Nursing as a professional final

A nurse attends a workshop on current nursing issues provided by the American Nurses Association. Which type of education did the nurse receive?

Graduate education

Inservice education

Continuing education

Registered nurse education

Continuing education

A nurse is using a guide that provides principles of right and wrong to provide care to patients. Which guide is the nurse using?

Quality and safety education for nurses

Standards of professional performance

Standards of practice

Code of ethics

Code of ethics

A nurse wants to become an advanced practice registered nurse. Which options should the nurse consider? (Select all that apply.)

1. Patient advocate

2. Nurse administrator

3. Certified nurse-midwife

4. Clinical nurse specialist

5. Certified nurse practitioner

1, 3, and 4

2, 3, and 4

3, 4, and 5

1, 2, and 3

3, 4, and 5

Which concept means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided?

Accountability

Patient advocacy

Autonomy

Patient education

Accountability

A nurse hears a co-worker state that anybody could be a nurse since it is so automated with infusion devices and electronic monitoring; technology is doing the work. What is the nurse’s best response?

"That is true in the 20th century."

"Technology use has to be combined with nursing judgment."

"If it's so easy, why don't you do it?"

"The focus of effective nursing care is technology."

"Technology use has to be combined with nursing judgment."

A patient is scheduled for surgery. When getting ready to obtain the informed consent, the patient tells the nurse, “I have no idea what is going to happen. I couldn’t ask any questions.” The nurse does not allow the patient to sign the consent and notifies the health care provider of the situation. Which role is the nurse displaying?

Manager

Patient advocate

Clinical nurse specialist

Patient educator

Patient advocate

A graduate of a baccalaureate degree program plans to start working as a registered nurse (RN) in the emergency department. Which action must the nurse take first?

Obtain certification for an emergency nurse.

Complete the Hospital Consumer Assessment of Healthcare Providers Systems.

Pass the National Council Licensure Examination.

Take a course on genomics to provide competent emergency care.

Pass the National Council Licensure Examination.

The nurse is caring for a patient who has been sullen and quiet for the past 3 days. Suddenly, the patient says, "I'm really nervous about surgery tomorrow, but I'm more worried about how it will affect my family." What should the nurse do first?

Inform the patient a social worker is available.

Assure the patient that everything will be all right.

Listen to the patient's concerns and fears.

Tell the patient that there is no need to worry.

Listen to the patient's concerns and fears.

The nurse asks a patient where their pain is located, and the patient responds by pointing to the area of pain. Which form of communication did the patient use?

Intonation

Nonverbal

Verbal

Vocabulary

Nonverbal

A nurse teaches a group of nursing students about nurse practice acts. Which information is most important to include in the teaching session about nurse practice acts?

Protects the provider.

Protects the public.

Protects the nurse.

Protects the hospital.

Protects the public

A nurse follows the “ethics of care” when working with patients. Which action will the nurse take?

Makes decisions for the patient solely using analytical principles.

Becomes the patient's advocate based on the patient's wishes.

Uses only intellectual principles to determine what is best for the patient.

Ignores unequal family relationships since that is a personal matter for the family.

Becomes the patient's advocate based on the patient's wishes.

The purpose of the therapeutic relationship between a nurse and a patient is to:

Form an interpersonal alliance to achieve healthcare goals

Help fill the nurse's need for belonging

Provide a learning opportunity for both

Inspire the patient to pursue a career in healthcare

Form an interpersonal alliance to achieve healthcare goals

Which characteristic tends to make a nurse the best communicator with patients?

Developed critical thinking skills

An interest in different kinds of people

Ability to maintain perceptual biases

Effective psychomotor skills

Ability to maintain perceptual biases

Of the following, which is the most encouraging invitation for a patient to ask questions?

"You look confused. What don't you understand?"

"Any questions?"

"All of this information can be overwhelming. Would it help to go over it again, or do you have questions?"

"I'm going to lunch. Here's a brochure."

"All of this information can be overwhelming. Would it help to go over it again, or do you have questions?"

A nurse is caring for a patient in the hospital. When should the nurse begin discharge planning?

When the patient is ready.

After an order is written/prescribed.

Close to the time of discharge.

Upon admission to the hospital.

