Iggy MC Ch 1-Overview of Professional Nursing Concepts for Medical-Surgical Nursing

Which important aspect of coordinating care within the interdisciplinary team is facilitated by use of the "SBAR" and "PACE" procedures?

A. Communication

B. Implementation

C. Policymaking

D. Protocol development

A. Communication

SBAR and PACE are acronyms for "hand-off" methods of communication used by health care organizations to share information between shifts and between departments

Bedside computers are an example of informatics used in health care primarily for which purpose?

CORRECT

A. Documenting interdisciplinary care

The largest application of health care informatics is the growing trend of the use of electronic medical records (EMRs) for documenting interdisciplinary care. Computers may be located at the client's bedside or in the treatment room for ease of access for documentation.

B. Enhancing collaboration and coordination of care

C. Offering clients access to e-mail and the Internet

D. Retrieving data for evidence-based practice

A. Documenting interdisciplinary care

The largest application of health care informatics is the growing trend of the use of electronic medical records (EMRs) for documenting interdisciplinary care. Computers may be located at the client's bedside or in the treatment room for ease of access for documentation.

The nurse has recently been assigned to a medical-surgical clinical rotation. According to the scope of medical-surgical nursing, what type of client assignments does the nurse expect to see?

A. Hospitalized children with acute and chronic illnesses

B. Hospitalized adults with acute and chronic illnesses

C. Older adults in a nursing home

D. Working adults in a corporate setting

B. Hospitalized adults with acute and chronic illnesses

The scope of medical-surgical nursing, sometimes called adult health nursing, is to promote health and prevent illness or injury in clients from 18 to 100 years of age or older. The most common practice setting is the acute care hospital.

Which of these hospital staff members will the nurse manager assign to coordinate the discharge of a client who will need community-based rehabilitation services after a traumatic injury?

A. The nurse responsible for the client's case management

B. The physical therapist who developed the client's exercise program

C. The health care provider assigned as the client's medical resident

D. The unit-based RN who has cared for the client during the hospital stay

A. The nurse responsible for the client's case management

The case manager role includes coordination of acute care and post-discharge community services for the client.

Which principal nursing actions best support a focus on client safety?

A. Client restraints

B. Handwashing

C. Preoperative checklists

D. Respect for others

E. Five rights of drug administration

B. Handwashing

C. Preoperative checklists

E. Five rights of drug administration

Handwashing is the number-one way to prevent infection in clients. Checklists can help prevent mistakes in care for a surgical client, thus ensuring a safe environment. Adhering to the five rights of medication administration helps to prevent errors in this important nursing care activity, providing for increased safety in client care.

An older client who has had a total hip replacement will be transferred to a rehabilitation center for continuing care before going home. The Joint Commission, along with National Patient Safety Goal standards, mandates communication between hospital nurses and other providers to ensure adequate transition management. Which aspects of this client's care plan are most important for the nurse to communicate to the rehabilitation center care team?

A. Third-party payer information

B. Pain medication needs

C. Primary care provider

D. Medical history of osteoarthritis

B. Pain medication needs

The goal of communication between the hospital nurse and the outside health agency is to provide safe transition of care. Important aspects of care, such as pain medications, oxygen needs, and fall risks must be communicated.

The nurse supports the client and family in deciding on a "Do Not Resuscitate" order. Which ethical principle that guides nursing clinical decision making is demonstrated in this situation?

A. Beneficence

B. Justice

C. Legality

D. Self-determination

D. Self-determination

Self-determination refers to the idea that clients are autonomous individuals capable of making informed decisions about their care. When the client is not capable of self-determination, the nurse is ethically obligated to protect the client as an advocate in the professional scope of practice.

The nursing student asks the supervising nurse whether a certain fall protocol used on the nursing unit is effective. To demonstrate effectiveness, what does the supervising nurse identify?

A. Information about how to implement a fall protocol and what nurses need to document

B. Data about the number of falls after the protocol was introduced compared with previous fall rates

C. The number of clients who currently have a fall protocol in place

D. National statistics about the use of fall protocols to prevent serious injury from falls

B. Data about the number of falls after the protocol was introduced compared with previous fall rates

Medical-surgical nurses, as part of the Quality and Safety Education for Nurses (QSEN) and evidence-based practice improvement (EBPI) quality improvement competency, are expected to be able to identify indicators to monitor quality and effectiveness of health care. Data that demonstrate evidence of improvement in falls after implementation of a protocol is a type of indicator of quality and effectiveness of care.

