Systems of care exam 3

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Systems of care exam 3
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systems of care NUR3138
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  1. A group of elderly women come to the community center for exercise classes taught by the community health nurse. This activity will help with which of the following?
    • A regular program of
    • exercise is important for maintenance of joint mobility and muscle tone and can
    • promote socialization. Physical activity will slow bone density loss and
    • decrease muscle atrophy and stiffness. Osteoporosis occurs in those who are
    • immobilized or physically inactive. (page 419)

    Weight bearing
  2. A nurse is teaching a
    wellness class for older adults. In order to address the sensory       loss that accompanies the aging process, the nurse
    should recommend that these clients:
              Hearing and visual aids –
    Lighting - Diet
    • Schedule routine eye
    • examinations to maintain and protect their vision. Also, wearing sunglasses
    • will help avoid the damaging effect of UV light. Inform them to use ear
    • protection devices when working in or around activities that produce loud
    • noise. (page 420)

    • Hearing loss-suggest
    • referral for hearing screening, check for impacted earwax, assistive hearing
    • devices, ear protection devices (when working in or around activities that
    • produce loud noise) page 420

    • decreased sense of smell
    • and taste- it is important for the nurse to teach the client and family about
    • safety issues involved with decr smell and taste and what strategies can be
    • implemented to promote the older adult’s safety (eg dating and labeling foods, using
    • smoke alarms) page 420

    • loss of skin receptors/decr
    • threshold for sensations such as pain, touch, and temp-it is important for the
    • nurse to teach about the involved safety risks and subsequent interventions (eg
    • setting the temp of water heater to 110 to prevent scalding [previous
    • quiz question]) pg 420
  3. A school nurse is bringing
    a group of students to a nursing home for a social exchange  project.
    Before the students arrive, the nurse reminds them to do which of the following
    when speaking to the residents? slow, clear and in a lower tone. 
    • “Speak in a low and
    • distinct voice tone” - use hard vowels like ay and ee and hard consonants like
    • k, d, t pg 420
  4. A nurse is preparing an education program on safety concerns for elderly adults who live at home.  To address the sensory changes in this age group, the nurse will recommend that this group have which of the following?   
    • Have routine eye exams,
    • hearing screenings, use smoke alarms, dating and labeling food, setting the
    • temp of the water heater to 110 degrees F to prevent scalding. (page 420)
  5. An elderly male client
    comes to the clinic and states to the nurse that he hasn't been        interested in sexual
    intercourse lately. He states: "I guess this is part of getting old,
    too." What should the nurse understand about decreased sexual
    interest in elderly clients?
    • If an older man reports a
    • loss in sexual interest, the nurse should be as concerned as when a younger man
    • reports this. the libido will decrease but not disappear. page 422

    • They have slower responses
    • to sexual stimulation

    • The major age-related
    • change in sexual response is timing. it takes longer to become sexually
    • aroused, longer to complete intercourse, and longer before sexual arousal can
    • occur again. Sexual response and performance SHOULD be present in the older
    • adult. pg 422
  6. A group of elderly clients
    are interested in living options available in the community when they may need
    some assistance with their daily needs. Which of the following would the nurse
    suggest as possibilities to meet these needs?

    Adult
    foster care - Group homes -
    Retirement villages - Long-term care facilities    Adult
    day-care centers
    • Adult foster care and group
    • homes: these programs offer
    • services to individuals who can care for themselves but require some form of
    • supervision for safety purposes. (page 424)
  7. An elderly client who has
    had a stroke is ready for hospital discharge. How should the nurse case manager
    support this client's independence?
    ** encourage themto complete ADLs on their own and offer assistance only when needed.

