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Chapter 1   Medical-Surgical Nursing in the 21st Century

 

1) A patient is instructed on the role of diet, exercise, and medication to control type 2 diabetes mellitus. Which core competency for healthcare professionals is the nurse implementing?

1. Quality improvement

2. Evidence-based practice

3. Patient-centered care

4. Teamwork and collaboration

Answer: 3

Explanation: 1. Identifying safety hazards and measuring quality is an example of the core competency quality improvement.

2. Using best research when providing patient care is an example of the core competency evidence-based practice.

3. Patient teaching is an example of the competency patient-centered care.

4. The core competency teamwork and collaboration involves collaboration between disciplines to provide continuous and reliable care.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively; listen openly and cooperatively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

2) The nurse is planning to utilize the core competency use informatics when providing patient care. Which action should the nurse perform when using this core competency?

1. Change the sharps container in a patient’s room.

2. Document the effectiveness of pain medication for a patient.

3. Discuss the effectiveness of bedside physical therapy with the therapist.

4. Search through a database of articles to find current research on wound care.

Answer: 4

Explanation: 1. Changing the sharps container is an example of quality improvement.

2. Documenting the effectiveness of pain medication for a patient is an example of patient-centered care.

3. Discussing the effectiveness of bedside physical therapy with the therapist is an example of teamwork and collaboration.

4. Searching through a database of articles to find current research on wound care is an example of use informatics.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: VI.B.2. Apply technology and information management tools to support safe processes of care | AACN Essentials Competencies: IV.1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice | NLN Competencies: Knowledge and Science: Practice-Know-How: Retrieve research findings and other sources of information | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

3) The nurse plans to implement evidence-based practice when providing patient care. Which activity should the nurse perform? Select all that apply.

1. Participate in education and research activities when possible.

2. Integrate research findings with clinical care to maximize patient outcomes.

3. Serve on the committee to create critical pathways for patient care.

4. Reinforce hand hygiene techniques with unlicensed assistive personnel.

5. Contact Environmental Services to report a malfunctioning infusion pump.

Answer: 1, 2

Explanation: 1. Participating in education and research activities when possible is an example of implementing evidence-based practice in the provision of patient care.

2. Integrating research findings with clinical care to maximize patient outcomes is an example of implementing evidence-based practice in the provision of patient care.

3. Serving on the committee to create critical pathways for patient care is an example of teamwork and collaboration.

4. Reinforcing hand hygiene techniques with unlicensed assistive personnel is an example of quality improvement.

5. Contacting Environmental Services to report a malfunctioning infusion pump is an example of quality improvement.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science; Knowledge: What is evidence-based practice (EBP)? Informatics? | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

4) The nurse is planning to meet with several community members during a health fair. Which nursing activity exemplifies the core competency patient-centered care?

1. Provide smoking cessation classes and literature.

2. Increase the hours for the healthcare providers to see patients.

3. Attend a continuing education program on clean water initiatives.

4. Evaluate the effectiveness of weight reduction strategies.

Answer: 1

Explanation: 1. Providing smoking cessation classes and literature is an example of an activity to provide patient-centered care.

2. Increasing the hours for the healthcare providers to see patients is an activity to support the competency teamwork and collaboration.

3. Attending a continuing education program on clean water initiatives is an activity to support the competency evidence-based practice.

4. Evaluating the effectiveness of weight reduction strategies is an activity to support the competency quality improvement.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Context and Environment; Knowledge; Environmental health; health promotion/disease prevention (e.g., transmission of disease, disease patterns, epidemiological principles); chronic disease management; healthcare systems; transcultural approaches to health; family dynamics | Nursing/Integrated Concepts: Nursing Process: Planning/Teaching/Learning

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

5) The nurse is instructing a patient on weight reduction and smoking cessation. Which code of nursing practice is the nurse implementing?

1. International Council of Nurses Code of Ethics for Nurses

2. American Nurses Association Standards of Professional Practice

3. American Nurses Association Code of Ethics for Nurses

4. State Board of Nursing Code

Answer: 1

Explanation: 1. The International Council of Nurses (ICN) Code of Ethics for Nurses specifies what nurses are accountable for in terms of people, practice, society, coworkers, and the profession. The philosophical basis for this code is that nurses are responsible for promoting health, preventing illness, and alleviating suffering. Instructing a patient on weight reduction and smoking cessation exemplifies the ICN Code of Ethics for Nurses.

2. The American Nurses Association Standards of Professional Practice are standards, not a code, and focus on specific behaviors to address education, ethics, evidence-based practice and research, quality practice, communication, leadership, collaboration, professional resource utilization, and environmental health.

3. The American Nurses Association Code of Ethics for Nurses has nine statements that address the nurse’s professional relationships, commitment to patients, patient rights, nursing practice, competency, conditions of employment, and contributions to the science of nursing, collaboration, and nursing values.

4. The state boards of nursing do not publish codes for nursing.

Page Ref: 12-13

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.4. Use behavioral change techniques to promote health and manage illness | NLN Competencies: Context and Environment; Knowledge; Environmental health; health promotion/disease prevention | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

6) The nurse is providing patient care within the American Nurses Association Standards of Professional Performance. Which activity is the nurse implementing?

