Review questions

Question 1

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

Answer 1

Moving from an acute illness to a health promotion, illness prevention model

Question 2

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.

Answer 2

Hospital Compare

Hospital Consumer Assessment of Healthcare

Question 3

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

Answer 3

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.

Question 4

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

Answer 4

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.

Question 5

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

Answer 5

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.

Question 6

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?

1. Bedside change of shift report is piloted on two medical-surgical units
2. Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change
3. The nursing council develops a strategy for bedside change of shift report
4. 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

Answer 6

3, 1, 2, 4

3. The nursing council develops a strategy for bedside change of shift report
4. Bedside change of shift report is piloted on two medical-surgical units
5. Patient satisfaction levels after implementation of the bedside report are compared to patient satisfaction levels before the change
6. After modifications are made in the shift report elements, bedside shift report is implemented on all nursing units

Question 7

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.

Answer 7

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.

Question 8

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

Answer 8

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.

Question 9

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

Answer 9

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.

Question 10

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

Answer 10

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.

Question 11

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

Answer 11

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.

Question 12

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

Answer 12

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.

Question 13

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

Answer 13

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.

Question 14

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

Answer 14

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.

Question 15

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

Answer 15

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.

Question 16

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

Answer 16

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.

Question 17

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

Answer 17

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.

Question 18

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

Answer 18

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.

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

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.

Answer 21

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.

Question 22

The components of the nursing metaparadigm:

Answer 22

Person, health, environment, nursing

Question 23

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?

Answer 23

Nightingale

Nightingale’s environmental theory directs the nurse to manipulate the environment to promote rest and healing.

Question 24

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:

Answer 24

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.

Question 25

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?

Answer 25

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.

Question 26

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

Answer 26

Psychosocial You can use various psychosocial theories to help patients with loss, death, and grief.

Question 27

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: 1. Ensures that the patient has access to appropriate community resources for long-term care. 2. Collaborates with the patient to identify specific patient needs 3. Collects essential information from the patient's health record. 4. Works with the patient to develop a plan for resolving patient issues.

Answer 27

3,2,4,1 3. Collects essential information from the patient's health record. 2. Collaborates with the patient to identify specific patient needs 4. Works with the patient to develop a plan for resolving patient issues. 1. 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).

Question 28

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

Answer 28

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.

Question 29

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

Answer 29

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.

Question 30

The nurse strives to relieve patient's distress theorist:

Answer 30

Kolcaba's Theory of Comfort

Question 31

The nurse progresses through 5 stages of expertise theorist

Answer 31

Benner's Skin Acquisition

Question 32

The nurse assists the patient to process and find meaning related to his or her illness theorist

Answer 32

Mishel's Uncertainty in Illness

Question 33

Matching nurse competencies to patient needs can improve patient outcomes theorist

Answer 33

AACN's Synergy Model

Question 34

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.

Answer 34

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.

Question 35

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.

Answer 35

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.

Question 36

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

Answer 36

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.

Question 37

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

Answer 37

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.

Question 38

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

Answer 38

Anxiety O stands for outcome; in this PICOT question, the outcome the nurse is concerned about is anxiety.

Question 39

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

Answer 39

Correlational In the correlational study the nurse researcher is correlating characteristics or factors with the decision to start exercising.

Question 40

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.

Answer 40

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.

Question 41

What is the appropriate order for the following steps of evidence-based practice (EBP)? 1. Integrate the evidence. 2. Ask the burning clinical question. 3. Create a spirit of inquiry 4. Evaluate the practice decision or change. 5. Share the results with others. 6. Critically evaluate the evidence you gather. 7. Collect the most relevant and best evidence.

Answer 41

3. Create a spirit of inquiry 2. Ask the burning clinical question. 7. Collect the most relevant and best evidence. 6. Critically evaluate the evidence you gather. 1. Integrate the evidence. 4. Evaluate the practice decision or change. 5. Share the results with others.

Question 42

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.