    • The nurse needs to
    • acknowledge their ability to think, reason, and make decisions. The nurse can
    • support a decision by an older adult even if eventually the decision is
    • reversed because of failing health. (page
    • 424)
  8. A group of nursing students
    are doing their first clinical rotation in a long-term care facility. The nurse
    educator, in meeting the needs of this particular client group, reminds a
    student to:
              Independence - Respect
    • The student should
    • encourage them to do as much as possible for themselves, provided that safety
    • is maintained. Do not take over for them. (page 425)

    • appreciate diversity-avoid
    • stereotyping, accept older people’s values and standards (ie cooking on stove
    • instead of microwave, hanging clothes to dry outside instead of using a dryer)
    • pg 425
  9. A nurse who works in a
    long-term care facility has noticed that one of the residents has been showing
    signs of impaired cognitive and self care abilities over the last 2 weeks. The
    nurse should:
              Normal age-related changes
    versus physiologic-related changes
    • Cognitive impairment that
    • interferes with normal life is not considered part of normal aging. A decline
    • in intellectual abilities that interferes with social or occupational functions
    • should always be regarded as abnormal. (page 425) Seek prompt medical
    • evaluation. 
  10. A hospitalized elderly
    client is recovering from an acute illness. As the client nears the end of his
    hospitalization, he questions the nurse about medications and care after
    discharge. The nurse should:
              Autonomy   
    • From Prof. M: “Autonomy is
    • very important. You’d keep that autonomy approach in mind as you ask him
    • questions about several things you know will influence his continued
    • improvement at his home. One thing that comes to mind is can he afford his
    • new medications?” 
  11. The community health nurse
    is providing information to elderly clients regarding health
    screening. Which of the following would be recommended for these
    clients?
              Types of screening and
    vaccines
    • Screenings: routine eye
    • examinations, hearing screenings, screening for colorectal cancer, total
    • cholesterol, mammogram, fecal occult blood test, sigmoidoscopy and colonoscopy,
    • STI testing, DM screen, pap smear, digital rectal exam, depression screen, family
    • violence screen, smoking cessation. (page 430)
    • Vaccines: annual flu
    • vaccine, pneumococcal, Shingles, Hep B, Td, varicella.
  12. During care activities, the
    80-year-old client talks about "the good old days" and often repeats
    the same stories. What action should the nurse plan?
              Reminiscence therapy
    • Use stories of life
    • histories - written, oral, or both - to improve psychological well-being. This
    • form of therapeutic intervention respects the life and experiences of the
    • individual with the aim to help the patient maintain good mental health. The
    • nurse could play songs from the 1920s, or ask about significant pictures.
  13. A client has just been
    enrolled (through her employer) in an HMO. The client's previous experience
    with health care coverage through her employer was with a PPO. The client asks
    the occupational health nurse to explain the difference. The best response by
    the nurse is which of the following?
    • PPO tends to be more
    • expensive than HMO plans. The PPO provides clients with a choice of health care
    • providers and services and they can choose them from out of network. In the HMO
    • plan, clients are limited in their ability to select health care providers and
    • services and they must have a primary care physician. Nurses in HMOs focus on
    • health promotion and illness prevention (emphasizes client wellness). (page
    • 113)
    • HMO - less choices, less expensive. PPO - more choices, more $$. (p 113)

