LA#1 (Nursing Process and Critical Thinking - Chapter 1 and 7 in Med Surg Flashcards Preview

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Flashcards in LA#1 (Nursing Process and Critical Thinking - Chapter 1 and 7 in Med Surg Deck (24)
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1

The nurse explains to the patient that together they will plan the patient’s care and set goals to achieve by discharge. The patient asks how this differs from what the physician does. Which statement best describes the difference between the roles of nursing and medicine in planning the patient’s care and setting goals to achieve discharge?
a. Medicine cures; nursing cares.
b. Nurses assist physicians to diagnose and treat patients with health care problems.
c. Very little role difference exists between medicine and nursing; nurses perform many of the procedures done by physicians.
d. Medicine focuses on diagnosis and treatment of the health problem; nursing focuses on diagnosis and treatment of the patient’s response to the health problem.

ANS: D
This response is consistent with the Canadian Nurses Association’s (CNA’s) definition of registered nursing, which states that registered nurses enable individuals, families, groups, communities, and populations to achieve their optimal level of health. The other responses describe some of the dependent and collaborative functions of the nursing role but do not accurately describe the nurse’s role in the health care system.

2

A woman with hypertension is concerned that if she sees the nurse practitioner (an advanced practice nurse), only her hypertension will be assessed, and she is worried that another health problem may not be diagnosed. What should the nurse tell the patient regarding nurse practitioners’ scope of practice as it relates to diagnosis?
a. They diagnose and treat all major health problems.
b. They have the same role and scope of practice as physicians.
c. They write prescriptions for all classifications of medications.
d. They focus on primary care and health promotion, including diagnosis.

ANS: D
Advanced practice nurses (for example, nurse practitioners) focus on the management of primary care and health promotion for a wide variety of health problems in various specialties; roles include physical examination, diagnosis, treatment of health problems, patient and family education, and counselling.

3

When asking a clinical question using the PICO format, which of the following would represent the “C”?
a. Controlled diabetes in a woman aged 50 to 65 years
b. Conditioning and exercise program for one hour, three times weekly
c. Weekly blood glucose levels within normal range
d. Standard care for women with diabetes

ANS: D
The “C” in PICO stands for comparison of interest, which would be standard care, in this case, for women with diabetes. Controlled diabetes in a woman aged 50 to 65 years is the “P,” the population. Conditioning and exercise program for one hour, three times weekly is the “I,” or intervention. Weekly blood glucose levels within normal range is the “O,” or outcome of interest.

4

How does the nurse primarily use the nursing process in the care of patients?
a. As a science-based process of diagnosing the patient’s health care problems
b. To establish nursing theory that incorporates the bio-psycho-social nature of humans
c. To promote the management of patient care in collaboration with other health care providers
d. As a tool to organize the nurse’s thinking and clinical decision making about the patient’s health care needs

ANS: D
The nursing process is a problem-solving approach to the identification and treatment of patients’ problems. Diagnosis is only one phase of the nursing process. The primary use of the nursing process is in patient care, not to establish nursing theory or explain nursing interventions to other health care providers.

5

An emaciated older adult patient is admitted to the critical care unit. The nurse plans a schedule of turning the patient every two hours to prevent skin breakdown. This is considered to be what type of nursing action?
a. Dependent
b. Cooperative
c. Independent
d. Collaborative

ANS: D
When implementing collaborative nursing actions, the nurse is responsible primarily for monitoring for complications or providing care to prevent or treat complications. Independent nursing actions are focused on health promotion, illness prevention, and patient advocacy. A dependent action would require a physician order to implement. Cooperative nursing functions are not described as one of the formal nursing functions.

6

A woman who is a lone parent is about to undergo gallbladder surgery. She tells the nurse on admission that she is uneasy about being in the hospital and leaving her two preschool children with a neighbour. During the assessment phase, what is an appropriate nursing action?
a. Reassure the patient that her children are fine.
b. Call the neighbour to determine whether she is an adequate care provider.
c. Have the patient call the children to reassure herself that they are doing well.
d. Gather more data about the patient’s feelings about the child care arrangements.

ANS: D
The assessment phase includes gathering multidimensional data about the patient. The other nursing actions may be appropriate during the implementation phase (after the nurse accomplishes further assessment of the patient’s concerns), but they are not part of the assessment phase.

