question

outcome identification and planning nurse wants to work in partnership with patient and family to:

answer

establish priorities, identify and write expected patient outcomes, select evidence based nursing interventions, communicate plan of nursing care

question

aim or end

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goal

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an expected conclusion to a patient health problem, or in the event of a wellness diagnosis, an expected conclusion to a patient's health expectation.

answer

patient outcome

question

used to refer to measurable criteria to evaluate the extent to which the goal has been met,

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expected outcomes

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performed by nurse with the admission nursing history and the physical assessment, comprehensive plan addresses each problem listed in the prioritized nursing diagnoses and identifies appropriate patient goals and the related nursing care

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initial planning

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prepared plans of care that identify the nursing diagnoses, outcomes, and related nursing interventions common to a specific population or health problem

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standardized care plans

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carried out by any nurse who interacts with the patient, its chief purpose is to keep the plan up to date to facilitate the resolution of health problems, manage risk factors, and promote function, the work is to state nursing diagnoses more clearly, develop new diagnoses, adjust patient outcomes to be more realistic, develop new outcomes as needed and develop nursing interventions that will best accomplish patient goals

answer

ongoing planning

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best carried out by the nurse who has worked most closely with the patient and family, possibly in conjunction with nurse or social worker with a broad knowledge of existing community resources, in acute care this type of planning begins as soon as the patient is admitted,

answer

discharge planning

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first comprehensive standardized language used to describe the patient outcomes that are responsive to nursing intervention

answer

nursing outcomes classification (NOC)

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any treatment based upon clinical judgement and knowledge that a nurse performs to enhance patient/client outcomes

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nursing intervention

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autonomous action based on scientific rationale that a nurse executes to benefit the patient in a predictable way related to the nursing diagnosis and projected outcomes

answer

nurse initiated intervention

question

first comprehensive validated list of nursing interventions applicable to all settings that can be used by nurses in multiple specialties greatly facilitates the work of identifying appropriate interventions

answer

nursing intervention classification

question

an intervention is initiated by a physician in response to a medical diagnosis but is carried out by a nurse in response to a doctor's order

answer

physician-initiated interventions

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nurses carrying out treatments initiated by other providers such as pharmacists, respiratory therapists, or physician assistants

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collaborative interventions

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a process in which two or more people with varying degrees or experiences and expertise discuss a problem and a solution often proves helpful

answer

consultation

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the written guide that directs the efforts of nursing team working with patients to meet their health goals, specifies nursing diagnosis, outcomes and associated nursing interventions, ensures the nursing team works efficiently to deliver holistic, goal-orientated, individualized care to patients

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plan of nursing care

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part of the electronic medical record, benefits include ready access to a large knowledge base, improved record keeping and resulting improvement in audits and quality assurance, documentation by all members of the health team with printouts,

answer

computerized plans of nursing care

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tools used in case management to communicate the standardized, interdisciplinary, plan of care for patients, intended to provide high quality, cost effective care for individuals, families and groups, emphasis is on clearly stating expected patient outcomes and specific times within which it is reasonable to achieve those outcomes

answer

clinical pathways (critical pathways or care maps)

question

describe the purpose and benefits of outcome identification and planning

answer

the purpose of outcome identification and planning is to design a plan of care with and for the patient that once implemented, results in the prevention, reduction, resolution of patient health problems and the attainment of patients health expectations as identified in the patients outcome

question

identify three elements of comprehensive planning

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initial planning, ongoing planning, and discharge planning

question

how do you prioritize patient health problems and nursing responses

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high priority diagnoses pose the greatest threat to patient's health and well being, diagnosis that are not life threatening are ranked as medium priorities, diagnoses that are not specifically related to current level of health or well being are low priority

question

what are three helpful guides when prioritizing patient problems ?

answer

maslows hierarchy of needs- basic needs before higher ones patient preference-thoughtful person-centered care anticipation of future problems-do not assign low priority to a diagnosis that the patient wants to ignore can result in harmful future consequences

question

describe how patient goals/expected outcomes and nursing orders are derived from nursing diagnosis

answer

outcomes are derived from the problem statement of the nursing diagnosis, for each nursing diagnosis in the plan of care, at least one outcome can be written that, if achieved, demonstrates a direct resolution of the problem statement

question

develop a plan of nursing care with properly constructed outcomes and related nursing interventions

