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This document discusses nursing audits, which involve systematically reviewing patient records to evaluate the quality of nursing care provided. It provides details on:
1) The purposes of nursing audits which include evaluating nursing care, achieving quality standards, and contributing to research.
2) The key differences between audits and research, with audits comparing performance to standards using existing treatments, while research investigates new treatments.
3) The methods of conducting nursing audits, which can be retrospective reviews of past patient records or concurrent reviews of current patients and their records. Criteria are developed to standardize the audit process.
This document discusses nursing audits, which involve systematically reviewing patient records to evaluate the quality of nursing care provided. It provides details on:
1) The purposes of nursing audits which include evaluating nursing care, achieving quality standards, and contributing to research.
2) The key differences between audits and research, with audits comparing performance to standards using existing treatments, while research investigates new treatments.
3) The methods of conducting nursing audits, which can be retrospective reviews of past patient records or concurrent reviews of current patients and their records. Criteria are developed to standardize the audit process.
This document discusses nursing audits, which involve systematically reviewing patient records to evaluate the quality of nursing care provided. It provides details on:
1) The purposes of nursing audits which include evaluating nursing care, achieving quality standards, and contributing to research.
2) The key differences between audits and research, with audits comparing performance to standards using existing treatments, while research investigates new treatments.
3) The methods of conducting nursing audits, which can be retrospective reviews of past patient records or concurrent reviews of current patients and their records. Criteria are developed to standardize the audit process.
NURSING PRACTICE I Foundation of Nursing and Professional Nursing Practice
Situation 1 The physician prescribed 1 liter of Dextrose 5% in Water to be administered at 50ml per hour. 1. Considering the physicians order, the intravenous infusion should last? D. 20 hours 2. The intravenous infusion was started at 10:00am. When the nurse checked the patient at 2:00pm, she noted the level of the solution to be 850 ml. How much solution should have been infused at this time? A. 200 ml 3. The nurse is analyzing the remaining fluid of 850 ml. Based from the amount to be consumed at 50 ml/hr, the nurse assessed that the infusion is: A. Delayed 4. Maintaining the prescribed flow rate of 50 ml/hr, in how many hours should the remaining 850 ml of 5% Dextrose in Water be consumed? A. 17 hours 5. At 10:00am, maintaining the prescribed flow rate of 50 ml/hr and considering the remaining 850 ml, how many drops per minute should the nurse regulate the IV infusion if the drop factor is 15 drops/ml? D. 13 drops/min Situation 2 Recording is a vehicle of communication that provides critical information to other health care professionals involved with the clients care. Failure to document not only renders other staffs potentially liable but also renders the health care facility liable. 6. A nurse clinically assesses the client, states the nursing diagnosis and determines the appropriate intervention. Which of the following procedures reflect the delivery of the nursing process? A. Nursing Audit Documentation is critical to determine if the standard of care was rendered to a patient to defend nursing actions. Failure to chart, omissions and poor communication are hard to defend. Nursing audit is a review of the patient record designed to identify, examine, or verify the performance of certain specified aspects of nursing care by using established criteria. Nursing audit is the process of collecting information from nursing reports and other documented evidence about patient care and assessing the quality of care by the use of quality assurance programmes. Nursing audit is a detailed review and evaluation of selected clinical records by qualified professional personnel for evaluating quality of nursing care. A concurrent nursing audit is performed during ongoing nursing care. A retrospective nursing audit is performed after discharge from the care facility, using the patient's record. Meaning : 1. Quality - a judgement of what constitutes good or bad. 2. Audit - a systematic and critical examination to examine or verify. 3. Nursing audit - (a) it is the assessment of the quality of nursing care (b) uses a record as an aid in evaluating the quality of patient care. 4. Medical audit - the systematic, critical analysis of the quality of medical care, including the procedures for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient. Definition : I. According to Elison "Nursing audit refers to assessment of the quality of clinical nursing". II. According to Goster Walfer a. Nursing Audit is an exercise to find out whether good nursing practices are followed. b. The audit is a means by which nurses themselves can define standards from their point of view and describe the actual practice of nursing. III. Nursing audit is defined as: .part of the cycle of quality assurance. It incorporates the systematic and critical analysis by nurses, midwives and health visitors, in conjunction with other staff, of the planning, delivery and evaluation of nursing and midwifery care, in terms of their use of resources and the outcomes for patients/clients, and introduces appropriate change in response to that analysis (NHS ME, 1991 Framework for Audit for Nursing Services). History of Nursing Audit : Nursing audit is an evaluation of nursing service. Before 1955 very little was known about the concept. It was introduced by the industrial concern and the year 1918 was the beginning of medical audit. George Groword, pronounced the term physician for the first time medical audit. Ten years later Thomas R Pondon MD established a method of medical audit based on procedures used by financial account. He evaluated the medical care by reviewing the medical records. First report of Nursing audit of the hospital published in 1955. For the next 15 years, nursing audit is reported from study or record on the last decade. The program is reviewed from record nursing plan, nurses notes, patient condition, nursing care. Purposes of Nursing Audit 1. Evaluating Nursing care given, 2. Achieves deserved and feasible quality of nursing care, 3. Stimulant to better records, 4. Focuses on care provided and not on care provider, 5. Contributes to research. Difference Between Audit and research Audit Research Is not randomised May be randomised Compares actual performance against standards Identifies the best approach, and thus the sets the standards Conducted by those providing the service Not necessarily provided by those providing the service Usually led by service providers Usually initiated by researchers Does not involve investigation of new treatments, but