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NU 2520 Exam 4 With
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[4 stages of coping]
during this stage, disorientation energy and attention are focused on responding to crisis - ANSWER shock
this term is defined as "willful infliction of physical injury or mental anguish and the deprivation of essential services." - ANSWER Abuse
This can be either physical, psychological or sexual. It is defined as... behavior exhibited by the abuser to the victim, a criminal act. - ANSWER Battering
[Match the concepts for a critical thinker on with the application of the term]
An RN displaying their critical thinking capabilities who anticipates how a patient might respond to a treatment., is applying critical thinking in which way - ANSWER analytically
A manager is reviewing the RN documentation entered by a staff RN in a Pt's EMR & finds the following entry, "Pt is difficult to care for, refuses suggestion for improving appetite." Which of the following statements is more appropriate for the manager to make to the staff RN who entered this information?
a. "Avoid rushing when documenting an entry in the medical record."
b. Use correction fluid to remove the entry."
c. "Draw a single line through the statement and initial it."
d. Enter only objective and factual information about a patient in the medical record. - ANSWER D
(Nurses should enter only objective and factual information about patients. Opinions have no place in the medical record. Because the information has already been entered and is not incorrect, it should be left on the record. Never use correction fluid in a written medical record.)
A preceptor observes a new grad RN discussing changes in a Pt's condition with a HCP over the phone. The new grad RN accepts a phone order for new meds + additional lab tests per the HCP.
During the conversation, the new grad writes med orders down on paper & plans to enter them into the EMR when a computer is available.
At this hospital, (new) med orders in the MREC can be viewed immediately by hospital pharmacists, & policy states, "all new meds must be reviewed by a pharmacist before being administered to Pt's."
The supervising RN will have to intervene if the new RN grad completes which action...
a. Read the orders back to the HCP to verify accuracy of transcribing the orders after receiving them over the phone
b. Documents the date and time of the phone conversation, the name of the physician, and the topics discussed in the electronic record.
c. Gives a newly ordered medication before entering the order - ANSWER C
(When provider orders for new medication(s) are entered into an electronic
nurse needs to be more specific; it does not provide enough information regarding the reason for the patient's concern.)
The RN is reviewing the HIPAA regulations w/ the patient during the admission process.
The Pt states, "I'm not familiar with these HIPAA regulations. How will they affect my care?"
Which of the following is the best response?
a. HIPAA allows all hospital staff access to your medical record.
b. HIPAA limits the information that is documented in your medical record.
c. HIPAA provides you with greater protection of your personal health information.
d. HIPAA enables health care institutions to release all of your personal information to improve continuity of care. - ANSWER C
(HIPAA provides patients with control over who receives and accesses their medical records. It does not allow uncontrolled access to the medical records. HIPAA also does not dictate what must be documented in the patient's medical record.)
A Pt states, "I would like to see what is written in my medical record." What is the nurse's best response?
a. "Only your family can read your medical record."
b. "You have the right to read your record."
c. "Patients are not allowed to read their records."
d. "Only health care workers have access to patient records." - ANSWER B
(Patients have the right to read their medical 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. Families may read the records only when the patient has given permission.)
Which of the following documentation entries is MOST accurate?
a. "Patient walked up and down hallway with assistance, tolerated well."
b. "Patient up, out of bed, walked down hallway and back to room, tolerated well."
c. "Patient up, walked 50 feet and back down hallway with assistance from nurse. Spouse also accompanied patient during the walk."
d. "Patient walked 50 feet and back down hallway with assistance from nurse; HR 88 and regular before exercise, HR 94 and regular following exercise." - ANSWER D
(This provides the most accurate, objective information for the chart.)
Match each line of documentation with the appropriate SOAP category...
"The pain increases every time I try to turn on my left side." - ANSWER S (Subjective)
Match each line of documentation with the appropriate SOAP category ...
Re-positioned patient on right side. Encouraged patient to use PCA device. - ANSWER P (Plan)
Match each line of documentation with the appropriate SOAP category...
The RN is transferring a patient to a long-term, skilled care facility and has just given a telephone report to a RN who works at that facility & who will be receiving the Pt.
In documenting this call, the RN begins w/ date & time the report was given & the name of the RN taking the report. Which of the following pieces of information does the RN include in the documentation of this telephone call? (Select all that apply.)
a. The patient's name, age, and admitting diagnoses
b. The discussion of any allergies to food and medications that the patient has
c. That the nurse receiving the report was advised that the patient is "needy" and "on the call light all the time"
d. That the patient's pain rating went from 8 to 2 on a scale of 1 to 10 after receiving 650 mg of Tylenol
e. Description of any unresolved problems and current interventions in place
(During transfer to another institution, include essential background information such as the patient's name, age, diagnosis, and allergies. Also include response to treatments such as response to pain-relieving measures. Information about how much the patient ate for breakfast is not necessary. This information is in the chart if the nurse really needs to know. Do not include critical comments about your patients.)
