological, and developmental needs are being met. As the patient’s condition improves, the nurse encourages the patient to begin doing these activities independently.
A nurse is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following theories?
Roy
When applying Roy’s adaptation model, the nurse helps the patient cope with/adapting to changes in physiological, self-concept, role function, and interdependence domains.
Which of the following categories of shared theories would be most appropriate for a patient who is grieving the loss of a spouse?
Biomedical
Leadership
Psychosocial
Developmental
Psychosocial
You can use various psychosocial theories to help patients with loss, death, and grief.
While working in a rehabilitation facility, it is important to obtain nursing histories and develop a therapeutic nurse-patient relationship. Which of the following lists in correct order the phases of Peplau’s theory as applied in this setting. The nurse:
- Ensures that the patient has access to appropriate community resources for long-term care.
- Collaborates with the patient to identify specific patient needs
- Collects essential information from the patient’s health record.
- Works with the patient to develop a plan for resolving patient issues.
3,2,4,1
- Collects essential information from the patient’s health record.
- Collaborates with the patient to identify specific patient needs
- Works with the patient to develop a plan for resolving patient issues.
- Ensures that the patient has access to appropriate community resources for long-term care.
The following phases characterize the nursepatient interpersonal relationship: preorientation (data gathering), orientation (defining issue), working phase (therapeutic activity), and resolution (termination of relationship).
Which of the following types of theory influence the “evidence” in current “evidence-based practice (EBP)”?
Grand theory
Middle-range theory
Practice theory
Shared theory
Middle-range theory
The original grand theories served as springboards for the development of the more modern middle-range theories, which, through testing in research studies, provide the “evidence” for EBP and promotes the translation of research into practice.
A nurse is preparing to begin intravenous fluid therapy for a patient. Which category of theory would be most helpful to the nurse at this time?
Grand theory
Middle-range theory
Practice theory
Shared theory
Practice theory
Practice theories bring theory to the bedside. Narrow in scope and focus, these theories guide the nursing care of a specific patient population at a specific time.
The nurse strives to relieve patient’s distress theorist:
Kolcaba’s Theory of Comfort
The nurse progresses through 5 stages of expertise theorist
Benner’s Skin Acquisition
The nurse assists the patient to process and find meaning related to his or her illness theorist
Mishel’s Uncertainty in Illness
Matching nurse competencies to patient needs can improve patient outcomes theorist
AACN’s Synergy Model
Theory is essential to nursing practice because it: (Select all that apply.)
Contributes to nursing knowledge.
Predicts patient behaviors in situations.
Provides a means of assessing patient vital signs.
Guides nursing practice.
Formulates health care legislation.
Explains relationships between concepts.
Contributes to nursing knowledge
Predicts patient behaviors in situations
Provides a means of assessing patient vital signs
Explains the relationships between concepts
A theory contains a set of concepts, definitions, and assumptions that explain a phenomenon. The theory explains how these elements are uniquely related in the phenomenon. These components provide a foundation of knowledge for nurses to direct and deliver caring nursing practices. A theory helps explain an event by defining ideas or concepts, explaining relationships between the concepts, and predicting outcomes of nursing care. A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care.
Which of the following statements related to theory-based nursing practice are correct?
Nursing theory differentiates nursing from other disciplines.
Nursing theories are standardized and do not change over time.
Integrating theory into practice promotes coordinated care delivery.
Nursing knowledge is generated by theory.
The theory of nursing process is used in planning patient care.
Evidence-based practice results from theory-testing research.
Nursing theory differentiates nursing from other disciplines
Integrating theory into practice promotes coordinated care delivery
Nursing knowledge is generated by theory
Evidence-based practice results from theory-testing research
The overall goal of nursing knowledge is to explain the practice of nursing as different and distinct from the practice of medicine, psychology, and other health care disciplines. Theory generates nursing knowledge for use in practice, thus supporting evidence-based practice. The integration of theory into practice leads to coordinated care delivery and therefore serves as the basis for nursing. Although the nursing process is central to nursing, it is not a theory. Nursing theories are not stagnant and continue to evolve over time.