evaluates the use of current treatments Involves comparators between new treatments and placebos Involves review of records by those entitled to access them Requires access by those not normally entitled to access them Ethical consent not normally required Must have ethical consent Results usually not transferable Results may be generalisable Hypothesis used to generate the standard Testable hypothesis generated Compares performance against the standard Presents clear conclusions Methods of Nursing Audit There are two methods: a. Retrospective view - this refers to an in-depth assessment of the quality after the patient has been discharged, have the patients chart to the source of data. Retrospective audit is a method for evaluating the quality of nursing care by examining the nursing care as it is reflected in the patient care records for discharged patients. In this type of audit specific behaviors are described then they are converted into questions and the examiner looks for answers in the record. For example the examiner looks through the patient's records and asks : a. Was the problem solving process used in planning nursing care? b. Whether patient data collected in a systematic manner? c. Was a description of patient's pre-hospital routines included? d. Laboratory test results used in planning care? e. Did the nurse perform physical assessment? How was information used? f. Were nursing diagnosis stated? g. Did nurse write nursing orders? And so on. b. The concurrent review - this refers to the evaluations conducted on behalf of patients who are still undergoing care. It includes assessing the patient at the bedside in relation to pre-determined criteria, interviewing the staff responsible for this care and reviewing the patients record and care plan. Method to Develop Criteria : 1. Define patient population. 2. Identify a time framework for measuring outcomes of care, 3. Identify commonly recurring nursing problems presented by the defined patient population, 4. State patient outcome criteria, 5. State acceptable degree of goal achievement, 6. Specify the source of information. 7. Design and type of tool Points to be remembered: a. Quality assurance must be a priority, b. Those responsible must implement a programme not only a tool, c. A co-ordinator should develop and evaluate quality assurance activities, d. Roles and responsibilities must be delivered, e. Nurses must be informed about the process and the results of the programme, f. Data must be reliable, g. Adequate orientation of data collection is essential, h. Quality data should be annualized and used by nursing personnel at all levels. Audit Committee : Before carrying out an audit, an audit committee should be formed, comprising of a minimum of five members who are interested in quality assurance, are clinically competent and able to work together in a group. It is recommended that each member should review not more than 10 patients each month and that the auditor should have the ability to carry out an audit in about 15 minutes. If there are less than 50 discharges per month, then all the records may be audited, if there are large number of records to be audited, then an auditor may select 10 per cent of discharges. Training for auditors should include the following : a. A detailed discussion of the seven components. b. A group discussion to see how the group rates t he care received using the notes of a patient who has been discharged, these should be anonymous and should reflect a total period of care not exceeding two weeks in length. c. Each individual auditor should then undertake the same exercise as above. This is followed by a meeting of the whole committee who compare and discuss its findings, and finally reach a consensus of opinion on each of the components. Steps to problem Solving Process in Planning Care : a. Collects patient data in a systematic manner, 1. includes description of patients pre-hospital routines, 2. has information about the severity of illness, 3. has information regarding lab tests, 4. has information regarding vital signs, 5. Has information from physical assessment etc. b. States nurses diagnosis, c. Writes nursing orders, d. Suggests immediate and long term goals, e. Implements the nursing care plan, f. Plans health teaching for patients, g. Evaluates the plan of care, Audit as a Tool for Quality Control An audit is a systematic and official examination of a record, process or account to evaluate performance. Auditing in health care organization provide managers with a means of applying control process to determine the quality of service rendered. Nursing audit is the process of analyzing data about the nursing process of patient outcomes to evaluate the effectiveness of nursing interventions. The audits most frequently used in quality control include outcome, process and structure audits. 1. Outcome audit Outcomes are the end results of care; the changes in the patients health status and can be attributed to delivery of health care services. Outcome audits determine what results if any occurred as result of specific nursing intervention for clients. These audits assume the outcome accurately and demonstrate the quality of care that was provided. Example of outcomes traditionally used to measure quality of hospital care include mortality, its morbidity, and length of hospital stay. 2. Process audit Process audits are used to measure the process of care or how the care was carried out. Process audit is task oriented and focus on whether or not practice standards are being fulfilled. These audits assumed that a relationship exists between the quality of the nurse and quality of care provided. 3. Structure audit Structure audit monitors the structure or setting in which patient care occurs, such as the finances, nursing service, medical records and environment. This audit assumes that a relationship exists between quality care and appropriate structure. These above audits can occur retrospectively, concurrently and prospectively. For the effective quality control, the nurse manager has to play following roles and functions. Advantages of Nursing Audit : 1. Can be used as a method of measurement in all areas of nursing. 2. Seven functions are easily understood, 3. Scoring system is fairly simple, 4. Results easily understood, 5. Assesses the work of all those involved in recording care, 6. May be a useful tool as part of a quality assurance programme in areas where accurate records of care are kept. Disadvantages of the Nursing Audit : 1. appraises the outcomes of the nursing process, so it is not so useful in areas where the nursing process has not been implemented, 2. many of the components overlap making analysis difficult, 3. is time consuming, 4. requires a team of trained auditors, 5. deals with a large amount of information, 6. only evaluates record keeping. It only serves to improve documentation, not nursing care Conclusion A profession concerns for the quality of its service constitutes the heart of its responsibility to the public. An audit helps to ensure that the quality of nursing care desired and feasible is achieved. This concept is often referred to as quality assurance.
