Questions and Answers
(Ch.15) A nurse enters a patient’s room at the beginning of a shift to assess his condition following a blood transfusion. The nurse cared for the patient on the previous day as well. The patient has several issues he wishes to share with the nurse, who takes time to explore each issue. The nurse also assesses the patient and finds no signs or symptoms of a reaction to the blood product. The nurse observed the patient the prior day and sees a change in his behavior—a reluctance to get out of bed and ambulate. Which of the following actions improve the nurse’s ability to make clinical decisions about this patient? (Select all that apply.)
(Ch.15) A nurse has seen many cancer patients struggle with pain management because they are afraid of becoming addicted to the medicine. Pain control is a priority for cancer care. By helping patients focus on their values and beliefs about pain control, a nurse can best make clinical decisions. This is an example of:
(Ch.15) The REFLECT model can improve learning after providing patient care. Place the steps of this model in the correct order:
- Think about your thoughts and actions at the time of a situation.
- Review the knowledge you gained from the experience.
- Review the facts of the situation.
- Set a schedule for completing your plan of action.
- Consider options for handling a similar situation in the future.
- Recall any feelings you had at the time of the situation.
- Create a plan for future situations.
(Ch.15) One element of clinical decision making is knowing the patient. Which of the following activities affect a nurse’s ability to know patients better? (Select all that apply.)
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(Ch.15) A nurse is preparing medications for a patient. The nurse checks the name of the medication on the label with the name of the medication on the health care provider’s order. At the bedside, the nurse checks the patient’s name against the medication order as well. The nurse is following which critical thinking attitude?
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(Ch.15) A nurse has been caring for a patient with a chronic wound that has not been healing. The nurse talks with a nurse specialist in wound care to find alternative approaches from what the health care provider ordered for dressing the wound. The two decide that because of the patient’s allergy to tape, a nonallergenic dressing will be used. The nurse obtains an order from the health care provider for the new dressing. After 2 days there is improvement in the wound. This is an example of which critical thinking standards? (Select all that apply.)
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(Ch.15) A nurse is assigned to care for a woman who is expecting her first child. The nurse organizes herself and plans to gather data about the patient by applying Pender’s health promotion model, including the patient’s characteristics and experiences and situational influences. She plans to observe patient behavior and consider the patient’s psychosocial issues. Such data will offer a clear understanding to help the nurse identify the patient’s needs. This is an example of which of the following concepts? (Select all that apply.)
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(Ch.15) A nurse is caring for a patient who has poor pain control. The patient has a history of opioid abuse. During the day, the patient made frequent requests for a pain medication. To make an effective clinical decision about this patient, the nurse needs to ask questions about the data available on the patient to make a thorough and thoughtful decision. The nurse asks herself, “How does my view about the patient’s pain tolerance compare with the patient’s, and does that pose a problem?” This is an example of:
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(Ch.15) A nurse is giving a patient a medication and notices the dosage. From the nurse’s experience, the dosage is higher than what is normally given. Which of the following steps should the nurse take to ensure a safe outcome for the patient? (Select all that apply.)
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(Ch.21) At 1300 the registered nurse (RN) says to the assistive personnel (AP), “You did a good job transferring Mr. Harvey into his chair this morning at 0830. I saw that you recorded how long he stayed in his chair. I saw that Mr. Harvey did not have any shoes or nonslip slippers on, though. For safety, the next time you transfer a patient into a chair, you need to make sure that the patient wears slippers or shoes. Please get Mr. Harvey up in his chair again by 1500.” Which characteristics of positive feedback did the RN use when talking to the AP? (Select all that apply.)
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(Ch.21) A nurse received change-of-shift reports on these four patients and starts rounding. Which patient does the nurse need to focus on as a priority?
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(Ch.21) A nurse asks an AP to help the patient in Room 418 walk to the bathroom right now. The nurse tells the AP that the patient needs the assistance of one person and the use of a walker. The nurse also tells the AP that the patient’s oxygen can be removed while he goes to the bathroom but to make sure that when it is put back on, the flowmeter is still at 2 L. The nurse also instructs the AP to make sure the side rails are up and the bed alarm is reset after the patient gets back in bed. Which of the following components of the “Five Rights of Delegation” were used by the nurse? (Select all that apply.)
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(Ch.21) While administering medications, a nurse realizes that a prescribed dose of a medication was not given. The nurse acts by completing an incident report and notifying the patient’s health care provider. Which of the following is the nurse exercising?
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(Ch.21) Which task is appropriate for a registered nurse (RN) to delegate to an AP?