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sample care plan on 296-297

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nurse initiated interventions do not require a physicians

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order

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whereas the problem that suggests nursing interventions it is the cause of the problem (etiology) that suggests

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nursing interventions

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the art of nursing involves the careful identification of the specific nursing interventions needed by particular patients to meet their individual

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needs

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the set of nursing interventions written to assist a patient to meet a outcome must be comprehensive, comprehensive nursing interventions specify

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observations, need to be made and how often, interventions need to be done and when they must be done, teaching, counseling, advocacy, needs patients and families have

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patient outcomes are meaningless unless the nurses evaluate the patients

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progress toward the achievement

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evaluative statements include a statement about achievement of a desired outcome and list actual patient behavior has evidence supporting the statement

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met, partially met, not met

question

concept map care plan is a

answer

diagram of patient problems and interventions, helps you to take a holistic view of patients situation

question

describe five common problems related to planning, their possible causes, and remedies

answer

failure to involve the patient in the planning process, insufficient data collection, use of inaccurate or insufficient data to develop nursing diagnoses, outcomes that are stated too broadly, outcomes derived from poorly developed nursing diagnoses, failure to write nursing orders that do not resolve the problem and failure to update plan of care

question

describe the rationale for standardized outcomes (NOC) and interventions (NIC) for nursing

answer

The rationale for the nursing intervention classification is that it is the first comprehensive, validated list of nursing interventions applicable in all settings that can be used by nurses in multiple specialties greatly facilitates the work of identifying appropriate interventions, Nursing outcomes classification presents the first comprehensive standardized language used to describe the patient outcomes that are responsive to nursing intervention, the rationale It is imperative that nursing define its interventions and outcomes and that these standardized nomenclatures be included in clinical nursing information systems in large data sets used for systematic analysis

question

a nurse is planning care for a male adolescent patient who is admitted to the hospital for a treatment of drug overdose. Which nursing actions are related to the outcome identification and planning step of the nursing process?

answer

the nurse identifies expected patient outcomes the nurse selects evidence based nursing interventions the nurse explains the nursing care plan to the patient

question

a nurse on a busy surgical unit relies on informal planning to provide appropriate nursing responses to patients in a timely manner, what are examples of this type of planning?

answer

the nurse assess a women for postpartum depression during routine care, a busy nurse takes time to speak to a patient who receives bad news, a nurse reassess a patient whose PRN pain medication isnt working,

question

when helping a patient turn in bed, the nurse notices that his heels are reddened and plans to place him on precautions for skin breakdown, this is an example of what type of planning

answer

ongoing planning

question

a nurse is prioritizing the following patient diagnoses according to Maslow's hierarchy of needs the diagnoses are: 1-disturbed body image 2-ineffective airway clearance 3-spiritual distress 4-impaired social interaction which answer choice below lists the problems in order of highest priority to lowest based on maslows model?

answer

2, 4, 1, 3 2-physiologic need 4-is an example of love and belonging need 1- is an example of self esteem need 3-is an example of a self actualization need

question

a nurse is using a critical pathway methodology for choosing interventions for a patient who is receiving chemotherapy which nursing action are characteristics of this system being used when planning care?

answer

the nurse uses a minimal practice standard and is able to alter care to meet patients individual needs the nurse is able to measure the cause and effect relationship between pathway and patient outcomes

question

a nurse is identifying outcomes for a patient who has a leg ulcer related to diabetes, an example of an affective outcome for this patient is

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by 6/12/15 the patient will verbalize valuing health sufficiently to practice new health behaviors to prevent recurrence of leg ulcer

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a nurse is preparing a clinical outcome for a 32 year old female runner who is recovering from a stroke that caused right-sided paresis, an example of this type of outcome is

answer

after receiving 3 weeks of physical therapy the patient will demonstrate improved movement on right side of her body

question

a nurse is caring for an elderly male patient who is receiving fluids for dehydration, which outcome for this patient is correctly written

answer

during the next 24 hour period the patients fluid intake will total at least 2400 mL

question

a nurse is collecting more patient data to confirm a diagnosis of emphysema for a 68 year old male patient, what type of diagnosis does this intervention seek to confirm?