7. The nurse is aware that proper documentation when taking care of the client is important. The purposes of client care documentation include the following: 1. Standardizes plan of care 2. Communicates vital information about clients health status to other health care providers 3. Serves as resource for research and education 4. Serves as a legal document C. 1, 2, and 4 8. While taking care of a client, a nurse was instructed by her head nurse to file incident report. The following situations warrant an incident report, EXCEPT: A. Medico-legal incident 9. The client expresses overall dissatisfaction and frequently objects to the care provided to him. The situation cannot be resolved. Which of the following is the most appropriate action of the nurse? A. Report the situation to the head nurse 10. A client who was brought to the hospital for treatment of abdominal discomfort refused the treatment ordered and refused to sign a consent form. This situation warrants what kind of reporting? D. Actual anecdotal report
SITUATION 3. The nurse has been asked to administer an injection via Z-track technique. 11. The nurse prepares an IM injection for an adult client using Z-track technique, 4 ml of medication is to be administered to the client. Which of the following site will be use? C. Ventrogluteal SITUATION 4: As a profession, nursing is a dynamic and its practices directed by various theoretical models. To demonstrate caring behaviour, the nurse applies various nursing models in providing quality nursing care. 12. When you clean the bedside in it and regularly attend to the personal hygiene of the patient as well as in washing your hands before and after a procedure and it between patients, you intend to facilitate the bodys reparative process. Which of the following nursing theory are you applying in the above nursing action? D. Florence Nightingale Correct Answer: D. Florence Nightingale, considered as the first nursing theorist defined nursing as the act of utilizing the environment of the patient to assist him is his recovery. She linked health with five environmental factors: pure or fresh air, pure water, efficient drainage, cleanliness and light (direct light). Kozier and Erbs Fundamentals of Nursing, 8th Ed, p. 43. 13. A communication skills is one of the important competencies expected of a nurse. Interpersonal process is viewed as human to human relationship. The statement is an application of whose nursing model? B. Joyce Travelbee Correct Answer: B. Joyce Travelbee is the proponent of the Interpersonal theory which emphasizes nurse-client relationship. 14. The statement, the health status of an individual is constantly changing and the nurse must be cognizant and responsive to these changes best explains which of the following facts about nursing? A. Dynamic Correct Answer: A. Dynamic: continuously changing. 15. Virginia Henderson professes that the goal of nursing is to work interdependently with other health care working in assisting the patient to gain interdependence as quickly as possible. Which of the following nursing best demonstrates this theory in taking care of a 94 year old client with dementia who is totally immobile? Feeds the patient, brushes the teeth, gives the sponges bath
Situation 5.
