NURS100/ NURS100 Assessment 3 V2 | Fundamentals of Nursing | WCU | Latest 2026–2027 Exam Questions & Correct Answers | Verified Solutions | Grade A

NURS100/ NURS100 Assessment 3 V2 | Fundamentals of Nursing | WCU | Latest 2026–2027 Exam Questions & Correct Answers | Verified Solutions | Grade A 2026 / 2027 Academic Year Q: Despite significant improvements in the overall health status of the U.S. population over the past few decades, disparities among ethnic and racial minorities have A. Decreased as education levels equal those of non-Hispanic whites. B. Disappeared in relation to non-Hispanic white populations. C. Remained a serious challenge locally and nationally. D. Decreased faster than anticipated. C. Remained a serious challenge locally and nationally. Q: Eliminating disparities in the health status of people from diverse racial, ethnic, and cultural backgrounds has become one of the two most important priorities of Healthy People 2020 because populations with health disparities have A. Increased incidence of disease. B. Lower levels of morbidity. C. Lower mortality rates. D. Decreased incidence of disease. A. Increased incidence of disease. Q: According to the Office of Minority Health (OMH), the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups are known as A. Culture. B. Subculture. C. Ethnicity. D. Cultural backlash. A. Culture. Q: When asked to describe the differences between ethnicity and race, what should the student nurse explain? A. Ethnicity refers to a shared identity, whereas race is limited to biological attributes. B. Ethnicity and race are actually the same and are based in cultural norms. C. Ethnicity can be understood only through an ethic worldview. D. Race refers to a shared identity, whereas ethnicity is limited to biological attributes. A. Ethnicity refers to a shared identity, whereas race is limited to biological attributes. Q: Care that includes the nurse learning about cultural issues involved in the patient's health care belief system and enable patients and families to achieve meaningful and supportive care is known as A. Ethnocentrism. B. Culturally competent care. C. Cultural imposition. D.Culturally congruent care. B. Culturally competent care. D. Practicing discrimination by not giving the patient pain medicine A. Utilizing cultural imposition by not asking the patient about his pain Q: The nurse is caring for a Native American who has had recent surgery. In the patient's culture, it is a sign of weakness to complain of pain. In the nurse's culture, people who are having pain ask for pain medicine. The nurse has assumed that the patient has not been having pain and does not need medication because he has not complained of pain. What is the nurse doing? A. Utilizing cultural imposition by not asking the patient about his pain B. Striving to provide culturally congruent care by allowing the patient to suffer C. Operating from an emic worldview of the patient's cultural beliefs Q: In performing a cultural assessment, knowledge of a patient's country of origin and its history and ecological contexts is known as A. Ethnohistory. B. Biocultural history. C. Social organization. D. Religious and spiritual beliefs. A. Ethnohistory Q: The nurse is caring for a patient of Asian descent who speaks very little English. The nurse is especially concerned and attempts to develop a trusting relationship with the patient. She does this knowing that A. Cultural assessment needs to be done quickly to provide the best care early. B. Miscommunication cannot be tolerated in cultural assessment. C. The goal is to get the patient to conform to American health care norms. D. Cultural assessment is intrusive in contrast to other types of interviews. D. Cultural assessment is intrusive in contrast to other types of interviews. Q: The nurse is caring for a patient who has emigrated from another country. The patient is in need of abdominal surgery but seems reluctant to sign the surgical permits. What is one tactic that the nurse should use? A. Determine the family social hierarchy. B. Encourage the patient to sign the permits. C. Call the physician so that surgery can be canceled. D. Impress on the patient that her life is in jeopardy. A. Determine the family social hierarchy. Q: The nurse is caring for a Chinese patient who is reluctant to answer questions about her health background. The nurse asks the patient if she would like her husband present when health questions are asked. The nurse does this knowing that the Chinese culture is a collectivistic and patrilineal culture. What does this mean? A. Kinship extends to both the father's side and the mother's side of the family. B. Kinship is limited to the side of the father. C. Kinship is limited to the side of the mother. D. The husband becomes part of the wife's clan after marriage. B. Kinship is limited to the side of the father. Q: The nurse is caring for a patient who does not speak English. She decides to use an interpreter to explain procedures and to answer questions that the patient may have. In performing the interview, what should the nurse do? A. Direct questions to the interpreter to ask the patient. B. Disregard the age and gender of the interpreter. C. Direct questions to the patient. D. Ask the interpreter to ask the patient for clarification at the end. C. Direct questions to the patient. Q: Which statement is true relative to caring for a Hindu patient who is dying? A. The family will turn his head eastward or to the right. B. A close kin will stay with the patient to hear his last wishes. C. Anointing of the sick is a common right of the dying. D. The family will place a drop of water on the patient's lips. D. The family will place a drop of water on the patient's lips. Q: In comparing American culture with Asian