NUR 222 Test Questions with Answers

NUR 222 Test Questions with Answers which activity would the nurse perform when preparing for the implementation phase of nursing process? - Correct Answer-- reassessing the patient - organizing resources and care delivery - reviewing and revising the existing nursing care plan which basic step of the nursing process includes setting priorities based on the patient's immediate needs? - Correct Answer-Planning while providing care, the nurse finds that a patient is untidy and uninterested in hygiene. which action does the nurse take first? - Correct Answer-assess the patient's ability to perform daily hygiene practices. which action would the nurse perform during the evaluation phase of the nursing process? - Correct Answer-discuss the patient's connectedness with family after providing spiritual care the nurse reviews the orders for the amount of negative pressure to be applied while provinding negative-pressure wound therapy. which step is this? - Correct Answer-assesment which activity is involved in the assessment phase of the nursing process? - Correct Answer-- asking the patient about the complaint - inquiring about the patient's current meds - asking about the patient's past and family medical history the nurse is reviewing the results of all laboratory reports of a patient. which standard of practice is the nurse performing? - Correct Answer-assessment a patient has a sprained ankle. the nurse instructs the patient to keep the leg elevated and applies old compress. which standard of nursing is this? - Correct Answer-implementation the nurse obtains vital signs, lung sounds, listen to heart beat, determines patient's level of comfort, and collects blood and sputum sample for analysis. which step is this? - Correct Answer-assessment which element is the final step of nursing process? - Correct Answer-evaluation which step of NP is performed when asking the patient to rate their pain 45 mins after administering an analgesic? - Correct Answer-evaluation which element is a chief component of the nursing process? - Correct Answer-- diagnosis - assessment - implementation the nurse compares the temp. reading with the patient's previous baseline. which step? - Correct Answer-evaluation which step is being performed when suctioning the tracheostomy in a patient? - Correct Answer-implementation which process involves clamping the chest tubes under specific circumstances as per health care provider's prescription? - Correct Answer-implementation which action is part of the assessment phase when caring for a patient diagnosed with malnutrition? - Correct Answer-determine the patient's nutritional energy needs. what should you do to help Lower Elementary School Students learn? - Correct Answer-- develop few simple rules - use concrete examples - demonstrate and then coach while they practice - include variety of activities - plan shorter lessons - introduce "personal responsibility for health"(hygiene) attention span times - Correct Answer-15 mins: preschool 30 mins: 1st-3rd grade 40-45mins: 4th-5th grade 60 mins: middle school Upper Elementary School Students - Correct Answer-- begin to see other viewpoints/ perspectives - use role-playing to practice(state feelings, listen to others, basic refusal skills) - begin understanding cause and effect, start problem solving Middle and Highschool Students - Correct Answer-- practice decision making - provide non-judgmental atmosphere - see themselves as immune - peer teaching can be more effective KEY: make it relevant to them Young and Middle Adults - Correct Answer-- learning must be relevant and practical - learner must see the need - encourage active and independent learning Older Adults - Correct Answer-Coordinate- start w/ person's concerns, plan enough time, match pace with theirs Anticipate- recognize more than 1 problem, screen for high-prevalence problems, be aware of communication barriers Manipulate: - Modify the environment: reduce noises, comfortable lighting, temp, and privacy - Consider person's comfort: do not rush! have assistive devices Validate- check info, read medical records Teaching methods for older adults - Correct Answer-use visual aids relate to past experiences active involvement simplicity and lots of repetition support belief that change is good Barriers to learning - Correct Answer--Misbehavior -Physical and mental problems -Discipline health literacy - Correct Answer-the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions Motivation - Correct Answer-an internal state(idea, emotion, need) that arouses, directs, and maintains behavior toward a goal - influenced by belief that the patient needs to know something Motivation Interviewing - Correct Answer-a counseling and educational technique focused on patient's goals and is patient centered - objective is not to solve patient's problems, the goal is to resolve mixed feelings, adapt self-care, develop momentum, and believe behavioral change is possible self-efficiacy - Correct Answer-a person's perceived ability to achieve a task learning domains - Correct Answer-cognitive, affective, psychomotor Cognitive domain - Correct Answer-"thinking" - ability to make sense of and use information -higher levels can analyze, synthesize, and evaluate teaching methods for cognitive - Correct Answer-discussion lecture 1 on 1 instruction printed material discovery evaluation of cognitive - Correct Answer-direct observation of behavior written measurements self-reports/self-monitoring Affective domain - Correct Answer-"feeling" - includes values, beliefs, feelings, and attitudes related to new info. - moves clients to attach worth to info. teaching methods for affective - Correct Answer-Role playing- allows for expression of