Chapter 1- Professional Nursing Practice Questions and Answers

Chapter 1- Professional Nursing Practice Questions and Answers A nurse is providing care for a patient who had a transurethral resection of his prostate this morning. The patient is receiving continuous bladder irrigation, and the urinary catheter is now occluded. The nurse is planning to contact the patient's health care provider and communicate using the SBAR (Situation-Background-Assessment-Recommendation) format. Which statement is a component of communication using SBAR? A. "What do you think could be causing this occlusion?" B. "I think that we should manually irrigate his catheter." C. "What do you know about this patient and his history?" D. "Could you please provide some direction for his care?" B."I think that we should manually irrigate his catheter." Proposing a recommendation is a component of the "R" component of SBAR communication. Asking the health care provider for possible contributing factors to the problem or for general direction may be appropriate in some circumstances, but these are not explicit components of SBAR. The nurse should briefly identify the patient and his circumstances, not ask an open-ended question regarding the health care provider's familiarity. What factor has been most clearly identified as an influence on the future of nursing practice? A. Aging of the American population and increases in chronic illnesses Correct B. Increasing birth rates coupled with decreased average life expectancy C. Increased awareness of determinants of health and improved self-care D. Apathy around health behaviors and the relationship of lifestyle to health A. Aging of the American population and increases in chronic illnesses The American population is aging at the same time that the incidence of chronic health conditions is increasing. There is no noted increase in the overall awareness of the determinants of health, but at the same time, observers have not identified apathy as a predominant attitude. Life expectancy is increasing, not decreasing. A registered nurse (RN) has delegated the administration of IV medications to a licensed practical/vocational nurse (LPN/LVN). Which statement accurately describes delegation? A. The RN must teach the LPN how to administer the IV medications. B. Ultimate responsibility for administering the medication lies with the LPN.. C. The RN is responsible for observing the LPN administer the IV medication D. The RN is the one accountable for the quality of care that the patient receives. D. The RN is the one accountable for the quality of care that the patient receives. Delegation entails a redistribution of nursing work, but the RN remains ultimately responsible and accountable for the execution of the task. It would be inappropriate to delegate if the LPN was unfamiliar with the task. The RN is not obliged to observe the LPN's execution of the task. In which patient care delivery model does the nurse plan and coordinate the aspects of patient care with other disciplines focusing on continuity of care and interprofessional collaboration even if the nurse is absent? A. Team nursing model B. Primary nursing model C. Total patient care model D. Case management nursing model B. Primary nursing model The primary nursing model includes planning the patient's care and coordinating and communicating all aspects of care with other disciplines and those providing care in the nurse's absence. The focus is on continuity of care and interprofessional collaboration. Team nursing uses the RN as the team leader to organize and manage the care for a group of patients with other ancillary workers. The RN has authority and accountability for the quality of care delivered by the team only during the work period. In a total patient care model, the nurse is accountable for the complete care of the patient during the assigned shift. Case management is not a model of care delivery but a collaborative process that involves assessing, planning, facilitating, and advocating for health services with a variety of resources to promote cost-effective outcomes. A nurse with an associate or baccalaureate degree who meets licensing requirements is qualified to practice as A. a nurse practitioner. B. a certified specialist. C. an entry-level generalist. D. an advanced practice nurse. C. an entry-level generalist Entry-level nurses with an associate or baccalaureate degree are prepared to function as generalists. With experience and continued study, nurses may specialize in an area of practice and may obtain certification in nursing specialties. Certification usually requires clinical experience and successful completion of an examination. A nurse practitioner is an example of an advanced practice nurse. An advanced practice nurse has a minimum of a master's degree with advanced education in pharmacology and physical assessment as well as expertise in a specialized area of practice. When nurses disagree about the effectiveness of a commonly practiced nursing intervention, the best evidence for determining which intervention to use is A. a systematic