Nursing 1 Unit 1

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Professionalism
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application of ideal qualities of individual with in a specific profession field – attributes and behaviors of a nurse as a representative of the profession.
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Collaboration
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Labor together – Nurses work with others (patients, families and health care workers) development of partnerships to achieve best possible outcomes that reflect the particular need of the patient, family or community requiring an understanding of what others have to offer
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Clinical Judgment
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Interpretations and inferences that influence action in clinical practice – process of forming an opinion or evaluation by discerning or comparing where as the second definition denotes capacity for judging, discernment, or the exercise of this capacity – something believed or asserted.
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Ethics
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Study or examination of morality (accepted set of social standards or morals that guide behavior) through a variety of different approaches. – Process involving critical thought and action.
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Code of Ethics for Nurses of ANA
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establishes clear priorities in the ethical practice of nursing, such as compassion , respect, and primary commitment to the patient as well as advocacy for patient rights.
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Veracity
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Principle of truth telling.
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Nonmaleficence
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Avoid harm to others, even risk of harm.
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Beneficence
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Obligation to do good by acting in ways that promote the welfare and best interests of others.
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Justice
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Treating people equitable, fairly and appropriately.
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Fidelity
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Loyal
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Utilitarianism
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Moral action is one that results in the greatest good for the greatest number.
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Leadership
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An interactive process that provides needed guidance and direction.
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Autocratic
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Leader makes all decisions
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Laissez – Faire
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Leader does not interfere with employees.
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Democratic
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Leader involves followers.
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Care Coordination
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A set of activities is purposefully organized by a team of personnel that includes the patient to facilitate the appropriate delivery of the necessary services and information to support optimal health and care across settings and over time.
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Clinical Reasoning
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Thinking process by which a nurse reaches a clinical judgment.
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Innovative
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Introduce something new or different.
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Confident
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Sure of yourself.
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Respect
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Esteem for a sense of worth or excellence of a person.
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Accountability
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Being accountable – Report or justify something.
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Autonomy
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Authority to make decisions.
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Advocacy
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The act of pleading for, supporting or recommending endorsing.
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Competence
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The quality of being competent – possession of required skill, knowledge, qualification or capacity.
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Personal Identity
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Distinct personality of an individual.
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Professional Identity
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Distinct professionalism of an individual.
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Transformational
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Change
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Transactional
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To carry on or conduct.
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Inference
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Conclude or judge.
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Critical Thinking
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Thinking that is clear, rational, open minded or informed by evidence.
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Altruism
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Practice of unselfish concern for or devotion to the welfare of others.
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Nursing Process
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A. Assess D. Diagnose P. Plan I. Implement E. Evaluate
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Maslov’s Hierarchy of Needs
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1. Physiological 2. Safety 3. Love & Belonging 4. Self Esteem 5. Self Actualization
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Nursing
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Protection, promotion and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of individuals, families, groups, communities and population.
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Attributes of Professionalism
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Education, Clinical judgment, ethics, comportment and therapeutic communication – accountability, leadership, respect and self awareness
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Attributes of Clinical Judgment
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Holistic view of the patient situation – consider all factors. Process orientation – deep understanding of the patient including backgrounds, experiences and values. Reasoning and interpretation – consider all possibilities and deduce the solution.
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Attributes of Collaboration
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Values/Ethics, roles/responsibilities, communication and teamwork/team based practice
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Scope of Professionalism
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Autonomy, knowledge, competence, professionhood, accountability, advocacy, collaborative practice and commitment
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Social Identity Theory
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Describes group biases for its members and against non group members. Nurses identify themselves as skilled vs. other areas of nursing.
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Delegation
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Transferring the authority or responsibility to perform a selected nursing task in a selected situation to a competent individual. 5 Rights – right task, right circumstances, right person, right direction and right supervision.
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Patient Centered Care
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Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
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Interrelated Concepts of Leadership
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Leadership development – the act of expanding the capacities of individuals, groups, and organizations to participate effectively in leadership roles and processes. Management – Maintaining order – plan, organize, staff directing and control. Communication – listening and clear communication
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Interrelated Concepts of Professionalism
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Clinical judgment, leadership, ethics, and communication
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Interrelated Concepts of Communication
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Listening, collaboration, care coordination, culture and critical thinking
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Interrelated Concepts of Care Coordination
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collaboration, interprofessional, and transitional care
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Interrelated Concepts of Team Work
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Collaboration, patient centered care, coordination of care, shared accountability, shared problem solving and shared decision making
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Ethical Principles & Theories
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Respect for others, nonmaleficience, , beneficence, justice and fidelity – duty (right thing to do), consequence, character (based on life experiences & willingness to reflect on our actions), Relationship – nature and obligation inherent in human relationships
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Ethics in Nursing
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Coverage, Compassion and Commitment – protecting patients, providing care with risks to the health of the nurse, using or not using chemical or physical restraints, understaffng, prolonging the living and dying process with inappropriate measure, policies that may threaten care, working with unethical or impaired colleagues
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Ethical Problem vs Dilemma
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Ethical problem has clear solutions. Ethical dilemma involves a problem for which in order to do something right you have to do something wrong.