    • PPO=preferred provider
    • organization
    • HMO=health maintenance org

    • HMO=the available services
    • are at a reduced and predetermined cost to the client pg113
  14. In order to comply with the
    U.S. Department of Health and Human Services’ most current healthcare goals as
    stated in Healthy People 2020, the nurse will:
              Primary health goals of Healthy
    People 2020
    * Attain high-quality, longer lives free of preventable disease, 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 health for all.* Promote quality of life, healthy development, and healthy behaviors across all life stages. (healthypeople.gov) Healthy people 2020 has a section on the elderly stating: -reduce the proportion of elderly with moderate to severe functional limitations.-Increase the proportion of elderly who have chronic health conditions who report confidence in being able to manage their condition (In notes)
  15. The nurse recognizes that a
    federally funded program is likely providing healthcare
       coverage for the:  
    • Medicare: health insurance
    • available for those with disabilities and people 65 years and over. It
    • is towards hospitalization, home care, and hospice. It also provides partial
    • coverage of outpatient and physician services. Does not cover dental,
    • eyeglasses, or hearing aids. Most preventative care is not included-physical
    • exams and associated diagnostic tests
    • Medicaid: available for
    • people who require financial assistance (low incomes). Some states
    • provide limited coverage, while others pay for dental, eyeglasses, and
    • prescription drugs. (page 111). must pay a deductible and co-insurance.
    • Supplemental Security
    • Income: Benefits for people with disabilities (the blind); for those not
    • eligible for Social Security. can use money for meds and extended health care
    • State Children’s Health
    • Insurance Program: Insurance coverage for poor and working class children when
    • parent/guardian employment does not provide insurance benefits; includes
    • primary care, prescriptions, hospitalization. Sometimes covers dental
    • Prospective Payments
    • System: Limits amount paid to hospitals that are reimbursed by Medicare
    • WIC (women, infants,
    • children)-low income mothers with children at nutrition risk 
  16. A client asks the nurse
    about her medications and tells the nurse she has been investigating on the
    Internet. The nurse's best response to this is:
              Therapeutic response
    • I believe the correct
    • answer is to have the patient explain what she already knows and then you
    • educate her when she is wrong or when there is a gap in her knowledge
    • (previous quiz question
  17. As part of orientation, the
    newly graduated nurse is rotating through specialty areas in the hospital
    (cardiac intensive care, neonatal intensive care).  Which of the following
    technology offered by the nurse informatics specialist might
    simulate ‘hands-on’ education in these areas?
    • Task trainers (systems that
    • use computers and small devices to provide skills practice like inserting
    • catheters), or high-fidelity human patient simulators (where they have the
    • ability to speak and breathe. (page 147) These devices allow for case scenarios
    • to be automated, in which one or more care providers interact with the
    • simulated clients to role play a specific situation. A critical component of
    • simulation is the debriefing discussion that occurs following the scenario.
  18. A nurse educator is
    preparing to co-write a new textbook.  She has taught the same courses for
    the past 5 years and each year implements a few minor changes. Over this time,
    the educator has stored the grade data, including homework and assignment
    scores, in order to track trends following the implemented changes. This
    educator is utilizing which of the following?
              Informatics - Student
    record management - Data warehousing - Management
                  Information System (MIS)
    • Student and core record
    • management-  utilizes data warehouse to store cumulative results

    • Data warehousing: this is
    • the accumulation of large amounts of data that are stored over time and can be
    • examined for output in different types of reports. (page 147) (slightly
    • better answer)
  19. The nurse educator
    appropriately impacts the learning of nursing students when
                using computer technology to:
    • Teach via distance. This
    • includes recorded lectures, e-books, management systems (Blackboard, eCollege),
    • podcasts, etc. More schools are likely to begin using distance learning
    • strategies to reach students around the world. (page 147)
  20. A nursing instructor shows
    an understanding of the ways computers can enhance student learning when:
              Education via computer
    • Computer technology has
    • significantly enhanced the realism provided in the traditional nursing skills
    • laboratory. Different simulation tools and case scenarios can be used.
    • Computer-assisted instruction (CAI) helps nursing students learn and
    • demonstrate learning. It includes tutorials as well. (page 146) CAI includes
    • tutorial, drill and practice, simulation, and testing. 
  21. Which of the following is
    the purpose of a family assessment:
              Functioning – Strengths/weaknesses – Interaction patterns –
    Legal authority
    • The purpose of family
    • assessment is to determine the level of family functioning, clarify family
    • interaction patterns, identify family strengths and weaknesses, and describe
    • the health status of the family and its individual members. (page 437)

