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NR 222
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NR222 Final Exam 1
NR222 Final Exam 1 NR 222 Final Exam Chamberlain College of Nursing NR222 Final Exam 1. Questions & Answers -Graded A Question 1 The nurse is to in... [Show More] struct the client about the long- term consequences of non-compliance to prescribed medication. Which education strategy would be most appropriate for the nurse to use in order to develop the affective learning domain of the client? A. Lecture followed by a simple written test. B. Role playing and group discussion C. Video presentation and handouts D. Demonstration and practice Question 2 A nurse manager is teaching a group of nurses about the levels of prevention. Which example of the tertiary level of prevention should be included in the instruction. A. Surgery to repair a hip dislocation of an older adult client. B. Teaching breastfeeding to expectant mothers in a prenatal clinic. C. Chemotherapy treatment to a client newly diagnosed with cancer. D. Physical therapy to a patient who has a right sided paralysis from a stroke. Question 3 A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension and has a BMI of 26. Which of the following goals should the nurse include? A. The client will list foods that are high in calcium, which should be avoided. B. The client will walk for 30 mins a day 5 days a week. C. The client will increase calorie intake by 200 cal per day. D. The client will replace cigarettes with smokeless tobacco products. Question 4 Which of the following emphasizes that an individual’s belief in being personally capable of preforming the behavior is required to influence one’s own health? A. Social Cognitive Theory B. Self–Efficacy Theory C. Health Belief Model D. Theoretical Model Question 5 The nurse is discussing the importance of routine preventive care with a Hispanic family who has recently immigrated to the United States. Which factor will the nurse consider as a barrier in the family’s interest to receive professional health care? Select All That Apply A. Lack of health insurance B. Concern about invasion of privacy C. Absence of transportation services D. Limited proficiency in the English Language E. Belief and accessibility to folk healers and remedies F. The availability of family members for support and help Question 6 The following are true about Healthy People 2020 initiative (Select All That Apply) A. Healthy People Initiative provides science-based, 10 year national objectives for improving the health of all Americans. B. Healthy People initiative seeks to change the health practices of people who are most at risk to illness and injury thereby decreasing the cost of health care and maintenance. C. For 3 decades, Healthy People initiative has established benchmarks and monitored progress over time in order to encourage collaborations across communities and sectors. D. Healthy People initiative was developed to established health improvement priorities and measure the impact of prevention activates. E. Healthy People initiative gives protocols to each state on how conduct community health prevention education and giving nurses standards on educational programs. F. Healthy People initiative empower individuals towards making informed health decisions. Question 7 True statements about the ANA Code of Ethics (Select All That Apply): A. The nurses primary commitment is to self-first; then, if the situation is favorable, commitment to the patients whether the individual, family, group, community, or population. B. The nurse has authority, accountability and responsibility for nursing practices; make decisions; and takes action consistent with the obligations to provide optimal patient care. C. The profession of nursing articulates its values through individual nurses without recommendations from professional organizations; maintaining integrity and principles of social justice into nursing and healthy policy is optimal for nurses. D. The nurse owes the same duties to self as to other, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence and continue personal and professional duties. E. It is the nurses’ responsibility to protect human rights, promote health diplomacy, and reduce health disparities. F. Nurse advocates for, and protects the rights, health, and safety of the patient. Question 8 The following are health concerns and issues of migrant workers (Select All that Apply) A. Pesticide exposure B. Iron deficiency anemia C. Constipation and Dehydration D. Tuberculosis E. Chronic Conditions F. Dental Disease Question 9 Which data represents objective findings? (Select All That Apply) A. Lab values B. Pain level state by the patients C. Patients stated emotional status D. Respiratory and pulse oximetry reading. E. The nurse’s description of the patient’s gait. Question 10 The steps included in the nursing process include: (Select All That Apply) A. Use a nursing diagnosis to state the problem. B. Plan care to help meet stated patient goals C. Collect data and asses the patient D. Establishes priorities, patient goals and outcomes. E. Determine appropriate nursing interventions for patient care. F. Order labs that are needed for the patient. Question 11 What information is about nursing standards of care? A. Nursing standards of care guidelines for nursing practice. B. Nursing standards of care are defined in Nurse Practice Acts. C. Nursing standards of care are used to measure nursing conduct in malpractice suit. D. Nursing standards of care are specific guidelines only for unlicensed assistive personnel. E. Nursing standards of care are upheld by law and indicate what standards nurse must follow. F. Nursing standards of care are used to determine whether the nurse acted as any reasonably prudent nurse under the same or similar conditions. Question 12 The nurse is discussing the importance of routine healthcare with a Hispanic family who has recently immigrated to the United States. Which factor will the nurse consider as a barrier to the family’s interest to receive professional health care? (Select All That Apply?) A. Lack of health insurance. B. Concern about invasion of privacy. C. Absence of transportation services. D. Limited proficiency in the English language E. Belief and accessibility to folk healers and remedies F. The availability of family member for support and help. Question 13 Which statement by the nurse best describes values? A. Values are not constant; they change over time. B. Values learned in childhood remain the same for a lifetime. C. It is impossible for people to understand their own values. D. The clients values are not considered when care is provided. Question 14 Which educational strategy would be most appropriate to use in order to provide affective learning domain of the