1. Integrating research findings into practice

2. Implementing a patient’s plan of care

3. Evaluating patient progress toward identified outcomes

4. Analyzing assessment data to determine issues

Answer: 1

Explanation: 1. The nurse who is practicing within the American Nurses Association Standards of Professional Performance would integrate research findings into practice. The standards focus on ethics, education, evidence-based practice and research, quality nursing practice, communication, leadership, collaboration, professional practice evaluation, resource utilization, and environmental health.

2. Implementing a patient’s plan of care is an example of adhering to the American Nurses Association Standards of Practice.

3. Evaluating patient progress toward identified outcomes is an example of adhering to the American Nurses Association Standards of Practice.

4. Analyzing assessment data to determine issues is an example of adhering to the American Nurses Association Standards of Practice.

Page Ref: 13

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science; Knowledge; What is evidence-based practice (EBP)? Informatics? | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

7) The nurse prescribes strategies and alternatives to assist a patient achieve expected outcomes. Within which American Nurses Association standard is the nurse practicing?

1. Planning

2. Assessment

3. Diagnosis

4. Implementation

Answer: 1

Explanation: 1. The American Nurses Association Standards of Practice follow the nursing process. The nurse who prescribes strategies and alternatives to assist a patient achieve expected outcomes is practicing within the standard of planning.

2. Assessment activities include data collection.

3. Diagnosis activities include analyzing data to determine issues.

4. Implementation activities include implementing the identified plan, coordinating care delivery, and employing strategies to promote health and a safe environment.

Page Ref: 13

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Practice-Know-How; Apply professional standards | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

8) A patient with a terminal illness is concerned about pain control. If the International Council of Nurses Code of Ethics for Nurses is followed, what should the nurse plan for the patient?

1. Measures to alleviate suffering

2. Modified activities of daily living

3. Enforcement of strict bed rest

4. Dietary interventions to maximize strength

Answer: 1

Explanation: 1. The philosophical basis for the International Council of Nurses Code of Ethics for Nurses is the responsibility to promote health, prevent illness, and alleviate suffering. The nurse should plan measures to alleviate the patient’s suffering.

2. Modified activities of daily living may not affect pain control.

3. Enforcement of strict bed rest may not affect pain control.

4. Dietary interventions to maximize strength may not affect pain control.

Page Ref: 12

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

9) A patient is angry after waiting over an hour for pain medication. What should the nurse respond to the patient that demonstrates clinical reasoning?

1. “I understand your anger and am sorry for the delay. I have your pain medication now.”

2. “I had other patients who needed my attention first, so I did a few things before getting the pain medication.”

3. “I needed to find out what your medication is and if you can have more when you asked.”

4. “It seems that you always ask for pain medication when I am trying to do other things.”

Answer: 1

Explanation: 1. Clinical reasoning involves complex and multiple cognitive processes, which integrates the unique context of a clinical situation and addresses individual concerns of the patient and family. For the patient who is angry, this statement demonstrates empathy and critical thinking.

2. This statement is not an example of clinical reasoning and would be an inappropriate response.

3. This statement is not an example of clinical reasoning and would be an inappropriate response.

4. This statement is not an example of clinical reasoning and would be an inappropriate response.

Page Ref: 6

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essentials Competencies: IX.6. Implement patient and family care around resolution of end-of-life and palliative care issues, such as symptom management, support of rituals, and respect for patient and family preferences | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

10) The nurse is identifying nursing diagnoses appropriate for a patient’s plan of care. What should the nurse use to determine these diagnoses?

1. Diagnostic reasoning

2. Communication techniques

3. Identified outcome criteria

4. Established priorities

Answer: 1

Explanation: 1. Making a diagnosis is a complex process, and the nurse uses diagnostic reasoning to choose nursing diagnoses that best define the individual patient’s health problems. Diagnostic reasoning is a form of clinical judgment used to make decisions about which label, or diagnosis, best describes the patterns of data. Steps in the process include identifying significant cues, clustering the cues and identifying gaps, drawing conclusions about the present health status, and determining etiologies and categorizing problems.

2. Communication techniques would be needed when conducting the patient assessment.

3. Identification of outcome criteria is a part of the planning phase of the nursing process.

4. Priorities are established during the implementation phase of the nursing process.

Page Ref: 8

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

11) The nurse plans and implements care for a patient based on nursing knowledge and skills. In which role is the nurse functioning?

1. Caregiver

2. Advocate

3. Educator

4. Leader

Answer: 1

Explanation: 1. The caregiver role for the nurse today is both independent and collaborative. Nurses independently make assessments and plan and implement patient care based on nursing knowledge and skills.

2. The nurse functioning as a patient advocate actively promotes the patient’s rights to autonomy and free choice.

3. The nurse functioning in the role of educator nurse assesses learning needs, plans and implements teaching methods to meet those needs, and evaluates the effectiveness of the teaching.

