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NURS300 PRACTICE EXAM 1 Questions
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Importance of EBN practice - Answer Evidence-Based Nursing Practice Important to improve patient outcomes
- research: one standard of pro performance should implement care based on "best" available evidence, nurse's expertise, pt's preference State Board of Nsg: Functions/ Purpose; - Answer Main purpose: Ensure enforcement of state nurse practice act Established by Ns Practice Act Regulates those under Ns practice act (NPA) and prevents those not under NPA from practicing nursing
- title of "nurse" is protected; HUNS; nursing student not student nurse Ns Practice Act: Purpose, Importance - Answer IMPORTANT - The Law in each state Addresses: LPNs, RNs, APNs, CNMs
- Sets educational requirements, exam requirements, licensing
- Defines actors and duties allowed and functions
- Defined and guided by each state by Common Law "protect public by setting and enforcing standards of nsg educ and practice"
- violations of nurs practice act is a criminal offense single most imperative piece of legislation for nsg; impacts every aspect of nsg practice; it is the law w/in each state scope of nursing practice
ANA - Answer American Nursing Association Care, Cure, Coordination
- under: distant, disinterested, neglect/detrimental to pt
- zone of helpfulness: majority of pt interactions should occur for effectiveness and pt safety
- over: boundary, crossed/violate, sexual misconduct Guidelines for professional behavior: - Answer - define and maintain boundaries
- zone of helpfulness
- cognisant of potential consequences
- do not cross boundary/repeat
- care environment and community, pt requirements and type of therapy Professionalism - Answer - other HTM (health team members)
- other disciplines, pts, families, public
- role models w/ service, compassion, care, passion, character, integrity
- As Christian servants we must strive to do our best in whatever we do, allowing the Lord to use us as He desires Theory and contributions of Florence Nightingale to nursing - Solution Environmental Theory, which integrated recovery of the patient's normal health state into care delivery—still follows. She mentioned in her nursing notes that nursing "is the act of utilizing the patient's environment to help him in his recovery"
- fresh air, pure water, effective drainage, light, cleanliness, quiet, warm, help dietary needs (Crimean War nurse, Nursing school at St. Thomas hospital in London, "Notes on Nursing" book)
- use pt's environment to assist him in recovery
- "lady with the lamp", improved status of nsg, 1st nurse researcher, improved nsg art/science and education, collect/report data
Influential societal influences on the nursing profession - Answer Improved status of women Civil rights/human rights Health care reform: Obama Care Morals/values Mobility Technological advances Multilevel care settings Political arena Cultural/Gender diversity Who defines standards of nsg practice - Answer American Nursing Associated through Nursing Practice Act Profession: Characteristics and Behaviors - Answer Stay in Zone of Helpfulness-not over-involved, not under-involved Roles of a professional nurse - Answer caregiver communicator teacher counselor advocate clinical decision maker leader/ change agent manager researcher friend/comforter surrogate parent
CNS - Answer Clinical Nurse Specialist Advanced degree, specific clinical speciality (Ex: diabetes, wound, cardiac care, etc.) CRNA - Certified Registered Nurse Anesthetists Specific types of anesthesia Order from physician CNM - Certified Nurse Midwife Prenatal, delivery, post-natal CNE - Certified Nurse Educator Examination first taken in Sept 2005 Other advanced practice roles - Nsg admin Nsg informatics Clinical ns leader nurse policy National patient safety goals: hospital and ltc/nursing care center - Joint Commission provides National Patient Safety Goals yearly Communication Probing- - p 472 Asking b/c of curiosity and not helping client. Prying - Asking "why" Pt can become defensive Reflecting-- Respond Direct ideas, feelings, questions, or content back to clients to allow them to explore their own ideas/feelings about a situation (EX: " What do you think would be helpful?") Attending-- Respond Being present to another or being w another (face the person, open posture, lean toward person, eye contact, relaxed)
Summarizing- - Answer State main points of discussion. Review, "We talked about." Encouraging Comparison- - Answer asking to describe similarities and differences among feelings, behaviors, and events. · "Can you tell me what makes you more comfortable, working by yourself or working as a member of a team?" Clarifying- - Answer Making client's broad meaning more measurable.can confess confusion or clarify their own message. General Leads- - Answer Encourage pt to verbalize, choose topic of conversation, and facilitate continued verbalization (Ex: " Then what?" Perhaps you would like to discuss. Offering Self- - Answer SUggesting one's presence, interest, or wish to understand client without demands/conditions. (Ex: "I'll stay w you until your fam arrives" or "You don't have to talk till you're ready" or "I'll help you get dressed.") Validation--Seek consensual validation, meaning of specific words.Clarifying a certain word/ sentence instead of the whole meaning. Personal space designations - Answer Intimate (0-18in) Personal (1.5-4ft) Social (4-12ft) Public (12+ft) Examples of therapeutic responses by the Nurse in patient situations - Answer restate, open-ended questions, state observations, acceptance, silence Examples of inhibition/barriers to therapeutic communication - Answer language sociocultural differences
