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98 Cards in this Set

  • Front
  • Back
The aim of public health nursing practice is to:
provide a healthy enviroment
Assessment, policy development, and access to resources are:
Functions essential to Public Health
A successful community health nursing practice involves development of relationships with the community and:
Responsiveness to changes withing the community
Because the homeless have few resources, their chronic health problems are often:
Exacerbated
What fear may inhibit substance abusers from seeking health care?
Being turned in to criminal authorities
A very important principle in dealing with persons who have suffered abuse is:
Protection of the individual
Collaborator, educator, coundelor, change agent, and client advocate are some:
Compentencies of a community Health Nurse
Assessment of a community includes what three elements?
Structure, people and social system
Healthy People 2010's overall goal are to:
Was established to create ongoing health care goals including increasing life expectancy and quality of the life and eliminate health disparities through improved delivery of health care services. Gathering information assessing needs, and developing and implementing public health policies are steps in achieving the goals sert forth by Healthy People 2010.
Vulnerable populations of clients are those who are more likely to develope health probles as a result of:
Excess risks who have limits in accesss to health care services or who are dependent on others for care. They are Specific populations with unique health care problems
What are the levels of prevention
Primary intervention is prevention of a health problem that has not yet occurred in the community.
Secondary intervention includes disease prevention after a health issue has been identified (eg. the nurse is asked to set up flue vaccines in local churches and centers after the CDC released infor that the flu was going to be very contagious this season)
Tertiary intervention occurs after a problem has occured and aims at preventiong longterm negative impacts recurrences in a population.
Define the nurses role as an educator.
An educator helps the community gain greater skills, including through the pressentation of educational programs.
eg. an nurse practicing in an occupational health setting notices there is a large number of employees who smoke, the nurse designs an employee assistance program for smoking cessation.
Define the nursing role of a collaborator.
Collaborator is an individual who engages in a combined effeort with other individuals to develop a nutually acceptable plan that will achieve common goals.
eg. the local school has an increasing number of adolescent parents, The nurse works with the school district to design and teach about infant care, child safety, and time management.
What factors will impact a clients potential to change.
1. The innovation or change must be perceived as more adventageous than other alternatives.
2. The innovation or change must be compatable with existing needs, values, and past experiences.
3. The innovation must be tried on a limited basis.
4. Simple innovations or changes are more readily adapted that those that are complex
What are 3 elements included in a community assessment?
Structure or locale, people, and social systems.
To develop a complete communith assessment, the nurse must take careful look at each of the 3 componets to begin to identify needs for health policy, health programs, and health services.
The focus of the community health nursi differs from that of public health nursing because the nursing care:
provides direct care to subpopulations who make up the community as a whole. Community health nursing focuses on the individual, family and community
In health people 2010, assurance refers to the role of public health in:
Making essential community wide health services avaliable and accessible
Whem completing an individual total assessment of a client, the community-based nurse will include consideration of:
The community structures, the populatin and the local social system in which the client lives. Industrial development, types of pollution, and cultural and religious groups are individual element in the community
A proposal written by a community based nurse for a new, highter quality adult care center will have increased probability of acceptance if the proposal includes:
Description of how advantageous, realistic, compatible, and adaptable the change will be when implemented.
What is Ethics of caring
Considers the nurse as client advocate, sensitive to unequal relationships, and attending to relationships
Recognition of the cultural variances in expression, process, and behviors is:
transcultural perspective
What behaviors communicate caring?
Eye contact
body language
tone of voice
listening
and a positive and encouraging attitude
A form of nonverbal communication that can promote comfort and security and improve self-esteem
Caring touch
Theorist who developed a thery of caring stating that a conscious intention to care potentiates healing and wholeness:
Jean Watson
What is Swantson's theory of caring?
Theory that describes caring as a nurturing way of relating to a valued other toward whom one feels a sense of commitment and responsibility, including knowing, being with, doing for and enabling through transistions and sustaining hope.
Describe touch in caring for a patient:
Touch is relational and helps create a connection between the nurse and the client. Touch is best used when there is a caring connection between nurse and client.