4. The nurse functioning in the role of leader directs, delegates, and coordinates nursing activities.

Page Ref: 14

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.B.4. Function competently within own scope of practice as a member of the healthcare team | AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

12) A patient has questions about a required surgical procedure. When performing as a patient advocate, what should the nurse do?

1. Contact the healthcare provider and ask that the procedure be explained to the patient.

2. Explain the procedure to the patient.

3. Document that the patient does not understand the proposed surgical procedure.

4. Instruct the patient in alternatives to the surgical procedure.

Answer: 1

Explanation: 1. The nurse as patient advocate actively promotes the patient’s rights to autonomy and free choice. The nurse should protect the patient’s right to self-determination about the surgical procedure.

2. The nurse should not explain the procedure to the patient. This is not patient advocacy.

3. The nurse should not do anything beyond documenting the patient’s lack of understanding about the procedure.

4. The nurse should not provide alternatives to the surgical procedure.

Page Ref: 16

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.2. Communicate patient values, preferences, and expressed needs to other members of healthcare team | AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

13) The nurse teaches a patient newly diagnosed with type 2 diabetes mellitus about the importance of an annual dilated-retina eye examination and annual urine tests to measure protein levels. Within which role is the nurse functioning?

1. Educator

2. Researcher

3. Advocate

4. Leader

Answer: 1

Explanation: 1. The nurse is functioning as an educator by instructing the patient on annual tests to maintain health.

2. As a researcher, the nurse would have a goal to improve the care nurses provide to patients.

3. As an advocate, the nurse actively promotes the patient’s rights to autonomy and free choice.

4. As a leader, the nurse manages time, people, and resources by delegating, directing, and coordinating nursing activities.

Page Ref: 15

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.B.15. Communicate care provided and needed at each transition in care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Learn continuously, learn cooperatively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

14) The nurse is providing care within the primary nursing delivery model. Which leadership activities should the nurse perform within this model? Select all that apply.

1. Communicate with patients, families, and other care providers.

2. Serve as the team leader by making assignments and being responsible for all care provided.

3. Make referrals and manage the quality of care to include timeliness and cost.

4. Manage a caseload of patients and the health team members providing care to the patients.

5. Create patient discharge plans.

Answer: 1, 5

Explanation: 1. When providing care to patients within the primary nursing care delivery model, leadership activities of the nurse include communicating with patients, families, and other care providers.

2. In the team nursing care delivery model, leadership activities of the nurse include serving as the team leader, making assignments, and being responsible for all care provided.

3. In the transitional care coordination model, leadership activities of the nurse include making referrals and managing the quality of care to include timeliness and cost.

4. In the transitional care coordination model, leadership activities of the nurse include managing a caseload of patients and the health team members providing care to the patients.

5. When providing care to patients within the primary nursing care delivery model, leadership activities of the nurse include creating discharge plans.

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.15. Communicate care provided and needed at each transition in care | AACN Essentials Competencies: I.4. Use written, verbal, non-verbal and emerging technology methods to communicate effectively | NLN Competencies: Quality and Safety; Practice-Know-How; Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

15) The nurse is using a specific process to plan smoking cessation activities for a patient. What is this nurse most likely using to plan the care for this patient?

1. Nursing process

2. Critical pathways

3. Evidence-based practice

4. Variance analysis

Answer: 1

Explanation: 1. The nursing process is a series of critical-thinking and clinical reasoning activities that nurses use to provide care to patients. The purpose of care may be to promote wellness, restore health, or facilitate coping with a disability or death.

2. Critical pathways are used primarily to manage disease conditions.

3. Evidence-based practice is used primarily to manage disease conditions.

4. Variance analyzing implies the use of statistics-based research.

Page Ref: 6-7

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

16) The nurse working on a quality improvement study wants to evaluate a patient care process. What should the nurse use to evaluate this process?

1. Nursing process

2. Critical pathway

3. Variance analysis

4. Evidence-based practice

Answer: 1

Explanation: 1. The nursing process can serve as a framework for the evaluation of quality care.

2. The use of critical pathways would not provide the best, recommended means to evaluate a patient care process.

3. The use of variance analysis would not provide the best, recommended means to evaluate a patient care process.

4. The use of evidence-based practice would not provide the best, recommended means to evaluate a patient care process.

Page Ref: 20

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: IV.A.1. Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice | AACN Essentials Competencies: II.1. Apply leadership concepts, skills, and decision making in the provision of high-quality nursing care; healthcare team coordination; and the oversight and accountability for care delivery in a variety of settings | NLN Competencies: Knowledge and Science; Knowledge; Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

17) The nurse is reviewing the outcome of care that was provided to a patient. Which nursing process step is the nurse implementing?

1. Evaluation

2. Assessment

3. Implementation

4. Planning

Answer: 1

Explanation: 1. The evaluation step allows the nurse to determine whether the plan was effective and whether to continue, revise, or terminate the plan. The outcome criteria that were established during the planning step provide the basis for evaluation.