Answer 42

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.

Question 43

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.

Answer 43

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.

Question 44

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.

Answer 44

Quality improvement

Question 45

Which of the following statements about evidence-based practice (EBP) made by a nursing student would require the nursing professor to correct the student’s understanding? “In evidence-based practice the patients are the subjects.” “It is important to talk with experts and patients when making an evidence-based decision.” “A nurse wanting to investigate the evidence to solve a problem starts by forming a PICOT question.” “It is important to ask a librarian for help when searching for literature to help you answer your PICOT question.”

Answer 45

“In evidence-based practice the patients are the subjects.” Multiple research studies, expert opinion, personal experience, and patient preferences create the data source for EBP. Patients are not the subjects of EBP; they are typically the subjects in a research study.

Question 46

A nurse is reading a research article. The nurse just finished reading a brief summary of the research study that included the purpose of the study and its implications for nursing practice. Which part of the article did the nurse just read? Abstract Analysis Discussion Literature Review

Answer 46

abstract An abstract is a brief summary of the purpose of the article. It also includes the major themes or findings and the implications for nursing practice.

Question 47

A researcher is studying the effectiveness of an individualized evidence-based teaching plan on young women’s intention to wear sunscreen to prevent skin cancer. In this study, which of the following research terms best describes the individualized evidence-based teaching plan? Sample Intervention Survey Results

Answer 47

Intervention An intervention is an action or treatment performed by a researcher on a sample.

Question 48

A nurse researcher is collecting data following approval from the institutional review board (IRB). In which part of the research process is this nurse? Analyzing the data Designing the study Conducting the study Identifying the problem

Answer 48

Conducting the study Conducting the study includes tasks such as obtaining necessary approvals and implementing the study protocol to guide data collection.

Question 49

A nursing student is preparing to read the methods section of a research article. What type of information will the student expect to find in this section? (Select all that apply.) How the researcher conducted the study A description about how to use the findings of the study The number and type of subjects who participated in the study Summaries of other research articles that support the need for this study Implications for future research studies

Answer 49

How the researcher conducted the study The number and type of subjects who participated in the study The methods section explains how a research study was organized and conducted to answer the research question or test the hypothesis and how many subjects or people participated in the study.

Question 50

A group of nurses on the research council of a local hospital are measuring nursing-sensitive outcomes. Which of the following is a nursing-sensitive outcome that the nurses need to consider measuring? (Select all that apply.) Frequency of low blood sugar episodes in children at a local school The number of patients who develop a urinary tract infection from a Foley catheter Number of patients who fall and experience subsequent injury on the evening shift Number of sexually active adolescent girls who attend the community-based clinic for birth control Patient reported quality of life following coronary artery bypass graft surgery and cardiac rehabilitation

Answer 50

The number of patients who develop a urinary tract infection from a Foley catheter Number of patients who fall and experience subsequent injury on the evening shift Nurse-sensitive indicators are outcomes that are sensitive to nursing practice; these outcomes will improve if the quantity or quality of nursing care improves.

Question 51

A nurse researcher wants to conduct historical research. Which of the following ideas for a study could the nurses conduct? (Select all that apply.) Determining the effect of unemployment on emergency room usage Understanding how Clara Barton shaped nursing in America Evaluating the effect of the Vietnam war on nursing leadership and practice Analyzing the evolution of nursing and patient care during recent disasters Investigating barriers to exercise in women who have become mothers in the past year

Answer 51

Understanding how Clara Barton shaped nursing in America Evaluating the effect of the Vietnam war on nursing leadership and practice Analyzing the evolution of nursing and patient care during recent disasters Historical studies are designed to establish facts and relationships concerning past events.