    • According to Mangueira the
    • answer is functioning
  22. A nurse is conducting a
    family assessment as part of the process for services provided through the
    community. Of the following, which would provide the best information in
    identifying existing or potential health problems?
              Ecomap – Genogram -
    Cultural assessment - Family communication patterns
    • Mangueira told me the answer is
    • genogram
  23. A nurse has been working with a family at the community health office and is alert to signs of family/domestic violence. Which of the following would the nurse most concerning?
    • Nurses should be alert to
    • the symptoms of family violence and act appropriately to report it and obtain
    • resources for the family. Most laws require that the nurse report suspected
    • abuse. (page 439)
    • If the answer is supposed
    • to be an actual sign of abuse- bruising in multiple stages of healing around
    • the flank and back of the person.

    • early signs in the
    • book-burns, cuts, fractures, depression, substance abuse, suicide attempts
  24. The nurse is performing a family
    risk assessment. Which of the following factors would indicate that
    this family is at risk of developing health problems?
    • Sudden loss of income, the
    • vulnerability of family health units to health probs may be based on maturity
    • level of individual family members, hereditary or genetic factors, sex,
    • ethnicity, sociologic factors, and lifestyle. pg 440
  25. A family member is hospitalized with an illness. Which of the following factors will the nurse assess to determine the impact this illness will have on the family:
              Illness nature, duration,
    cause effect on family or finances
    • The nature of the illness
    • (ranges from minor to life threatening), the duration (short to long term),
    • effects (none to permanent disability), the meaning of the illness to the
    • family and its significance to family systems, financial impact (influenced by
    • insurance and ability of the ill person to return to work), effect on future
    • family functioning. (page 443)

    • Found question in back of
    • chapter. The exact answers will be
    • - duration of illness
    • -the meaning of the illness
    • to the family and it’s significance to the family system
    • -financial impact of the
    • illness (including factors such as insurance and ability of the ill member to
    • work)
  26. The nurse appropriately prepares to assess a family regarding the impact of one of its members being diagnosed with diabetes when considering:
    • Assess family’s ability to pay for meds, assess the emotional stability of the family, financial needs, insurance, if they have had experience with this illness in
    • the past, etc.
  27. An occupational health
    nurse is providing a hypertension screening at a local
    manufacturing plant. Among the employees, the primary focus group
    of the intervention is:
    • Young African American
    • adult males (the young adult), people that smoke, are obese, eat a high sodium
    • diet and have high stress levels (page 402).
  28. A nurse is working in a
    community of factory workers and is planning an educational
                      session for wellness, targeting
    the young adult group. In order to address one of the health
    problems of this group, the nurse plans to:
    • Morbidity and mortality of
    • tobacco
    • The nurse’s role regarding
    • smoking is to serve as a role model by not smoking, provide educational
    • information regarding the dangers, help make smoking socially unacceptable, and
    • help find resources for those who want to stop smoking. Also, let them know
    • that drug abuse can lead to lung cancer and cardiovascular disease. (page 401)
  29. During an educational
    session regarding physical changes of the middle-aged adult, a
    question is asked regarding typically experienced weight changes.
    The nurse's best response is:
    fat decreasing peripherally and moves to the hips and abdomen