Upon admission to the hospital.

Nonverbal communication represents 80% to 90% of what is being communicated and includes all of the following EXCEPT:

Intonation

Facial expression

Spoken language

Physical stance

Spoken language

A nurse believes that the nurse-patient relationship is a partnership and that both are equal participants. Which term should the nurse use to describe this belief?

Authenticity

Attentive

Mutuality

Critical thinking

Mutuality

A patient just received a diagnosis of cancer. Which statement by the nurse best demonstrates empathy?

"Tomorrow will be better."

"This must be hard news to hear."

"What's your biggest fear about this diagnosis?"

"I believe you can overcome this because I've seen how strong you are."

"This must be hard news to hear."

A nurse is using SURETY to facilitate active listening. What is the focus of the letter R?

Continuously provide reassurance to the patient

Projection of a sense of relaxation

Implementing reminiscence to support memory

Demonstrating respect for the patient

Continuously provide reassurance to the patient

Our ability to perceive others with accuracy is jeopardized when:

We use affirmations to increase self-esteem

We resist stereotypes and preconceptions

We assume that others think and behave as we do

We use self-disclosure in professional relationships

We assume that others think and behave as we do

The nurse tells a patient, “Oh, it can’t be all that bad.” This is an example of:

Advising

Active listening

Dismissing concerns

Clarifying

Dismissing concerns

During the initial home visit, a home health nurse lets the patient know that the visits are expected to end in about a month. Which phase of the helping relationship is the nurse in with this patient?

Termination

Working

Preinteraction

Orientation

Orientation

An older-adult patient is wearing a hearing aid. Which technique should the nurse use to facilitate communication?

Turn off the television.

Chew gum.

Speak clearly and loudly.

Use at least 14-point print.

Turn off the television.

The patient is about to undergo a certain procedure and has voiced concern about outcomes and prognosis. The nurse caring for the patient underwent a similar procedure and stops to listen. Which response by the nurse may be most beneficial?

"I had a similar procedure and I can tell you what I went through if you want."

"I think you'll be alright, but of course, there are no sure guarantees."

"I don't think you have anything to worry about. They do lots of these."

"I can call the doctor and cancel the procedure if you are really concerned."

"I had a similar procedure and I can tell you what I went through if you want."

A patient was admitted 2 days ago with pneumonia and a history of angina (chest pain). The patient is now having chest pain with a pulse rate of 108. Which piece of data will the nurse use for “B” when using SBAR?

Pulse rate of 108bpm

Oxygen is needed

Having chest pain

History of angina

History of angina

Subjective patient data would include:

A patient's feelings, perceptions, and reported symptoms.

A description of the patient’s behavior.

Observations of a patient’s health status.

Measurements of a patient’s health status

A patient's feelings, perceptions, and reported symptoms.

Which of the following is an example of objective data?

Patient describing excitement about discharge

A family’s description of the patient’s wound care before admission

Patient stating fears regarding upcoming surgery

Patient pacing the floor while awaiting test results

Patient pacing the floor while awaiting test results

When planning patient care, a goal can best be described as:

a statement describing the patient’s accomplishments without a time restriction.

a realistic statement predicting any negative responses to treatments.

a broad statement describing a desired change in patient behavior or status.

an identified long-term nursing diagnosis.

a broad statement describing a desired change in patient behavior or status.

Which expected patient outcome statement includes all five components of the SMART acronym for writing goal and outcome statements?

The patient will ambulate in hallways.

The nurse will administer pain medication every 4 hours to keep the patient free from discomfort.

The nurse will monitor the patient’s heart rhythm continuously this shift.

The patient will effectively feed self at all mealtimes today without complaints of shortness of breath.

The patient will effectively feed self at all mealtimes today without complaints of shortness of breath.

The following items are listed in the plan of care for this patient. A correctly worded expected outcome is:

The patient will consume adequate nourishment

The nurse will encourage family to bring in foods the client prefers

The patient will eat at least 50% of each food item offered at every meal by end of their hospital stay

The nurse will provide small meals every 2-3 hours until discharge

The patient will eat at least 50% of each food item offered at every meal by end of their hospital stay

Consider the nursing diagnosis statement:

Constipation related to decreased gastrointestinal motility as evidenced by the patient reporting no bowel movement in seven days, abdominal distention, and complaints of abdominal pain.