Nurses have developed theories in response to: (Select all that apply.)
Changes in health care
Prior nursing theories
Changes in nursing practice
Research findings
Government regulations
Theories from other disciplines
Physician opinions
Changes in health care
Prior nursing theories
Changes in nursing practice
Research findings
Theories from other disciplines
Nursing theories often build on the works of prior theories from nursing and other disciplines. As nursing education has expanded, so has the practice of nursing in response to changes in society and health care. In addition, nursing research, which serves as the foundation for evidence-based practice, has increased.
A nurse researcher studies the effectiveness of a new program designed to educate parents to promote the immunization of children. The nurse divides the parents randomly into two groups. One group receives the typical educational program and the other group receives the new program. This is an example of which type of study?
Historical
Qualitative
Correlational
Experimental
Experimental
In experimental studies the subjects are randomly assigned into groups with one group receiving the standard treatment and the other group receiving the intervention.
A nurse who works on a pediatric unit asks, “I wonder if children who interact with therapy dogs have reduced anxiety when they are in the hospital.” In this example of a PICOT question, which of the following is the O?
Children
Therapy dogs
Pediatric unit
Anxiety
Anxiety
O stands for outcome; in this PICOT question, the outcome the nurse is concerned about is anxiety.
A nurse researcher wants to know what factors are associated with a person’s decision to exercise. The nurse distributes a survey to people who recently joined an exercise wellness program and analyzes the data to determine what factors and characteristics are most significantly linked to the decision to start exercising. What type of a research study is this?
Qualitative
Descriptive
Correlational
Randomized controlled trial
Correlational
In the correlational study the nurse researcher is correlating characteristics or factors with the decision to start exercising.
A group of nurses have identified that the elderly patients on their unit have a high incidence of pressure ulcers after they have a stroke. During a unit meeting, they discuss different interventions they think may reduce the development of pressure ulcers. What is the nurses’ next step to investigate this clinical problem further?
Conduct a literature review.
Share the findings with others.
Conduct a statistical analysis.
Create a well-defined PICOT question.
Create a well-defined PICOT question.
In this case the nurses need to develop a PICOT question next to search for appropriate evidence that might offer answers to this clinical problem.
What is the appropriate order for the following steps of evidence-based practice (EBP)?
- Integrate the evidence.
- Ask the burning clinical question.
- Create a spirit of inquiry
- Evaluate the practice decision or change.
- Share the results with others.
- Critically evaluate the evidence you gather.
- Collect the most relevant and best evidence.
- Create a spirit of inquiry
- Ask the burning clinical question.
- Collect the most relevant and best evidence.
- Critically evaluate the evidence you gather.
- Integrate the evidence.
- Evaluate the practice decision or change.
- Share the results with others.
When recruiting subjects to participate in a study about the effects of an educational program to help patients at home take their medications as ordered, the researcher tells the subjects that their names will not be used and no one but the research team will have access to their information and responses. This is an example of:
Bias.
Anonymity.
Confidentiality.
Informed consent.
Confidentiality
Confidentiality guarantees that any information a subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team.
Nurses in a community clinic have seen an increase in the numbers of obese children. The nurses who care for children are discussing ways to reduce childhood obesity. One nurse asks a colleague, “I wonder what the most effective ways are to help school-aged children maintain a healthy weight?” This question is an example of a/an:
Hypothesis.
PICOT question.
Problem-focused trigger.
Knowledge-focused trigger.
Problem-focused trigger
A problem-focused trigger is a clinical problem you face while caring for patients; the nurses in this question have identified a clinical problem that they want to investigate further.
The nurses on a medical unit have seen an increase in the number of medication errors on their unit. They decide to evaluate the medication administration process based on data gained from chart reviews and direct observation of nurses administering medications. Which process are the nurses using?
Evidence-based practice.
Research.
Quality improvement.
Problem identification.
Quality improvement