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Advance Directive
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allows individual to state their preferences – Power of Attorney or Living Will
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HIPPA
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Protects patients privacy
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Interrelated Concepts of Ethics
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Professionalism, leadership, technology and information, collaboration, evidence, safety, quality, health care policy, health care law, and health care economics
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A nurse with associates or baccalaureate degree who meets licensing requirements is qualified to practice as:
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An entry level generalist
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When nurses disagree about the effectiveness of a commonly used nursing intervention, the best evidence for solving the question related to an intervention is:
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a systematic review of randomized controlled trials
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The nurse establishes priorities and determines outcomes for an individual patient during the:
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planning phase of the nursing process
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A nurse is monitoring all of the patients in outpatient procedure area for complication of IV fluid administration. What type of function is the nurse demonstrating?
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Collaborative nursing function
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A 40 year old female patient is being prepared for discharge home after a laparoscopic cholecystectomy. Which team member can be assigned to complete a discharge assessment and provide patient teaching for post-discharge care?
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Registered Nurse (RN)
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When the nurse encourages a patient with heart failure to alternate rest and activity periods to reduce cardiac workload, what phase of the nursing process is being used?
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Implementation
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When planning care for a patient, the nurse may use a visual diagram of patient problems and interventions to illustrate the relationships among pertinent clinical data. What is the format called?
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Concept map
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A nurse is providing care for a patient who had transurethral resection of his prostate this morning. The patient is receiving continuous bladder irrigation, but his urinary catheter is now occluded. The nurse is now planning to phone the patient’s health care provider and communicate using the SBAR format. Which statement is a component of communication using SBAR?
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\”I think that we should manually irrigate his catheter.\”
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What factor has been most clearly identified as an influence on the future of nursing practice?
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Aging of the American population and increases in chronic illnesses.
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A group of nurses have a plan to implement evidence based practice for care of patients with pressure ulcers. What will this change in practice encompass?
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Consulting with the wound care and ostomy nurse, the preferences of patients and their particular circumstances, nurses’ expertise and their bodies of experience and knowledge, journal articles that address the care of patients with pressure ulcers.
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A registered nurse (RN) has delegate the administration of IV medications to a licensed practical/vocational nurse (LPN/LVN). Which statement describes delegation?
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The RN is still accountable for the quality of care and procedures that the patient receives.
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Nurses deliver patient centered care in collaboration with interdisciplinary health care team within the framework of a care delivery model. In which care delivery model does the nurse plan and coordinate the aspects of patient care with other disciplines with a focus on continuity of care and interdisciplinary collaboration even when the nurse is absent?
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Primary nursing model
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Which interventions are independent nursing actions?
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IV insertion, assessing lung sounds
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Telehealth includes using devices to provide which types of care for the patient?
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Evaluation of weight loss, video assessment of wounds, monitoring peak flow meter results, real time blood pressure assessment
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What is a medical diagnosis?
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Acute renal failure
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What is a NANDA diagnosis?
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Activity intolerance
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What is the cause or etiology?
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Impaired skin integrity r/t physical immobilization.
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What is 2.5 cm partial thickness open wound to the sacrum, the defining characteristic is?
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Objective – Impaired skin integrity r/t physical immobilization aeb by 2.5 partial thickness open wound to the sacrum.
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The related to guides which part of the nursing process?
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Nursing implementations/ interventions
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What is a wellness nursing diagnosis?
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Readiness for enhanced knowledge is an example of a nursing diagnosis
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What is a non-acceptable nursing diagnosis?
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Impaired gas exchange r.t. COPD aeb O2 Sat decreased to 88% with activity – shouldn’t use medical diagnosis
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What is an acceptable nursing diagnosis?
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NANDA nursing diagnosis is subjective and objective data supports the nursing diagnosis – impaired gas exchange r.t. aveolar capillary membrane changes aeb: patient states \”I get short of breath when I get OOB.\” Respirations 28, O2 sat decreased to 88% when walking to the bathroom
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What is an independent nursing intervention?
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Nurse will elevate the clients head of the bed to optimize lung expansion
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What is an independent nursing intervention
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Nurse will auscultate breath sounds every 1-4 hours
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What is a dependent nursing intervention?