Which of the following is a defining characteristic in the statement above?

Decreased gastrointestinal motility

Pain medication

Abdominal distention

Constipation

Abdominal distention

Again consider the nursing diagnosis statement:

Constipation related to decreased gastrointestinal motility as evidenced by the patient reporting no bowel movement in seven days, abdominal distention, and complaints of abdominal pain.

Which of these selections is an etiology (cause or associated factor) for the nursing diagnosis statement?

Constipation

Decreased gastrointestinal motility

No bowel movement

Complaints of abdominal pain

Decreased gastrointestinal motility

In which step of the nursing process does the nurse provide nursing interventions to patients?

Assessment

Diagnosis

Planning

Implementation

Evaluation

Implementation

Which diagnosis will the nurse document in a patient’s care plan that is NANDA-I approved?

Sore throat

Acute pain

Sleep apnea

Heart failure

Acute pain

The nurse completes a thorough assessment of a patient, analyzes the data and identifies nursing diagnoses. Which step will the nurse take next in the nursing process?

Assessment

Diagnosis

Planning

Implementation

Planning

A patient exhibits the following symptoms: tachycardia, increased thirst, headache, decreased urine output, and increased body temperature. The nurse analyzes the data. Which nursing diagnosis will the nurse assign to the patient?

Adult failure to thrive

Hypothermia

Deficient fluid volume

Nausea

Deficient fluid volume

Which action should the nurse take to best develop critical thinking skills?

Study 3 hours more each night.

Attend all in-service opportunities.

Actively participate in clinical experiences.

Interview staff nurses about their nursing experiences.

Actively participate in clinical experiences.

The standing orders for a patient include acetaminophen 650 mg every 4 hours prn for headache. After assessing the patient, the nurse identifies the need for headache relief and determines that the patient has not had acetaminophen in the past 4 hours. Which action will the nurse take next?

Administer the acetaminophen.

Notify the health care provider to obtain a verbal order.

Direct the nursing assistive personnel to give the acetominophen.

Perform a pain assessment only after administering the acetaminophen.

Administer the acetaminophen.

Vital signs for a patient reveal a blood pressure of 187/100. Orders state to notify the health care provider for diastolic blood pressure greater than 90mm/Hg. What is the nurse's first action?

Follow the clinical protocol for a stroke.

Review the most recent lab results for the patient's potassium level.

Assess the patient for other symptoms or problems, and then notify the health care provider.

Administer an antihypertensive medication from the stock supply, and then notify the health care provider.

Assess the patient for other symptoms or problems, and then notify the health care provider.

A patient has reduced muscle strength following a left-sided stroke and is at risk for falling. Which intervention is most appropriate for the nursing diagnostic statement Risk for falls?

Keep all side rails down at all times.

Encourage patient to remain in bed most of the shift.

Place patient in room away from the nurses’ station if possible.

Assist patient into and out of bed every 4 hours or as tolerated

Assist patient into and out of bed every 4 hours or as tolerated

A nurse is getting ready to discharge a patient. What does the nurse need to do before discontinuing the patient’s plan of care?

Determine whether the patient has transportation to get home.

Evaluate whether patient goals and outcomes have been met.

Establish whether the patient has a follow-up appointment scheduled.

Ensure that the patient’s prescriptions have been filled to take home.

Evaluate whether patient goals and outcomes have been met.

Which of the following is an example of a nursing intervention?

The patient will ambulate in the hallway twice this shift using crutches correctly.

Impaired physical mobility related to inability to bear weight on right leg.

Provide assistance while the patient walks in the hallway twice this shift with crutches.

The patient is unable to bear weight on right lower extremity.

Provide assistance while the patient walks in the hallway twice this shift with crutches.

A patient recovering from a leg fracture after a fall reports having dull pain in the affected leg and rates it as a 7 on a 0 to 10 scale. The patient is not able to walk around in the room with crutches because of leg discomfort. Which nursing intervention is priority?

Assist the patient to walk in the room with crutches.

Obtain a walker for the patient.

Consult physical therapy.

Administer pain medication.