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(Ch.21) A nurse performs the following four steps in delegating a task to an AP. Place the steps in the correct order of appropriate delegation.
- Do you have any questions about walking with Mr. Malone?
- Before you take him for his walk to the end of the hallway and back, please take and record his pulse rate.
- In the next 30 minutes please assist Mr. Malone in Room 418 with his afternoon walk.
- I will make sure that I check with you in about 40 minutes to see how the patient did.
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(Ch.21) Which example demonstrates a nurse performing the skill of evaluation?
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(Ch.21) The nurse manager from the surgical unit was awarded the nursing leadership award for practice of transformational leadership. Which of the following are characteristics or traits of transformational leadership displayed by the award winner? (Select all that apply.)
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(Ch.21) A new nurse graduate is in orientation on a surgical unit and is being mentored by an experienced nurse. Which action completed by the new nurse graduate requires intervention by the experienced nurse? (Select all that apply.)
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(Ch.24) When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.)
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(Ch.24) A patient has gone through a number of treatment changes during a shift of care. During the hand-off report, the nurse plans to communicate effectively with the nurse who will be caring next for the patient for which of the following reasons? (Select all that apply.)
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(Ch.24) A nurse is using motivational interviewing with a patient. What outcomes does the nurse expect? (Select all that apply.)
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(Ch.24) Which techniques demonstrate a therapeutic response to an adult patient who is anxious? (Select all that apply.)
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(Ch.24) A patient states, “I don’t have confidence in my doctor. She looks so young.” What is the nurse’s therapeutic response?
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(Ch.24) The nurse applying effective communication skills throughout the nursing process should: (Place the following interventions in the correct order.)
- Validate health care needs through verbal discussion with the patient.
- Compare actual and expected patient care outcomes with the patient.
- Provide support through therapeutic communication techniques.
- Complete a nursing history using verbal communication techniques.
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(Ch.24) A nurse works with a patient using therapeutic communication during all phases of the therapeutic relationship. Place the nurse’s statements in order according to these phases
- The nurse states, “Let’s work on learning injection techniques.”
- The nurse is mindful of biases and knowledge in working with the patient with B12 deficiency.
- The nurse summarizes progress made during the nursing relationship.
- After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship.
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(Ch.24) Which strategies should a nurse use to facilitate a safe transition of care during a patient’s transfer from the hospital to a skilled nursing facility? (Select all that apply.)
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(Ch.24) What outcome demonstrates the effective use of silence as a therapeutic communication technique?
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(Ch.22) The nurse is caring for a patient who needs a liver transplant to survive. This patient has been out of work for several months, does not have health insurance, and cannot afford the procedure. Which of the following statements speaks to the ethical elements of this case?
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(Ch.22) When designing a plan for pain management for a patient following surgery, the nurse assesses that the patient’s priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient’s priority is met. If the nurse’s actions are driven by respect for autonomy, what aspect of this scenario best demonstrates this action?
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(Ch.22) The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology?
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(Ch.22) The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other approaches to ethical problems? (Select all that apply.) Ethics of care:
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(Ch.22) The following are steps in the process to help resolve an ethical problem. What is the best order of these steps to achieve resolution?
- List all the possible actions that could be taken to resolve the problem.
- Articulate a statement of the problem or dilemma that you are trying to resolve.
- Develop and implement a plan to address the problem.
- Gather all relevant information regarding the clinical, social, and spiritual aspects of the problem.
- Take time to clarify values and identify the ethical elements, such as principles and key relationships involved.
- Recognize that the problem requires ethics.
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(Ch.22) Which social media uses can be implemented with patients and families without violating confidentiality? (Select all that apply.)
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(Ch.22) Resolution of an ethical problem involves discussion with the patient, the patient’s family, and participants from appropriate health care disciplines. Which statement best describes the role of the nurse in the resolution of ethical problems?
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(Ch.22) Which statements reflect the difficulty that can occur for agreement on a common definition of the word quality when it comes to quality of life? (Select all that apply.)
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(Ch.22) Which statements properly apply an ethical principle to justify access to health care? (Select all that apply.)