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Administer bronchodilator (Ventolin) aerosol treatment every 4 hours as ordered
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What is a collaborative nursing diagnosis?
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Consult with dietician to see client regarding diabetic food choices consistent with ADA diet
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What is evidence based practice?
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In the Ackley Nursing Diagnosis handbook after the intervention is rationale. The rationale for performing the interventions is based upon
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What is client centered?
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In order for the nursing care plan to be effective this must occur
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What is the nursing process?
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A systematic problem solving process that guides all nursing actions
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What is assessment
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The 1st part of the nursing process where the nurse gathers subjective and objective data
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What are nursing interventions?
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This art of the nursing process will assist the nurse in achieving the client’s outcomes/goal
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T/F This is an appropriately written client outcome. The client will inspect and monitor skin integrity at least once a shift for color changes and signs of infection.
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False – This is a nursing intervention not a client outcome/goal
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What is SMART?
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Specific, Measurable, Attainable, Realistic, & Time Framed
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Which of the following social issues have been championed by nurses throughout nursing’s history
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Safe & affordable housing, women’s right to vote, and advocating for the under deserved and their needs
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The new nurse understands that the purpose of the ANA includes which of the following activities?
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Safe & quality patient care, code of ethics, social policy and standards
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What is the main reason for nurses to participate in organizations such as the ANA?
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Nursing organizations influence policies affecting nursing, nursing practice and the health of the community
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\”Nurses advancing our procession to improve health for all\” is the mission statement of the
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American Nurses Association
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To enter the nursing profession, an individual must successfully complete
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Licensure examination
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What group is primarily protected under the laws that regulate nursing practice?
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The Public
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The goal of the professional nurse in the team leader role is
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positive outcomes and patient satisfaction
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Professionalism exemplars related to leadership include
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Influential
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The nurse teaches a student nurse about how to apply the Tanner Model of Clinical Judgment when providing patient care. Which statement made by the student nurse indicates that teaching was successful?
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The Tanner Model has four aspects of clinical judgment
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The nurse uses clinical judgment to compare actual nursing outcomes to the expected nursing outcomes to:
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Determine if progress is made or to determine if revisions are needed.
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Nurses design interventions that are:
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Based on clinical reasoning and expected to help the patient meet goals quickly
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An interpretivist nurse is caring for a patient in the hospital setting. Which of the following factors will the interpretivist consider when care for this patient?
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Context of care, Information from the chart, information from significant others and friends, the nurse’s previous experiences, values, and emotions.
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A nurse wishes to obtain data about a new patient’s self esteem. To gain the clearest picture, the nurse uses the assessment technique of:
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Interviewing the patient in an unstructured format, observing for relevant verbal and nonverbal clues
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A nurse is caring for a patient in a long term care facility who has not been sleeping well. She notes that the patient is new to the facility, has been refusing therapy, and is also not eating well. The nurse interprets tis to mean that the patient has been having trouble adjusting. The nurse decides to meet with the patient’s care team. The team decides to assess the patient’s willingness to participate in group recreational activities. The patient agrees to participate. After 1 week, the nurse reevaluates the plan of care and notes that the patient has been sleeping much better. Which of the following terms best describe processes used in the nurse’s plan:
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Clinical judgment, the nursing process, and collaborative care planning
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Your are a new graduate nurse working with a nurse who has been out of school for 10 year. The seasoned nurse states, \”I don’t see the difference between this clinical reasoning and the nursing process.\” Which of the following statements would be an appropriate response?
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Clinical reasoning involves reflecting on interventions and reevaluation the plan of care based on the results of reflection, Clinical reasoning is the thinking process by which a nurse reaches a clinical judgment, Clinical reasoning is a process of noticing, interpreting, and responding – reasoning in transition with a fine attunement to the patient and how the patient responds to the nurse’s actions.
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Which of the following statements are included in the clinical reasoning communication category?
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The thinking process by which a nurse reaches a clinical judgment, relying heavily on analytic reasoning that requires systematically breaking a situation down into parts, examining alternatives, and weighing options
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A nurse manager reviews the rules and policies with the staff and explains what is expected of the staff. This is an example of which type of management
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Bureaucratic
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The nurse manager assesses the staff members’ knowledge base and maturity level prior to delegating assignments. This is an example of which type of leadership?
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Situational leadership
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The nurse understands that in the transformational leadership style, the nurse manager exhibits which of the following leadership behaviors?
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Allows staff independence
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Hospital leadership seeking Magnet status implemented a new governance structure, including a clinical nursing council that governs clinical nursing standards and care for the organization. This is an example of which leadership style?