client? A. Lecture followed by simple written test B. Video presentation and handouts C. Role playing and group discussion D. Demonstration and practice Question 15 The American Nurses Association (ANA) has recommended the following competency for RNs? A. The RN’s to recognize their own values, beliefs, and cultural heritage. B. The RNs to function independently and occasionally engage in collaboration. C. The RNs to be concerned about the existence of vulnerable cultural groups. D. The RNs to provide health care opportunities to those with financial capabilities. Question 16 An RN is teaching a group of patients about Diabetes Management material from a Diabetes Education Program. Which of the following should an RN prepare prior to each teaching session? A. Plan handouts on general principles that patients can understand materials at the high school level. B. Implement changes during class whenever a patient complains the material is too difficult to understand. C. Assess materials to be relevant plan changes according to the needs of patients, implement teaching according to the patients ability to understand the information. D. Assess, plan, implement, and evaluate teaching materials only according to the recommendations of the director of nursing. Question 17 Which statement is true regarding secondary prevention? A. The nurse creates a care plan for the patient’s outpatient therapy. B. The nurse identifies individuals in an early detectable state of the disease process. C. The nurse focuses on increasing the patient’s self-care by providing prevention instructions. D. The nurse is driven by the objective to minimize the effect of the disability through rehabilitation. Question 18 One Leading Health Indicator (LHI) of Healthy People 2020 is the availability of medical services to all people. Which topic does this cover? A. Injury and Violence B. Environmental Quality C. Access to Health Services D. Clinical Preventative Services Question 19 How would the nurse approach this ethical dilemma: Two patients are on the list for kidney transplants and they will both die without one. Which patient would get the one kidney that is immediately available for transplantation. A. Choose the patients who has the ability to fiancé the hospitalization and treatment. B. Advocate for the younger of the two clients since that client will live longer. C. Use ethical principles to guide the decision making process. D. Select a client who is most productive in society. Question 20 The leading health indicators found in Healthy People 2020 are the following: (Select all that apply) A. Access to health services B. Holistic and CAM strategies C. Oral Health D. Issues related to legal and illegal immigration E. Environmental health F. Holistic Care Question 21 Which statement best describes Erikson’s Theory of Development. A. The premise of the theory is that individuals are interdependent beings. B. Developmental stages result in an attempt to make sense of the world. C. A healthy personality will achieve the pre-conventional stage by 15. D. An individual’s achievements of identity is through sequential psychosocial stages. Question 22 A patient with chest pain is being admitted to the ER. When asked about the next of kin the patients states, “Don’t bother calling my daughter; she is always too busy.” Which is best response by the nurse? A. “She might be upset if you don’t call her.” B. “ What does your daughter do that makes her so busy?” C. “Is there someone else that you would like me to call for you?” D. “I cant imagine that your daughter wouldn’t want to know that you are sick.” Question 23 A patient states, “Do you think I could have cancer?” The nurse responds, “What did the doctor tell you?” Which interviewing approach did the nurse use? A. Paraphrasing B. Confrontation C. Reflective Technique D. Open-ended question Question 24 A patient is admitted to the hospital with cirrhosis of the liver causes by long-term alcohol abuse. Which is the best response by the nurse when the patient says “I really don’t believe that my drinking a couple of beers a day has anything to do with my liver problem?” A. “You find it hard to believe that beer can hurt the liver” B. “How long is it that you have been drinking several beers a day?” C. “ Each beer is equivalent to one shot of liquor so its just as damaging to the liver as hard liquor.” D. “ Do you believe that beer is not harmful even though research shows that it is just as bad for you as hard liquor?” Question 25 A patient is extremely upset and mentions something about work-related issues that the nurse cannot understand. Which is the nurse’s best response? A. “It’s natural to worry about your job.” B. “Your job must be very important to you.” C. “Calm down so I can understand what you are saying.” D. “I’m not quite sure I heard what you were saying about your work.” Question 26 A nurse must conduct a focused interview to complete an admission history. Which interviewing technique should the nurse use? A. Probing B. Clarification C. Direct questions D. Paraphrasing statements Question 27 The home care nurse is visiting an older client whose spouse died 6 months ago. Which behaviors by the client indicates effective coping? A. Neglecting personal grooming B. Looking as old snapshots of family. C. Participating in a senior citizens program D. Visiting spouses grave once a month E. Decorating a wall with the spouses’ pictures and awards received. Question 28 A nurse is planning to provide personal health care information to several patients. Which patients should the nurse anticipate will be more motivational to learn? A. 55 y/o F who has a mastectomy and is very anxious about her body image. B. 56 y/o M who has a heart attack last week and is requesting information about exercise C. 18 y/o M who smokes two packs per day and is in denial about the dangers of smoking. D. 47 y/o F who has a long leg cast after sustaining a broken leg and is still experience severe pain. Question 29 The nurse asses a patient and collects a variety of data. Identify the human response that are subjective data. Select all that apply: A. Nausea B. Jaundice C. Dizziness D. Diaphoresis E. Hypotension. Question 30 A nurse is collecting information to prepare a teaching plan for a patient with type 1 diabetes. Which question asked by the nurse is associated with collecting information in the cognitive domain of leaning? A. “How do you inspect your feet each day?” B. “Can you measure a serum glucose levels?” C. “What do you know about diabetes mellitus?” D. “Are you able to perform a subcutaneous injection? Question 31 Which of the following emphasizes an individual’s belief and being personably capable of preforming the behavior is required to influence one’s own health. A. Social cognitive theory B. Self-efficiency theory C. Health Belief Model D. Trans theoretical Model Question 32 A nurse sets up an education program to discuss health disparities for high school students, one of the first steps of the process is for: Which of the following A. Describe health behaviors B. Decrease morbitity [Show Less]