The nurse demonstartes the concept of knowing the client when he or she:
Is able to detect changes in the clients condition based on shared information and bonding
The nurse who knows the pt can predict responses: capacity, and endurance because the two have a mutual sense of bonding, a relationship is necessary
What effects a persons well-being?
Spirit, mind, and body, and an individuals beliefs and expectations.
Nurses should not forse their beliefs on clients, but sharing is a part of caring.
A number of strategies have the potential for creating work environments tha enable nurses to demonstrate more caring behaviors some of these include:
Providing flexibility, autonomy, and improved staffing.
Strategies to create work enviroments that allow nurses to demonstrate more caring behaviors include introducing greater flexibility in the work in environment structure, rewarding more experienced nurses in nonmonetary ways, improving staffing and providing nurses with autonomy over their practices
Listening includes not only taking in what a client says bu also:
Interpreting and understanding what the client means and communication that understanding back to the person talking
"Presence" involves a person-to-person encounter that:
Conveys closeness and a sense of caring
Prsesnce invloves "being there" and "being with" a client, including communication and understanding
Clients perceptions are important becuase health care organizations are:
Placing greater emphasis on client satisfaction
The caring aspect of nursing may be negatively affected in clinical practice today primarily because of:
Ris in technology that takes nurses attention away from clients
The nurse demonstrates caring behavior when he or she:
Pats the clients arm when approaching the bed
Physical contact is a means of expressing caring
According to Watson's transpersonal caring theory, the nurse should understand which of the following?
Caring can increase healing and promote well being
Conscious caring by the nurse can promote healing and is complementary to conventional nursing practice, Caring can be shared and is a powerful connection between individuals. It is important for the nurse to appreciate the culture of the client and incorporate this into the care. Caring is individual and is different for all.
Because client and nurses may differ in their perceptions of caring, it is important that the nurse:
Seek information regarding what is important to the client
It is important to assess the clients needs and expectations of care. Clients relate to nurses on a personal level. The clients beliefs must be considered. Personnel at all levels of nursing should have effective relationships with clients
Give an example of a nurse providing presence in a caring relationship
The staff nurse who stays with a client who is undergoing an unfamilar procedure.
Coaching a client through an experience is any example of presence, as is sitting by a clients bedside
The nurse demonstrates listening skills by:
Paying attention to the tone of voice in addition to the clients words so the meaning is clear
The clients tone of voice supplies cues that allow the nurse to better understand the clients frame of reference.
Nonverbal cues add meaning to the verbal communication and increase understanding
The nurse can best demonstrate caring to a client who has recently suffered a loss through miscarriage by:
Sitting with the client in silence
Offering self is a powerful demonstration of caring and allows the client to trust and feel the presence of a caring person
A nurse who normally uses touch when caring for clients might consider this inappropriate for which of the following clients:
A psychiactric patient who is displaying suspicion and fear.
The psychiatric client may interpret a gesture as a threat, and futher assessment is required. There is no contraindiction to touching a client of the opposite sex or to touching a client when family members are present unless the client indicates that he or she in uncomfortable
Family members making comments about the nursing care. Which should be investigated futher?
"The night nurse tells us to wait and ask the doctor our questions"
A caring nurse should show interest in answering questions and giving clear explanations. Teaching the family is important and gives the family the feeling of being useful. Honesty is a quality of caring. False reassurence is dishonest and is not helpful
In caring for a client the nurse would describe learning about hte clients family as:
Essential
Each individual experiences life through their relationships with others so learning about the clients family is essential in learning about the client.
What does Watson mean by "transformative model"?
A relationship influencs both the nurse and the client, for better or for worse.
What five categories does Swansons theory of carring consists of?
Knowing
Being with
Doing for
Enabling
Maintaining belief
Explain the differences between three categories of touch.
Task-oriented-- when performing a task or procedure conveys security and a sense of competence
Caring-- a form of nonverbal communication influences a clients comfort and security enhances self esteen and improves reality oreientation
Protective-- to protect the nurse and or client can be viewed as positive or negative
List the 11 caring behaviors tha are perceived by families.