2. During the assessment phase, the nurse is actively collecting data.

3. Implementation is the phase of the nursing process during which the nurse performs interventions.

4. Determining the needs of the patient and devising a plan of action take place during the planning phase.

Page Ref: 11-12

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.C.10. Value active partnership with patients or designated surrogates in planning, implementation, and evaluation of care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

18) A patient says, “I have pain in my leg when I stand too long.” As which type of data should the nurse categorize this information?

1. Subjective

2. Evaluative

3. Qualitative

4. Objective

Answer: 1

Explanation: 1. Information that is perceived only by the person experiencing it is subjective data.

2. Evaluative data is used to assess responses to care.

3. Qualitative data refers to the presence or absence of a factor.

4. Objective data can be measured by someone or something other than the patient.

Page Ref: 8

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview; implementation of care plan; and evaluation of care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Practice-Know-How; Read and interpret data; apply health promotion/disease prevention strategies | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

19) While providing care, the nurse stops to assess a new patient problem. What type of assessment is the nurse conducting?

1. Focused

2. Initial

3. Objective

4. Subjective

Answer: 1

Explanation: 1. Focused assessments are ongoing and continuous, occurring whenever the nurse interacts with the patient. In a focused assessment, data are gathered about an identified or potential problem and are used to evaluate nursing actions and make decisions about whether to continue or change interventions to meet outcomes. Focused assessments enable the nurse to identify responses to a disease process or treatment modality not present during the initial assessment, and to identify new problems.

2. The initial assessment refers to the first interaction.

3. Subjective assessment is not indicated in this scenario.

4. Objective assessment is not indicated in this scenario.

Page Ref: 8

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview; implementation of care plan, and evaluation of care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Practice-Know-How; Read and interpret data; apply health promotion/disease prevention strategies | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

20) At the completion of an assessment, the nurse chooses a nursing diagnosis that best defines the patient’s health problems. Which type of clinical judgment should the nurse use at this time?

1. Diagnostic reasoning

2. Evidence-based practice

3. Critical pathway

4. Nursing process

Answer: 1

Explanation: 1. Diagnostic reasoning is a form of clinical judgment used to make decisions about which diagnostic label best describes the patterns of patient data.

2. Evidence-based practice refers to the implementation of care initiatives that have been supported by research.

3. A critical pathway is a healthcare plan developed to provide care with a multidisciplinary, managed action focus.

4. The nursing process is a series of critical thinking and clinical reasoning activities nurses use as they provide care to patients.

Page Ref: 8

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

21) The nurse is creating outcome criteria for identified nursing diagnoses for a patient. What characteristics should the nurse include when creating the criteria?

1. Patient-specific, time-specific, and measurable

2. Constructedas nursing goals

3. Structuredas statements

4. Focus on psychomotor actions

Answer: 1

Explanation: 1. Outcome criteria for nursing diagnoses are patient-centered, time-specific, and measurable. They are classified into three domains: cognitive, affective, and psychomotor.

2. The focus of the outcome criteria is the patient, not the nurse.

3. While the outcome criteria are often written as statements, this option does not encompass all of the criteria that are to be included.

4. Outcome criteria are not limited to psychomotor skills; they may also be cognitive or affective.

Page Ref: 8-9

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.8. Describe the limits and boundaries of therapeutic patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Quality and Safety; Practice-Know-How; Contribute to assessment of outcome achievement | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

22) The nurse is implementing a plan of care for a patient. After providing care, what should the nurse do as the final step in the process?

1. Document

2. Reassess the patient

3. Measure vital signs

4. Provide report to the charge nurse

Answer: 1

Explanation: 1. Documenting interventions is the final component of implementation as well as a legal requirement.

2. Ongoing assessment of the patient is an essential component of implementation, but it is not the final step.

3. Measuring vital signs can be completed at any time and not necessarily at the end of implementing the plan of care.

4. Providing report is an ongoing process and is not necessarily completed after implementing the plan of care.

Page Ref: 11

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: VI.B.4. Document and plan patient care in an electronic health record | AACN Essentials Competencies: IV.4. Understand the use of CIS (clinical information systems) systems to document interventions related to achieving nurse sensitive outcomes | NLN Competencies: Knowledge and Science; Practice-Know-How; Document via electronic health records; use software applications related to nursing practice | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

23) A patient care issue has been raised about the actions taken by a nurse who provided care to a patient whose healthcare decisions were considered controversial. What should the nurse manager consult to protect the patient and evaluate the care in question?

1. Nursing Code of Ethics

2. Hospital quality improvement guidelines

3. Nurse Practice Act

4. Critical pathway

Answer: 1

Explanation: 1. An established code of ethics is one criterion that defines a profession. Ethics are principles of conduct. Codes of ethics for nurses provide a frame of reference for ideal nursing behaviors that are congruent with the principles expressed in the Code for Nurses.

2. Quality improvement uses data to monitor the outcomes of care and the processes used to deliver that care.

3. The Nurse Practice Act provides the standards for an individual state’s stance on the nurse’s scope of practice.

4. A critical pathway is a healthcare plan developed to provide care with a multidisciplinary, managed action focus.

Page Ref: 12

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patient-centered care | AACN Essentials Competencies: VIII.12. Act to prevent unsafe, illegal, or unethical care practices | NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional standards | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

24) The nurse is preparing a patient to go home. Which skill should the nurse use when preparing this patient?