16. The nurse finds it necessary to recheck the blood pressure reading. In case of such reassessment, the nurse should wait for a period of: B. 1 to 2 minutes Correct Answer: B. The nurse should wait 1 to 2 minutes before making further determinations. This permits blood trapped in the veins to be released Kozier and Erbs Fundamentals of Nursing, 8th Ed, p. 557. 17. If the arm is said to be elevated when taking the blood pressure reading, it will create: B. False low reading Correct Answer: B. The reading will be erroneously low. Kozier and Erbs Fundamentals of Nursing, 8th Ed, p. 555. 18. You are to assessed the temperature of Lady Manahan, the next morning and found out that she ate ice cream. How many minutes should wait before assessing Christine oral temperature? C. 30 minutes Correct Answer: C. If the client has been taking cold or hot food or fluids or smoking, the nurse should wait 30 minutes in order to ensure that the temperature of the mouth is not affected by the temperature of the food, fluid or warm smoke. Kozier and Erbs Fundamentals of Nursing, 8th Ed, p. 532. 19. When auscultating the Ladys blood pressure, the nurse hears the following. From 150 mmHg to 130 mmHg: Silence. Then, thumping sounds continuing down to 100mmHg, muffled sound, continuing, down to 80 mmHg and then silence. What is the Christines blood pressure? A. 130/80 Korotkoffs Sounds Phase 1: First faint, clear tapping or thumping sounds. Considered as the systolic blood pressure Phase 2: Muffled, whooshing or swishing quality Phase 3: Blood flows freely to an increasingly open artery, the sounds become crisper, more intense and again assume a thumping quality but softer than phase 1 Phase 4: Sounds Become muffled and have a soft, blowing quality (Diastolic in Children) Phase 5: Pressure level when the last sound is heard. (Diastolic in adults) 20. In a client with a previous blood pressure of 130/80, 4 hours ago. How long will it take to release the blood pressure cuff to obtain an accurate reading? B. 10-20 sec Correct Answer: B. The cuff should be deflated at the rate of 2-3 mmHg per second. Four hours ago, the clients blood pressure is 130/80. In succeeding measurements, 30mmHg should be added to the systolic pressure in order to know until what pressure the cuff will be inflated (160mmHg). From 160 mmHg to 80 mmHg, there is a difference of 80 mmHg. This 80 mmHg will be released 2-3mmHg per second. 80 mmHg divided by 2 mmHg/s = 40s. Situation 6 A client is diagnosed with active tuberculosis. Airborne precaution is observed and he is placed in isolation. He resents the isolation and appears angry. 21. Your best nursing intervention for the behavior manifested by this client is to: A. Explain the isolation procedure and provide meaningful stimulation 22. The psychological implication of isolation to the client includes which of the following: B. Sense of loneliness due to disruption of normal social relationship 23. Which of the following interventions must be carried out by the nurse to improve the clients sensory stimulation during isolation? C. Maintain a clean and pleasant environment and allow recreational activities 24. The client was visited by friends. What instruction should you give the visitors who will come in contact with the client? D. Talk with the relatives outside the clients room Situation 7 Bed rest is a therapeutic intervention that achieves beneficial effect. However, prolonged bed rest can be counterproductive to a clients recovery. The inactivity imposed by bed rest may cause structural changes in joints and shorten muscles. Moving, turning and positioning of clients are essential aspects of nursing care. 25. A nurse is giving the 8:00AM medication to a client who happens to have slid down the bed from the Fowlers position. Which of the following interventions is most effective when the nurse repositions the client? A. Ask the client to flex the hips and knees and position the feet for effective pushing up 26. Using an overhead trapeze for repositioning client can be accomplished by instructing the client to grasp the: Overhead trapeze with both hands and lift and pull during the move 27. A client on bed rest is rolled to a lateral position by the nurse. The nurse is negotiating the move correctly when he: Places one hand on the clients far hip and the other on the clients far shoulder rock backward and roll onto side of the body facing him. 28. A client with injured left is sitting on the bed preparing to transfer to a wheelchair. The nurse is assisting the client and positions the wheelchair on the: C. Clients right side Park the wheelchair as close as possible to the area where you will be transferring the person to or from. Park the wheelchair so that the person's stronger side of their body is the side that the transfer will be done on. 29. A client has difficulty walking and needs a wheelchair to facilitate performance of daily activities. Anticipating the needs of the client, the nurse should have the wheelchair ready by placing it at: 45-degree angle to the bed Instructions Things You'll Need Wheelchair properly fitted to patient Transfer board, transfer belt, pivot or transfer disk Slippers with nonslip soles Assistant (optional) Advance Planning is Key for Caregivers 1. Talk through your course of action with the elderly person and make sure she knows what you will be doing first. Demonstrate if necessary. 2. Lock the wheels on the wheelchair and the bed (optional). Make sure the wheelchair is positioned so it is parallel to the bed, facing the foot end of the bed or at a 45-degree angle to the bed. It also should be near the middle of the bed. 3. Fold the footrest away. Remove the armrest if possible. Make sure the bed rail is down. 4. Have the elderly person place the hand that is closest to the bed on top of the mattress, with her other arm poised on the armrest, ready for a push 5. Position yourself toe-to-toe and knee-to-knee with the elderly person. Bend slightly and grab him around his upper waist and torso 6. Instruct her to lift herself with her arms to help support her weight. Simultaneously, bend your legs to produce a lift and a pivotal shift toward the bed. Lifting is best done with your legs and gluteus muscles flexed tightly to take pressure off your back. 7. Once the patient is seated, allow him time to regain his balance. Place one arm over his back to the opposite shoulder and the other arm under his thigh. Bend your legs slightly. Turn and lower his back onto the bed while shifting his thighs onto the bed. Note: Using a waist belt with grab handles, a flexible transfer board or a pivot disk will help with this process tremendously.