When developing a standardized plan of care for clients with a diagnosis of pneumonia, how does the nurse find the best information about providing optimal nursing care?

A. Access a website that reports on randomized controlled studies on nursing care for clients with pneumonia.

B. Research the most recent articles in nursing magazines that discuss care for clients with pneumonia.

C. Review the chart to determine what primary health care provider's prescriptions are frequently written for clients with pneumonia.

D. Survey experienced RNs about which nursing actions are effective when caring for clients with pneumonia.

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A. Access a website that reports on randomized controlled studies on nursing care for clients with pneumonia.

The best evidence-based nursing practice will be developed by using information from randomized controlled studies testing the impact of various nursing interventions on outcomes for clients with pneumonia. This type of data collection is the most scientifically based approach listed here.

Which nursing activity is best for the charge nurse on the medical-surgical unit to delegate to staff members who are unlicensed assistive personnel (UAPs)?

A. Feeding a client whose hands are affected by rheumatoid arthritis

B. Increasing the oxygen flow rate for a client who has wheezes

C. Positioning a client who has just returned from hip surgery

D. Taking vital signs for a client who is having acute chest pain

A. Feeding a client whose hands are affected by rheumatoid arthritis

Although all of these actions may sometimes be delegated to UAPs, the client with rheumatoid arthritis is the most stable of the clients described here.

Which nursing action demonstrates use of the principle of justice?

A. A 32-year-old client is prevented from falling during the initial postoperative period following her hysterectomy.

B. A 67-year-old client with dementia is shown the same respect as his 47-year-old roommate with prostate cancer.

C. An 82-year-old client is provided access to the hospital Patient Advocate for processing of a complaint.

D. The parents of a 13-year-old are included in discussions about the course of their teen's treatment and care.

B. A 67-year-old client with dementia is shown the same respect as his 47-year-old roommate with prostate cancer.

The principle of justice refers to equality—all clients should be treated equally and fairly, as demonstrated by the respect shown to the client with dementia.

Which action does the nurse take first when preparing to do discharge teaching for the 73-year-old client who is being discharged after prostate surgery?

A. Ask what the client knows about self-care after prostate surgery.

B. Have family members available during the teaching.

C. Provide written information about postdischarge care.

D. Plan to teach early in the morning after the client has eaten.

A. Ask what the client knows about self-care after prostate surgery.

When planning education, the nurse's initial action should be to assess whether the client is receptive to teaching and identify the client's current knowledge level. The other actions may be appropriate depending on the nurse's assessment of the client's learning needs, preferred learning style, and desire to share health information with his family. The family may be needed, but this is not the primary focus if the client is competent.

The nurse is working in the intensive care unit. When does the nurse call the Rapid Response Team (RRT)?

A. An 87-year-old client awakens confused, then reorients quickly.

B. A newly admitted client requests pain medication.

C. A postoperative client's dressing has bloody drainage.

D. A postoperative client's blood pressure suddenly drops.

D. A postoperative client's blood pressure suddenly drops.

The RRT should be called whenever a client has a slow or sudden deterioration in clinical condition, such as a sudden drop in blood pressure. The older adult client awakening in a confused state and then reorienting can be a normal occurrence because of the client's age. Pain medication should be indicated in the health care provider's prescription. If it is not, the admitting health care provider should be called, not the RRT. Drainage on the dressing of the postoperative client is normal.

The nurse educator is instructing newly hired registered nurses about patient-centered care. Which competency categories are included in this content?

A. Attitudes

B. Environments

C. Judgments

D. Knowledge

E. Skills

F. Values

A. Attitudes

D. Knowledge

E. Skills

Attitudes, knowledge, and skills are the patient-centered care competencies needed to ensure quality care. These characteristics, which were developed by the Institute of Medicine and the Quality and Safety Education for Nurses (QSEN) groups, are the areas cited and enumerated by both groups. A delineation (and examples of each) of knowledge, skills, and attitudes constitutes competent nursing practice. Environment, sound nursing judgments, and values are important to the client's care but are not included in the patient-centered care competencies.

