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Foundations Nursing
Foundations Nursing set 2
| Question | Answer |
|---|---|
| The nursing diagnosis is formed based on information obtained during which part of the nursing process? | Assessment. |
| What are the benefits of using nursing diagnoses? | -Promotes accountability in nursing care. -Supports independence in nursing practice. -Establishes standardization of patient care. |
| What does the nurse do with the nursing diagnosis during the diagnosis step of the nursing process? | -Selects. -Individualizes. |
| Which statement about the diagnosis step of the nursing process is true? | The nurse makes clinical judgments about a patient's experiences and responses to problems, or life events. |
| What is the purpose of the nursing diagnosis? | Identify health problems or life processes. |
| What was the purpose of the first unofficial nursing diagnosis conference in 1973? | Develop a nursing taxonomy. |
| What are the goals of NANDA? | -Revise nursing taxonomy. -Generate nursing diagnostic categories. -Promote research to validate diagnostic labels. -Encourage nurses to use taxonomy in practice. |
| What is the purpose for NANDA-I to continue to meet every two years? | Revise and update the taxonomy. |
| Where are nursing diagnostic labels selected from? | NANDA-I approved list |
| The nurse is writing a care plan for a patient with pulmonary embolism. Which step of the nursing process is nursing diagnosis? | Second. |
| When formulating a nursing diagnosis, what does the nurse analyze to identify patient problems and select appropriate nursing diagnoses? | Assessment data. |
| How does the nursing diagnosis provide an effective means of communicating the patient's status? | By consolidating a great volume of information into a concise statement. |
| What does use of nursing diagnoses promote? | -Accountability in nursing. -Independent nursing practice. -Patient care standardization. -Effective communication. |
| What is the process of identifying a patient's illness in order to provide appropriate medical care? | Medical diagnosis. |
| Which statement is true regarding the International Classification for Nursing Practice (ICNP®) taxonomy? | The taxonomy has widespread application due to being translated into many languages besides English. |
| Which explanation would a nursing instructor provide to a student regarding how the ICNP® helps generate nursing research? | Integration of the ICNP® into clinically-based electronic medical records (EMRs) has created a large and accessible database. |
| Which explanation of the use of supporting data in the ICNP® nursing taxonomy is accurate? | Supporting data are the assessment findings that direct the nurse to an appropriate nursing diagnosis. |
| Where are NANDA-I nursing diagnostic labels selected from? | NANDA-I approved list |
| In which way does the nursing diagnosis provide an effective means of communicating the patient's status? | By consolidating a great volume of information into a concise statement. |
| Use of properly formulated nursing diagnoses promotes which outcome? | Accountability in nursing, Independent nursing practice, Patient care standardization, and Effective communication |
| During which process is a patient’s illness identified in order to provide appropriate medical care? | Medical diagnosis |
| Which statement comparing medical diagnosis and nursing diagnosis is true? | The purpose of nursing diagnosis is to clearly identify problems so appropriate nursing care can be provided. The purpose of medical diagnosis is to identify illness so medical treatment can be provided. |
| NANDA identified which goal initially during the development process? | Implement nursing diagnostic categories. |
| NANDA is known for its pioneering work in which aspect of nursing? | Nursing language and classification. |
| Which group of people make up NANDA? | Nurses from all nursing areas |
| NANDA-I members meet every two years. Which initiative is the focus of this meeting? | Taxonomy revision and Evaluation of nursing research |
| The patient fell and fractured his hip. He also has diabetes, heart failure, and osteoporosis. Which aspect of the patient's history would a nursing diagnosis focus on? | Sudden onset of pain |
| Why does the nurse focus on airway status when developing a nursing diagnosis for a patient with asthma? | To identify the patient's response to illness |
| Which outcomes are the result of using nursing diagnoses? | Promotes accountability in nursing care, Supports independence in nursing practice, and Establishes standardization of patient care |
| In which way is the ICNP® taxonomy different from the NANDA-I taxonomy? | The ICNP® taxonomy includes different catalogs of nursing diagnoses, outcomes, and interventions. |
| In which way is the ICNP® taxonomy valuable to the nursing profession? | Documentation of the validity of nursing practice is a result of its use. |