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NR 222 Exam 2 Study Guide
NR 222 Exam 2 Study Guide 1. Chamberlain care model • We are not just another College of Nursing-we are distinctly Chamberlain College of Nursing. Our ... [Show More] distinction is rooted in our culture of care-Chamberlain Care-that permeates every aspect of the College and is embedded in the mindful actions of each and every one of us. Chamberlain Care is our way of being: caring for ourselves informs and sustains caring relationships with our colleagues, students, patients, and the community we touch. 2. Healthy people 2020 goals (4 goals) • Attain high quality, longer lives free of preventable diseases, disability, injury, and premature death. • Achieve health equity, eliminate disparities and improve the health of all groups. • Create social and physical environments that promote good heath for all. • Promote quality of life, healthy development, and healthy behaviors across all life stages. 3. HP 2020 LHI • LHI’s alters us to evidence of problem areas • Provide us with goal outcomes based on scientific evidence to help improve those outcomes • Drive many public health projects today and influence organization in both preventative and restorative efforts • Services include: Leading Health indicator Access to health service Affordable care act Improved access to health care insurance Centers for Medicare and Medicaid • Examples of LHI Tobacco Adults who smoke currently Adolescents who have smoked within 30 days Mental health and substance abuse Alcohol and/or drug use by adolescents Binge drinking by adults Major depression in adolescents Suicide Environmental quality Air quality index > 100 Children exposed to second hand smoke 4. Steps of the nursing process ADOPIE • Assessment- gather info about patient condition Collect and analyze data Types of assessment: o the patient-centered interview during a nursing health history. o a physical examination. o the periodic assessments you make during rounding or administering care. • Diagnose- identify the patient’s problem • Outcome- set goals • Plan- identify appropriate nursing actions to reach goal • Implementation- perform the nursing actions or plan into action; includes teaching in this step. • Evaluate- determine if goals and outcomes have been achieved. 5. How to plan teaching for low literacy levels • Determine goals and expected outcomes that guide the choice of teaching strategies and approaches with a patient: o Set priorities. o Select timing to teach. o Organize the teaching materials. o Use teamwork and collaboration. 6. What is important to asses regarding patient’s health needs (communication) • See through the patient’s eyes. o Teaching is patient-centered. • Assess the patient’s learning needs. o Information or skills needed to perform self-care and to understand the implications of a health problem. o Patient experiences that influence the need to learn. o Information that family caregivers need to support patient needs. • Motivation to learn • Ability to learn • Teaching environment • Resources for learning • Health literacy: the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health. • Health literacy includes patients’ reading and mathematics skills, comprehension, and decision-making and functioning skills regarding health care. 7. Type of space/zone for nurse teaching patient • Social (9-12 ft)- Knocking to enter • Personal (18 inches- 4ft)- moving closer to the patient • Intimate (up to 18 inches)- when taking vitals/assessment • Public (12 feet and over)- speaking from far distance. Interaction with an audience. Nurses can speak about health-related topics. Effective communication can increase audiences knowledge about important health issues. • Intrapersonal- Occurs WITHIN an INDIVIDUAL EX: communication with yourself, making a to-do list counts, journaling, writing in a calendar, or even psyching yourself up to do something. We use it to develop self-awareness and a positive self-concept that will enhance self-expression. Can improve self-esteem and healthy by replacing negative thoughts with positive. • Interpersonal- One-to-one interaction BETWEEN two people; Level most frequently used in nursing. It is important to validate meanings or mutually negotiate it. Results in exchange of ideas, problem solving, expression of feelings, decision making, goal accomplishments, team building, and personal growth. • Small group- Interaction that occurs when a small number of persons meet together. • Transpersonal- Interaction that occurs within a person's spiritual domain. Nurses have a responsibility to assess client's spiritual needs and intervene to meet those needs. EX: prayer, meditation, and guided reflection. 8. Violence- intimate partner HP 2020- those most at risk. • Each year, women experience about 4.8 million intimate partner-related physical assaults and rapes. • Men are the victims of about 2.9 million intimate partner-related physical assaults. • A history of exposure to adverse experiences in childhood, including exposure to violence and maltreatment, is associated with health risk behaviors such as smoking, alcohol and drug use, and risky sexual behavior, as well as obesity, diabetes, sexually transmitted diseases, attempted suicide, and other health problems 9. Types of learner-3 • Kinesthetic- Is a learning style in which learning takes place by the student carrying out a physical activity, rather than listening to a lecture or watching a demonstration. o 3 ways to study: o 1. Keep your desk of distracting objects. o 2. Cover the page you're not reading. o 3. Gets plenty of sleep. • Visual- Is a teaching and learning style in which ideas, concepts, data, and other information are associated with images and techniques. o 3 ways to study: o 1. Take notes, make picture, graphs, and charts. Use FlashCards and highlight key details. o 2. Sit close to a teacher so that you can watch his/her face and gestures. o 3. Takes notes or make lists as you listen to directions. • Auditory- learns through listening and speaking. This type of learner needs to hear information to be able to process and comprehend as well as have the opportunity to reinforce that information orally. o 3 ways to study: o 1. Read your work out loud. Summarize what you read on tape. o 2. Say words inside your head silently. o 3. Brainstorm ideas with others. From study groups. 