    metabolism slows down
  30. A community health nurse is
    doing a screening for cervical cancer at a women's health fair.
    Which of the following clients would have the highest risk factor for cervical
    cancer?
    • Women most at risk for
    • cervical cancer are those with a history of multiple sexual partners, sexual
    • intercourse at age 17 years or younger, or both. A woman who has never been
    • sexually active has a very low risk for developing cervical cancer. Also, those
    • who smoke and take oral contraceptives for more than 5 years. 
  31. An 18-year-old
    client who plans to attend a university and live in a dorm asks the nurse about
    appropriate immunizations. The nurse should recommend the client:
    • Adult tetanus-diptheria
    • vaccine, MMR, pneumococcal, HPV, and hep B vaccine (page 395), meningococcal
    • vaccine
  32. The nurse is providing
    assistance at a community health fair that targets the middle-       aged client. Which of the following statements is true for
    this age group?
              Physical and mental changes
    • Hair begins to thin and
    • gray, wrinkling occurs, skin turgor and moisture decrease, metabolism slows,
    • and cognitive and intellectual abilities change very little. (page 406)
  33. A middle-aged
    client is struggling with life changes, including menopause. The
    best response by the nurse to this client is:
    • Listen to the client’s
    • concerns and what symptoms she is experiencing. Explain to her that these
    • things are normal, and if the symptoms are severe, there are medication options
    • available. Try to find out what specifically is the concern for her.
    • “It is common for women to
    • experience menopause in their late 40s.” (page 409)
  34. A group of middle-aged
    clients are inquiring about nutritional related health problems
    inherent in their age group. In order to best address these concerns of this
    specific age group, the nurse will:
    • Talk about the importance
    • of adequate protein, calcium, and vitamin D. Also, nutritional and exercise
    • factors that may lead to cardiovascular disease (i.e. obesity, cholesterol and
    • fat intake, lack of exercise). (page 408)
    • Females need calcium
    • The muscular tone of the
    • large intestine decreases so an increase in fiber is necessary to prevent
    • constipation.
  35. The nurse recognizes a
    “Baby Boomer” when the client:
              Psycho-social
    characteristics
    • “tend to be interested in
    • improving themselves”
    • Baby boomers are
    • characterized by an individualistic outlook, tend toward a “workaholic”
    • orientation, want to be respected at work, and are loyal and dedicated. (page
    • 400)
  36. The nurse shows an
    appropriate understanding of the health promotion needs of an
       older adult client when:
              Textbook graphics (chapter
    23)
    •           Textbook graphics (chapter 23)
    • - Home safety measures
    • -Teaching about diet-
    • especially vit d and calcium, adequate liquid and fiber
    • - exercise daily
    • - look for social groups
    • for social health
    • -look for signs of maltreatment

    (book)
  37. An action that allows new
    parents to feel in control when being taught how to bathe their infants would
    be when the nurse:
              Teaching and counseling
    with therapeutic awareness
    • Lets the parents bathe the
    • baby with direction and guidance from the nurse
  38. During the nursing
    process of implementing care and treatment for a client, the nurse
    realizes there are several entities included in this phase:  
    • ”The first step of
    • implementing is reassessing the client to determine that the activity is still
    • indicated and safe. The next action would be to determine if assistance is
    • required, and then implement the intervention, and last document the
    • intervention.”

    • Reassessing the client,
    • determining the nurse’s need for assistance, implementing the nursing
    • interventions, supervising the delegated care, and documenting nursing
    • activities. (page 238
  39. On one of the first days
    working alone, the novice nurse must provide teaching on            tracheostomy care to the
    client as well as the client's spouse. This nurse is not familiar with the teaching aspect. The best action for the nurse is to:
              Appropriate actions to
    fulfill the obligation while maintaining patient safety
    • Communicate with another
    • nurse without revealing the patient’s identity. Review the procedure with the
    • nurse and also review online.

    • Ask the nurse mentor to
    • assist with the teaching after reviewing the procedure.
  40. One of the clients assigned
    to the nurse's care is to receive a medication that the nurse is not familiar
    with and is not listed in the drug reference manual. The best action of the
    nurse is to:
    • Call the pharmacy and do
    • further investigating before administering the medication.
  41. The nurse understands that
    respect for the dignity of the client is extremely important in
    providing nursing care. Which of the following is an example of this aspect?
    • Allowing clients to
    • complete their own hygiene when possible, drapes the client appropriately,
    • closes the door when possible, and includes the patient in procedures.
  42. A nurse has provided
    routine morning care to a client, including all the medications and scheduled
    treatments. The most appropriate action after this is completed is for the
    nurse to:
              Nursing process of
    implementation
    • Document all cares in the
    • progress notes.
  43. After implementing
    interventions and reassessing the client's response, the nurse completes the process
    by evaluating. Evaluation includes which of the following:  
              Nursing process of
    evaluation - components
    • Purposeful activity,
    • nursing accountability, continuous, judgments.  <- is that right?