answer

collaberative

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nursing actions planned are carried out, purpose is to help the patient achieve valued health outcomes

answer

implementing

question

nursing intervention

answer

any treatment based upon clinical judgement and knowledge that a nurse performs to enhance patient/client outcomes

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a treatment performed through interaction with the patients, this type of care include both physiological and psychosocial nursing actions and include both the "laying of hands" actions and those that are more supportive and counseling in nature

answer

direct care intervention

question

a treatment performed away from the patient but on behalf of a patient or group of patients, this type of care include nursing actions aimed at management of the patient care environment and interdisciplinary collaboration, these actions support the effectiveness of this type of care

answer

indirect care intervention

question

written plans that detail nursing activities to be executed in specific situations, some specify routine aspects of care

answer

protocols

question

included in other protocols, which empower the nurse to initiate actions that ordinarily require the order or supervision of a physician examples include: admission protocols, protocols for bowel programs, narcotic overdoses etc

answer

standing orders

question

people who are trained to function in an assistive role to the licensed registered nurse, in the provision of patient activities are delegated by and under the supervision of the registered professional nurse

answer

unlicensed assistive personnel

question

the transfer of responsibility for the performance of an activity to another person while retaining accountability for the outcome,

answer

delegation

question

use 8 guidelines for implementation 1) when implementing care remember to act in partnership with the

answer

patient and family

question

use 8 guidelines for implementation 2) before implementing any nursing action reassess the patient to determine

answer

whether the action is still needed

question

use 8 guidelines for implementation 3) approach the patient competently, know how to perform the nursing action, why the action is being performed and

answer

potential adverse responses, have all equipment and supplies ready

question

use 8 guidelines for implementation 4)approach the patient caringly, explain the nursing action using language the patient understands, communicate genuine

answer

concern for what the patient is experiencing

question

use 8 guidelines for implementation 5)modify nursing interventions according to the patients

answer

1) developmental and psychosocial background 2) ability and willingness to participate in the plan of care, 3)responses to previous nursing measures and progress toward goal/outcome acheivement

question

use 8 guidelines for implementation 6) check to make sure that the nursing interventions selected are consistent with

answer

standards of care and within legal and ethical guides to practice

question

use 8 guidelines for implementation 7) always question that the nursing intervention selected is the

answer

best of all possible alternatives, consult colleagues and the nursing and related literature to see if other approaches might be more successful, evaluate the effectiveness of the intervention selected, noting any factors that positively or negatively influenced the outcomes

question

use 8 guidelines for implementation 8) develop a repertoire of skilled nursing interventions, the more options one can choose from the greater the likelihood of

answer

success

question

use ongoing data collection to determine how to safely and effectively implement a plan of care

answer

in every patient encounter it is important to be sensitive to both subtle and dramatic changes in the patients condition, skilled nurses monitor the patients responses to planned interventions to determine if the plan of care is working, these assessment findings are used to update and revise the plan of care,

question

explain why reassessment after nursing intervention is important

answer

it is important because a patients condition can change dramatically in a matter of minutes, it is critical to assess the patient carefully before initiating any nursing intervention to make sure the plan of care is still responsive to the patient's needs and prioritized to the most pressing of those needs

question

describe the risks and responsibilities of delegating nursing interventions

answer

the risks and responsibilities include the new mix of professional and nonprofessional staff being threatening to patient safety, it is important for the new nurses to critically identify which nursing interventions require professional nurses and which can be safely delegated

question

to implement the plan of nursing care nurses need blended use of

answer

cognitive, interpersonal, technical, ethical/legal, and QSEN competencies to implement a plan of nursing care

question

for actual nursing diagnosis interventions seek to:

answer

reduce or eliminate contributing factors of the diagnosis, promote higher level wellness, monitor and evaluate status

question

for risk nursing diagnosis interventions seek to

answer

reduce or eliminate risk factors, prevent the problem, monitor and evaluate status

question

for possible nursing diagnosis interventions seek to

answer

collect additional data to rule out or confirm the diagnosis

question

for collaborative problems interventions seek to

answer

monitor for changes in status, manage changes in status with nurse prescribed and physician prescribed interventions, evaluate response

question

a school nurse notices that a female adolescent student is losing weight and decides to perform a focused assessment of her nutritional status to determine if she has a eating disorder, how should the nurse proceed?