1. Familiarity with adult learning principles

2. Ability to follow written orders

3. Ability to use critical thinking

4. Ability to support patient decision making

Answer: 1

Explanation: 1. The nurse will function as an educator when preparing a patient for discharge. To do this adequately, the nurse will need to have some level of familiarity with adult learning principles to provide effective patient education and evaluate the outcome.

2. Following written orders is considered a basic caregiver skill.

3. Using critical thinking would be considered a basic caregiver skill.

4. The ability to support patient decision making relates to the role of patient advocate.

Page Ref: 16

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Learn continuously, learn cooperatively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

25) The nurse is preparing to provide patient care information to a group of unlicensed assistive personnel. Which type of care delivery system is this nurse most likely using to provide patient care?

1. Team nursing

2. Functional nursing

3. Primary nursing

4. Case management

Answer: 1

Explanation: 1. Team nursing is practiced by teams of healthcare providers with various levels of education, including unlicensed assistive personnel. Team members work together and provide the care for which they are individually trained.

2. Functional nursing is not a recognized term.

3. In primary nursing, total nursing care is provided by the assigned nurse.

4. The focus of case management is meeting the needs and care of a group of patients, with concurrent goals of maximized outcomes and cost containment.

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.B.5. Assume role of team member or leader based on the situation | AACN Essentials Competencies: VI.1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e., scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork; Knowledge; Scope of practice, roles, and responsibilities of healthcare team members, including overlaps | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

26) A nurse has delegated the collection of vital signs, including blood pressure readings, to two unlicensed assistive personnel. What is the nurse’s responsibility for the delegated care?

1. The nurse is accountable for the care that was delegated.

2. The nurse is not responsible for these vital signs.

3. The nurse is not accountable for these vital signs.

4. The nurse is responsible for re-measuring all the vital signs.

Answer: 1

Explanation: 1. When the nurse delegates nursing care activities to another person, that person is authorized to act in the place of the nurse, while the nurse retains accountability for the activities performed.

2. The nurse retains responsibility/accountability for the vital signs.

3. The nurse is accountable for reviewing the data collected and ensuring it is done appropriately.

4. The purpose of delegation is to share tasks appropriately, not to increase the workload of the primary nurse.

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.B.5. Assume role of team member or leader based on the situation | AACN Essentials Competencies: VI.1. Compare/contrast the roles and perspectives of the nursing profession with other care professionals on the healthcare team (i.e., scope of discipline, education, and licensure requirements) | NLN Competencies: Teamwork; Knowledge; Scope of practice, roles, and responsibilities of healthcare team members, including overlaps | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

27) The nurse manager completes chart audits for a specific group of patients. What should the manager do with this information?

1. Create an action plan to address any negative findings.

2. Share it with the hospital administrator.

3. Submit it to the agency’s accrediting body.

4. Place it in a file to compare with the next set of audits.

Answer: 1

Explanation: 1. The results of quality assurance audits can be used to develop a plan of action to resolve differences or issues with patient care. Nurses use the information if it will have a positive impact on the nursing practice.

2. There is no real purpose to sharing the results of a quality assurance audit with the hospital administrator.

3. While the accrediting body of an institution may encourage quality improvement activities, there is no reason to provide the chart audit results.

4. Nurses use the information if it will have a positive impact on the nursing practice.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: IV.B.5. Use quality measures to understand performance | AACN Essentials Competencies: II.10. Use improvement methods, based on data from the outcomes of care processes, to design and test changes to continuously improve the quality and safety of healthcare | NLN Competencies: Knowledge and Science; Practice; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

28) The nurse reviews the role of advocacy with a group of new graduate nurse employees. Which statement by a graduate nurse indicates the need for further education?

1. “Patient advocates have the authority to make decisions for the patient.”

2. “Being a patient advocate entails making efforts to improve patient outcomes.”

3. “Providing education to the patient and family is a key way to be a positive patient advocate.”

4. “Communicating patient needs to the members of the healthcare team is a role of the patient advocate.”

Answer: 1

Explanation: 1. The nurse who serves as a patient advocate may assist and support the patient in decision making. The nurse cannot make decisions for the patient.

2. This is an element of being a successful patient advocate.

3. This is an element of being a successful patient advocate.

4. This is an element of being a successful patient advocate.

Page Ref: 16

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.2. Communicate patient values, preferences, and expressed needs to other members of healthcare team | AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

29) The director of nursing is reviewing situations that require attention. Which situation is an ethical dilemma that might need to be analyzed by the hospital Ethics Committee?

1. A 20-year-old male patient with an opportunistic disease is HIV positive and does not want to share this information with sexual partners.