7

A patient with a stroke is paralyzed on the left side of the body and is not responsive enough to turn or move independently in bed. A pressure ulcer has developed on the patient’s left hip. What is the most appropriate nursing diagnosis?
a. Impaired physical mobility related to paralysis
b. Impaired skin integrity related to altered circulation and pressure
c. Risk for impaired tissue integrity related to impaired physical mobility
d. Ineffective tissue perfusion related to inability to turn and move self in bed

ANS: B
The patient’s major problem is the impaired skin integrity as demonstrated by the presence of a pressure ulcer. The nurse is able to treat the cause of altered circulation and pressure by frequently repositioning the patient. Although impaired physical mobility is a problem for the patient, the nurse cannot treat the paralysis. The risk for diagnosis is not appropriate for this patient, who already has impaired tissue integrity. The patient does have ineffective tissue perfusion, but the impaired skin integrity diagnosis indicates more clearly what the health problem is.

8

A patient with an infection has a nursing diagnosis of fluid volume deficit related to excessive diaphoresis. What is an appropriate patient outcome?
a. Balanced intake and output are achieved.
b. Patient verbalizes a need for increased fluid intake.
c. Bedding is changed when it becomes damp.
d. Skin remains cool and dry throughout hospitalization.

ANS: A
This statement gives measurable data showing resolution of the problem of fluid volume deficit that was identified in the nursing diagnosis statement. The other statements would not indicate that the problem of fluid volume deficit was resolved.

9

Which characteristic is consistent with critical thinking?
a. Do not use abstract ideas.
b. Think within alternative systems of thought.
c. Encourage cooperative relationships from positions of power and authority.
d. Use the trial-and-error method for effective problem-solving options.

ANS: B
Critical thinking is the art of analyzing and evaluating thinking with a view to improving it. Characteristics of critical thinking include thinking open-mindedly within alternative systems of thought, and recognizing and assessing their assumptions, implications, and practical consequences.

10

The nurse reads on the care plan that a patient is at risk for developing an infection. What does the nurse recognize about this patient’s problem?
a. It is always a nursing diagnosis.
b. It is always a collaborative problem.
c. It may be either a nursing diagnosis or a collaborative problem, depending on the etiology.
d. It should not be addressed as a special problem because all nursing measures should protect patients from infection.

ANS: C
If the source of the risk for infection is something that can be treated by nursing, then the problem is a nursing diagnosis. If it is one that requires treatment by other health care providers, the problem is collaborative. In either case, the risk for infection should be included in the care plan.

11

Which of the following is an example of the “P” in a SOAP progress note?
a. The patient stating that her right arm is numb
b. Encouragement of alternating rest and activity periods
c. Activity intolerance related to fatigue
d. Blood pressure 140/85 mm Hg

ANS: B
“P” stands for plan in the SOAP method of documentation; encouraging alternating rest and activity periods is an example of a specific intervention related to a diagnostic problem. The patient stating that the right arm is numb is an example of subjective data. Activity intolerance is a nursing diagnosis and is an example of assessment. A blood pressure reading is an objective assessment.

12

Which of the following refers to the use of communication and information technologies in order to support the delivery and integration of clinical care?
a. e-Health
b. Nursing informatics
c. Electronic health record
d. ICT (information and communication technology)

ANS: A
e-Health refers to the use of communication and information technologies in order to support the delivery and integration of clinical care. Nursing informatics refers to the integration of nursing science, computer science, and information technology to manage and communicate data, information, and knowledge in nursing practice. Electronic health record is an electronic version of the patient health record. ICT consists of tools and applications that support the management of clinical data, information, and knowledge.

13

Which phase of the nursing process is too often not addressed sufficiently?
a. Planning
b. Diagnosis
c. Implementation
d. Evaluation

Which of the following refers to a situation that results in unintended harm to the patient and is related to the care or services provided rather than the patient’s medical condition?
a. Negligence
b. Adverse event
c. Incident report
d. Nonmaleficence

14

Which of the following refers to a situation that results in unintended harm to the patient and is related to the care or services provided rather than the patient’s medical condition?
a. Negligence
b. Adverse event
c. Incident report
d. Nonmaleficence

ANS: B
An adverse event is an event that results in unintended harm to the patient and is related to the care or services provided rather than the patient’s medical condition. Negligence is an ethical principle, not a situation that results in unintended harm to the patient, although it is related to the care or services provided rather than the patient’s medical condition. An incident report may be completed; however, it is not the event itself. Nonmaleficence is an ethical principle, not a situation that results in unintended harm to the patient, although it is related to the care or services provided rather than the patient’s medical condition.