review of randomized controlled trials. B. a qualitative research study with a large sample size C. a methodological Internet search using key medical terms. D. anecdotal evidence retrieved from two or more case studies. A. a systematic review of randomized controlled trials. Systematic reviews of randomized controlled trials (RCTs) are considered the strongest level of evidence to answer questions about interventions (i.e., cause and effect). The nurse establishes priorities and determines outcomes for an individual patient during which phase of the nursing process? A. Analysis B. Planning C. Evaluation D. Assessment B. Planning During the planning phase of the nursing process, patient outcomes or goals are developed and nursing interventions are identified to accomplish the outcomes. The assessment phase of the nursing process includes the collection of subjective and objective patient information on which to base the plan of care. The evaluation phase of the nursing process determines if the patient outcomes have been met as a result of nursing interventions. Nursing diagnosis is the act of analyzing the assessment data and making a judgment about the nature of the data. A nurse is monitoring all of the patients in an outpatient procedure area for complications of administering IV fluids. What type of nursing function is being demonstrated by the nurse? A. Dependent B. Independent C. Autonomous D. Collaborative D. Collaborative A collaborative nursing function is demonstrated when the nurse monitors patients for complications of acute illness, administers IV fluids and medications per health care provider's orders, and implements nursing interventions such as providing emotional support or teaching about specific procedures. Nursing functions may be dependent, collaborative, or independent. The nurse functions dependently when carrying out medical orders. Physician-initiated nursing functions may include administering medications, performing or assisting with certain medical treatments, and assisting with diagnostic tests and procedures. Independent nursing functions include interventions such as promotion and optimization of health, prevention of illness, and patient advocacy. A patient is being prepared for discharge home after a laparoscopic cholecystectomy. Which team member can be assigned to complete a discharge assessment and provide patient teaching for post-discharge care? A. Registered nurse (RN) B. Nursing technician (NT) C. Unlicensed assistive personnel (UAP) D. Licensed practical/vocational nurse (LPN/LVN) A. Registered nurse (RN) Nursing interventions that require independent nursing knowledge, skill, or judgment such as assessment, patient teaching, and evaluation of care cannot be delegated. These interventions are the responsibility of the RN. The scope of practice for LPN/LVNs is determined by each state board of nursing. The RN must know the legal scope of practical/vocational nursing practice and delegates and assigns nursing functions appropriately. In most states LPN/LVNs may administer medications, perform sterile procedures, and provide a wide variety of interventions planned by the RN. UAP are unlicensed individuals who serve in an assistive role to the RN and may include nursing assistants or technicians. The RN may delegate specific activities such as obtaining routine vital signs on stable patients, feeding/assisting patients at mealtimes, ambulating stable patients, and helping patients with bathing and hygiene. A group of nurses has a plan to implement evidence-based practice (EBP) for care of patients with pressure ulcers. What will this change in practice encompass (select all that apply.)? A. Consulting with the wound care and ostomy nurse B. Nurses' expertise and bodies of experience and knowledge C. The preferences of patients and their particular circumstances D. The traditions that surround pressure ulcer practices on the unit. E. Journal articles that address the care of patients with pressure ulcers A. Consulting with the wound care and ostomy nurse B. Nurses' expertise and bodies of experience and knowledge C. The preferences of patients and their particular circumstances E. Journal articles that address the care of patients with pressure ulcers EBP draws on research, data from local quality improvement, professional organization standards, patient preferences, and clinical expertise. The particular traditions on the nursing unit are not part of EBP. Telehealth devices are commonly used to provide which types of patient care (select all that apply.)? A. Evaluation of weight loss B. Medication administration C. Video assessment of wounds D. Monitoring peak flow meter results E. Real-time blood pressure assessment A. Evaluation of weight loss C. Video assessment of wounds D. Monitoring peak flow meter results E. Real-time blood pressure assessment Telehealth enables the nurse to provide distance assessment, planning, intervention, and evaluation of outcomes of nursing care using technologies such as the Internet, digital assessment tools, and telemonitoring equipment. Among the many uses of telehealth are monitoring patients with chronic or critical conditions and helping patients manage symptoms. Which interventions are independent nursing actions (select all that apply.)