Translator? Process recording: primary purpose - Answer to evaluate your communication skills with your patient, how you can improve or things that worked well; IPR Purpose of nursing process - Answer - identify pt health status
- identify actual or potential health care needs
- establish plans to meet needs
- provide specific individualized nsg interventions to meet needs (provide individualized nursing care)
- assess effectiveness of interventions Nursing Critical thinking - Answer - intentional higher level thinking "nursing judgement"
- essential to nsg practice
- guides ns in all aspects of pt care
- critical analysis, clarify, questions, reason (inductive/deductive), infer, differ facts/opinion, recognize assumptions Attitudes to promote critical thinking - Answer - independence, fair-mindedness, insight to egocentric, intellectual health, courage, integrity, persevere, confident, curious
- ns should use knowledge from other subjects, deal with changes in stressful environ, make important decisions, hold high standard, responsible, practice tech skills, gain interpersonal skills, flexible/independent/self confident Nursing process: purposes, all steps in order, interrelatedness of each step - Answer Assessment Diagnosis Planning Implementation Evaluation SEE example slides
Each step is dependent on accuracy of previous phase, not always in order, may do phases simultaneously, interrelated Assessment - Answer collect/organize data
- interview/observation, physical exam Compare subj/obj data, validate conflicting data, double check!
- Observation (Ex: inspect skin)
- Interaction/Interview (Ex: mental status, pt reporting, hx taking)
- Measurement/Exam (Ex: Intake and output, edema, skin type, vitals, etc.) Diagnosis - Answer identify pt strengths/problems Planning - Answer Set goals and write nsg orders Implementation-Answer Carry out plan of action Evaluation-Answer Determine if plan was effective, revise Differentiating between assessing in assessment and assessing in evaluation-Answer Evaluation assessment is seeing if plan was effective and revising it. benefits of using nsg process-Answer- organize method of giving nsg care
- prevents omissions and unnecessary repetitions
- helps ns make interventions for individual (not dz)
- helps pts and families realize their input is important and strong points are assets
- promotes flexibility and independent thinking
- provides incr. communication
- helps ns have satisfaction with results
What is nursing Analysis/Diagnosis - Answer mental process, ns applying critical thinking/nsg judgment; identifies patterns, and makes a judgment about human response to actual/potential problems
- thought process, flows into and from other steps
- directs interventions - > outcomes for which ns accountable Nsg Dx importance- Answer personalized care, more efficient organization of nsg care, identifies scope of nsg, enhances professional interdisciplinary communication, more professional autonomy and responsibility for nursing, enhances computerized planning of care/ electronic health records only when proficient in the of nursing and medicine will the nurse be recognized as a professional and not just a helper for the doctor - Answer science road to nsg dx - Answer data clustering - > data validation - > interpret of data - > ID of pt needs - > formulation of nsg diagnoses Human responses occur in all and occur at levels of functioning including , , and - Answer demensions, cellular/systemic/holistically Purposes of a nursing diagnosis - Answer Purpose: identify pt health status, actual/potential health care needs. Establish plans, deliver specific individualized interventions. Evaluate effectiveness Different types of nursing diagnosis/problems [actual, risk, possible] - Answer An actual diagnosis identifies a CURRENT health problem (Ex: inadequate airway clearance as evidence by the inability to maintain adequate oxygenation on room air), present at any time of assessment A risk diagnosis identifies when a patient could be at RISK for additional health problems (Ex: infection), likely develops if ns not intervene, pt has risk factors
A wellness or health promotion diagnosis identifies a patient's READINESS to move to a higher level of wellness (Ex: readiness for improved self-care to enhance cardiac output related to increased cardiac output due to pacemaker insertion) A syndrome diagnosis determines SYMPTOMS based on specific situations. (Ex: post-trauma syndrome or relocation stress syndrome) A Possible diagnosis resulting from UNCLEAR OR INCOMPLETE EVIDENCE to a particular health problem (Ex: possible social isolation), have data to suspect but not enough to be sure Nsg diagnoses based on what? How does the nurse develop an accurate patient problem list? - Answer based on pt. information, scientific rationale/research (EBP); critical thinking, nsg judgment, human responses The NANDA diagnosis has three parts 1. label-short phrase that describes the patient's health