| Which statements made by a nursing student would indicate an understanding of the benefits of using the ICNP® nursing taxonomy in practice? | ICNP® nursing diagnoses can be applied in the acute care setting as well as in other health care related settings, Use of the ICNP® taxonomy gives nursing a voice within the comprehensive health information system, The standardized terminology makes the I |
| _______ is public service over personal gain. Nurses recognize nursing as their life's work. It is an important component of their lives and clearly defines who they are. Nurses focus on service to their patients and the community. | Altruism |
| Nursing has ____ demonstrated powerful contributions to education, research, administration and professional practice for guiding nursing thought and action. That knowledge has shifted the primary focus of the nurse from nursing functions to the person. | theoretical knowledge |
| Nursing _____ is essential for developing trusting relationships with patients and coworkers. ______ involves accepting responsibility for actions and omissions, as well as legal, ethical, and professional implications. | accountability |
| _______ offers nurses greater professional opportunities and the training necessary to extend nursing science through advanced practice and research. | Higher education |
| ______ in nursing is the ability of the nurse to assess and perform nursing actions for patient care based on competence, professional expertise, and knowledge | autonomy |
| Practice and conduct within a profession is guided by a _____. _____ is the standards of right and wrong behavior | code of ethics |
| Numerous _______ support and encourage high standards in nursing. Each nursing organization determines responsibilities and standards of conduct and regulates its members’ adherence to its own professional standards. | professional organizations |
| Members of a profession have legally recognized _______ that demonstrate basic competency to practice. | licensure |
| According to the ICN, nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. | diversity |
| Which nursing action demonstrates altruism? | Focusing on service to others |
| What is the purpose of the Nursing Code of Ethics? | Guiding nurse practices and conduct |
| Which requirement is mandatory to obtain the RN credential in the United States? | State licensure |
| standards of practice | Assessment Diagnosis Outcomes identification Planning Implementation Evaluation |
| professional performance: | Ethics Education Evidence-based practice and research Quality of practice Communication Leadership Collaboration Professional practice evaluation Resource utilization Environmental health |
| main concepts | Accountability, Advocacy, Autonomy, Beneficence, Confidentiality Fidelity Justice Nonmaleficence Responsibility Veracity |
| Which values does the Nursing Code of Ethics address? | Equal treatment Patient advocacy Commitment to others |
| What do state nurse practice acts define for nurses residing or working in that state? | Scope of practice Legal practice limits |
| Which examination must a nursing student pass for licensure? | NCLEX |
| Registered nurses can delegate to which other level of health care provider? | LPN/LVN |
| A nurse must obtain which educational degree prior to obtaining licensure as an advanced practice nurse? | Master of science in nursing |
| Which statements are true of advanced practice registered nurses (APRNs)? | APRNs provide at least some level of direct patient care. Collaboration is a core competency for APRNs. APRNs have acquired theoretical research-based and practical knowledge |
| Which activity is within the LPNs/LVNs scope of practice? | Collect patient data Administer intramuscular medications |
| During the role of socialization process, which ability does the student acquire to transform into a nurse? | Prioritize concerns |
| The new graduate nurse attending the hospital's orientation session is an example of which process? | Role socialization |
| Which characteristic exemplifies nursing as a profession? | Autonomy in decision-making |
| When the nurse collaborates with the dietary department to provide a kosher meal for a patient, which professional criterion does this action support? | Diversity |
| A nurse taking continuing education classes is an example of which professional nursing criteria? | Licensure |
| Which is the most important group a nurse can join to gain support and foster growth within the profession? | Professional organization |
| Which term describes nurses who engage in selfless acts? | Altruistic |
| Which is the best document for the nurse to consult when making decisions about nursing practice or conduct? | Code of ethics |
| Which entity publishes and updates the Standards of Nursing Practice? | American Nurses Association |
| Which is the best document for the nurse to consult to ensure delivery of quality patient care? | ANA Standards of Nursing Practice |