Question 52

Nursing diagnosis:

Answer 52

clinical judgment concerning a human RESPONSE to health conditions/life processes or VULNERABILITY for that response by an individual, family or community that a nurse is licensed and competent to treat

Question 53

Collaborative problem:

Answer 53

actual or potential physiological complication that nurses monitor to detect the onset of changes in a patient's health status

Question 54

Problem focused nursing diagnosis

Answer 54

a clinical judgment concerning an undesirable human response to a health condition/life process that exists in an individual, family or community

Question 55

Defining characteristics:

Answer 55

observable assessment cues such as patient behavior and physical signs that support each problem-focused diagnostic judgment.

Question 56

Related factor:

Answer 56

an etiological or causative factor for diagnosis (the data that appear to show some type of patterned relationship with a nursing diagnosis) Related factor allows you to individualize a problem-focused nursing diagnosis for a specific patient

Question 57

Risk nursing diagnosis:

Answer 57

clinical judgment concerning the vulnerability of an individual, family, group or community for developing an undesirable human response to health conditions/life processes no defining characteristics or related factors because they have not yet occurred

Question 58

Risk diagnosis has:

Answer 58

risk factors that can be environmental, physiological, psychological, genetic or chemical elements that place a person at risk for a health problem

Question 59

Health promotion nursing diagnosis:

Answer 59

clinical judgment concerning a patient's motivation and desire to increase well-being and actualize human health potential

Question 60

Health promotion nursing diagnoses have only

Answer 60

defining characteristics, although you may use a related factor to improve understanding of the diagnosis

Question 61

Data clusters:

Answer 61

set of cues signs or symptoms gathered during assessment each cue is an objective or subjective sign, symptom, or risk factor that when analyzed with other cues, begins to lead to diagnostic conclusions

Question 62

The diagnostic label is:

Answer 62

the name of the nursing diagnosis as approved by NANDA

Question 63

NANDA-I

Answer 63

North American Nursing Diagnosis Association International List that contains diagnoses and continues to grow on the basis of nursing research

Question 64

A complete diagnostic statement will also include a

Answer 64

related factor (appropriate for problem-based and some health promotion diagnoses)

Question 65

Related factors for NANDA-I diagnoses include which 4 categories

Answer 65

Pathophysiological (biological or psychological) treatment-related situational (environment or personal) maturational

Question 66

To write a 3 part nursing diagnosis use PES

Answer 66

P: Problem, NANDA-I label, example: Impaired physical mobility E: Etiology or related factor, example: incisional pain S: Symptoms or defining characteristics) List defining characteristics that show evidence of health problem. Example: evidenced vt restricted turning and positioning Impaired physical mobility related to incisional pain as evidenced by restricted turning and positioning

Question 67

The nursing diagnosis Impaired Parenting related to mother’s developmental delay is an example of a(n): Risk nursing diagnosis. Problem-focused nursing diagnosis. Health promotion nursing diagnosis. Wellness nursing diagnosis.

Answer 67

Problem-focused nursing diagnosis This is an example of a problem-focused nursing diagnosis with a related factor, based on NANDA-I diagnostic terminology. Most health promotion diagnoses do not have established related factors based on NANDA-I; their use is optional. Wellness diagnoses are not one of the types of NANDA-I diagnoses.

Question 68

A nurse interviewed and conducted a physical examination of a patient. Among the assessment data the nurse gathered were an increased respiratory rate, the patient reporting difficulty breathing while lying flat, and pursed-lip breathing. This data set is an example of: Collaborative data set. Diagnostic label. Related factors. Data cluster.

Answer 68

Data cluster A data cluster is a set of cues (i.e., the signs or symptoms gathered during assessment).

Question 69

A nurse is reviewing a patient’s list of nursing diagnoses in the medical record. The most recent nursing diagnosis is Diarrhea related to intestinal colitis. For which of the following reasons is this an incorrectly stated diagnostic statement? Identifying the clinical sign instead of an etiology Identifying a diagnosis on the basis of prejudicial judgment Identifying the diagnostic study rather than a problem caused by the diagnostic study Identifying the medical diagnosis instead of the patient’s response to the diagnosis.