Situation 8 The nurses understanding of death as a natural part of mans life cycle allows her to help her clients. 30. A client, 37 years old, married and mother of two children ages ten (10) and eight (8), was diagnosed with advanced metastatic breast cancer. She is depressed and expressed concern about the welfare of her family. Which of the following actions should the nurse plan to do first for a client who is experiencing depression? Assist the patient to express feelings, beliefs and values 31. The nurse ensures that the client is treated with dignity and assists her in determining her own physical, psychological and social priorities. Part of the nurses challenge that should be incorporated in the plan of care is: Supporting the clients will and hope 32. To provide a sense of dignity for the client, the nurse should aim for the client to achieve which of the following? Acceptance of the diagnosis 33. While the nurse is assisting the client in her care, the client starts to cry and strikes her. The behavior that the client is manifesting best describes which of the following stages of death and dying? C. Anger 34. When planning for the care of dying person, the essential elements that the nurse should consider are the following EXCEPT? Help in clarifying distorted pattern
35. In the self care deficit theory by Dorothea Orem, nursing care becomes necessary when a patient is unable to fulfil his psychological and social needs. A pregnant client needing prenatal check is classified as: C. Supportive Educative Correct Answer: C. Supportive Educative systems are designed for persons who need to learn to perform self- care measures and need assistance to do so. A pregnant client will be expective an impending delivery thus needs additional health teachings regarding child bearing and child rearing. Kozier and Erbs Fundamentals of Nursing, 8th Ed, p. 44.
Situation 9- you are conducting a class on proper nutrition as part of health promotion. 36. Part of your teaching plan that helps address nutrition problems in the community include all EXCEPT: Eating small meals frequently 37. Through health education, the nurse disseminates information about nutrition related problems that could lead to serious non-communicable diseases (NCD). The nurse discourages this eating practice to avoid NCD: Increased salt and increased processed food intake 38. The nurse observes that childhood is more common now. The frequent cause of this is the Filipino parents belief that: A fat child is healthy, a thin child is sickly 39. In nutrition education, your targeted participants include all EXCEPT: C. Food service people 40. One mother asks the nurse why eating food cooked in vegetable oil is considered healthy. The nurses most appropriate response is that: Vegetable oil increases energy intake and helps prevent vitamin A deficiency Situation 10 The nurse has varied functions that helps meet the clients needs depending upon the situation or phase of illness. 41. When the nurse assists the client to identify and cope with stressful emotional problems, the nurse is assuming the role of: B. Counselor 42. The expanded role of the nurse acquired after specialized training and credentialing is described as: C. Clinical nurse specialist 43. When the hospital director gives the nurse a position of authority within a formal organization, she assumes the role of: Manager 44. The nurse who uses his interpersonal skills to guide the client in making decisions about his health care is acting the role of: C. Advocate 45. An activity that demonstrates autonomy in nursing profession is exemplified by: Becoming a member in a national professional organization Situation 11 The nurse is taking care of clients who have varied nutritional needs. The nurse should have adequate knowledge of nutrition and how it promotes health, affects growth and development and healing of clients in any setting. 46. In a health education class at the health center, the nurse informs the clients that certain food substances are related to non-communicable diseases. An example of this is: Hypertension linked to increased intake of caffeinated products, processed food intake, artificial flavorings and refined sugars
47. After surgery, a client has lost more than 20% of his body weight. The nurse wants to ensure that the clients nutritional needs are met at home. The nurse should: Provide the client a written recommendation of what food to eat using the food pyramid guide 48. The doctor orders clear liquid diet for a post surgery client. The food allowed includes which of the following? C. Tea, cola drinks, gelatin CLEAR LIQUID: Transparent liquid foods: vegetable broth; bouillon, clear fruit juices; clear fruit ices; popsicles; clear gelatin desserts and no carbonated drinks FULL LIQUID DIET: CLEAR AND OPAQUE LIQUID FOODS WIT A SMOOTH CONSISTENCY milk, milkshakes, ice cream; pudding; strained cream soup, fruit nectar with pulp, smooth cooked cereals such as porridge and cream of wheat butter and honey 49. A client practices Islam and his diet must consider his religious practices and beliefs. You are aware that this client would avoid which of the following food? 1. Shrimps and crabs 4. Pork products like bacon 2. Wine and alcoholic drinks 5. Caffeinated products like cola drinks 3. Fish with scales D. 1, 2, and 4 Situation 12 The nurse noted encrustations around the stoma of a client with tracheostomy. The client is due for routine tracheostomy care. 50. The nurse informs the client about the procedure then prepares the equipment needed. When cleaning the tracheostomy tube site, which of the following should the nurse observe to reduce the transmission of microorganisms? Wash hands, don clean disposable gloves and mask 51. In addition to observing appropriate infection control measures the nurse should do which of the following interventions prior to the removal of the inner cannula? Suction tracheostomy prior to cleaning 52. The nurse is correctly performing the removal of the inner cannula when he/she: Unlocks inner cannula by turning counterclockwise and gently withdrawing in line with its curvature 53. After thoroughly cleansing the lumen and the entire inner cannula in hydrogen peroxide solution the nurse is now ready to return the cannula to the tracheostomy site. To ensure that the cannula is in place the nurse should: Replace the inner cannula following the curve of the tube, lock by rotating the external ring clockwise until it clicks in place. 54. The nurse is changing the tracheostomy ties of the client. The most appropriate technique to follow when changing soiled tracheostomy ties is to: Thread end of tie through trach flange then thread through slit in tie and pull tight