10. Maslow’s hierarchy of needs • This model is used by nurse to understand the interrelationships of basic human needs • The higher order needs can only be met when the ones beneath have been met satisfactorily • Physiological -1 Airway Breathing Circulation Nutrition Electrolytes elimination • Safety and security-2 Safety measures Education for the patient Things you should be monitoring for when they go home • Love and belonging-3 Friendships Romantic attachments Family Social groups Community groups Churches and religious organizations • Self-esteem-4 People need to sense that they are valued and by others and feel that they are contributing to the world. Participation in professional activities academic accomplishments athletic or team participation personal hobbies can all play a role in fulfilling the esteem needs. • Self-actualization- 5 This level of need pertains to what a person’s full potential is and realizing that potential. “what a man can be, he must be” is the basis of the perceived need for self-actualization. This as the desire to become everything that one can become. 11. Communication styles verbal/nonverbal • Verbal: o Use of spoken or written words. Aspects: o Vocabulary- Communication is unsuccessful if sender and receiver cannot translate each other's words and phrases. Limiting of medical jargon in conversations with other health care team members will improve communication. Children have limited vocabulary, Teenagers use unique words and slang. o Denotative- is the dictionary meaning. A baseball= A baseball. o Connotative- Connotative meaning is the interpretation of the words meaning influenced by thoughts, feelings, or ideas people have about the word. Code= Emergency. o Pacing- Conversation is more successful at an appropriate speed or pace. Long pauses and rapid shifts to another subject give the impression that the nurse is hiding the truth. o Intonation- Tone of voice. Be aware of voice tone to avoid sending unintended messages. Tells nurses emotional state + energy level. Patronizing tone breaks client relationship. Can reflect a caring or disinterested attitude. o Clarity and brevity- Effective communication is simple, brief, and direct. fewer words equals less confusion. Repeat important phrases and give examples. Phrases such as "you know" or "ok" detract from clarity. o Timing and Relevance- Timing is critical. You do not begin routine teaching when a client is in extreme pain. When a patient is going into surgery you should not start describing a diet plan. Pick appropriate time. o Words are symbols for ideas o Includes sign language, braille, touch language o Communication with language is critical ability o Challenge: language differences o Functions: to inform, to trigger response, to describe • Nonverbal o Personal appearance o Posture and gait o Facial expressions o Eye contact o Gestures o Sounds o Territoriality and personal space o Particularly vulnerable to misunderstanding o Culturally and situationally bound o Great power to transmit info thoughts, feelings, etc. o Nonverbal messages from both patient and nurse 12. Open-ended statements (examples) • Where have you looked already? • What kind of information about your care are you looking for? • What would you like to know about the hospital? • When you said you are hurt, what do you mean? • What do you mean by being frustrated? • How might you use the information I have given you? • What are you trying to understand? 13. Polypharmacy • refers to three or more medications prescribed at the same time. This may include an attempt to treat side effects of other drugs. • Since polypharmacy is a consequence of having several underlying medical conditions, it is much more common in elderly patients. • Polypharmacy can become problematic when multiple healthcare providers work independently of each other and prescribe patients too many medications 14. What are components of the affective domain • Recognition of values, relationships, attitudes • Determining Outcomes Outcomes driven by public health, societal, and participant goals Program goals: long-range expected outcomes Learning goals are established jointly Identify desired health behavior or status Learning objectives o Steps to be taken by learner o Should be behavioral o Use action verb o State what to be done, under what conditions, at what level 15. Strategies to promote health literacy in an effective teaching environment • Health literacy- degree to which individual have capacity to obtain (understand) health information to make appropriate decisions • Nurses have key role in promoting health literacy • Majority of persons have deficient health literacy • Goals of health education Help individuals, families, and communities achieve optimal health (via their own actions) Two objectives of health education/counseling o Change health behaviors o Encourage positive, informed changes in lifestyle o Empower the individual Improve health status o Prevent acute and chronic disease o Decrease disability o Enhance wellness 16. Nurses’ actions to decrease bias and be effective in culturally competent care • Cultural Awareness Bias: a predisposition to see people or things in a certain light, either positive or negative. Becoming more self-aware of your biases and attitudes about human behavior is the first step in providing patient-centered care • Knowledge World views World view o Emic (insider perspective) o Etic (outsider perspective) Avoid stereotyping Treat the individual See every patient encounter as cross-cultural Iceberg analogy o Most aspects of a person’s world view are hidden Conduct a cultural assessment • Culture assessment Cultural assessment model o The goal of a cultural assessment is to obtain accurate information from a patient that allows you to formulate a mutually acceptable and culturally relevant plan of care for each health problem of a patient. Open-ended, focused, and contrasted questions o You need to assess and interpret a patient’s perspective during your assessment. Use open-ended, focused, and contrasted questions. Explanatory model o One effective approach to assessment is to ask questions that will help you understand a patient’s explanatory model—his or her views about health and illness and its treatment. o There are five questions in most explanatory models: etiology, time and mode of onset of symptoms, pathophysiology, course of illness and treatment for an illness episode Trust o Cultural assessment is intrusive and may take more time to conduct because it requires building a trusting relationship between participants. 