Answer 69

Identifying the medical diagnosis instead of the patient's response to the diagnosis Intestinal colitis is a medical diagnosis. The related factor in a nursing diagnostic statement is always within the domain of nursing practice and a condition that responds to nursing interventions. Nursing interventions do not change a medical diagnosis.

Question 70

A nurse is assigned to a new patient admitted to the nursing unit following admission through the emergency department. The nurse collects a nursing history and interviews the patient. What are the steps for making a nursing diagnosis in the correct order, beginning with the first step? 1. Considers context of patient's health problem and selects a related factor 2. Reviews assessment data, noting objective and subjective clinical information 3. Clusters clinical cues that form a pattern 4. Chooses diagnostic label

Answer 70

2. Reviews assessment data, noting objective and subjective clinical information 3. Clusters clinical cues that form a pattern 4. Chooses diagnostic label 1. Considers context of patient's health problem and selects a related factor

Question 71

A nursing student reports to a lead charge nurse that his assigned patient seems to be less alert and his blood pressure is lower, dropping from 140/80 to 110/60. The nursing student states, “I believe this is a nursing diagnosis of Deficient Fluid Volume.” The lead charge nurse immediately goes to the patient’s room with the student to assess the patient’s orientation, heart rate, skin turgor, and urine output for last 8 hours. The lead charge nurse suspects that the student has made which type of diagnostic error? Insufficient cluster of cues Disorganization Insufficient number of cues Evidence that another diagnosis is more likely

Answer 71

Insufficient number of cues It is likely the charge nurse suspects that the student has not collected enough cues to support the diagnosis. A change in blood pressure and mental status changes are significant findings that can be attributed to fluid volume excess and other diagnoses. The recommendation of the symptom cluster by the registered nurse would allow the student to have sufficient data to confirm a deficient fluid volume.

Question 72

A nurse in a mother-baby clinic learns that a 16-year-old has given birth to her first child and has not been to a well-baby class yet. The nurse’s assessment reveals that the infant cries when breastfeeding and has difficulty latching on to the nipple. The infant has not gained weight over the last 2 weeks. The nurse identifies the patient’s nursing diagnosis as Ineffective Breastfeeding. Which of the following is the best “related to” factor? Infant crying at breast Infant unable to latch on to breast correctly Mother’s deficient knowledge Lack of infant weight gain

Answer 72

Mother's deficient knowledge In this scenario the related factor is the mother’s deficient knowledge. A related factor is a condition, historical factor, or etiology that gives a context for the defining characteristics, in this case the infant crying, inability to latch on to breast, and absent weight gain.

Question 73

Review the following problem-focused nursing diagnoses and identify the diagnoses that are stated correctly. (Select all that apply.) Impaired Skin Integrity related to physical immobility Fatigue related to heart disease Nausea related to gastric distention Need for improved Oral Mucosa Integrity related to inflamed mucosa Risk for Infection related to surgery

Answer 73

Impaired skin integrity related to physical immobility Nausea related to gastric distention

Question 74

A nurse reviews data gathered regarding a patient’s ability to cope with loss. The nurse compares the defining characteristics for Ineffective Coping with those for Readiness for Enhanced Coping and selects Ineffective Coping as the correct diagnosis. This is an example of the nurse avoiding an error in: (Select all that apply.) Data collection. Data clustering. Data interpretation. Making a diagnostic statement. Goal setting.

Answer 74

Data collection Data interpretation This is an example of an error in interpretation and data collection. When making a diagnosis, the nurse must interpret data that he or she has collected by identifying and organizing relevant assessment patterns to support the presence of patient problems. In the case of the two diagnoses in this question, there can be conflicting cues. The nurse must obtain more information and recognize the cues that point to the correct diagnosis.