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(CH 25)A nurse who works in an outpatient chemotherapy infusion center is assigned to the care of a 56y.o male patient who is receiving chemotherapy for colon cancer. This is the patient’s first clinic visit. The nurse reviews the patient’s medical record and sees a note about the patient receiving instruction on how chemotherapy treats can- cer, but the note doesnt summarize the patient’s response. The Dr makes a quick visit and tells the patient, “We will get your treatment started today and will be checking your blood each week for any problems.” The doctor leaves and the patient asks the nurse, “What are the blood tests for?” To determine this patient’s learning needs, what should the nurse assess? (Select all)
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(CH25)A nurse who works in an outpatient chemotherapy infusion center is assigned to the care of a 56y.o. male patient who is receiving chemotherapy for colon cancer. This is the patient’s first clinic visit. The nurse reviews the patient’s medical record and sees a note about the patient receiving instruction on how chemotherapy treats cancer; the note doesnt summarize the patient’s response. The nurse’s assessment reveals that the patient is motivated to learn more about his chemotherapy and is alert and currently feeling well. The nurse has prepared the first infusion, regulated it, and now takes time to begin instruction. Which teaching approaches are best suited for this situation?
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(CH25)A 26-year-old patient visits a medical clinic and asks a nurse to provide instruction on how to perform a breast self-examination. “My mom had cancer so I want to learn how.” Which domains are required to learn this skill? (Select all that apply.)
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(CH25)A patient suddenly experienced a severe headache with numbness and decreased movement in the left arm. An emergency brain scan confirmed a cerebral vessel clot. With a stroke confirmed, the emergency room physician consults with a neurosurgeon to schedule an emergent angiogram to remove the clot. Which teaching approach is most appropriate for explaining to the patient what to expect from the procedure?
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(CH25)A nurse is teaching an older-adult patient about ways to detect a melanoma. Which of the following are age-appropriate teaching techniques for this patient? (Select all that apply.)
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(CH25)A 55-year-old man has been in the hospital for over a week follow- ing surgical complications. The patient has had limited activity but is now ordered to begin a mobility program. The patient just re- turned from several diagnostic tests and tells the nurse he is feeling fatigued. The nurse prepares to instruct the patient on the mobility program protocol. Which of the following learning principles will likely be affected by this patient’s condition?
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(CH25)A patient recovering from open heart surgery is taught how to cough and deep breathe using a pillow to support or splint the chest incision. Following the teaching session, which of the following is the best way for the nurse to evaluate whether learning has taken place?
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(CH25) Match the ACCESS model component with the nursing approach
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(CH25)Match the correct model term to the nursing approach
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(CH25)A nurse is preparing to teach a patient who has sleep apnea how to use a continuous positive airway pressure (CPAP) machine at night. Which action is most appropriate for the nurse to perform first?
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(CH25)Which of the following scenarios demonstrate that patient learning has taken place? (Select all that apply.)
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(CH26)A nurse contacts the health care provider about a change in a patient’s condition and receives several new orders for the patient over the phone. When documenting telephone orders in the EHR, what should the nurse do?
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(CH26)You are a nurse who is working in an agency that has recently implemented an EHR. Which of the following are acceptable practices for maintaining the security and confidentiality of EHR information? (Select all that apply.)
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(CH26)When documenting an assessment of a patient’s cardiac system in an EHR, the nurse uses the computer mouse to select the “WNL” statement to document the following findings: “Heart sounds S1 & S2 auscultated. Heart rate between 80 and 100 beats/min, and regular. Denies chest pain.” This is an example of using which of the following documentation formats?
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(CH26)The nurse works at an agency where military time is used for documentation and needs to document that a patient was medicated for pain after midnight. Identify the correct military time to document medication administered at 12:05 a.m.
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(CH26)The nurse who works at the local health care agency is transferring a patient to an acute rehabilitation center in another town. To com- plete the transfer, information from the patient’s EHR must be printed and faxed to the acute rehabilitation center. Which of the following actions are appropriate for the nurse to take to maintain privacy and confidentiality of the patient’s information when faxing this information? (Select all that apply.)
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(CH26)The nurse is administering a dose of metoprolol to a patient and is completing the steps of bar-code medication administration within the EHR. As the bar-code information on the medication is scanned, an alert that states, “Do not administer dose if apical heart rate (HR) is ,60 beats/min or systolic blood pressure (SBP) is ,90 mm Hg” appears on the computer screen. The alert that appeared on the computer screen is an example of what type of system?
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(CH26)The nurse is writing a narrative progress note. Identify each of the following statements as subjective data (S) or objective data (O):
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(CH26)The nurse is writing a narrative progress note. Identify each of the following statements as subjective data (S) or objective data (O):
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(CH26)The nurse is discussing the advantages of using CPOE with a nursing colleague. Which statement best describes the major advantage of a CPOE system within an EHR?