    • Collecting data related to
    • desired outcomes, comparing the data with outcomes, relating nursing activities
    • to outcomes, drawing conclusions about problem status and continuing, modifying
    • or terminating the nursing care plan (graphic bubble design in notes)
  44. The written goal statement
    in a client's care plan is: Client will have clear lung sounds bilaterally
    within 3 days. One of the interventions to meet this goal is that the nurse
    will teach the client to cough and deep breathe and have the client do this
    several times every 2 hours. At the end of the third day, the client's lungs
    are indeed clear. In order to relate the intervention to the outcome, the nurse
    should:
              Components of evaluation –
    Cause and Effect
    Goal met: Lungs are clear

    • Evaluate: Collect data
    • related to desired outcomes and determine if they were met.
  45. A home health client has
    been experiencing 5 days of diarrhea and vomiting. A goal was established that
    the client’s symptoms would be eliminated within 48 hours. The client is being
    seen after a week and has had no diarrhea or vomiting for the past 5 days. The
    home health nurse should:
              Components of goal –
    Nursing process – Problem Identification
    • Document that the problem
    • has been resolved and discontinue the care for the problem.
    • Is the answer nursing
    • process??
  46. A client has neurologic
    deficits that are causing tremors, unsteadiness, and weakness.
           A goal for this client is not to
    sustain any injuries for the next month. The client, however, has fallen
    several times.  In this situation, the nurse should do which of the
    following?
              Nursing process
    • Evaluate: Investigate
    • whether the best nursing interventions were selected
  47. A nursing unit has had a
    large number of negative client responses about various aspects of their care
    in the previous quarter. The quality assurance officer is evaluating this unit,
    paying particular attention to which of the components of care?
              Nursing process
    • Evaluation: Looking at the
    • effectiveness of the care plan, determine clients’ progress, nurses demonstrate
    • responsibility and accountability for their actions, relating nursing
    • activities to outcomes, collecting data related to the desired outcomes,
    • drawing conclusions about problem status, comparing the data with outcomes,
    • continuing, modifying or terminating the nursing care plan/goals

    • I think the answer is
    • process evaluation (pg 243). process eval focuses on how the care was given.
  48. A nursing unit's records of
    client care have been reviewed for accuracy in documentation. This type of
    review is which of the following?
              Nursing audit - Peer review - Individual audit - Concurrent
    audit
    • There are two types of peer
    • review: individual and nursing audits. Individual peer review focuses on the
    • performance of an individual nurse, while the nursing peer review focuses on
    • evaluating nursing care through the review of records. The success of these
    • audits depends on accurate documentation. (page 245)
  49. A nurse is working on a
    medical unit, and assigns a nurse's aide to take vital signs for
                      several clients. The aide completes this task
    and documents them accordingly. One of the clients had a blood pressure reading
    of 180/110, which was not reported to the nurse until the end of the shift.
     The physician was immediately notified and orders were received for
    treatment.  Which responsibility of delegation did the nurse fail to carry
    out?
              Delegation responsibilities
    • Appropriately supervising
    • care
  50. The nurse shows an
    understanding of the relationship of evaluation to the other phases of the
    nursing process when:
              Nursing Process
    • 1. Being careful to
    • effectively assess the client's needs.
    • 2. Selecting the
    • appropriate nursing diagnosis related to the client's needs.
    • 3. Collecting
    • client-focused data with a specific need in mind.
    • 4. Evaluating by using
    • assessment data to determine effective achievement of goals and outcomes.
  51. When assessment data show a
    change in the client’s condition, the nurse—before            changing the care
    plan—asks:
              Nursing Process
    • Are the new data complete?
    • Are the new data accurate? Do the new data require a change in the care plan?

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