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Shared leadership
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Which of the following statements are true?
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Task leaders will communicate the most effective was to accomplish the work.
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A leader exhibiting the attribute of change is best portrayed by which of the following descriptions?
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The leader communicates the vision and goals of the organization and how the departmental goals will serve these goals.
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The formal nursing leadership model
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Adapts to the size and needs of the health care system.
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Which of the following statements is false?
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Leadership in health care is an act reserved only for designated administrators and managers.
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The nurse teaches a student nurse about how to apply the ethical principle of autonomy. Which of the following selection demonstrates an understanding of this principle?
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The nurse explores alternative solutions and then makes a choice
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The nurse is concerned about the use of bed alarms and restraints. Which ethical principle most clearly applies to this situation?
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Justice
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The nurse enters a patient’s room with the morning medications and forgets to get the patient’s scheduled pain medication. The nurse gets busy with other duties and signs the pain medication out as given. What is the legal significance of a nurse’s action?
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The nurse has been negligent
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A homeless man presents to he emergency room with hypothermia. He tells the nurse that he is HIV positive and sought revenge by deliberately having sex with his mate, who does not know of his HIV status. This patient is violating the ethical principles of ____________.
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Beneficence
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A patient and her husband used in vitro fertilization to become pregnant. The unused sperm were frozen so the couple could have more children later. They bore a little girl who was diagnosed with Leukemia when she was 5 years old. The child now needs a bone marrow transplant (BMT). The best chance of a match for the BMT is a sibling. The couple would like to use the sperm to have another child s that they can increase the likelihood of a match. The nurse realizes that the unborn child poses an ethical dilemma involving?
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Human dignity
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A drug addicted nurse switches a patient’s morphine injection with normal saline so that the nurse can use the morphine. The nurse is violating which principles of ethics?
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Autonomy, Utilitarianism and Beneficence
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Which of the following ethical terms matches this statement: A problem for which in order to do something right you have to do something wrong.
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Ethical dilemma
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The nurse believes that a patient who states he is in pain is \”faking it\” and is hoping to get \”high.\” The nurse decides to give the patient a placebo instead of the pain medication that was ordered for the patient. The nurse is violating which principle of ethics?
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Autonomy, Utilitarianism, & Beneficence
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A nurse completes an admission database and explains that the plan of care and discharge goals will be developed with the patient’s input. The patient asks, \”how is this different from what the doctor does?\” Which response by the nurse is most appropriate?
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In addition to caring for you while you are sick, the nurses will assist you to develop an individualized plan to maintain your health.
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What factors have led to the need for increased collaboration in the health care system?
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Polypharmacy, the increased number of people who have chronic diseases, and care that is not congruent to diagnosis
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The nurse is teaching a patient how to use the automatic blood pressure cuff. How can the nurse be assured that the patient will be adherent to the plan and understands the information?
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By obtaining feedback from the patient that indicated accurate comprehension
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Which of the following statements by a nursing student demonstrates an understanding of collaboration?
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Collaboration with patients has been used by nurses throughout the history of nursing.
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A nurse working in a free clinic has recognized that health promotion for teenager who are pregnant is needed. The nurse works to develop a team of health are experts in several disciplines from across the region to work toward improving the nutrition of pregnant teenager. This is an example of what type of collaboration?
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Interorganizational collaboration
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Which of the following behaviors by a nurse indicates the effective use of collaboration with other professionals?
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Negotiates with others
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A nurse is explaining why collaboration is valued to a new nurse during her orientation to the unit. Which of the following outcomes is a key patient care outcome that occurs when collaboration is correctly used?
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There are fewer errors that occur in patient care
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A nurse mentor is explaining the benefits of collaborative practice to a nurse new to a facility. Which of the following research based benefits is the nurse likely to identify as positive outcomes of collaboration?
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Decreased length of stay for patients, Decreased staff resignations, Increased job satisfaction of the staff
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The provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel (UAP) is:
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Supervision
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Which of the following is considered a major disadvantage to group decision making?
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Disruptive conflicts
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A nurse and a student nurse are talking about health care coordination. Which of the following statements would the nurse make about the subject?
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Community health nurses coordinate care for the patient.
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When coordination and continuity of health care are transferred between different locations or different levels of care within the same location, this identified as
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Transitional care
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Two nurses are discussion the important attributes of care coordination. They both know that care coordination should be
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Team based
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A student nurse asks why care coordination is now a top priority for health system redesign. The nursing instructor’s best response is
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Every patient will need coordinated care services at some time in life
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Coordination of health care services is complicated by which of the following:
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Involving one or more services, Poorly funded social programs, Authority for managing services, and lack of health care systems

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