v v v v v v v v
Chapter 1 v Concepts and Trends in Healthcare v v v v
◦ A new nurse is working with a preceptor on an inpatient medical-surgical unit.
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The preceptor advises the student that which is the priority when working as a
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professional nurse? v v
◦ Attending to holistic client needs v v v v
◦ Ensuring client safety v v
◦ Not making medication errors
v v v
◦ Providing client- v
focused care v v
ANS: B v v
◦ All actions are appropriate for the professional nurse. However, v v v v v v v v
ensuring client safety is the priority. Up to 98,000 deaths result each
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year
v
from errors in hospital care, according to the 2000 Institute of Medicine report. Many
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more clients have suffered injuries and less serious outcomes. Every nurse has the
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responsibility to guard the clients safety.
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◦ DIF: Understanding/Comprehension REF: 2 v v v
KEY: Patient safety MSC: Integrated Process: Nursing
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Process: Intervention
v v
◦ NOT: Client Needs Category: Safe and Effective Care v v v v v v v
Environment: Safety and Infection Control
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◦ A nurse is orienting a new client and family to the inpatient unit. What
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vinformation does the nurse provide to help the client promote his or her own
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vsafety?
◦ Encourage the client and family to be active partners. v v v v v v v v
◦ Have the client monitor hand hygiene in caregivers.
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◦ Offer the family the opportunity to stay with the client.
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◦Tell the client to always wear his or
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her armband. ANS: A
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◦ Each action could be important for the client or family to perform. v v v v v v v v v v v
However, encouraging the client to be active in his or her health care as a partner is
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the most critical. The other actions are
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◦
◦ very limited in scope and do not provide the broad protection that v v v v v v v v v v v
being active and involved does.
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◦ DIF: Understanding/Comprehension REF: 3 v v v
v KEY: Patient safety MSC: Integrated Process: Teaching/
v v v v v v
,Learning
◦ NOT: Client Needs Category: Safe and Effective Care
v v v v v v v
, Environment: Safety and Infection Control v v v v
◦ A nurse is caring for a postoperative client on the surgical unit. The clients blood
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pressure was 142/76 mm Hg 30 minutes ago, and now is 88/50 mm Hg. What
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action by the nurse is best?
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◦ Call the Rapid Response Team. v v v v
◦ Document and continue to monitor. v v v v
◦ Notify the primary care provider. v v v v
◦ Repeat blood pressure measurement v v v
in 15 minutes. ANS: A
v v v v v
◦ The purpose of the Rapid Response Team (RRT) is to intervene when v v v v v v v v v v v
clients are deteriorating before they suffer either respiratory or cardiac arrest. Since the
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client has manifested a significant change, the nurse should call the RRT. Changes in
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blood pressure, mental status, heart rate, and pain are particularly significant.
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Documentation is vital, but the nurse must do more than document. The primary care
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provider should be notified, but this is not the priority over calling
v v the RRT. The
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clients blood pressure should be reassessed frequently, but the priority is getting
v v v the v v v v v v v v v
rapid care to the client.
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◦ DIF: Applying/Application REF: 3 v v v
◦ KEY: Rapid Response Team (RRT)| v v v v
medical emergencies MSC: Integrated Process:
v v v v v
Communication and Documentation v v
◦ NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation v v v v v v v
◦
◦ A nurse wishes to provide client-centered care in all interactions. Which
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action by the nurse best demonstrates this concept?
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◦ Assesses for cultural influences affecting health care v v v v v v
◦ Ensures that all the clients basic needs are met v v v v v v v v
◦ Tells the client and family about all upcoming tests
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◦ Thoroughly orients the client and v v v v
family to the room ANS: A
v v v v v v
◦ Competency in client-focused care is demonstrated when the nurse v v v v v v v v
v focuses on communication, culture, respect, compassion, client education, and
v v v v v v v v
v empowerment. By assessing the effect of the v v v v v v
◦
◦ clients culture on health care, this nurse is practicing client-focused care. v v v v v v v v v v
v Providing for basic needs does not demonstrate this competence. Simply telling the
v v v v v v v v v v v
v client about all upcoming tests is not providing empowering education. Orienting the
v v v v v v v v v v v
v client and family to the room is an important safety measure, but not directly related to
v v v v v v v v v v v v v v v
v demonstrating client-centered care. v v
◦ DIF: Understanding/Comprehension REF: 3 v v v