Question 75

The use of standard formal nursing diagnostic statements serves several purposes in nursing practice, including which of the following? (Select all that apply.) Defines a patient’s problem, giving members of the health care team a common language for understanding the patient’s needs Allows physicians and allied health staff to communicate with nurses how they provide care among themselves Helps nurses focus on the scope of nursing practice Creates practice guidelines for collaborative health care activities Builds and expands nursing knowledge

Answer 75

Defines a patient’s problem, giving members of the health care team a common language for understanding the patient’s needs Helps nurses focus on the scope of nursing practice Builds and expands nursing knowledge The use of nursing diagnosis creates a common language for nurses to communicate patient care needs, allows nurses to focus on the realm and scope of nursing practice, and helps to develop nursing knowledge. It is not a language for physicians and allied health staff because they do not rely on providing nursing interventions. Terminology in nursing diagnosis may be familiar to other health care providers but not in a way for directing nursing interventions. Nursing diagnosis has the purpose of creating practice guidelines for nursing.

Question 76

Which of the following nursing diagnoses is stated correctly? (Select all that apply.) Fluid Volume Excess related to heart failure Sleep Deprivation related to sustained noisy environment Impaired Bed Mobility related to postcardiac catheterization Ineffective Protection related to inadequate nutrition Diarrhea related to frequent, small, watery stools

Answer 76

Sleep Deprivation related to sustained noisy environment Ineffective Protection related to inadequate nutrition The correct diagnoses of Sleep Deprivation and Ineffective Protection are worded with related factors that will respond to nursing interventions. Nursing interventions do not change a medical diagnosis or diagnostic test. Instead nurses direct nursing interventions at behaviors or conditions that they are able to treat or manage. The first two incorrect diagnoses use a medical diagnosis and diagnostic procedure respectively as related or etiological factors. These are not conditions that nursing interventions can treat. The last diagnosis is incorrect because it is related to an assessment finding of a symptom or a defining characteristic.

Question 77

An expected outcome is the

Answer 77

measurable change that must be achieved to reach goal | patient behavior, physical state, or perception

Question 78

A patient centered goal:

Answer 78

reflects a patient's highest possible level of wellness and independence in function realistic and based on patients specific behavior, not our own goals or interventions

Question 79

Nursing-sensitive patient outcome:

Answer 79

measurable patient, family, community state, behavior or perception largely influence by and sensitive to nursing interventions

Question 80

Examples of nursing-sensitive outcomes include

Answer 80

reduction in pain frequency and severity incidence of pressure ulcers incidence of falls

Question 81

SMART acronym

Answer 81

S: Specific M: Measurable A: Attainable R: Realistic T: Timed Useful approach for writing goals and outcome statements more effectively

Question 82

Short term goal:

Answer 82

objective behavior or response that you expect a patient to achieve in a short time, USUALLY LESS THAN A WEEK Acute care setting goals are often set over the course of a FEW HOURS

Question 83

Long term goal:

Answer 83

Longer period, usually over several days, weeks or months

Question 84

3 categories of nursing interventions:

Answer 84

Nurse-initiated health care provider-initiated collaborative interventions (some patients require all 3)

Question 85

Nurse-initiated interventions are the:

Answer 85

independent nursing interventions or actions that a nurse initiates WITHOUT the SUPERVISION or DIRECTION from others Positioning patients to prevent pressure ulcers, instructing patients on side effects of medications providing skin care to an stony site DO NOT REQUIRE AN ORDER FROM ANOTHER HEALTH CARE PROVIDER AUTONOMOUS ACTIONS BASED ON SCIENTIFIC MORALE

Question 86

According to NPA (Nurse practice acts), independent nursing interventions pertain to:

Answer 86

activities of daily living, health education, promotion and counseling

Question 87

Dependent nursing interventions are:

Answer 87

actions that REQUIRE AN ORDER FROM A HEALTH CARE PROVIDER Based on the health care providers response to treating or managing a medical diagnosis Carry out orders! Administering a medication, implementing an invasive procedure, preparing patient for diagnostic tests specific nursing responsibilities and technical nursing knowledge