| Which process is involved in the nurse’s socialization into the profession of nursing? | Learning the theory necessary for the nursing role |
| Which option is available to nurses who want to expand their practice, but do not desire to return to formal education? | Become certified in current practice area. |
| Which statement differentiates APRNs from RNs? | They are approved to practice in expanded roles. |
| Who can update a patient’s plan of care, but cannot initiate that plan of care? | LPN/LVN |
| A patient is considering a new health care provider. What is the difference between a FNP and a CNS? | Serve as primary care providers. |
| A nurse who holds a PhD can engage in which role? | Researcher Educator Scholar |
| What is a benefit for new nurses who join professional organizations as part of the socialization process? | Access to current resources |
| What are the methods through which assessment is conducted? | Methods through which assessment is conducted include observation, the patient interview, and a physical examination. |
| Using sight, hearing, and smell to observe general affect, hygiene | Observation |
| Collection of demographic and medical data | Patient Interview |
| Systematic assessment of the patient’s body | Physical examination |
| What is the first thing a nurse should do when interacting with a patient? | Provide a personal introduction |
| During which phase of the patient interview does the nurse state the purpose of the interview? | Orientation |
| A nurse is performing an interview and asks the patient about allergies and medications. These questions occur during which phase of the patient interview? | Working |
| Which type of assessment is a five-tier system that classifies patients by levels numbered 1 through 5? | Triage |
| Thorough interview, health history, and physical exam | comprehensive |
| Brief assessment when there is a concern about the patient’s condition | focues |
| Very focused survey with rapid decisions to address immediate concerns | emergency |
| Frequent assessments to evaluate the patient and note changes in baseline | shift |
| Which type of assessment is performed on a patient entering an emergency department to identify if the patient needs to be treated immediately or can wait to see the health care provider? | Triage |
| The nurse enters the patient’s room and says, “Hi, my name is Barbara. I am your nurse. Let’s discuss why you have been admitted to the hospital.” What phase of the patient interview is taking place in this situation? | Orientation |
| A nurse is performing an interview and asks the patient about allergies and medications. These questions occur during which phase of the patient interview? | Working |
| At the end of the interview, the nurse lets the patient know the interview is complete and the doctor will be in shortly. Before leaving the room, the nurse asks the patient if there are any questions. Which phase | Termination |
| Which assessment should be performed during the patient’s initial visit to a new health care provider? | Comprehensive |
| A nurse enters a patient room to assess the patient's blood pressure, temperature, pulse, and pain. What type of assessment is being performed? | Focused |
| Which assessments are completed first during an emergency? | Airway, Breathing, Circulation |
| During which type of assessment would the nurse be most likely to assess skin turgor and capillary refill to determine the patient's clinical status? | Shift |
| What information should be included in a health history? | Patient's social history, Reason for seeking medical care, Patient demographic information, Medications the patient is currently taking |
| Which action is appropriate when attempting to build trust and rapport with a patient during the assessment process? | Ensuring patient comfort and privacy |
| What information is obtained during a patient interview? | Current health concerns, Medical and surgical history, Culture, ethnicity, and spiritual views |
| Which type of physical assessment is usually governed and directed by the policies of the health care facility? | Shift |
| Laboratory and other diagnostic tests are obtained during a patient office visit. These tests are associated with which type of patient assessment? | Comprehensive |
| During which phase of the interview is the patient given an opportunity to ask questions and add any additional information that may have been forgotten? | Termination |
| In addition to patient statements, what should the nurse be very attentive to during the interview? | Non-verbal cues |
| The nurse is about to conduct a focused assessment at the beginning of the work shift. Which assessments will be performed? | Peripheral pulses, Skin turgor, Urinary output, Wounds |
| When nurses make determinations about patients needing emergent, urgent or non-urgent care, which type of assessment are they using? | Triage |