15

Which of the following is a current trend in home health nursing?
a. Increased numbers of registered nurses (RNs) are being employed as home health nurses.
b. Decreased numbers of licensed practical nurses (LPNs) are being employed as home health nurses.
c. There are more employment opportunities for newly graduated nurses.
d. A minimum of two years of acute care experience is required before employment as a home health nurse.

ANS: C
Partly because of the nursing shortage, enhancements to the scope of practice and educational programs for LPNs, and the need to provide long-term intervention to a growing population with complex and unpredictable health care needs, many home health employers now hire RNs and LPNs right after graduation.

16

Which of the following is considered a foundational concept of home health nursing?
a. Acute care management
b. Health promotion
c. Chronic disease management
d. Health restoration

ANS: B
The two foundations of home health nursing are health promotion and illness prevention. Health restoration is an element of home health nursing rather than a foundational concept.

17

Home health care nurses deliver care to a variety of patients with acute and chronic illnesses as part of their nursing practice. These nurses would explain to their patients that they are practising which type of nursing?
a. Public health nursing
b. Long-term care nursing
c. Community-based nursing
d. Community health nursing

ANS: C
The shared history of visiting and public health nursing continues to unify the two groups of community health nurses, who are now joined by nurses in many other community-based roles. Although the community is the context of care for community-based nurses, they possess an understanding of the entire health system continuum and are able to deliver care to patients who are acutely or chronically ill.

18

Health care services by a specific institution are often implemented through case management. Which of the following is an activity related to case management?
a. Each member of the health care team performs specific tasks for patient care under the supervision of a case manager.
b. One nurse manages all interventions required to meet the needs of the patient in the hospital and the community.
c. The patient’s nurse collaborates with other health care disciplines to plan and implement coordinated patient care.
d. A professional nurse assesses the patient’s needs and plans and coordinates patient care with other nurses under the direction of a physician.

ANS: A
Case management is a collaborative patient-driven strategy undertaken by health care providers and patients to maximize the patient’s ability and autonomy through advocacy, communication, education, identification of and access to requisite resources, and service coordination.

19

A 78-year-old woman hospitalized for surgical repair of a fractured hip has recovered from the surgery but continues to have a nursing diagnosis of impaired physical mobility related to decreased muscle strength. In planning continued care for the patient, in which setting would the nurse consider that the patient’s needs would best be met?
a. A public health unit
b. A community health centre
c. The patient’s home
d. An occupational health facility

ANS: C
The patient no longer needs registered nursing care, nor does she need to be in an acute care setting; therefore, she could be discharged to her home, as a home health care provider is able to meet her needs. The home health care provider may see the patient in her home as often as several times a week, depending on the patient’s needs.

20

A patient hospitalized with diabetes mellitus is being referred to a certified home health care agency on discharge from the hospital. Which of the following people will coordinate the care?
a. A case manager
b. A community registered nurse
c. The patient’s family physician
d. A certified diabetic educator from the hospital

ANS: A
The case manager coordinates the comprehensive care plan and services for the patient, including arranging for and funding services.

21

How should the nurse describe home care services to a patient requiring extended care?
a. Home care services are limited to visits by nurses or home health aides.
b. For the expenses of home care to be covered, the patient must be confined to bed.
c. The patient’s family will need to be included in planning and teaching about the patient’s care.
d. Technologically complex therapies, such as parenteral chemotherapy and mechanical ventilators, cannot be managed at home.

ANS: C
The home health care nurse negotiates the care with the patient and the family. Families often provide care for ill members and assist in decision making about all aspects of the care provided.

22

Which of the following is a key principle of primary health care?
a. Universal access to health care on an economic basis
b. Focus on acute illness and cure
c. Partnership with other professions and sectors for health
d. Individuals as passive recipients of health care

ANS: C
One of the six key principles of primary health care is to partner with other disciplines, communities, and sectors for health (intersectoral approach).

23

On average, what is the approximate national percentage of provincial/territorial budgets in Canada that are expended on health care costs?
a. 19%
b. 29%
c. 39%
d. 49%

ANS: C
Approximately 39% of provincial and territorial budgets are consumed with health care costs; the range is between 30% in Quebec and 47% in Nova Scotia, giving an average of 38.5%.

24

Primary health care is increasingly being embraced as a strategy to shift the health system’s focus from treatment of disease to health promotion. This shift is known as which of the following?
a. Economic shift
b. Reforming the system
c. Enhancing primary health care
d. Chronic disease management in home care settings

ANS: B
This shift is also known as reforming the system. Primary health care is increasingly being embraced as a strategy to shift the health system’s focus from diagnosis and treatment of illness and injury to health promotion and disease prevention.