Administer pain medication.

Consider the nursing diagnosis statement:

Imbalanced nutrition, less than required related to inability to ingest food as evidenced by weight loss of 30 pounds in 3 months and lack of interest in food

The diagnostic label is:

imbalanced nutrition, less than required

inability to ingest food

advanced lung cancer

30-pound weight loss

lack of interest in food

imbalanced nutrition, less than required

Again consider the following nursing diagnosis statement:

Imbalanced nutrition, less than required related to inability to ingest food as evidenced by weight loss of 30 pounds in 3 months and lack of interest in food

The defining characteristics are:

imbalanced nutrition, less than required

inability to ingest food secondary to chemotherapy

30-pound weight loss in 3 months and lack of interest in food

inability to ingest food and 30-pound weight loss in 3 months

30-pound weight loss in 3 months and lack of interest in food

How does nursing integrate the art and science of caring?

• Protects, promotes, and optimizes health and human functioning

• Prevents illness and injury

Primary prevention

True prevention that lowers the chances that a disease will develop

Smoking bans, vaccines, and health lifestyle campaigns are examples of what kind of prevention?

primary prevention

Secondary prevention

Focuses on those who have health problems or illnesses and are at risk for developing complications or worsening conditions

Blood tests, early screenings/detection, and preventative medication are examples of what type of prevention?

secondary prevention

Tertiary prevention

Occurs when a defect or disability is permanent or irreversible

Examples of tertiary measures

disease management, support groups, rehabilitation programs

What is health literacy?

“The ability of people to find, understand, and use information and service to inform health-related decisions and actions for themselves and others”

Pts with low health literacy are more likely to

• visit an emergency room

• longer hospital stays

• less likely treatment plans

• higher mortality rates

What are the 4 health models we talked about in class?

• Health Belief Model

• Health Promotion Model

• Maslow’s Hierarchy of Needs

• Holistic Health Models

Health Belief

Addresses relationship between a person’s beliefs and behaviors. Helps us understand patient’s perceptions and beliefs about health and their behaviors.

Health Promotion:

Health is defined in this model as a positive, dynamic state. Health-promoting behavior is the desired behavioral outcome and end point of the health promotion model

Maslow’s

Helps us understand the interrelationships between human needs, and the basic physiological needs must be met before higher needs can be addressed.

Holistic Health:

considers emotional, spiritual, and other dimensions of health to create conditions that promote optimal health. Patient is the center of care/the ultimate expert concerning their own health and is therefore empowers patient to engage in and take some responsibility for their own recovery and health maintenance.

social determinants of health

• education access and quality

• economic stability

• social and community context

• neighborhood and built environment

• health care access and quality

Autonomy

Commitment to include patients in decisions

Beneficence

Taking positive actions to help others

Nonmaleficence

Avoidance of harm or hurt

Justice

Being fair

Fidelity

Agreement to keep promises

Ethical and legal responsibilities of nurses

• Info cannot be shared unless with other health professionals that are caring for that same pt or have been authorized to be given this info

• Talking about patients (identified by name or not) with others outside the healthcare team is inappropriate.

• Maintaining a respectful presence online is an example of professional demeanor and important even when nurses are not at work.

What is HIPAA?

Health Insurance Portability and Accountability Act of 1996 is a federal law that protects patients' health information and gives patients rights over their records

3 aspects of HIPPA

• the privacy rule

• the security rule

• the breach notification rule

The Privacy Rule

sets national standards for when protected health information (PHI) may be used and disclosed

The Security Rule

specifies safeguards that covered entities and their business associates must implement to protect the confidentiality, integrity, and availability of electronic protected health information (ePHI)

The Breach Notification Rule

requires covered entities to notify affected individuals, U.S. Department of Health & Human Services (HHS), and in some cases, the media of a breach of unsecured PHI

What does HIPAA Privacy Rule apply to?