17. Health risk factors common for each cultural group. • Asian America/Pacific islanders o Health concerns and care issues Hesitancy to seek early diagnosis/screening Higher rate of tuberculosis Mental health problems due to adjustment issues Lower rate of obesity, hypertension Risk factors o Barriers to care Poverty Stress in intergenerational relationships Cultural norms that prevent health care seeking Loss of social networks Poor access to services • Native American o Health concerns and care issues Linked to social and economic conditions Smoking, substance abuse Deaths: unintentional injuries, cirrhosis, homicide, suicide, pneumonia, diabetes Risk factors o Barriers to care Difficult access to care Underserved population • African American o Health concerns and care issues Higher cancer deaths HIV Hypertension Obesity Mental health concerns Risk factors o Barriers to care Poverty Lack of health insurance Inadequate or unsafe environments • Arab o Health concerns and care issues Adult-Onset Diabetes Mellitus Coronary artery disease Role of acculturation Mental health Teenage smoking Risk factors o Barriers to care Religious belief and practices Cultural norms/modesty Gender issues regarding providers Communication difficulty Folk remedies Lack of culturally competent providers • Latino/Hispanic Health concerns and care issues o Higher incidence of o Stomach cancer o Diabetes mellitus o Cardiovascular disease o HIV Risk factors o Barriers to care Highest uninsured rate of any U.S. racial/ethnic group Use/receive less preventative health care Lack of interpreter services in health care Lack culturally appropriate health care services Reliance on folk systems of healing 18. Values belief pattern • Value A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior • Value clarification Ethical dilemmas almost always occur in the presence of conflicting values To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinions 19. Domains of learning • Three domains of learning: 1. Cognitive: new facts or concepts, building on knowledge 2. Psychomotor: developing physical skills 3. Affective: recognition of values, beliefs, relationships, attitudes 20. Piaget cognitive theory and stages/examples • Sensorimotor (birth-2 yrs.)- Reflexes begin to turn into simple reflex to a symbolic process. EX: my son touched the radiator and got burned. He’ll never do that again. • Preoperational (2 to 7 years)- Marked by the use of symbols to represent objects. Development of egocentric thinking. EX: my daughter asked an obese lady if she had a baby in her stomach. • Concrete operations (7 to 11 years)- Child uses mental operations to solve problems and to reason. Mastering facts EX: my son is learning math and is getting 100s on his test. He is so smart. • Formal operations (11 years to adulthood)- logical thought and abstract concepts. EX: my daughter is on the debate team at school. We go to interschool now. 21. Freud id/ego/superego • Id- A reservoir of unconscious psychic energy that constantly strives to satisfy basic drives to survive, reproduce, and aggress. Id operates on the pleasure principle. EX: Michael saw a $5 bill fall out of Nick's backpack as he pulled his books out of his locker. As Nick walked away, Michael bent over, picked up the money, and slipped it into his pocket, glancing around to make sure no one was looking. • Ego- young child learns to cope with the real world. (conscious mind) operates on the reality principle. EX: Even though Michael needed money, he decided not to steal the money from the cash register because he didn't want to get in trouble. • Superego- a voice of conscience that forces the ego to consider not only the real but the ideal. its sole focus is on how one ought to behave. develops as we internalize the morals and values of parents and culture, what is right and wrong. strives for perfection, judges our actions which produce pride or guilt. EX: When Michael saw the $5 bill lying on the floor with no one around it, he turned it into the school office in case anyone came looking for it. He wouldn't want to lose $5 and hoped that whoever had lost it would ask about it in the office. 22. ISBAR • I- Introduction; Identify yourself, your unit, the patient's name and room number. If calling another M.D. or staff member: identify patient's primary M.D. • S- Situation; State the problem. It's a to-the-point punchline to get the attention of the receiver. when it started and how severe it is. • B- Background; Patient's admitting diagnosis and date of admission. Any clinical information related to current problem: mental status, VS, meds, IV fluids, lab results, allergies, code status. Give what is pertinent to the call-not complete history. • A- Assessment; An assessment of the situation is made: -What you think is going on with the patient -What you think the problem is • R- Request/Recommendation; What's your recommendation for solving the situation? What do you want/need from the M.D. This is the step most nurses are least comfortable with. 'I suggest/request that you...' Are tests needed? 23. Phases of nurse-patient relationship • 1. Pre-interaction phase: occurs before meeting the patient EX: Obtaining available information about the client from his or her charts, significant others or other health team members. From this information the initial assessment is begun. Also, the nurse plans how she is going to interact with the patient, what she is going to achieve from this interaction and how she is going to help the patient. • 2. Orientation phase: when the nurse and the patient meet and get to know each other. EX: Nurse introduce herself to the patient, build trust and rapport by demonstrating acceptance, establishing a therapeutic environment ensuring safety and privacy • 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. EX: The nurse discusses the termination phase with the client encourages to identify the progress that the client has made and explores the necessity of any referral that maybe beneficial to the patient. 24. Elements of communication (circular transactional model) • Message- content of the communication • Sender- person who desires to deliver a message to another person or group of people • Referent- cues that initiate communication • Interpersonal variables- factors within a person that influence communication • Environment- the setting of the interaction • Receiver- person or persons who receive the encoded message sent by the sender • Channels- means of sending and receiving messages • Feedback- how the receiver indicates they understood the message 25. Non-therapeutic communication techniques • Asking personal questions • Giving personal opinions • Changing the subject • Automatic responses • False reassurance • Sympathy • Asking for explanations • Approval or disapproval • Defensive responses • Passive or aggressive response • Arguing 26. Therapeutic communication techniques • Therapeutic communication techniques are specific responses that encourage the expression of feelings and ideas and convey acceptance and respect. • Sharing observations • Sharing empathy • Sharing hope • Sharing humor • Sharing feelings • Using touch • Using silence • Providing information • Clarifying • Focusing • Paraphrasing • Validation • Asking relevant questions • Summarizing • Self-disclosure • Confrontation 27. Informed consent • Ensuring that a person has all necessary info to formulate autonomous decisions • Must be competent to make decision • Proxy decision-making- need someone to make decision for them o Examples: children, person with dementia or mental impairment, prisoners o Decisions must account for a likely individual preference and probably goals/values 28. Moral Development • Preconventional- punishment vs reward • Conventional- approval vs. disapproval • Postconventional- achieving justice, establishing personal moral standards 29. Speak up initiatives • TJC’s Speak Up Tips • Speak up if you have questions or concerns. • Pay attention to the care you get. • Educate yourself about your illness. • Ask a trusted family member or friend to be your advocate. • Know which medicines you take and why. • Use a health care organization that has been carefully evaluated. • Participate in all decisions about your treatment. 30. Empathy/sympathy • Empathy-understanding or acceptance of other feelings • Sympathy- concern, sorrow or pity felt for another 31. Erikson’s stages • Stage 1: trust vs mistrust (birth-1 yr.) infancy. EX: feeding, being comfort, teething, sleeping • Stage 2: autonomy vs shame and doubt (1-3 yrs.) toddler. EX: bodily functions, toilet training, muscular control, walking • Stage 3: initiative vs guilt (3-6 yrs.) preschool. EX: exploration and discovery, adventure and play • Stage 4: industry vs inferiority (6-11 yrs.) school-age. EX: achievement and accomplishment • Stage 5: identity vs role confusion (puberty) adolescence. EX: resolving identity and direction, becoming a grown up • Stage 6: intimacy vs isolation (young adult) EX: work and social life, intimate relationships • Stage 7: generative vs self-absorption & stagnation (middle age) EX: giving back, helping, contributing • Stage 8: integrity vs despair (old age) EX: meaning and purpose, life achievements 32. Ways to reduce barriers in learning and teaching/how to plan for low literacy levels; what is important to assess regarding patient health needs. • Determine learner characteristics and learn needs (assess) o Age, developmental stage, level of education o Health beliefs o Motivation, readiness to learn o Health risks o Current knowledge and skills o Barriers and facilitators to learning • Teaching plan o Time, available resources, adequate participants o Desired behavior changes for health promotion o Individual is an active participant o Specify actions or abilities desired during or at end of program. • Barriers of effective communication o Anxiety: Alters perception, distorts reality o Attitudes: Bias/stereotypes- limits ability to relate o Gaps between the nurse and individual: Sex, age, ethnicity, language o Resistance: Behavior to reduce anxiety, GOAL- Identify interpret, and understand behavior. o Transference /countertransference: Reacting to another as if the person is someone from the past. GOAL- understands feelings/thoughts; remove distorted reality. o Sensory barriers: (individual with limitations) Use other senses; obtain specialized assistance. o Failure to address concerns/needs: correct source of failure such as inadequate assessment o Setting: Control/alter disturbing environmental factors. 33. Teaching strategies for low health literacy learners • Establish a trusting relationship. • Invite a second person to attend the teaching session, if appropriate. • Discuss with the person what he or she can and want to do. • Limit information to essentials for achieving desired behaviors. Be realistic. • Plan what to say and organize information with the three most important points. (Frame the message first.) • Slow down! • Use common words consistently — no medical jargon. • Define terms. • Make instructions concrete/specific and vivid rather than general. • Teach one step at a time. • Break down complex instructions. • Make time for the patient to tell his/her story and express feelings. • Use a variety of teaching methods and tools. • Use techniques of tailoring and cuing. • Verify patient understanding by using teach-back technique and problem-solving situations. • Use praise and rewards. 34. Options for health care services for older adults who can no longer take care of self at home. • Private homes • Apartments • Retirement communities • Adult day care centers • Assisted living facilities • Nursing centers 35. Healthy people 2020 goal Older adults • Healthy people 2020 o increase the number of older adults with one or more chronic conditions who report confidence in maintaining their conditions. o Reduce the proportion of older adults who have moderate-to-severe functional limitations. o Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-term physical activities 36. Signs in teenager of possible related substance abuse. • Mood changes • Bad grades • Loss of interest in activities • Poor hygiene • Secretive behavior 37. Behavior of adolescent that may be risk for self-harm. • Poor school performance • Lack of interest in things that were of interest to the adolescent in the past • Social isolation • Disturbances in sleep or appetite • Expression of suicidal thoughts 38. Teaching strategies for each developmental stage (all 8) • Toddler (preoperational stage, symbolic thought) o Play imperative----learn by repletion o Picture books o Singing songs • Preschool (preoperational stage, symbolic thought) o Promote early literacy (books, storytelling) o Create a playful environment o Teach through observation o Creativity and art o Teach alphabet with animal images o Give natural examples • School-age (concrete operational) o Teaching should be interesting and meaningful o Use concrete materials o Games • Adolescence (formal operational, abstract concepts) o Interact with them o Break down objectives o Addition of emotion can help them remember o Practice/rehearsal o Visual o Analogy o Hands on • Young adult/middle adult (formal operational) o Keep relevant o Integrate emotion into lesson o Encourage exploration o Always offer feedback o Motivate • Older adults (formal operational) o More than words o Learn at slower rate o Maintain a positive attitude o Identify and try to accommodate any disability that may affect the learning process. o Stop teaching if the patient appears tired or stressed o Break each topic into small parts. Repeat sessions when necessary. Give pertinent, positive feedback. [Show Less]
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NR 222 Final Exam – Question with Answers