Being Honest
Advocating for clients care preferences
Giving care explanations
Heeping family members informed
Trying to make client comfortable
Showing interest in answering questions and answereing them honestly
Providing necessary emergency care
Providing for and maintaining client privacy
Assuring the client tha nursing services will be avaliable
Helping clients do as much for themselves as possible
Teaching the family how to keep the relative physically comfortable
A nursing student gives herself positie messages regarding her ability to do well on a test. This is an example of what level of communication:
Intrapersonal
Intrapersonal communication is a powerful form of communication that occus with in an individual
The nurse demonstrates active listening by:
Assuminng a relaxed posture and leaning toward the client
Active listening means being attentive to what the client is saying both verbally and nonverbally
During the orientation phase of the helping relationship, the nurse might do which of the following:
Discuss the cards and flowers in the room
During the orientation phase, the nurse and client meet and get to know each other.
If the nurse is working with a client who has expressive aphasia it would be most helpful for the nurse to:
Allow the client extra time to respond
The professional nurse can best be said to be engaging in collaboration with others to develop the clients plan of care when the nurse:
Works with colleagues and clients families to take advantage of combined expertise in planning care
Collaboration is teamwork in which individuals in multiple disiplines work together, each contributing his or her esperties to the clientss care. The collaborative team works together to provide care for the client
The nurse tells the client "I'm not sure I understand what you mean by sicker than usual. What is different now?" The nurse is using the therapeutic technique of:
Clarifying
Clarifying gives the client a chance to be more specific or give more information
The nurse says to the client "Weve talked alot about your medications but lets look more closely at the trouble your having in taking them on time" The nurse is using the threapeutic technique of:
Focusing
Focusing is used to center attention on key conceps or elements in a message
Whe nworking with an older adult the nurse should remember to avoid:
Shifting from subject to subject becuse it can create confusion
Whic of the following statements by the nurse would be nontherapeutic and tend to block communication:
"Why are you so nervous"
"If I were you, I'd have the surgery"
"Im sure the test results will come out fine"
Nontheraputic statements hinder communication. False reassurances block communication and destroy trust. Asking for explanations can be interpreted as "testing" and can cause resentment, insecurity and mistrust. Giving personal opinions takes the decision making away from the client
a nurse should consider zones of personal space and touch when caring for clients if the nurse is taking the clients nursing history she should:
be 18 inches to 4 feet from the client
the personal zone
A pregnant client mentally reherases giving birty in her mind. This is an exampel of:
Intrapersonal communication
also called self-talk, self-instruction and inner thought.
The nurse my facilitate verbal communication with clients by:
using shour sentences that express an idea simply and directly
Verbal communication should be clear and brief. Fewer words result in less confusion Communication that is simple, brief, and direct is more effective.
A nurse feels flustrated becasue she is behind in administering her clients medications. She comes to the clients bedside hurriedly with a frown on her face and sighs while she is waiting for the client to swallow the medications The nurse then says brightly Isnt it a relaxing day. The nurse should remember that
When there is incongruity between verbal and nonverbal communication, the receiver usually "hears" the nonverbal message as the true message.
A clients family member wipes her eyes as she cries at the loss of a loved one and says, "its no bid deal I mean, we all have to die sometime, right?" The nurse is engaging in metacommunication when the nurse respons:
Losing a loved one can be really difficult, It looks like your pretty upset I'd like to help
Meta communication uncover the deeper message beneath what is being overly said.
In a nurse-client helping relationship, the nurse should:
convey nonjudgemental accfeptance with a willingness to hear a message or to acknowledge feelings.
The nurse-client helping relationship is characterized by the nurses nonjudgmental acceptance of the client. Acceptance conveys a willingness to hear a message or to acknowledge feelings even if the nurse does not agree with the client.
A client with diabetes is hospitalized with a sore on his foot that has failed to heal. The nurse is gathering a videotape and some printed material on diabetes to begin teaching the client whe he calls the nurse asking for something to decrease his pain. In terms of the elements of the communication process, the referent in this situation is:
the clients pain
A referent motivates one person to communicate with another. In this case, sensations and perceptions of pain initiated communication.
Which of the following illustrates the focus of the nurses interactions during the working phase of the nurse-client helping relationship?
The nurse asks the client. "What do you think would help you recover more quickly from your surgery?"
During the working phase, the nurse helps the client with self-exploration and goal setting.