? A. Reinserting an IV B. Assessing lung sounds C. Obtaining informed consent D. Administering IV medication E. Turning a patient every two hours A. Reinserting an IV B. Assessing lung sounds E. Turning a patient every two hours Independent nursing actions are those that a nurse is legally able to order or begin independently (e.g., turn every two hours, monitor for complications). Dependent interventions are physician-initiated. Medication administration is collaborative care as the health care provider must order the medication. The health care provider legally must obtain informed consent from the patient, although the nurse may witness the consent. A patient with coronary artery disease is admitted to the hospital. An electronic health record (EHR) is generated for the patient. Which information will be present in the EHR? Select all that apply. Medications Laboratory data Financial background Educational qualifications Medical and surgical history Medications Laboratory data Medical and surgical history The electronic health record (EHR) is a computerized record of protected health information (PHI). It includes information such as patient demographics, progress notes, problems and medications, vital signs, medical history, immunizations, and laboratory and radiology reports. The educational qualifications of the patient are not included in EHR. Similarly, the financial background of the patient is not mentioned in the EHR. When planning care for a patient, the nurse may use a visual diagram of patient problems and interventions to illustrate the relationships among pertinent clinical data. What is this format called? Concept map Critical pathway Clinical pathway Nursing care plan Concept map A concept map is another method of recording a nursing care plan. In a concept map, the nursing process is recorded in a visual diagram of client problems and interventions. A clinical (critical) pathway is a prewritten plan that directs the entire health care team in the daily care goals for select health care problems. A nursing care plan is a documented plan of care for a patient. A nurse is dispensing medications to patients. What precaution should the nurse take to ensure the safe use of medications? Discard all unlabeled medicines. Use hand sanitizer only after contact with the patient. To increase efficiency, place the medicines for the next dose at the bedside. To verify that medicines have been checked, relabel medicines which already have a label provided by Pharmacy. Discard all unlabeled medicines. The nurse should discard all unlabeled medicines to ensure the safety of medications. Unlabeled medicines are difficult to identify. The nurse should avoid placing medicines that are scheduled for a later time at the bedside; the patient may accidentally consume them and this may result in an overdose. Relabeling medicines that are already labeled should be avoided because it can lead to inaccurate administration. Soap, water, and hand sanitizer should be used before and after contact with the patient to reduce the risk of infections. The nurse is reviewing the use of linkages among NANDA-I nursing diagnoses, Nursing Outcomes Classification (NOC) patient outcomes, and Nursing Interventions Classification (NIC) nursing interventions. Which statement best describes the use of these linkages? They are used to evaluate data. They help the nurse to predict the results of nursing care. They provide guidance and are the basis for planning care. These linkages help to reduce the length of written care plans. They provide guidance and are the basis for planning care. NANDA, Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC) (NNN) linkages show how the three distinct nursing terminologies can be connected and used together when planning care for patients. Linkages may assist in planning nursing care by determination of a nursing diagnosis, projection of a desired outcome, or selection of interventions to achieve the desired outcome. The linkages are not used to evaluate data, to predict the results of nursing care, or to reduce the length of written care plans. According to the American Nurses Association (ANA), to which of these should nursing diagnosis and treatment be directed? Patient complaints and concerns Signs and symptoms of the health issue Medical diagnoses upon presentation for care Human response to actual or potential health problems Human response to actual or potential health problems The American Nurses Association (ANA) defines nursing as dealing with the human response to health issues, not specifically medical diagnoses, signs and symptoms, or patient complaints and concerns. Although these may be related to or contribute to the human response, by this definition nurses deal with the human response. Which of the following provides nursing interventions that are selected to achieve patient outcomes for which nursing is accountable? Nursing