Question 88

Collaborative interventions are

Answer 88

interdependent interventions which are therapies that require the combined knowledge, skill and expertise of MULTIPLE HEALTH CARE PROVIDERS

Question 89

When choosing interventions consider 6 important factors:

Answer 89

desired patient outcomes characteristics of nursing diagnosis research base knowledge for intervention feasibility for doing the intervention acceptability to the patient own competency

Question 90

Nursing intervention domains: (7)

Answer 90

Physiological: basic Physiological: complex Behavioral Safety Family Health System Community

Question 91

Nursing care plan consists of

Answer 91

nursing diagnoses goals and/or expected outcomes specific nursing interventions section for evaluation findings so any nurse is able to quickly identify a patient's clinical needs and situation

Question 92

SBAR approach:

Answer 92

Situation Background Assessment Recommendation

Question 93

Nursing intervention:

Answer 93

any treatment based on clinical judgment and knowledge that a nurse performs to enhance patient outcomes

Question 94

Indirect care interventions include:

Answer 94

treatments performed away from a patient but on behalf of the patient or group of patients managing environment (safety and infection control) documentation interdisciplinary collaboration

Question 95

Clinical practice guideline:

Answer 95

protocol that is systematically developed set of statements that helps nurses, physicians and other health care providers MAKE DECISIONS about appropriate health care for specific clinical situations

Question 96

Standing order:

Answer 96

preprinted document containing orders for routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical setting.

Question 97

Time devoted to nursing care has 3 components:

Answer 97

Physical (the physical amount of time consumed in the completion of nursing activities) Psychological (what nursing care patients experience and how they experience it) Sociological (the sequential ordering of events within the daily routines of a practice setting)

Question 98

Instrumental activities of daily living:

Answer 98

Independent in society: shopping preparing meals housecleaning writing checks taking medications.

Question 99

Activities of daily living:

Answer 99

performed in the course of a normal day ambulation eating dressing bathing grooming

Question 100

A lifesaving measure:

Answer 100

physical care technique that you use when a patient's physiological or psychological state is threatened admin emergency medication cpr

Question 101

Counseling:

Answer 101

direct care method that helps patients use problem solving processes to recognize and manage stress and facilitate interpersonal relationships

Question 102

Interdisciplinary care plans:

Answer 102

plans representing the contributions of all disciplines caring for a patient.

Question 103

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 Implementation of public health policies Home safety assessment Increased access to care. Determining rates of specific illnesses

Answer 103

Community assessment Implementation of public health policies Increased access to care. Correct 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. 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.

Question 104

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

Answer 104

Decrease the incidence of asthma attacks in the community. Increase patients' ability to self-manage their asthma. Provide asthma education programs for the teachers in the local schools

Question 105

The purpose of NOC (Nursing outcomes classification) is to

Answer 105

Identify, label, validate and classify nurse-sensitive patient outcomes to field test and validate the classification to define and test measurement procedures for the outcomes and indicators using clinical data

Question 106

Self-management evaluation:

Answer 106

Self-efficacy health behavior health status health service utilization quality of life psychological indicators

Question 107

TEEAMS approach

Answer 107

Time on the unit with staff sharing ideas Empowers the staff Enthusiastic about seeking opportunities to enhance Appreciation and recognizes team members Manages the team and holds team members accountable Support in the stressful health care environment

Question 108

5 rights of delegation:

Answer 108

right task right circumstances right person right direction/communication right supervision/evaluation

Question 109

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.

Answer 109

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.

Question 110

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.

Answer 110

Quality improvement Quality improvement studies evaluate how processes work in an organization. The nurses in this example are evaluating the medication administration process.

Question 111

Direct care interventions are:

Answer 111

treatments performed through interactions with patients medication admin, insertion of a urinary catheter, discharge instruction or counseling during a time of grief

Question 112

Indirect care interventions:

Answer 112

treatments performed away from a patient but on behalf of the patient (patients environment - safety and infection control)