NR 222 Final Exam – Question with Answers NR 222 Final Exam – Question with Answers 1.) The nurse is to instruct the client about the long- term c... [Show More] onsequences of non-compliance to prescribed medication. Which education strategy would be most appropriate for the nurse to use in order to develop the affective learning domain of the client? • A. Lecture followed by a simple written test. • B. Role playing and group discussion • C. Video presentation and handouts • D. Demonstration and practice 2.) A nurse manager is teaching a group of nurses about the levels of prevention. Which example of the tertiary level of prevention should be included in the instruction. • A. Surgery to repair a hip dislocation of an older adult client. • B. Teaching breastfeeding to expectant mothers in a prenatal clinic. • C. Chemotherapy treatment to a client newly diagnosed with cancer. • D. Physical therapy to a patient who has a right sided paralysis from a stroke. 3.) A nurse is establishing health promotion goals for a female client who smokes cigarettes, has hypertension and has a BMI of 26. Which of the following goals should the nurse include? • A. The client will list foods that are high in calcium, which should be avoided. • B. The client will walk for 30 mins a day 5 days a week. • C. The client will increase calorie intake by 200 cal per day. • D. The client will replace cigarettes with smokeless tobacco products. 4.) Which of the following emphasizes that an individuals belief in being personally capable of preforming the behavior is required to influence one’s own health? A. Social Cognitive Theory B. Self–Efficacy Theory C. Health Belief Model D. Theoretical Model 5.) The nurse is discussing the importance of routine preventive care with a Hispanic family who has recently immigrated to the United States. Which factor will the nurse consider as a barrier in the family’s interest to receive professional health care? Select All That Apply A. Lack of health insurance B. Concern about invasion of privacy C. Absence of transportation services D. Limited proficiency in the English Language E. Belief and accessibility to folk healers and remedies F. The availability of family members for support and help 6.) The following are true about Healthy People 2020 initiative (Select All That Apply) • A. Healthy People Initiative provides science-based, 10 year national objectives for improving the health of all Americans. • B. Healthy People initiative seeks to change the health practices of people who are most at risk to illness and injury thereby decreasing the cost of health care and maintenance. • C. For 3 decades, Healthy People initiative has established benchmarks and monitored progress over time in order to encourage collaborations across communities and sectors. • D. Healthy People initiative was developed to established health improvement priorities and measure the impact of prevention activates. • E. Healthy People initiative gives protocols to each state on how conduct community health prevention education and giving nurses standards on educational programs. • F. Healthy People initiative empower individuals towards making informed health decisions . 7.) True statements about the ANA Code of Ethics (Select All That Apply): • A. The nurses primary commitment is to self first; then , if the situation is favorable, commitment to the patients whether the individual, family, group, community, or population. • B. The nurse has authority, accountability and responsibility for nursing practices; make decisions; and takes action consistent with the obligations to provide optimal patient care. • C. The profession of nursing articulates its values through individual nurses without recommendations from professional organizations; maintaining integrity and principles of social justice into nursing and healthy policy is optimal for nurses. • D. The nurse owes the same duties to self as to other, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence and continue personal and professional duties. • E. It is the nurses responsibility to protect human rights, promote health diplomacy, and reduce health disparities. • F. Nurse advocates for, and protects the rights, health, and safety of the patient. 8.) The following are health concerns and issues of migrant workers (Select All that Apply) • A. Pesticide exposure • B. Iron deficiency anemia • C. Constipation and Dehydration • D. Tuberculosis • E. Chronic Conditions • F. Dental Disease 9.) Which data represents objective findings? (Select All That Apply) • A. Lab values • B. Pain level state by the patients • C. Patients stated emotional status • D. Respiratory and pulse oximetry reading. • E. The nurse’s description of the patient’s gait. 10.) The steps included in the nursing process include: (Select All That Apply) • A. Use a nursing diagnosis to state the problem. • B. Plan care to help meet stated patient goals • C. Collect data and asses the patient • D. Establishes priorities, patient goals and outcomes. • E. Determine appropriate nursing interventions for patient care. • F. Order labs that are needed for the patient. 11.) What information is about nursing standards of care? • A. Nursing standards of care guidelines for nursing practice. • B. Nursing standards of care are defined in Nurse Practice Acts. • C. Nursing standards of care are used to measure nursing conduct in malpractice suit. • D. Nursing standards of care are specific guidelines only for unlicensed assistive personnel. • E. Nursing standards of care are upheld by law and indicate what standards nurse must follow. • F. Nursing standards of care are used to determine whether the nurse acted as any reasonably prudent nurse under the same or similar conditions. 12.) The nurse is discussing the importance of routine healthcare with a Hispanic family who has recently immigrated to the United States. Which factor will the nurse consider as a barrier to the family’s interest to receive professional health care? (Select All That Apply?) • A. Lack of health insurance. • B. Concern about invasion of privacy. • C. Absence of transportation services. • D. Limited proficiency in the English language • E. Belief and accessibility to folk healers and remedies • F. The availability of family member for support and help. 13.) Which statement by the nurse best describes values? • A. Values are not constant; they change over time. • B. Values learned in childhood remain the same for a lifetime. • C. It is impossible for people to understand their own values. • D. The clients values are not considered when care is provided. 14.) Which educational strategy would be most appropriate to use in order to provide affective learning domain of the client? • A. Lecture followed by simple written test • B. Video presentation and handouts • C. Role playing and group discussion • D. Demonstration and practice 15.) The American Nurses Association (ANA) has recommended the following competency for RNs? • A. The RN’s to recognize their own values, beliefs, and cultural heritage. • B. The RNs to function independently and occasionally engage in collaboration. • C. The RNs to be concerned about the existence of vulnerable cultural groups. • D. The RNs to provide health care opportunities to those with financial capabilities. 