diagnosis Nursing assessment NANDA International (NANDA-I) Nursing Outcomes Classification (NOC) Nursing diagnosis The nursing diagnosis provides nursing interventions that are selected to achieve patient outcomes for which nursing is accountable. NANDA-I is the organization that develops and maintains the standard classification system for nursing diagnosis. The nursing assessment is part of the nursing process. The NOC is a list of patient outcomes developed to evaluate the effects of interventions provided by nurses. What communication tool will the nurse utilize to provide safe, effective care when reporting a change in a patient's condition? Clinical pathway Nursing care plan Nursing diagnosis Situation-Background-Assessment-Recommendation (SBAR) tool Situation-Background-Assessment-Recommendation (SBAR) tool The SBAR tool is a structured technique that provides a way for members of the healthcare team to talk about a patient's condition. A nursing diagnosis provides a basis for selecting nursing interventions to achieve patient outcomes for which a nurse is accountable. A nursing care plan is a guide for routine nursing care. A clinical pathway is an interprofessional nursing care plan that specifies care and desired outcomes during a specific time period for patients with particular diagnoses or health conditions. What is a serious reportable event (SRE)? A serious reportable event is an event that happens to a patient that is considered preventable and can affect reimbursement to the health care organization from insurance companies. Health care error event, adverse health care event, and serious preventable event are not terms that refer to an event that happens to a patient and is considered preventable. On what do the nursing terminologies, Nursing Interventions Classification (NIC), NANDA International (NANDA-I), and Nursing Outcomes Classification (NOC) specifically focus? Specific phases of the nursing process The nursing terminologies, Nursing Interventions Classification (NIC), NANDA International (NANDA-I), and Nursing Outcomes Classification (NOC) focus on the specific phases of the nursing process. Quality patient care relates to high-quality healthcare. A nursing care plan provides an individualized plan of care for a patient. Classifications of outcomes are in the Nursing Outcomes Classification (NOC), which is a list of patient outcomes developed to evaluate the effects of interventions provided by nurses. What is case management? Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. Primary care is a holistic approach involving one nurse caring for a patient or family. Team care is the distribution of aspects of patient care among a team of health care professionals, often composed of a registered nurse, licensed practical nurse, and unlicensed assistive personnel. The interprofessional team is composed of providers from various healthcare disciplines, working together and sharing ideas to meet the needs of individual patients. A patient is hospitalized for the treatment of asthma. Which phases of the nursing process are required for complete analysis of the patient? Select all that apply. Planning Evaluation Assessment Rehabilitation Implementation Nursing diagnosis Assessment, Diagnosis, Planning, Implementation, Evaluation The nursing process consists of five phases. All five phases are involved in the complete analysis of the patient. Assessment is the first phase of the nursing process. This process involves collection of subjective and objective information of the patient. The second phase is nursing diagnosis, which is helpful for identifying the health problem. The third phase is planning. In this phase, the nursing diagnosis directs the development of patient outcomes or goals. It helps in the identification of nursing interventions to accomplish nursing outcomes. The fourth phase is implementation. It is the process of activation of the plan with the use of nursing interventions. The last phase is evaluation, which is a continual activity in the nursing process. Rehabilitation is not a part of the nursing process framework. What activities contributing to leadership fall under the scope of professional nursing practice? Select all that apply. Prescription of drug therapies Diagnosis of medical conditions Assessment of patients, families, and communities Administration of interventions to help resolve issues Participation in an interprofessional health care team Assessment of patients, families, and communities Administration of interventions to help resolve issues Participation in an interprofessional health care team The essential core of nursing practice is to deliver holistic, patient-centered care. It includes assessment and evaluation, administration of a variety of interventions, patient and family teaching, and participation in an interprofessional health care team. Diagnosis of medical conditions is the role of the primary health care provider or advanced practice personnel as is prescription of drug therapies. Diagnosis and prescription are legally out of the nurse's scope of practice.