- definition-defined explanation
- defining characteristics-cues (S and O data) that lead one to determine the presence of the label Diagnosis problem statement includes: - Problem: describes health condition, pinpoints what needs to be modified Etiology: cause, risk factors may or may not come from NANDA, permit individualization Related to: links, does not use "due to" since it infers a direct cause/effect
- write diagnosis w/ qualifiers 1st like ineffective airway clearance or decreased cardiac output Basis for accuracy of nursing diagnoses Answer Read backwards! Problem/Etiology > Related to >. problem (dysfunctional health pattern) r/t etiology (influencing/assoc factors)
Barton - Red Cross! Richards - First training nurse, nurses note Mahoney - First black nurse Wald - Nursing schools, public health nsg Dock Sanger Breckinridge Christman Shultz Malone - Answer Dock - Feminist, political activist, nsg school Sanger - Birth control!, planned parenthood Breckinridge - Midwives, pioneer ns in kentucky, horse Christman - Male nurse! Shultz - President NLN for 2 yrs, first dean of HCCN Malone - first black president/CEO of NLN Define Nurse - Answer Nutrix (Latin) "To nourish"
- promote health, prevent illness, restore health, facilitate coping with disability/death Nursing is: - Answer art (display yourself), science (knowledge), caring (interact), holistic, pt-centered, service-oriented profession patient vs. client - Answer patient: may imply passive acceptance of care client: implies collaboration and responsibility for own health philosophy of nursing - Answer addresses: man, health, society, environment, global perspective, caring
Special knowledge - Answer - distinct from other disciplines, socialization process, based on research (EBP) Special skills - Answer orientation to, standards of special preparation - Answer - standards in educ. programs, accreditation (meet standards) Autonomy - Answer - standards of educ. and practice determined by Members of profession
- regulate self, code of ethics Socialization - Answer - Patricia Benner- novice to expert NANDA - Answer ANA practice councils for development, review, and approval of nursing diagnosis Every 2 years - approved diagnostic labels, researched/tested clinically Human Dimensions - Answer Cellular, systemic, hollistically Human responses - Answer Physical, Psychological, Social, Emotional, Spiritual Nursing advocacy - Answer - speak for those who cannot speak for themselves
- see situation from pt. perspective
- "walk the walk"
- ANA code of ethics compassion - Answer - Job and Jesus
qualities of a caring nurse cont. - Answer - calm under stress, mild anxiety, empathy/understanding demonstrate warmth
- listen carefully, answer questions promptly and honestly Marcus Engel - Response - "I'm Here", nickname, shared experience, privacy, do not say "I know how you feel", acknowledge their circumstances and let them know you're there for them, let them know if their vitals were good Kent Brantley - Response use compassion over fear modes of comm - Response verbal (10%) - para verbal cues provide meaning nonverbal (90%) - more universal, body language, face electronic/digital art/photography Nonverbal messages Answer facial expressions : support, contradict, disguise Eyes / lips Posture (leaning forward/back), gestures (culture), touch (caution), physical appearance Never assume, always validate message Therapeutic communication - Answer - purpose, goal, boundaries, pt focus, nonjudge, well-planned, accurate, enhance ns-pt relationship
- Appropriate, privacy/confidential, guidelines, comfort, encourage/accept, be aware of one's feelings Comm influencing factors - Answer - perception: past, expect/goal, develop level, edu, culture, time space and distance: proxemics study of distance between people/objects personal space buffer zone invasion discomfort anxiety fight/flight Types of personal space - Answer intimate: 0 - 18 inches in this mostly with patients personal: 1.5- 4 feet
social: 4 ft - 12 ft public: 12 ft and beyond components of therapeutic comm - Answer - warmth accept/care empathetic appreciate/aware genuine one's self/self aware/sincere attentive listening comm techniques for pt with special needs - Answer pt who cannot speak clear, cog impair, cannot hear clearly, unresponsive, do not speak english
- process recording (IPR): used to assess communication skills Facilitators of Comm - Answer - enhance social interact, paraphrase, open ended questions, listen, use of silence, touch, gentle humor, summarize, assertive (pg. 420 - 421) Barriers to Comm - Answer - falsely reassure, defensive, disapproval, stereotype, ask why, change subject, belittle, give opinion, pet names (pg. 422)
- lang diff, sociocultural diff, gender diff, health status, developmental level, knowledge diff, emotional distance, emotions, daydreaming/texting
- treat dz vs. treat pt Hospital national safety goals - Answer - pt ID (2 ways, blood transfusion)
- staff comm (test results in lab) meds (never admin something someone else prepares, label, anticoagulants, correct info/medicine reconciliation) alarms ("alarm fatigue") infection (hand washing, resistant to treat, blood, surgery, UTIs from catheters) pt safety risks (suicide/falls/pressure ulcers) surgical errors (correct surgery, body part, "time out" to catch mistakes)