A group of RN's are discussing advantages of using computerized provider order entry (CPOE).
Which statement indicates that the RN's understand the advantage of using CPOE?
a. "CPOE reduces transcription errors."
b. "CPOE reduces the time needed for health care providers to write orders."
c. "CPOE eliminates verbal and telephone orders from health care providers."
d. "CPOE reduces the time nurses use to communicate with health care providers." - ANSWER A
(CPOE eliminates the need for someone to transcribe the orders because it allows the provider to enter the order directly, thus eliminating the need to transcribe orders. There is no evidence that CPOE reduces the time needed for providers to write orders for their patients, or the time nurses must spend communicating with providers. Nurses use CPOE systems under certain circumstances to enter orders given by a provider in person, or over the phone.)
An RN is supervising a new RN student & allows the student to complete documentation of Pt while observing...
Which action would be considered innappropriate for the RN student, & requires intervention by the supervising RN?
(Select 2 that apply.)
a. Documents a medication given by another nursing student.
b. Includes the date and time of the entry into the medical record.
c. Enters assessment data into the electronic medical record using the computer mounted on the wall in the patient's room.
a.m. and 12 noon, with the exception that you add a leading "0" to times before 10:00 a.m. (ex: 08:00 instead of 8:00 a.m.). To convert military time to civilian time: For a military time that's 13:00 or larger, simply subtract 12: to get the standard time (ex: If someone says "Meet me in room 202 at 15:45, subtract 12:00 from 15:45 to get 3:45 pm). To convert standard time to military time: add 12:00 to any time from 1:00 p.m. to 11:00 p.m. (ex: If you want to say 6:30 p.m. in military time, add 12:00 to 6:30 to get 18:30).)
The RN is caring for a Pt w/ a nasogastric feeding tube who is receiving a continuous tube feeding @ a rate of 45 mL per hour. The RN enters the patient assessment data and information that the head of the patient's bed is elevated to 20 degrees. An alert appears on the computer screen warning that this patient is at a high risk for aspiration because the head of the bed is not elevated enough. This warning is known as which type of system?
a. Electronic health record
b. Clinical documentation
c. Clinical decision support system
d. Computerized physician order entry - ANSWER C
(A clinical decision support system is based on rules that are triggered by data entry. When certain rules are not met, alerts, warnings, or other information may be provided to the user.)
While reviewing the pulmonary assessment entered by a RN in a Pt's electronic medical record (EMR), a HCP notices that the only information documented in that section is "WDL" (within defined limits). The HCP also is not able to find a narrative description of the Pt's respiratory status in the RN's progress notes. What is the most likely reason for this?
a. The nurse caring for the patient forgot to document on the pulmonary system.
b. The EMR uses a charting-by-exception format.
c. The computer shut down unexpectedly when the nurse was documenting the assessment.
d. Because of HIPAA regulations, physicians are not authorized to view the nursing assessment. - ANSWER B
(Given that the initial assessment indicated that the pulmonary system was within normal limits, the facility is most likely documenting by exception. There is no need for further documentation unless the pulmonary assessment changes and is no longer within normal limits.)
What is the appropriate way for a RN to dispose of information printed out from a patient's EHR?
a. Rip the papers up into small pieces and place the pieces into a standard trash can
b. Place all papers in the flip-top binder designated for that patient that is located in the nurse's station on the patient care unit
c. Place papers with patient information in a secure canister marked for shredding
d. Burn documents with patient information in the steel sink located within the dirty supply room on the patient care unit - ANSWER C
(Confidential patient information should be shredded. It is generally collected in large secure containers and shredded at scheduled times.)
patient's values and beliefs. Clinical decisions are then just, faithful to the patient's choices, and beneficial to the patient's well-being.)
A RN prepares to insert a Foley catheter. The procedure manual calls for the patient to lie in the dorsal recumbent position. The patient complains of having back pain when lying on her back. Despite this, the RN positions the patient supine w/ knees flexed as the manual recommends and begins to insert the catheter. This is an example of:
A. Accuracy.
B. Reflection.
C. Risk taking.
D. Basic critical thinking. - ANSWER D
(Basic critical thinking is concrete and based on a set of rules or principles, such as the guidelines in a hospital procedure manual. The nurse's approach is not accurate, as accuracy requires use of all of the facts (e.g. the patient's discomfort). A critical thinker is willing to take risks in trying different ways to solve problems; following one basic approach is not risk taking. This is also not an example of reflection.)