2. The nurse-patient ratio is 5:1 on a medical-surgical care area.

3. A nurse inexperienced with electrocardiogram interpretation was assigned to the telemetry unit to provide care.

4. Nursing staff provide medication to patients after doses are dropped on the floor.

Answer: 1

Explanation: 1. A dilemmais a choice between two unpleasant, ethically troubling alternatives. Nurses who provide medical-surgical nursing care face dilemmas almost daily. Many commonly experienced dilemmas involve confidentiality, patient rights, and issues of dying and death. Nurses respect the right to confidentiality of patient information found in the patient’s record or secured during interviews. An individual’s right to privacy and confidentiality creates a dilemma when it conflicts with the nurse’s right to information that may affect personal safety. The law in most states mandates that HIV test results can be given to another person only with the patient’s written consent. Many healthcare providers believe that this law violates their own right to personal safety.

2. This situation is not a dilemma but may violate standards of care or standards of practice.

3. This situation is not a dilemma but may violate standards of care or standards of practice.

4. This situation is not a dilemma but may violate standards of care, codes of ethics, or standards of practice.

Page Ref: 13-14

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patient-centered care | AACN Essentials Competencies: VIII.12. Act to prevent unsafe, illegal or unethical care practices | NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional standards | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

30) The nurse accepts tickets to a sporting event from a patient in exchange for free home care for 1 week. Which standards did the nurse violate? Select all that apply.

1. HIPAA

2. ANA standards

3. Professional boundaries

4. State nurse practice acts

5. Standards pertinent to specific hospital protocols

Answer: 3, 4

Explanation: 1. HIPAA involves violations of patient confidentiality.

2. A violation of ethics in the ANA Standards of Care would not apply here.

3. Professional boundaries are the borders between the vulnerability of the patient and the power of the nurse. It is vital that nurses recognize this relationship and establish boundaries to safely and effectively meet the patient’s needs. Confusion between the needs of the nurse and those of the patient can result in boundary violations.

4. Professional boundaries are outlined in individual state nurse practice acts.

5. Hospital protocols are not identified in the question; however, the nurse’s action violates a professional boundary.

Page Ref: 13

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.7. Explore ethical and legal implications of patient-centered care | AACN Essentials Competencies: VIII.1. Demonstrate the professional standards of moral, ethical, and legal conduct | NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional standards | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

31) A seasoned nurse does not want to assist nursing students during clinical rotations and often obstructs the students’ learning process. Which standard is this nurse violating?

1. ICN Code of Ethics

2. ANA Standards of Professional Performance

3. ANA Code of Ethics

4. State practice acts

Answer: 2

Explanation: 1. The ICN Code of Ethics for Nurses helps guide nurses in setting priorities, making judgments, and taking action when they face ethical dilemmas in clinical practice.

2. The nurse is violating the standards of leadership and collaboration by refusing to assist the students during the learning process.

3. The nurse is not violating the Code of Ethics.

4. The nurse is not violating the state nurse practice act.

Page Ref: 13

Cognitive Level: Analyzing

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: II.C.6. Value teamwork and the relationships upon which it is based | AACN Essentials Competencies: VIII.1. Demonstrate the professional standards of moral, ethical, and legal conduct | NLN Competencies: Context and Environment; Knowledge; Code of Ethics; regulatory and professional standards | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.3 Explain the importance of nursing and interprofessional codes of ethics, standards of practice, and legal and ethical issues as guidelines for clinical nursing practice.

MNL Learning Outcome: 3. Integrate nursing and interprofessional codes of ethics, standards of practice, and legal and ethical guidelines in clinical practice.

32) The nurse attends interprofessional meetings to discuss the plan of care for a trauma patient who has been transferred to the medical-surgical unit. In what role is this nurse functioning?

1. Caregiver

2. Team leader

3. Delegate

4. Advocate

Answer: 4

Explanation: 1. The caregiver works independently and collaboratively with the patient.

2. Team leaders are nurses who are participating in roles of leadership in that they manage time, people, resources, and the environment to ensure that staff is able to provide the proper care.

3. Delegates are nurses who are responsible for completing care as assigned.

4. The nurse as advocate actively promotes the patient’s rights to autonomy and free choice. The nurse will communicate with other healthcare team members and assist and support patient decision making.

Page Ref: 16

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.B.2. Communicate patient values, preferences, and expressed needs to other members of healthcare team | AACN Essentials Competencies: VI.2. Use inter- and intraprofessional communication and collaborative skills to deliver evidence-based, patient-centered care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

33) The director of nursing is planning an initiative to improve the quality and safety of patient care. After reviewing the Triple Aim approach, which action should the director recommend? Select all that apply.

1. Improve the patient care experience.

2. Maximize positive outcomes.

3. Reduce the per capita costs of healthcare.

4. Implement evidence-based practice.

5. Support nursing continuing education plans.

Answer: 1, 2, 3

Explanation: 1. The Institute of Health Improvement Triple Aim has three objectives. Improve patient care experience is one of these objectives.

2. The Institute of Health Improvement Triple Aim has three objectives. Maximize positive outcomes is one of these objectives.