feelings + attitudes stimulation group discussion(group or 1 on 1) debate values clarification exercises evaluation of affective - Correct Answer-adopts behaviors consistent with new values express how learning has changed Psychomotor domain - Correct Answer-"skill" includes physical and motor skills uses cues from environment must have physical, mental, and emotional readiness Teaching methods of psychomotor - Correct Answer-Demonstration: presentation of procedures/skills by nurse, client models the nurses behavior Practice: gives client opportunity to perform skills, provides repetition Return demonstration: permits client to perform skills as nurse observes, provide feedback Independent Projects: requires teaching method that promotes adaptation and organization, allows learner to use new skills Ability to Learn - Correct Answer-- is the patient developmentally capable? - are they physically and mentally able to?(age?) Readiness to Learn - Correct Answer-are they ready to learn? - associated with stages of grieving. have they accepted their outcome and ready to adapt? Stages of Grieving - Correct Answer-1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance Denial or disbelief - Correct Answer-Patient avoids discussion of illness ("I'm fine; there's nothing wrong with me"), withdraws from others, and disregards physical restrictions. Patient suppresses and distorts information that has not been presented clearly. Anger - Correct Answer-Patient displays anger that they are sick, "why me!" blames or directs anger towards others Bargaining - Correct Answer-patient offers to live better/healthier life in exchange for promise of better health Resolution - Correct Answer-patient expresses emotions openly, realizes illness will create changes, asks questions Acceptance - Correct Answer-patient recognizes reality of condition, pursues info, strives for independence The Nursing Process - Correct Answer-Assessment Diagnose Planning Implement Evaluation Assessment - Correct Answer-gather patient data thru observation, interviews, physical assessment, and diagnostic results Diagnose - Correct Answer-analyze, validate, and cluster data to identify problems Planning - Correct Answer-identify short and long-term SMART goals, prioritize nursing diagnosis, Maslow! Implement - Correct Answer-take action and do what you planned. initiate specific interventions(dependent, independent, collaborative) + treatments designed to help patients achieve goals and outcomes Evaluate - Correct Answer-determine whether patients goals are met, partially met, or not met. examine effectiveness of interventions and decide whether plan of care should be continued, discontinued, or revised. Subjective data - Correct Answer-what the patient says Objective Data - Correct Answer-what the nurse observes or measures objective data examples - Correct Answer-Heart rate Blood pressure Body temperature Height Weight General Appearance Levels of consciousness subjective data examples - Correct Answer-pain scale, dizziness, headache, vomiting, feeling hot Clinical Reasoning Process - Correct Answer-Exploring, Analyzing, Prioritizing, Explaining, Deciding, Evaluating secondary data - Correct Answer-medical record and family history Clinical reasoning - Correct Answer-refers to how nurses think about unexpected patient outcomes- cues clinical judgment - Correct Answer-refers to the conclusions we reach and decisions we make in the patients care which happens first, clinical reasoning or clinical judgement? - Correct Answer-clinical reasoning happens 1st clinical judgment happens 2nd clinical reasoning/judgment application - Correct Answer-Recognize cues: filtering info from different sources-what cues do you see? Analyze cues: organizing and linking recognized cues . know needs and concerns- which cues are abnormal? Prioritize hypothesis: evaluating and ranking hypothesis to define a set of interventions for expected outcomes- what solution could resolve the cue? Generate solutions: identify expected outcomes- what solution could resolve the cue? Take action: implement the solution that addresses the highest priorities- what can you do to prevent this from happening again? Evaluate outcomes: comparing observed outcomes against expected outcomes- how can you evaluate patients response to your nursing intervention? Nursing process - Correct Answer-patient focused clinical judgment process - Correct Answer-Nurse's determination, provision of appropriate care to client what is the order of the following in the nursing process? 1. diagnose 2. evaluate 3. implement 4. assess 5. plan - Correct Answer-4, 1, 5, 3, 2 assess, diagnose, plan, implement, evaluation which of the following is an objective assessment data? a. pain is reported 8/10 b. heart rate= 125 c. patient asks if he can have ice chips d. patient states he has passed gas since surgery - Correct Answer-b. heart rate which is focused on the nurse thought process? a. nursing process b. clinical judgment & reasoning - Correct Answer-b. clinical judgment & reasoning what should goals always have? - Correct Answer-a time line which are evaluations for a nurse to use for a patient who is short of breath? SATA a. observe the patient's comfort with breathing b. administer a bronchodilator c. measure the respiratory rate d. tell the patient to perform deep breathing e. ask the patient if he is breathing easier after intervention - Correct Answer-a, c, d which activity would be a component of the evaluation part of the nursing process? SATA a. determine goals b. writing expected patient outcomes c. assessing the patient for nursing needs d. measuring a patient's clinical progress e. judging if the desired change in patient condition has occurred - Correct Answer-d + e