A nursing instructor notices that a student nurse is showing a lack of professionalism when the student:
Shares personal information about his assigned client with other students not involved in the client's care.
Sharing personal information about others violates nursing ethical codes and practice standards.
Whic of the following is an example of a positive outcome of a nurse-health team relationship?
The nurse receives encouragement and support from co-workers to cope with the many stresses associated with the nursing role.
Benefits of positive nurse-health team relationships include building morale and strengthening bonds so that team members can help one another cope with the stresses of working in the health care field.
A nurse is meeting a 3-year-old for the first time. Communication with the child will be facilitated if the nurse:
Kneels down whild holding and talking to a teddy bear.
Kneeling down puts the nurse at the child's eye level. Holding and talking to a teddy bear is monthreatening and allows the child to make the first move in interpersonal contacts. Children are especially responsive to nonverbal messages, and sudden movements, loud noises, or threatening gestures can be frightening.
To facilitate communication with an older adult who is hard of hearing the nurse should:
Face the client and maintain eye contact.
The nurse should get the clients attention befor speaking and face the client so the client can see the nurses mouth. The nurse should speal slowly and clearly while maintaining eye contact. Words should be supplemented with visual gestures.
A client says to the nurse, It was a stupid thing that I did. If I had just stayed home, this care accident would't have happented. The nurse's best response is.
"You feel responsible for the accident, as though it could've been prevented."
Demonstartes the therapeutic communication technique of paraphrasing. Paraphrasing is restating anothers message more briefly using ones own words. Through paraphrasing, the nurse sends feedback that lets the client know that the nurse is actively involved in the search for understanding
The nurse says to the client,"We've talked alot about your surgery and the implications fro you when you go home. Lets discuss some of the exercsises you can do" Thsi is an example of:
Focusing
The nurses statements depict the therapeutic communication technique of focusing. Focusing is used to center attention on key elemets or concepts of a message. Focusing helps guide the direction of the conversation.
Which of the following is an example of transpersonal communication?
Prayer
Interaction takes place in one's spiritual domain.
A manager is reviewing the nurses notes in a clients medical record. She find the following entry. "Client is difficult to care for, refuses suggestions for improving appetite." Which of the following directions should the manager give to the staff nurse who entered the note?
Enter only objective and factual information about the client.
Opinions have no place in the chart.
A client tells the nurse "I have stomach crams and feel nauseous" This is an example of what type of data?
Subjective
Symptoms that the client feels bu that are not measurable.
A primary benefit of the Health Insurance Portability and Accountability Act (HIPPA) is to:
Probide clients with greater control ove personal health care information
HIPPA provides client with control over who receives and accesses their medical record.
Clients frequently request copies of their medical records. The nurse understand that:
Clients have the right to read those records
but the nurse should always know the facility policy regarding personal access to medical records, because some require a nurse manager or other official to be present to answer questions about what is in the record
Accurate entries are an important characteristic of good documentation. Which of the following charting entries is mos accurate in the way it is written?
Client up out of bed, walked 50 feet and back down hallway with assistancefrom nurse, heart rate 88 and regular befor exercis, 94 and regular after exercise.
Which of the following represents a breach of confidentiality and privacy?
A nurse telephones the clients church to have the clients name placed on a prayer list
Purposes of the clients medical record include
Education and research
The purposes of keeping a medical record include communication, legal documentation, financial billing, education, research, and auditing-monitoring. Research may also be conducted based on data collected from medical records.
Whic of the following is a guideline for leagally sound documentation?
If an ordr is questioned, record that clarification was sought.
If a nurse carries out an order known to be incorrect, the nurse is just as liable for prosecutions as is the physician.
Which of the following is the best example of quaility documentation?
Six centimeter incision on right lower quadrant, edges pink and well approximated with sutures, no drainage noted
most factual, accurate, and complete
According to the guidelines, quality documentation and reporting should be all of the following
Current, factual, accurate
The five guidelies call for documentation and reporting to be factual, accurate, complete, current, and organized.