3. The Institute of Health Improvement Triple Aim has three objectives. Contain costs is one of these objectives.

4. Implementing evidence-based practice is not a Triple Aim objective.

5. Supporting nursing continuing education plans is not a Triple Aim objective.

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: IV.B.5. Use quality measures to understand performance | AACN Essentials Competencies: II.11. Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and/or system-wide practice improvements that will improve the quality of healthcare delivery | NLN Competencies: Quality and Safety; Knowledge; Current best practices | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

34) The nurse would like to do a research project that focuses on vending machine choices that patients prefer. What should the nurse question before proceeding with this research study?

1. Is the research valid?

2. Will this promote patient independence?

3. Is this a project that would add value to the hospital experience?

4. Does this research contribute to patient care?

Answer: 4

Explanation: 1. To be relevant, nursing research must have a goal to improve the care that nurses provide patients. This means that all nurses must consider the researcher role to be integral to nursing practice. The research might be valid; however, it does not improve patient care.

2. To be relevant, nursing research must have a goal to improve the care that nurses provide patients. This means that all nurses must consider the researcher role to be integral to nursing practice. The research might promote patient independence but may not improve patient care.

3. To be relevant, nursing research must have a goal to improve the care that nurses provide patients. This means that all nurses must consider the researcher role to be integral to nursing practice. The research might add value to the hospital experience but may not improve patient care.

4. To be relevant, nursing research must have a goal to improve the care that nurses provide patients. This means that all nurses must consider the researcher role to be integral to nursing practice.

Page Ref: 20

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.1. Participate effectively in appropriate data collection and other research activities | AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science; Knowledge; Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

35) The nurse is identifying nursing diagnoses for a patient’s care. In which order should the nurse complete this process? Place in order the steps of the process.

Choice 1. Draw conclusions about the present health status.

Choice 2. Determine etiologies and categorize problems.

Choice 3. Cluster cues and identify data gaps.

Choice 4. Verify the problem or diagnoses.

Choice 5. Recognize significant cues.

Answer: 5, 3, 1, 2, 4

Explanation: Choice 1. Based upon the data clusters and gaps identified, the patient’s health status can be determined.

Choice 2. Once the patient’s present health status is determined, the etiology of problems can be identified and then categorized.

Choice 3. After cues are identified, they are to be clustered so that data gaps can be identified.

Choice 4: The final step is to verify the patient’s problems and finalize the appropriate diagnoses.

Choice 5. When identifying nurse diagnoses, significant cues should be identified first.

Page Ref: 9

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care | NLN Competencies: Knowledge and Science; Practice-Know-How; Translate research into practice in order to promote quality and improve practices | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

36) The nurse is hired to coordinate care in a community health clinic that opened after the implementation of the Affordable Care Act. Which types of care should the nurse expect to provide? Select all that apply.

1. Health promotion

2. Disease prevention

3. Chronic disease management

4. Rehabilitation

5. Palliative care

Answer: 1, 2, 3

Explanation: 1. The original intent of the ACA continues to influence healthcare policy and reimbursement, and it is changing provider practice and the environment. The nursing profession is well positioned to respond to demands of a transitioning healthcare system that emphasize health promotion.

2. The original intent of the ACA continues to influence healthcare policy and reimbursement, and it is changing provider practice and the environment. The nursing profession is well positioned to respond to demands of a transitioning healthcare system that emphasize disease prevention.

3. The original intent of the ACA continues to influence healthcare policy and reimbursement, and it is changing provider practice and the environment. The nursing profession is well positioned to respond to demands of a transitioning healthcare system that emphasize management of chronic disease.

4. Rehabilitation is not a new model of care that will be provided in a community health clinic.

5. Palliative care is not a new model of care that will be provided in a community health clinic.

Page Ref: 2

Cognitive Level: Applying

Client Need & Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment; Knowledge; Environmental health; health promotion/disease prevention (e.g., transmission of disease, disease patterns, epidemiological principles); chronic disease management; healthcare systems; transcultural approaches to health; family dynamics | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

37) The nurse manager is evaluating the use of evidence-based practice guidelines to guide care on a patient care area. Which observation indicates that these guidelines are being used appropriately? Select all that apply.

1. Guidelines are posted on the staff bulletin board in the break room.

2. A guideline was quoted in a narrative note in a patient’s medical record.

3. A guideline is placed in the Kardex to support the use of a nursing diagnosis for a patient’s health problem.

4. Guidelines are accessed through the clinical documentation system by nurses prior to writing patient care plans.

5. A guideline was referenced prior to implementing skin care interventions for a patient prone to pressure ulcer formation.

Answer: 2, 3, 4, 5

Explanation: 1. Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare. Posting the guidelines on the staff bulletin board does not indicate that they are being used appropriately.

2. Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare. Basing patient care on an evidence-based guideline indicates that it is being used appropriately.

3. Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare. Placing a copy of an evidence-based guideline in the Kardex to support a particular nursing diagnosis indicates that it is being used appropriately.

4. Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare. Observing staff access evidence-based guidelines through the clinical documentation system indicates they are being used appropriately.

5. Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal healthcare. Referring to an evidence-based guideline before planning skin care interventions indicates the guideline is being used appropriately.