Situation 13 Urethral catheterization requires a physicians order. Special care and strict aseptic technique must be observed for clients with indwelling catheter. 55. A day after the insertion of the urinary retention catheter, the client complains of discomfort in the bladder and urinary meatus. The initial action of the nurse would be to: A. Establish patency of the catheter B. Milk the catheter towards the collecting receptacle C. Check the bladder if distended D. Inform the head nurse 56. The nurse is preparing to irrigate the indwelling urinary catheter of the client. As ordered by the physician, the client is to have closed intermittent catheter irrigation. The nurse performs the procedure in the following order: 1. Aspirate sterile solution into the syringe 2. Using aseptic technique, put sterile solution in sterile graduated cup 3. Clamp indwelling retention catheter 4. Withdraw syringe, leave solution for around 20 minutes 5. Slowly inject sterile irrigant into the catheter and bladder 6. Remove the clamp and allow irrigant to drain into the collection bottle/bag A. 2, 1, 3, 5, 4, 6 C. 2, 3, 1, 4, 5, 6 B. 3, 2, 1, 4, 5, 6 D. 1, 2, 3, 4, 5, 6 57. When a client has a retention catheter, the nurse is expected to: A. Clean the urinary meatus and adjacent skin periodically B. Encourage liberal amount of fluid intake C. Flush the catheter as needed D. Perform perineal flushing as needed 58. An order to discontinue catheterization of the client was implemented. She complains of difficulty in her first attempt to urinate. The nurse explains that this is due to: A. Attempt of the body to adjust to normal reflex mechanism B. Fluid and electrolyte imbalance C. Irritation of the urethra D. Irritation of the urinary bladder 59. When considering the safety needs of a client with a urinary catheter, which of the following should the nurse observe? a. Keep a closed sterile drainage system C. Keep the bag lower than the bed B. Irrigate the catheter daily D. Measure intake and output daily
Situation 14 Nurses communication skills are often put to test when interacting with clients assigned to them. 60. A 70 year old client is admitted to the hospital for difficulty of breathing and chest pain. He is accompanied by his son who asks the nurse what he should do about his fathers hearing problem. Which of the following responses by the nurse reflects therapeutic communication? A. I will ask your father for more information B. What kind of hearing problems does your father have? C. Your father will be referred to a specialist after a hearing test is done. D. Hearing problems occur as people get older. 61. While conducting nursing rounds, the nurse found a 30-year-old, post mastectomy client lying on her side facing the wall. When the nurse approached her, she says leave me alone, I need rest. The nurse responds by saying: A. I understand you. B. I will be back. C. You sound upset. D. Dont worry you can cover up the loss. 62. While waiting for three hours to be called in the doctors clinic, a client suddenly shouts: Why is this taking so long? I have been waiting for several hours and nobody attends to us? What should be the initial response of the nurse? A. Approach client and tell her that there are other clients to be attended to B. Instruct the client to be quiet and assure her that she will be attended to soon. C. Talk to the client and determine her immediate needs D. Pacify the client and send her to the adjacent room 63. A 26 year old mother of 8 month old twins brought one infant to the doctors clinic for fever and cough. She tells the nurse, I cant handle this anymore with other children to attend to, this is overwhelming for me. Which of the following is the best initial response by the nurse? A. You will survive this crisis, just like other mothers in similar situations. B. I will refer you to the social services for assistance. C. You should know what is best for the infant. D. What seems to be the problem? It must be tough having other children to attend to. 64. The day prior to surgery, a 40 year old client says to the nurse, Im nervous. Is the doctor competent in this kind of surgery How should the nurse best respond? A. Several clients who have undergone similar surgery always recover. B. Do you want to talk with the client who has similar surgery and has fully recovered? C. You seem concerned about the surgery. D. Your doctor is very competent Situation 15 The nurse is taking care of a client newly diagnosed with asthma. The client tells the nurse that a relative with asthma has been prescribed Salmotorol Xinaloate, a long acting medication and wonders why she has been prescribed Salbutamol, a short acting drug. 65. To provide accurate information the nurse should do which of the following activities? A. Consult the attending physician regarding the medication prescribed B. Refer to the head nurse the concern of the client C. Ask the client what she knows about the action of both drugs D. Collect the most relevant and best evidence to answer the question 66. The nurse is ready to implement the decision of the health care team on the prescribed medication to the client. Which of the following should be considered? 