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(CH26)The nurse is reviewing health care provider orders that were handwritten on paper when all computers were down during a system upgrade. Which of the following orders contains an inappropriate abbreviation included on TJC’s “do not use” list and should be clarified with the health care provider?
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(CH26)The nurse is changing the dressing over the midline incision of a patient who had surgery. Assessment of the incision reveals changes from what was documented by the previous nurse. After documenting the current wound assessment, the nurse contacts the surgeon by telephone to discuss changes in the incision that are of concern. Which of the following illustrates the most ap- propriate way for the nurse to document this conversation?
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(Ch.15) Match the concepts for a critical thinker on the left with the application of the term on the right,
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(Ch.24) A nurse prepares to contact a patient’s health care provider about a change in the patient’s condition. Put the following statements in the correct order using SBAR (Situation, Background, Assessment, and Recommendation) communication.
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(Ch.22) Match the following actions with the terms listed below:
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JoAnn, a nurse, is calling a patient’s health care provider about a problem that her patient, Ms. Ducote, is having during a blood transfusion. The health care agency uses the SBAR system in reporting patient problems. Put the statements in the correct order according to the SBAR system.
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Study Notes
Clinical Decision Making
- A nurse's ability to make clinical decisions is improved by:
- Knowing the patient
- Seeking truth and finding possible solutions
- Being open-minded and non-judgmental
- Being analytical and systematic
- Focusing on the patient's values and beliefs
- The REFLECT model improves learning after providing patient care:
- Think about thoughts and actions at the time of the situation
- Review the knowledge gained from the experience
- Review the facts of the situation
- Set a schedule for completing the plan of action
- Consider options for handling a similar situation in the future
- Recall feelings at the time of the situation
- Create a plan for future situations
- A nurse's ability to know patients better is affected by:
- Assessing the patient's behavior and attitude
- Focusing on the patient's values and beliefs
- Seeking feedback from the patient
Critical Thinking
- Critical thinking attitudes:
- Seeking truth and finding possible solutions
- Being open-minded and non-judgmental
- Being analytical and systematic
- Focusing on the patient's values and beliefs
- Critical thinking standards:
- Truth seeking
- Open-mindedness
- Analyticity
- Systematicity
- A nurse uses critical thinking by:
- Assessing the patient's situation and identifying possible solutions
- Evaluating the patient's data and making a thoughtful decision
Delegation
- The Five Rights of Delegation:
- Right task
- Right person
- Right direction
- Right supervision
- Right evaluation
- A nurse delegates a task to an assistive personnel (AP) by:
- Providing clear instructions
- Providing the necessary resources
- Ensuring the AP understands the task
- Supervising and evaluating the task
Communication
- SBAR (Situation, Background, Assessment, and Recommendation) communication:
- Situation
- Background
- Assessment
- Recommendation
- Effective communication:
- Uses active listening
- Uses clear and concise language
- Focuses on the patient's needs
- Uses nonverbal cues
- Therapeutic communication:
- Uses empathy and understanding
- Focuses on the patient's feelings
- Uses open-ended questions
- Encourages the patient to express themselves
Ethical Decision Making
- Ethical principles:
- Autonomy
- Beneficence
- Nonmaleficence
- Justice
- Deontology:
- Focuses on the moral rules and principles
- Emphasizes the importance of duty and obligation
- Ethics of care:
- Focuses on the relationships and care for others
- Emphasizes the importance of empathy and compassion
- Steps to resolve an ethical problem:
- Articulate the problem
- Gather relevant information
- Identify the ethical elements
- Develop and implement a plan
- Evaluate the outcome
Teaching and Learning
- The nurse assesses the patient's learning needs by:
- Identifying the patient's priorities
- Assessing the patient's knowledge and understanding
- Evaluating the patient's response to teaching
- Teaching approaches:
- Lecture
- Demonstration
- Return demonstration
- Discussion
- Learning principles:
- Focus on the patient's needs
- Use clear and concise language
- Use active learning
- Use reinforcement and feedback
Electronic Health Records (EHRs)
- EHRs:
- Improve patient safety
- Improve communication
- Increase efficiency
- Reduce errors
- Accessing and maintaining EHRs:
- Use passwords and authentication
- Use secure networks and systems
- Limit access to authorized personnel
- Use audit trails and logs
- Documenting in EHRs:
- Use clear and concise language
- Use standardized formats and templates
- Use accurate and complete information
- Use electronic signatures and authentication
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Identify the patient/population component in a research question. Practice critical thinking and comprehension in research methodology. Evaluate the effectiveness of guided imagery on post-operative pain in adolescents.