An RN is preparing medications for a Pt. The RN checks the name of the med on the label w/ the name of the med on the HCP's order. At the bedside the RN checks the Pt's name against the med order as well. The RN is following which critical thinking attitude:
a. Responsible
b. Complete
c. Accurate
d. Broad - ANSWER A
(The nurse is demonstrating responsibility for correct medication and patient identification. The other three choices are critical thinking intellectual standards.)
A RN on a busy medicine unit is assigned to four Pt's. It is 10 am. 2 Pt's have meds due & one of those has a specimen of urine to be collected. One Pt is having complications from surgery & is being prepared to return to the operating room.
The 4th Pt requires instructions about activity restrictions before going home this afternoon.
Which of the following should the RN use in making clinical decisions appropriate for the Pt group? (Select 3 that apply)
A. Consider availability of assistive personnel to obtain the specimen
B. Combine activities to resolve more than one patient problem
C. Analyze the diagnoses/problems and decide which are most urgent based on patients' needs
D. Plan a family conference for tomorrow to make decisions about resources the patient will need to go home (X)
E. Identify the nursing diagnoses for the patient going home - ANSWER A B & C
(Analyzing urgency of problems helps in prioritization as does considering the resources that are available (such as assistive personnel) to complete
c. Intuition.
d. Problem solving. - ANSWER A
(The mother had difficulty the first time breast feeding. The nurse relied on reflection to consider her previous actions, review what was successful and the opportunities for improvement. The nurse has not yet problem solved but might do so after reflection and anticipating the patient's next clinic visit.)
Place the steps of the scientific method in their correct order.
The number 1 being the first step of the process.
- Formulate a question or hypothesis. 2. Evaluate results of the study. 3. Collect data. 4. Identify the problem. 5. Test the question or hypothesis.
a. 4, 3, 1, 5, 2
b. 3, 4, 1, 2, 5
c. 4, 3, 2, 1, 5
d. 3, 4, 1, 5, 2 - ANSWER A
(The correct order of the steps of the scientific method are:
- Identifying the problem, 2. Collecting data, 3. Formulating a question or hypothesis, 4. Testing the question or hypothesis, and 5. Evaluating results of the test or study.)
An RN changed a Pt's surgical wound dressing the day before & now
prepares for another dressing change.
The RN had difficulty removing the gauze from the wound bed yesterday, causing the Pt discomfort.
Today he gave the Pt an analgesic 30 mins before the dressing change. The RN adds some sterile saline to loosen the gauze before removing it. The Pt reports the procedure was much more comfortable.
Which of the following describes the nurse's approach to the dressing change?
(Pick 2 that apply.)
A. Clinical inference
B. Basic critical thinking
C. Complex critical thinking
D. Experience
E. Reflection - ANSWER C & D
(The nurse relies on experience and the ability to adapt a procedure such as a dressing change (complex critical thinking) to make it successful.)
Which of the following describes a RN's application of a specific knowledge base during critical thinking? (Select all that apply.)
a. Working in multiple health care settings
b. Learning good communication skills
c. Spending time establishing relationships with patients
d. Relying on evidence in practice - ANSWER C
(Knowing the patient relates to a nurse's experience with caring for patients, time spent in a specific clinical area and having a sense of closeness with them. However, a critical aspect to knowing the patient and thus being able to make timely and appropriate decisions is spending time establishing relationships with patients.)
In which of the following examples, is an RN applying critical thinking skills in practice?
(Pick 3 that apply.)
a. The nurse thinks back about a personal experience before administering a medication subcutaneously.
b. The nurse uses a pain-rating scale to measure a patient's pain.
c. The nurse explains a procedure step by step for giving an enema to a patient care technician.
d. The nurse gathers data on a patient with a mobility limitation to identify a nursing diagnosis.
e. A nurse offers support to a colleague who has witnessed a stressful event.
(X) - ANSWER A B & D
(Reflection, using a pain rating scale to be precise and specific, and nursing assessment (the first step of the nursing process) are examples of critical thinking skills. Explaining a procedure based on policy is not critical thinking
- however performing a procedure following policy is basic critical thinking. Offering support to a colleague is an important way to assist another in managing stress but is not a critical thinking skill.)
An RN enters a 72-year-old Pt's home & begins to observe her behaviors and examine her physical condition.
The RN learns that the patient lives alone & notices bruising on the patient's leg. When watching the patient walk, the RN notes that she has an unsteady gait and leans to one side.
The Pt admits to having fallen in the past. T
he RN identifies the Pt as having the RN diagnosis of Risk for Falls. This scenario is an example of:
A. Inference.
B. Critical thinking.
C. Evaluation.
D. Diagnostic reasoning. - ANSWER D
(Diagnostic reasoning begins when you interact with a patient or make physical or behavioral observations. An expert nurse sees the context of a