1. Integrate the evidence found from the literature search with the health care provider 2. Expertise in the clinical assessment of the client 3. Available health care resources 4. Preferences and values of the client A. 1, 2, 3, and 4 C. 2, 3, and 4 B. 1 and 2 D. 1 and 4 67. The treatment plan has been implemented. Which of the following is the MOST appropriate action based on clinical decision? A. Ask the client what he feels about the treatment B. Conduct physical assessment and gather more data C. Evaluate how effective the clinical decision is with the client D. Generate more information by doing literature search Situation 16 Nurses are expected to use critical thinking in the practice of nursing. 68. The nurse determines that her client has altered elimination. She identifies the following as the possible causes for the nursing diagnosis EXCEPT? A. Decreased mobility C. Reduced fluid intake B. Hip replacement D. Low fiber diet 69. A nurse writing a nursing diagnosis after assessing his client. Which of the following is the appropriate nursing diagnosis? A. Chronic pain related to insufficient pain medication B. Anxiety related to cardiac monitor C. Using bedpan frequently as a result of altered elimination pattern D. Pain related to difficulty ambulating Situation 17 The nurse researcher would like to see the importance of humor to hospitalized clients that can reduce anxiety associated with being in the hospital. 70. Which of the following should the researcher consider to be able to determine the type of data to be collected? A. Research design C. Research process B. Pilot study D. Scientific method Seven steps of research process finding info for a research paper and documenting the sources you find: 1. Identify and develop your topic; 2. Find background info; 3. Use catalogs to find books and media; 4. Use indexes to find periodical articles; 5. Find Internet resources; 6. Evaluate what you find; and 7. Cite what you find using a standard format. Research design: how data are collected Pilot study: pilot experiment; small scale preliminary study conducted in order to evaluate feasibility, time, cost, adverse events, and effect size in an attempt to predict an appropriate sample size and improve upon the study design prior to performance of a full scale research project. Scientific method: what to ask and answer scientific questions by making observation and doing experiments; 1. Ask a question; 2. Do background research; 3. Construct a hypothesis; 4. Test your hypothesis by doing an experiment; 5. Analyze your data and draw a conclusion; 6. Communicate your results 71. Which of the following is the most appropriate for the researcher to study if she would do a correlational study? A. Humor experienced by hospitalized patients B. Humor, a basis for reducing anxiety among hospitalized patients C. Effect of humor on anxiety of hospitalized patients D. Anxiety among hospitalized patients experiencing humor 72. Research requires that variables are defined operationally. Which of the following should the researcher consider when she defines humor and anxiety? A. Adapt definition of selected theorists on humor and anxiety B. Define humor and anxiety according to how these are measured in the study C. Restate definition of humor and anxiety as stated in the conceptual framework D. Humor and anxiety as defined in Websters dictionary 73. After having been approved, the researcher is now ready for the implementation of the study. Which of the following should the researcher do first before the actual study is carried out? A. Review related literature C. Conduct a pilot study B. Consult an statistician D. Select the target population Research steps: Identification or formulation of research problem REVIEW OF RELATED LITERATURE conceptualization of conceptual or theoretical framework choosing the appropriate design choosing sample from population conducting final study or pilot study collection of data base analysis and interpretation of data base disseminating the conclusion and recommendation 74. To obtain 30 appropriate samples for the study, the researcher decided to use simple random sampling. Which of the following should the researcher do? A. Include post-operative clients only B. Select every 3 rd hospitalized client in the list C. Pick out 30 from the list of hospitalized clients D. Choose 15 male and 15 female hospitalized clients Probability sampling 1. Simple random sampling equal chance to be chosen 2. Stratified random sampling create subdivided population 3. Cluster random sampling sub areas 4. Systematic random sampling sampling frame
Situation 18 Nursing Practice is governed by many legal concepts. Nurses are obligated to provide legal and ethical client care that demonstrates respect for others. 75. A lawsuit is filed for a negligent act performed by a nurse. Of the following who should be included in the lawsuit? A. Employer C. Attending Physician B. Chief nurse D. Hospital administrator 76. Basic nursing care errors resulting in negligence are committed by the nurse during the planning phase when the nurse fails to: A. Gather and chart client information adequately - assessment B. Administer medications correctly - implementation C. Chart each identified problem D. Perform nursing task correctly - implementation 77. The nurse is administering the 12:00nn oral medication to a client. When the orange capsule is handed to the client, he states that he has not been receiving a capsule but a tablet. Which of the following is the MOST appropriate action of the nurse? A. Allow the client to describe the medicine he has been receiving B. Ignore the client since medication order has been checked C. Tell the client that the medicine is prescribed by the physician D. Withhold the medication and recheck the medication order 78. A client is complaining of acute abdominal pain. The nurse tells the client that her complaints will be referred to the physician. Since the nurse is attending to his other clients he failed to call the physician. As a result the client suffered a ruptured appendix. The action of the nurse constitute: A. Battery B. Negligence C. Misdemeanor D. Assault 79. in the course of their clinical experience, nursing students may minimize chances of liability when they observe the following EXCEPT: A. Ask for additional help or supervision in situations for which they feel inadequately prepared B. Comply with the policies of the agency in which they obtain their clinical