Page Ref: 5

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essentials Competencies: III.2. Demonstrate an understanding of the basic elements of the research process and models for applying evidence to clinical practice | NLN Competencies: Knowledge and Science; Knowledge; What is evidence-based practice (EBP)? Informatics? | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1.1 Describe the core competencies for healthcare professionals: Patient-centered care, interprofessional teams, evidence-based practice, quality improvement, safety, and health information technology.

MNL Learning Outcome: 1. Demonstrate use of the core competencies for healthcare professionals in nursing practice.

38) An interprofessional team is meeting to create a care bundle to prevent the development of contractures in patients with limb paralysis from neurological health problems. Which action should the committee members include when creating this care bundle? Select all that apply.

1. Define the patient population

2. Identify three to five interventions

3. Ensure the elements of the bundle are independent

4. Ensure the bundle elements are descriptive

5. Mandate that the bundle elements are prescriptive

Answer: 1, 2, 3, 4

Explanation: 1. Care bundles are interprofessional care standards that pull together a short list of interventions and treatments that are already recommended and are generally accepted in national guidelines. The bundle is used with a defined patient population in one location.

2. The bundle has three to five interventions (elements), with strong clinician agreements.

3. Each bundle is relatively independent. The bundle is developed so that if one of the interventions of care is not implemented it will not affect whether other bundle elements are implemented.

4. Bundle elements should be descriptive rather than prescriptive, to allow for local customization and appropriate clinical judgment.

5. Bundle elements should be descriptive rather than prescriptive.

Page Ref: 11

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: III.B.6. Participate in structuring the work environment to facilitate integration of new evidence into standards of practice | AACN Essentials Competencies: III.9. Describe mechanisms to resolve identified practice discrepancies between identified standards and practice that may adversely impact patient outcomes | NLN Competencies: Context and Environment; Knowledge; Codes of ethics, regulatory and professional standards, ethical decision-making models, scope of practice considerations, principles of informed consent, confidentiality, patient self-determination | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.

39) The nurse is coordinating care for patients within a patient-centered medical home (PCMH). Which action should the nurse prepare to complete when functioning in this role? Select all that apply.

1. Communicate with the patient after discharge.

2. Monitor the implementation of the plan of care.

3. Manage the accuracy, timeliness, and cost of care.

4. Develop the plan of care with the patient and family.

5. Collaborate with the patient to implement the plan of care.

Answer: 1, 2, 3, 5

Explanation: 1. The nurse functioning as a care coordinator within a PCMH will be in contact with the patients after discharge to ensure continuity of care and health maintenance.

2. The nurse functioning as a care coordinator within a PCMH will monitor the implementation of the patient’s plan of care.

3. The nurse functioning as a care coordinator within a PCMH manages the quality of care provided, including accuracy, timeliness, and cost.

4. The PCMH team is led by the patient’s primary care provider, who is responsible for leading the development of the plan of care with the patient and the family.

5. The nurse functioning as a care coordinator within a PCMH collaborates with the patient to implement the plan of care.

Page Ref: 17

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: IV.A.1. Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice | AACN Essentials Competencies: II.11. Employ principles of quality improvement, healthcare policy, and cost-effectiveness to assist in the development and initiation of effective plans for the microsystem and/or system-wide practice improvements that will improve the quality of healthcare delivery | NLN Competencies: Teamwork; Knowledge; Scope of practice, roles, and responsibilities of healthcare team members, including overlaps | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.4 Explain the activities and characteristics of the nurse as caregiver, educator, advocate, leader and manager, and researcher.

MNL Learning Outcome: 4. Consider the various role of the nurse as in medical-surgical nursing practice.

40) The nurse is using clinical reasoning to plan patient care. Which foundational source of knowledge should the nurse use? Select all that apply.

1. Know the profession

2. Know self

3. Know the case

4. Know the patient

5. Know the patient’s health insurance

Answer: 1, 2, 3, 4

Explanation: 1. Knowing the profession means the nurse has knowledge of standards of practice, scope of practice, competencies, skills, and the role of nurses.

2. Knowing self means knowledge of one’s own strengths, limitations, skills, experience, assumptions, preconceptions, learning, and other needs.

3. Knowing the case means knowledge of pathophysiology, patterns that exist in typical cases, evidence-based practices relevant to appropriate patient population, predicted trajectory, and predictable patient responses.

4. Knowing the patient means knowledge of a patient’s baseline data, patterns that exist in laboratory or other data, and patterns in physiologic responses to pathology and treatment.

5. Knowing the patient’s health insurance is not a foundational source of knowledge.

Page Ref: 6

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Management of Care

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: I.7. Integrate the knowledge and methods of a variety of disciplines to inform decision making | NLN Competencies: Context and Environment; Knowledge; Change, uncertainty, complexity theories, impact of continual knowledge explosion and constant evolution of technology, decision making in uncertainty, management of conflicting information, blurring of role boundaries, and the resultant uncertainty about role expectation | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1.2 Apply the attitudes, mental habits, and skills necessary for clinical reasoning when using the nursing process in patient care.

MNL Learning Outcome: 2. Recognize the skills necessary for clinical reasoning when using the nursing process in patient care.