When the nurse follows the SOAP method of chartig. the information the nurse would record under "O" would be:
Right foot red, +4 pitting edema, capillary refil less than 3 seconds
(subjective, objective, assessment, and plan) objective data for "O"
A method of charting which the nurse writes a progress note only when the standardized statement on the for is not met is called:
Charting by exception
A nurse needs to document only significant findings or exceptions to the predefined norms.
Critical path ways are a valuable tool in client care because:
They provide members of the health care team a way to document their contributions to the cliets total plan of care
Critical pathways are multidisciplinary care plans tha include client problems, key interventions, and expected outcomes withing an established time frame. They promote integration of information so that each discipline has access to notes written by others.
One advantage of standardized care plans is:
They establish clinically sound standards of care for similar groups of clients
A nursing instructor is helping a student nurse with discharge planing fro a client. The instructor realizes that futher education is needed when the student nurse says:
I really cant start discharge planning until the physician writes the discharge orders
Ideally discharge planning begins on admission
Besides high blood pressure values, what other sighns and symptoms may the nurse observe if hypertension is present?
Headache, flusing of the face, and nosebleed
Hypertension is often asymptomatic until pressure is very high. HA , facial flushing, nosebleed, and fatigue are common symptos of hypertension.
Whic of the following values fro vital sighns would the nurse address first?
Oxygen saturation by pulse oximetry=89%
because this indicatis that a client needs oxygen.
Which vital sign value would take priority in intiatin care?
Temperature = 39C 102F tympanic
The client who has been on bed rest for 2 days asks to get out of bed to go to the bathroom. He has new ordres up ab lib What action should the nurse take?
obtain orthostatic blood pressure measurements
Using an oral electronic thermomerter, the nurse checks the early morning temp of a client. The cliets temp is 36.1C Te cliets remaining vital signs are in the normally acceptable range. What should the nurse do next?
Check the clients temp history
The nurse decides to take an apical pulse instead of a radial pulse. Which of the following client conditions influenced the nurses decision?
The client has an arrhythmia
The apical pulse give the nurse the most information and accuracy when assessing irregular cardiac rhythm.
The carotid or femoral pulses are usually used to assess a client in shock.
The radial pulse is adequate for determining routine postopreative vital signs and for checking changes in orthostatic heart rate.
The nurse is to measure vital signs as part of the prepartation for a test. The client is talking with a visiting pastor. How should the nurse handle measuring the rate of respiration?
Document th respiration rate as deferred and measure the rate later, since the talking client is obviously not in respiratory distress
A judgement call by the nurse
Delegation of some tasks may becone one of the decisions the nurse will make while on duty. For which of the following clients would it be most apporpriate for unlicensed assistive personnel to measure the clients vital sighns?
A client who is being admitted for elective surgery who has a history of stable hypertension
The nurse may deligate when the client is in stable condition
The client has an oral temp of 39.2 C 102.6 F what are the most appropriate nursing interventions?
Reduce external coverings and keep clithing and bed linens dry: administer antipyretics as ordered
The hkypothalamus controls body temperature. The anterior hypothalamus controls heat loss, and the posterior hypothalamus controls heat production. What heat conservation mechanisms will the posterior hypothalamus initiate when it senses that the cliets body temperature is lower that confortable?
Vasoconstrictin, reductin of blood flow to extremities, and shivering
The anterior hypothatlamus controls heat loss by initiating the mechanisms of sweating and vasodialation of blood vessels.
The nurses documentation indicates that a client has a pulse deficit of 14 beats. The pulse deficit is measured by:
Assesing the apical pulse and the radial pulse for the same minute and subtracting the difference
The nurse observes that a clients breating pattern represents Cheyne-Strokes respiration. Which statement best describes the Cheyne-Strokes pattern?
Cheyne Strokes respiration is an irregular respiratiory rate and depth with alternation perods of apnea and hyperventilation: it begins with slow breaths and climaxes in apnea befor respiration resumes.
The nurse finds that the systolic blood pressure of aduld client is 88 mm Hg What are the appropriate nursing interventions?
Recheck the blood pressure, make sure the client is safe. and report the findings
All questionalbe blood pressure readings should be rechecked. Ensuring the clients safety is a necessary safeguard, because low blood pressure is generally accompanied by weeakness. For the majority of people low blood pressure is an abnormal finding and should be reported.