answer

perform the focused assessment, this is an independent nurse-initiated intervention

question

a nurse is using the implementation step of the nursing process to provide care for patients in a busy hospital setting. what applies?

answer

the nurse carefully removes the bandages from a burn victims arm, the nurse turns the patient in bed every 2 hours to prevent pressure ulcers, the nurse checks for community resources for a patient with dementia

question

nurses use the nursing interventions classification taxonomy structure as a resource when planning nursing care for patients, what information would be found in this structure?

answer

nursing interventions each with a label, a definition, and a set of activities that a nurse performs to carry it out with a short list of background readings

question

a new RN is being oriented to a nursing unit that is currently understaffed and is told the the UAPs have been trained to obtain the initial nursing assessment what is the best response of the RN?

answer

tell the charge nurse that he or she chooses not the delegate the admission assessment until further clarification is received from the administration

question

a nurse performs nurse initiated nursing actions when caring for patients in a skilled nursing facility, which are examples of these type of interventions?

answer

a nurse checks the skin of bedridden patients for skin breakdown, a nurse orders a kosher meal for an orthodox Jewish patient, a nurse prepares a patient for minor surgery according to facility protocol

question

a nurse is about to perform a pin site care for a patient who has a halo traction device installed, what is the first nursing action that should be taken prior to performing this care?

answer

reassess the patient

question

a student nurse is on a clinical rotation at a busy hospital unit, the RN in charge tells the student to change a surgical dressing on a patient while she takes care of other patients, the student has not changed dressings before and does not feel confident about the procedure what should be the students response?

answer

tell the RN that he or she lacks the technical competencies to change the dressing independently

question

a nurse develops a detailed plan of care for a 16 year old female who is a new single mother of a premature infant, the plan includes collaborative care measures and home health care visits, when presented with the plan the patient states "we will be fine on our own, I do not need any more care" what is the nurses best response?

answer

"lets take a look at the plan again and see if we can adjust it to fit your needs"

question

an RN working on a busy hospital unit delegates patient care to an unlicensed assistive personnel, which patient care could the nurse most likely delegate to the UAP safely?

answer

making patient beds, giving patient bed baths, ambulating patients, assisting patients with meals

question

a student nurse is organizing clinical responsibilities for an 84 year old female patient who is diabetic an is being treated for foot ulcers, the patient tells the student "I need to have my hair washed before I can do anything else today, I am ashamed of the way I look" The patients needs include diagnostic testing, dressing changes, meal planning, counseling, and assisting with hygiene, how would the nurse best prioritize care?

answer

arrange to wash the patient's hair first, perform hygiene, and schedule diagnostic testing and counseling

question

the nurse and patient together measure how well the patient has acheived outcomes specified in the plan of care,

answer

evalutating

question

measurable qualities, attributes, or characteristics that identify skills, knowledge, or health status, they describe acceptable levels of performance by stating what is expected of the nurse or patient,

answer

criteria

question

levels of performance accepted by and expected of nursing staff or other health team members, they are est. by authority, custom, or consent

answer

standards

question

after the data has been collected and interpreted to determine patient outcome achievement, the nurse makes and documents a judgement summarizing the findings,

answer

evaluative statement

question

4 steps for performance improvement?

answer

1-discover a problem 2-plan a strategy using indicators 3-implement a change 4-assess the change, if the outcome is not met, plan a new strategy

question

evaluation of one staff member by another staff member on the same level in the hierarchy of the organization is an important mechanism nurses can use to improve their professional performance

answer

peer review

question

special programs that promote excellence in nursing, range from small to developed for entire institution

answer

quality assurance programs

question

audit, focuses on the environment in which care is provided, standards describe physical facilities and equipment, organizational characteristics, policies, and pocedures, fiscal resources, and personnel resources

answer

structure evaluation

question

nature and sequence of activities carried out by nurses implementing the nursing process, criteria make explicit acceptable levels of performance for nursing actions related to patient assessment, diagnosis, planning, implementation, evaluation

answer

process evaluation

question

focuses on measurable changes in the health status of the patient or the end results of nursing care, critical element is demonstrating changes in patient health status

answer

outcome evaluation

question

the commitment and approach used to continuously improve every process in every part of an organization, with the intent of meeting and exceeding customer expectations and outcomes