16.) An RN is teaching a group of patients about Diabetes Management material from a Diabetes Education Program. Which of the following should an RN prepare prior to each teaching session? • A. Plan handouts on general principles that patients can understand materials at the high school level. • B. Implement changes during class whenever a patient complains the material is too difficult to understand. • C. Assess materials to be relevant plan changes according to the needs of patients, implement teaching according to the patients ability to understand the information. • D. Assess, plan, implement, and evaluate teaching materials only according to the recommendations of the director of nursing. 17.) Which statement is true regarding secondary prevention? • A. The nurse creates a care plan for the patients outpatient therapy. • B. The nurse identifies individuals in an early detectable state of the disease process. • C. The nurse focuses on increasing the patient’s self-care by providing prevention instructions. • D. The nurse is driven by the objective to minimize the effect of the disability through rehabilitation. 18.) One Leading Health Indicator (LHI) of Healthy People 2020 is the availability of medical services to all people. Which topic does this cover • A. Injury and Violence • B. Environmental Quality • C. Access to Health Services • D. Clinical Preventative Services 19.) How would the nurse approach this ethical dilemma: Two patients are on the list for kidney transplants and they will both die without one. Which patient would get the one kidney that is immediately available for transplantation. • A. Choose the patients who has the ability to fiancé the hospitalization and treatment. • B. Advocate for the younger of the two clients since that client will live longer. • C. Use ethical principles to guide the decision making process. • D. Select a client who is most productive in society. 20.) The leading health indicators found in Healthy People 2020 are the following: (Select all that apply) • A. Access to health services • B. Holistic and CAM strategies • C. Oral Health • D. Issues related to legal and illegal immigration • E. Environmental health • F. Holistic Care 21.) Which statement best describes Erikson’s Theory of Development. • A. The premise of the theory is that individuals are interdependent beings. • B. Developmental stages result in an attempt to make sense of the world. • C. A healthy personality will achieve the pre-conventional stage by 15. • D. An individuals achievements of identity is through sequential psychosocial stages. 22.) A patient with chest pain is being admitted to the ER. When asked about the next of kin the patients states, “Don’t bother calling my daughter; she is always too busy.” Which is best response by the nurse? • A. “She might be upset if you don’t call her.” • B. “ What does your daughter do that makes her so busy?” • C. “Is there someone else that you would like me to call for you?” • D. “I cant imagine that your daughter wouldn’t want to know that you are sick.” 23.) A patient states, “Do you think I could have cancer?” The nurse responds, “What did the doctor tell you?” Which interviewing approach did the nurse use? • A. Paraphrasing • B. Confrontation • C. Reflective Technique • D. Open-ended question 24.) A patient is admitted to the hospital with cirrhosis of the liver causes by long-term alcohol abuse. Which is the best response by the nurse when the patient says “I really don’t believe that my drinking a couple of beers a day has anything to do with my liver problem?” • A. “You find it hard to believe that beer can hurt the liver” • B. “How long is it that you have been drinking several beers a day?” • C. “ Each beer is equivalent to one shot of liquor so its just as damaging to the liver as hard liquor.” • D. “ Do you believe that beer is not harmful even though research shows that it is just as bad for you as hard liquor?” 25.) A patient is extremely upset and mentions something about work-related issues that the nurse cannot understand. Which is the nurses best response? • A. “Its natural to worry about your job.” • B. “ Your job must be very important to you.” • C. “Calm down so I can understand what you are saying.” • D. “ I’m not quite sure I heard what you were saying about your work.” 26.) A nurse must conduct a focused interview to complete an admission history. Which interviewing technique should the nurse use? • A. Probing • B. Clarification • C. Direct questions • D. Paraphrasing statements 27.) The home care nurse is visiting an older client whose spouse died 6 months ago. Which behaviors by the client indicates effective coping? • A. Neglecting personal grooming • B. Looking as old snapshots of family. • C. Participating in a senior citizens program • D. Visiting spouses grave once a month • E. Decorating a wall with the spouses pictures and awards received. 28.) A nurse is planning to provide personal health care information to several patients. Which patients should the nurse anticipate will be more motivational to learn? • A. 55 y/o F who has a mastectomy and is very anxious about her body image. • B. 56 y/o M who has a heart attack last week and is requesting information about exercise • C. 18 y/o M who smokes two packs per day and is in denial about the dangers or smoking. • D. 47 y/o F who has a long leg cast after sustaining a broken leg and is still experience severe pain. 29.) The nurse asses a patient and collects a variety of data. Identify the human response that are subjective data. Select all that apply: • A. Nausea • B. Jaundice • C. Dizziness • D. Diaphoresis • E. Hypotension. 30.) A nurse is collecting information to prepare a teaching plan for a patient with type 1 diabetes. Which question asked by the nurse is associated with collecting information in the cognitive domain of leaning? • A. “ How do you inspect your feet each day?” • B. “Can you measure a serum glucose levels?” • C. “ What do you know about diabetes mellitus?” • D. “Are you able to preform a subcutaneous injection? 31.) Which of the following emphasizes an individuals belief and being personably capable of preforming the behavior is required to influence ones own health. • A. Social cognitive theory • B. Self efficiency theory • C. Health Belief Model • D. Transtheoretical Model 32.) A nurse sets up an education program to discuss health disparities for high school students, one of the first steps of the process is for: Which of the following • A. Describe health behaviors • B. Decrease morbitity [Show Less]
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