| A nurse makes preliminary observations about a patient. What is the term for this action? | General survey |
| Problem-based interventions: | Implemented to manage and treat existing problems |
| Prevention-based interventions: | Implemented to prevent problems |
| Independent nursing interventions: | Initiated and conducted by the nurse |
| Dependent nursing interventions: | Initiated by a provider in the form of an order, and conducted by the nurse |
| Collaborative nursing interventions: | Initiated by the nurse or through consult with other healthcare team members, and conducted by other healthcare team members |
| Direct-care interventions: | Involve direct personal contact with the patient |
| Indirect-care interventions: | Benefit the patient, but do not involve face-to-face contact with the patient |
| The nurse is performing patient care interventions and documenting interventions in the chart. Which step of the nursing process is this? | Implementation. |
| Implemented to manage and treat existing problems | Problem-based |
| implemented to prevent problems | Prevention-oriented |
| Involves direct personal contact with the patient | Direct-care |
| Does not involve face-to-face contact with the patient | Indirect-care |
| Initiated and conducted by the nurse | Independent nursing |
| Initiated by a provider in the form of an order, and conducted by the nurse | Dependent nursing |
| Initiated by the nurse and conducted by other health care team members | Collaborative nursing |
| Which is the type of intervention that benefits the patient but does not involve face-to-face contact with the patient? | Indirect-care |
| Which statement about indirect-care interventions is true? | Delegation is an indirect-care intervention. |
| Which statement about nursing documentation is true? | Documentation conveys interventions and outcomes to other care providers. |
| Which is a comprehensive, research-based, standardized collection of interventions and activities that nurses often reference when documenting interventions? | Nursing Interventions Classification (NIC) |
| What was Nursing Interventions Classification (NIC) developed to do? | Provide a standardized language to document nursing interventions. |
| Documentation of interventions is provided to insurance companies for billing and reimbursement. Which Federal guidelines do health care facilities follow when providing patient information to other agencies? | Health Insurance Portability and Accountability Act (HIPAA) |
| Monitoring a patient's temperature and skin color for fever | Independent |
| Administering antipyretic medication for fever as ordered by the provider | dependent |
| Nursing assistant providing bathing and dressing assistance to a patient | collaborative |
| What are the highest-priority interventions? | Problem-oriented |
| Which is an example of a collaborative nursing intervention? | Nursing assistant providing range-of-motion on the patient |
| Which is an example of an indirect-care intervention? | Communication with providers |
| Which are the indirect-care interventions? | Collaboration Referrals Delegation |
| Which are the direct-care interventions? | Informal counseling ADLs Reassessment |
| nurse assessed patient established a diagnosis of Risk for Impaired Skin Integrity related to immobility. determined interventions to reposition every two hours and maintain skin hygiene so that skin integrity is maintained. What is the next step | Implement the interventions |
| Why should the nurse reference Nursing Interventions Classification (NIC) when documenting interventions? | It is useful for clinical documentation. |
| The nurse performs patient care interventions according to the individualized care plan. What is the next step in the process? | Document the interventions. |
| Nurses coordinate many types of interventions when initiating a care plan. How are nursing interventions categorized? | By purpose By who initiates or conducts them By type of patient contact |
| The nurse is caring for a postoperative patient in the medical-surgical unit. Which interventions are considered to be independent nursing interventions? | Use of incentive spirometer Hand hygiene Ambulating the patient |
| The nurse is caring for a patient receiving anticoagulant therapy. Which intervention is considered to be a dependent intervention? | Holding dose due to abnormal lab value |
| The nurse is caring for a post-operative patient. Which intervention is considered to be prevention-oriented? | Post-operative ambulation |
| The nurse is caring for a post-operative patient following hip repair. Which intervention is considered to be collaborative? | Ambulation with physical therapy |
| Nurses conduct change-of-shift reports to communicate assessment findings and outstanding nursing interventions. What type of intervention is this? | Indirect-care |
Created by:
colby.caswell