experience C. Take assigned clients given by the nursing instructors D. Prepare to carry out the necessary care for assigned clients. Situation 19 Nurses are expected to assess, contribute and preserve work environment that supports fulfilling their ethical responsibility. The following questions apply to this. 80. The nurse is attending to a client brought to the Emergency Department for treatment of acute abdominal pain. Which of the following actions of the nurse demonstrates respect of clients autonomy? A. Complying when the physician attempts to delegate obtaining informed consent B. Facilitating and supporting clients choices regarding treatment options C. Describing the risks and benefits of the reasonable alternative treatments D. Notifying appropriate parties if a patient has not given adequate information 82. Which of the following statements is correct regarding informed consent? A. Nurse may not be legally liable if they know that informed consent was not obtained B. It is ethical or legal for nurses to obtain informed consent for procedures that are to be performed by a physician C. It is an ethical responsibility of nurses to provide client with opportunities to give informed consent D. It is not with a nurses domain of responsibility to notify the health team if a client has not given an informed consent for the procedure 83. The nurse is taking the blood pressure of a male client and noted a reading of 160/100. When asked the nurse avoids telling the client that his blood pressure is elevated because she believes the information will upset the client and consequently further elevate his blood pressure. The situation illustrates an example of: A. Beneficence C. Self-determination B. Paternalism D. Autonomy 84. The nurses compassion is aroused when a severely impaired neonate under her care is suffering and in a prolonged life-sustaining machine. Many times the nurse experiences feeling of uneasiness and anguish. This human condition that confronts the nurse gives rise to: A. Ethical dilemma C. Human indignation B. Unavoidable trust D. Moral suffering 85. The nurse shows respect to human dignity when she observes which of the following situations when caring for clients? A. Asking the clients priorities after assessing the clients capabilities of in past and in the present B. Evaluating response of client to the nursing care rendered by the health care team as planned. C. Planning nursing care together with the client and immediate relatives D. Constant monitoring of clients condition and reporting any usual occurrences to the health team Situation 20 Accuracy in the computation and administration of medications ordered is extremely important when preparing medications. 86. A client is ordered to receive 20 mEq of Potassium Chloride. The bottle is labeled KCl elixir 10 mEq/ml. How many ml should be given? A. 1.5 ml B. 2 ml C. 0.5 ml D. 1 ml 87. A client is ordered to receive Digoxin 0.325 mg OD. The stock is 0.25 mg per tablet. How many tablets should be given to the client? A. 2 tablets B. 3 tablets C. 1.5 tablet D. tablet 88. Dilantin 5 mg/kg body weight is ordered to a client who weighs 50 lbs. The drug is to be administered in 3 equal doses. The label reads Dilantin suspension 125 mg/ml. How much medication should be administered to the client? A. 1.8 ml B. 1.5 ml C. 1.0 ml D. 0.5 ml 89. A male client had exploratory laparotomy and has an order for Meperidine Hydrochloride 50 mg IM every four hours PRN. The multiple dose vial is labeled 50 mg/ml. What is the correct dose to be administered to this client when he complains of pain? A. 0.5 ml B. 2 ml C. 1.0 ml D. 1.5 ml 90. An order is given to a young adult to receive 1 million units of Penicillin IM. The stock on hand is Penicillin 500,000 units and the direction reads, add 1.3 ml to yield 2 ml. What is the correct amount to be administered? A. 3 ml B. 2 ml C. 4 ml D. 2.5 ml Situation 21 Part of your professional development is to participate in various trainings and continuing professional education. This promotes updating yourself professionally and staying globally competitive in your skills development. 91. A nurse is attending a cardiopulmonary resuscitation training to review her previous CPR training as a requirement in the new hospital where she was recently employed. This is an example of: A. Continuing education C. In-service training B. Advanced training D. Professional training 92. A new graduate who is seeking employment decides to attend training on IV therapy program offered by an accredited nursing organization. This is: A. Advanced training C. Continuing education B. Professional training D. In-service education 93. Graduating at the top of his class, a nurse says he just wants to be a good nurse, after a year and half of working in a hospital, he decides to pursue a masters degree in nursing. Graduate education in nursing prepared the nurse for the following, EXCEPT: A. Take advance training as a clinical specialist B. Assume managerial positions in nursing service C. Carry out research to advance nursing theory D. Take lead roles in nursing educational settings 94. A nurse believes that health is a fundamental right of every individual. He believes in the worth and dignity of each human being and recognizers the primary responsibility to preserve health at all costs. These statements are part of the: A. Philippine Nursing Act of 2002 B. Code of Ethics for Registered Nurses C. Code of Good Governance for the Professions D. Standards of Nursing Practice 95. The objectives of continuing professional education programs in nursing are the following, EXCEPT: A. Protect and promote the general welfare of the public by attaining the highest standards and quality in the practice of profession B. Make the professional globally competitive by maintaining capability for delivering professional services C. Augment the nurse educational preparation for admission to the practice of his profession D. Make available latest trends in the profession brought by scientific and technological advancement in the profession
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