answer

quality improvement

question

conducted by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met

answer

concurrent evaluation

question

may use post discharge questionnaires, patient interviews, or chart review to collect data,

answer

retrospective evaluation

question

describe evaluation, its purpose, and its relation to other steps in the nursing process

answer

the purpose of evaluation is to allow the patients achievement of expected outcomes to direct future nurse-patient interactions, its relation to other steps in the nursing process is when evaluation needs to modify nursing care the nurse reviews each preceding step of the nursing process,

question

evaluate the patients achievement of four types of outcomes specified in the plan of care

answer

cognitive, psychomotor, affective, and physiologic

question

manipulate factors that contribute to success or failure in outcome acheivement

answer

when interpreting and summarizing findings, consider factors that influence outcome achievment, numerous patient, nurse and health care system variables contribute positively or negatively to patient outcome acheivement, identifying these variables allows the nurse to reinforce positive factors by drawing on them in the future, as well as to deal with other variables that are creating problems, the more sensitive and responsive nurses are to these variables the more rewarding the practies will be

question

use the patients response to the plan of care to modify the plan as

answer

needed

question

explain the relation between quality assurance/ quality improvement programs and excellence in health care

answer

the relation between quality assurance and quality improvement and excellance in health care is that one works to improve quality of care while the other works to assure quality of care

question

describe the AACN standards for establishing and sustaining healthy work environments and describe the seven crucial conversations in health care

answer

AACN's commitment is to actively promote the creation of healthy work environments that support and foster excellence in patient care, the seven crucuial conversations in healthcare are: 1-broken rules 2-mistakes 3-lack of support 4-incompetence 5-poor team work 6-disrespect 7-mircomanagement

question

vvalue self evaluation as a critical element in developing the ability to deliver quality, person centered

answer

nursing care

question

a student health nurse is counseling a female college student who wants to lose 20 pounds. The nurse develops a plan to increase the student's activity level and decrease the consumption of wrong type of foods and excess calorie. The nurse plans to evaluate the student's weight loss monthly, when the student arrives at her first weigh in, the nurse discovers that the student only lost 1 pound instead of the projected 5 pounds. which is the best response?

answer

modify the plan of care after discussing the possible reasons for the student's partial success

question

a nurse uses the following classic elements of evaluation when caring for patients, which item below places them in their correct sequence?

answer

identify evaluative criteria and standards, collect data to determine whether evaluative criteria and standards are being met, interpret and summarize findings, document ones judgement, terminating, continuing or modifying the plan

question

a new urse who is being oriented to the subacute care unit is expected to follow existing standards when providing patient care, which nursing actions are examples of these standards?

answer

monitoring patient status every hour, turning a patient on bed rest every 2 hours, administering pain medication ordered by the physician

question

a nurse is collecting evaluative data for a patient who is finishing recieving chemotherapy for osteosarcoma, which nursing action represents this step of nursing process?

answer

the nurse collects data to measure acheivement

question

a nurse writes the following outcome for a patient who is trying to stop smoking, "the patient appreciates or values a healthy body sufficiently to stop smoking" This is an example of what type of outcome?

answer

affective

question

a nurse writes the following outcome for a patient who is trying to lose weight: "The patient can explain the relationship between weight loss, increased exercise, and decreased calorie intake." This is an example of what type of outcome?

answer

cognitive

question

a nurse is writing an evaluative statement for a patient who is trying to lower her cholesterol through diet and exercise, which evaluative statement is written correctly?

answer

"1/21/15- Outcome not met. Patient reports no change in diet or activity level."

question

A nurse is attempting to improve care on the pediatric ward of a hospital. Which nursing interventions might the nurse employ when following the recommendations of the Institute of Medicine's Committee on Quality of Health Care in America?"

answer

basing patient care on continuous healing relationships, using evidence-based decsision making, using safety as a system priority

question

a quality assurance program reveals a higher incidence of falls and other safety violations on a particular unit. A nurse maneger states "We'd be better find the folks responsible for these errors and see if we can replace them" This is an example of

answer

quality by inspection

question

after one nursing unit with an excellent safety record meets to review the findings of an audit the nurse manager states, "We're doing well, but we can do better! Who's got an ideat to foster increased patient well-being and satisfaction." This is an example of leadership that values

answer

quality improvement

Establishing Patient Outcomes and Developing a Plan of Care for Optimal Health.

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