The nurse is asked to collaborate with others to implement an interdisciplinary plan of care for a client. Which health care team members are essential for the client's daily care regimen?

A. Anesthesiologist

B. Case manager

C. Health care provider

D. Occupational therapist

E. Chaplain

B. Case manager

C. Health care provider

The case manager and the health care provider must see the client on a daily basis to collaborate with the nurse caring for the client. The anesthesiologist, occupational therapist, and chaplain are not needed on a daily basis.

The nurse is appointed to a hospital committee whose goal is to "improve the safety of nursing practice." Which areas of practice are included in the committee's task?

A. Attentiveness/surveillance of clients

B. Mandatory reporting

C. Medication administration

D. Participation in professional organizations

E. Prevention of errors or complications

F. Teaching clients about their care regimens

A. Attentiveness/surveillance of clients

B. Mandatory reporting

C. Medication administration

E. Prevention of errors or complications

Attentiveness/surveillance of clients, mandatory reporting, medication administration, and prevention of errors or complications are initiatives of the National Council of State Boards of Nursing (NCSBN) published findings about breakdowns in nursing practice. Participation in professional organizations and teaching clients about their care regimens are not initiatives of the NCSBN.

A previously stable postoperative client on the medical-surgical unit now has a blood pressure of 88/40 mm Hg and a heart rate of 124 beats/min. After placing the client in Trendelenburg position, which action does the nurse perform next?

A. Activate the Rapid Response Team.

B. Call for a Code Blue.

C. Determine the cause of the changes.

D. Re-check the vital signs in 5 minutes.

A. Activate the Rapid Response Team.

Because Rapid Response Teams (RRTs) have been demonstrated to reduce the number of cardiac or respiratory arrests, the nurse's first action should be to call the RRT. The client is not experiencing a cardiac or respiratory arrest, so calling a Code Blue is not appropriate. Re-checking and determining the cause of the vital sign changes are needed actions, but they are not the first action that the nurse should take because the client's mean arterial pressure is 56, which is below the threshold required for organ perfusion. A 5-minute delay in the client's care could be life-threatening!

Which role of the medical-surgical nurse is demonstrated when writing a plan of care for a client who is newly admitted to the hospital?

A. Advocate

B. Caregiver

C. Communicator

D. Educator

B. Caregiver

In the caregiver role, medical-surgical nurses assess clients, analyze collected information to determine their needs, develop nursing diagnoses and collaborative problems, plan care and carry out the plan with the health care team, and evaluate the care given. In the role of advocate, the medical-surgical nurse assists the client and family through caring interventions. "Communicator" is not a defined nursing role. In the role of educator, the nurse strives to improve health by facilitating client learning regarding health promotion, disease and illness, and specific treatment by teaching clients and family members or other caregivers.

When transferring a client who was admitted with chest pain from the emergency department (ED), which information is essential for the ED nurse to communicate to the nurse on the medical-surgical unit?

A. "The client is being admitted for ongoing monitoring of pain and vital signs."

B. "The client has private insurance and is also covered by Medicare."

C. "Nitroglycerin and morphine sulfate were given to relieve the pain."

D. "Frequent reassurance is needed because the client has a high anxiety level."

E. "The client has a family history of heart disease and hypertension."

F. "A coronary arteriogram should be scheduled as soon as possible."

A. "The client is being admitted for ongoing monitoring of pain and vital signs."

C. "Nitroglycerin and morphine sulfate were given to relieve the pain."

D. "Frequent reassurance is needed because the client has a high anxiety level."

E. "The client has a family history of heart disease and hypertension."

F. "A coronary arteriogram should be scheduled as soon as possible."

"Hand-off" communication between departments should include client information that is essential to the client's nursing care, such as why the client is being admitted, medications that have been given, the fact that the client has a high anxiety level, family history of heart disease, and needed procedures.

The nursing student has been assigned to the hospital's Rapid Response Team (RRT). Which statement by the student indicates a correct understanding of the RRT member's purpose?

A. "I will be caring for clients in the hospital."

B. "I will be riding along in the hospital's ambulance."

C. "I will be admitting clients to the hospital."

D. "I will be participating in Code Blue resuscitations."

A. "I will be caring for clients in the hospital."

Members of the RRT are critical care experts who are on site in the hospital and are available at any time.