• Health plans

• Health care clearinghouses

• health care providers

HIPAA Offense Tiers

• tier 1: unaware of HIPAA violation

• tier 2: Reasonable cause that the covered entity knew about or should have known about the violation by exercising reasonable due diligence

• tier 3: willful neglect of HIPAA rules with the violation corrected within 30 days of discovery

• tier 4: willful neglect of HIPAA rules and no effort made to correct the violation within 30 days of discovery

Fine for tier 1 HIPPA offense

$100-50,000

Fine for tier 2 HIPPA offense

$1000-50000

Fine for tier 3 HIPPA offense

$10,000-$50,000

Fine for tier 4 HIPPA offense

$50,000

What is the maximum fine for each HIPAA fine tier?

$1.5 milliion per year

As a Student and Practicing Nurse always

• Know the rules in  your clinical setting

• Use  social media in a professional manner

• If unsure, ask your employer or faculty member BEFORE you post anything.

As a Student and Practicing Nurse never post

• At work or clinical site

• Patient information

• Pictures of patient

• Pictures or clinical site info

• Demeaning comments related to clinical site, employer, school, faculty, or peers.

Just Culture does not

Does not tolerate or condone:

At Risk Behavior: behavior that increases risk where risk is not recognized or is mistakenly believed to be justified

Reckless Behavior: Actions taken with conscious disregard for clear risks to patients

Gross Misconduct (falsifying records, performing professional duties while intoxicated, etc.)

Just culture

acknowledges and accepts the likelihood of human error

Behaviors that Reduce Errors

•Establish and encourage  “Just Culture”

• High reliability organizations

• Speak up and speak out

• Advocate

• Report

•Communicate

What is the Nursing: Scope and Standards of Practice?

1960: Documentation began

Standards of Practice

Standards of Professional Performance

what is the goal of the Nursing: Scope and Standards of Practice?

To improve the health and well-being of all individuals, communities, and populations through the significant and visible contributions of registered nursing using standards-based practice

What does the code of ethics address?

• Character (type of person)

• Conduct (How to act)

• Duties to: Patients, profession, public,  global humanity, and the planet

Code of ethics for nurses

Integral part of the nursing profession

Nursing has a distinguished history of concern for the sick, injured, vulnerable, and for social justice

Nurse Practice Acts (NPAs)

• Overseen by State Boards of Nursing

• Regulate scope of nursing practice

• Protect public health, safety, and welfare

Nursing Licensure and certification

• Licensure: NCLEX-RN® examination

• Certification: requirements vary

Basic Assumptions of Communication Theory

• We only know about ourselves and others through communication.

• Faulty communication results in:

  • Flawed feelings

  • Flawed actions

  • Misinformation

• Feedback is the only way we can verify that our perceptions are valid.

• It is impossible not  to communicate.

How much of our conversation is nonverbal?

93%- 55% expressions and gestures, 38% tone and volume

Perception

are the unique reality of each individual based on life experiences.

Problematic Human Tendencies that impact Perceptions

• sterotypes

• first impressions

• believing others are like us

• favor negative impressions

• expectations

• harsh judgement

• deny responsibility for failure

• blame others when mistakes are made

therapeutic relationships

Therapeutic nurse-client relationships are vital in nursing care.

Nurses engage in compassionate, supportive, professional relationships with their clients as part of the “art of nursing.”

est. trust and rapport and facilitate therapeutic communication

characteristics of a therapeutic relationship

• Occurs between healthcare provider and person in need

• Healing relationship that is goal driven

• Goal is promotion of person’s health and well-being

• Has a defined beginning, middle and end

• Dependency and vulnerability

• Requires nonjudgmental acceptance, confidentiality and trust

Active listening

Being attentive to what a patient is saying both verbally and nonverbally

SURETY Model

SURETY model

S - Sit at a slight angle facing the patient.

U - Uncross legs and arms.

R - Relax.

E - Eye contact.

T - Touch.

Y - Your Intuition.

non-therapeutic communication

• Getting too personal

• Changing the subject

• False reassurance

• Sympathy, Pity

• Asking WHY?

• Voicing opinions

• Defensive responses

• Passive aggressive or aggressive responses

• Arguing

Phases of therapeutic relationship

1. Preinteraction phase: occurs before meeting the patient

2. Orientation phase: when the nurse and the patient meet and get to know each other

3. Working phase: when the nurse and the patient work together to solve problems and accomplish goals

4. Termination phase: occurs at the end of a relationship

Pre-interaction

• Review all information

• Physically

• Mentally