cultures, which of the following statements is true? A. American culture supports collectivism. B. Asian communication can be ambiguous. C. American communication patterns downplay autonomy. D. Asian communication is direct to avoid conflict. B. Asian communication can be ambiguous. Q: When caring for a patient of a different culture, it is important for the nurse to understand that A. The nurse should protect the patient from family intrusion in her health care decisions. B. Working within the established family hierarchy produces better outcomes. C. Women as primary caregivers make independent health decisions. D. Gender is not a factor when it comes to role expectations. B. Working within the established family hierarchy produces better outcomes. Q: The nurse is caring for a member of the Jewish faith who needs to undergo a critical procedure on Saturday. The patient is refusing the procedure because it is scheduled to be done on the Sabbath. The nurse impresses on the patient the urgency of the procedure, stating that delaying the procedure would put his life at risk. The patient continues to refuse. What should the nurse do? A. Cancel the procedure. B.Seek permission from the patient to contact the patient's rabbi. C.Have a family member sign the permit. D.Have the procedure done against patient wishes. B. Seek permission from the patient to contact the patient's rabbi Q: The nurse is providing diabetic diet teaching to a Hispanic man and his wife. When the nurse is discussing foods that are acceptable, the wife continues to interrupt with statements like, "Oh, he doesn't eat that," or, "All he eats is rice and beans." What should the nurse do? A. Ask the wife to leave so he/she can focus on teaching the patient. B. Explain how "rice and beans" are not acceptable foods on a diabetic diet. C. Provide a diet plan with only food alternatives selected by the patient. D. Refer the patient and his wife to a dietitian familiar with Spanish food choices. D. Refer the patient and his wife to a dietitian familiar with Spanish food choices Q: Providing culturally congruent care means providing care that A. Fits the patient's valued life patterns and set of meanings. B. Is based on meanings generated by predetermined criteria. C. Is the same as the values of the professional health care system. D. Holds one's own way of life as superior to those of others. A. Fits the patient's valued life patterns and set of meanings. Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care. These modes are "cultural care preservation or maintenance," "cultural care accommodation," and "cultural care repatterning." When assessing patients during the admission process, the nurse utilizes A.These action modes in a distinct order. B.These action modes individually, one at a time. C.Only one action mode per patient. D.All these action modes simultaneously. D. All these action modes simultane Describe cultural influences on health and illness. Causal beliefs about health (punishment from God or biomedical cause) Illness expression (lightly or dramatically) Symptoms of illness (related to illness expression) Taboos (whether or not mental health is accepted) Describe cultural competence and culturally congruent care. Cultural competence - enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients Culturally Congruent Care - care that fits a person's life patterns, values, and system of meaning (patient-centered) Explain the concept of health disparities. Health Disparity - A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage Health Care Disparities - differences among populations in their availability, accessibility, and quality of health care services Example - poor health outcomes due to lower wages What is ethics? The study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large. Discuss the role of values in the study of ethics. A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. An ethical dilemma is caused by conflicting values. Discuss the role of ethics in professional nursing. helps professional groups settle questions about practice or behavior Professional Nursing Code of Ethics - set of guiding principles that all members of a profession accept What are the basic philosophies of health care ethics. Utilitarianism, deontology, and ethics of care What is utilitarianism? decision based on greatest good aka what is good for the most people ex: redistributing of Alzheimer's research funds to breast cancer research or giving Ebola vaccines to health care providers first so they can continue to care for patients What is deontology? doing right is a moral duty ex: someone gets into a car accident and is emitted into the ER, care must be provided despite lack of medical insurance What is ethics of care? Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives What is accountability? the procedures and processes by which one party justifies and takes responsibility for its activities What is autonomy? commitment to include patients in decisions What is beneficence? taking positive actions to help others What is nonmaleficence? avoidance of harm or hurt What is fedelity? agreement to keep promises What is veracity? telling the truth Discuss the steps of ethical dilemma resolution. To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion. Steps: 1. Is this an ethical problem? 2. Gather information 3. Identify the ethical elements, clarifying values 4. Name the problem 5. Identify possible courses of action 6. Create and implement an action plan 7. Evaluate the plan over time What is illness The way that individuals and families react to disease What is disease Malfunctioning biological or psychological processes How does culture relate to disease and illness? Culture affects how an individual defines illness and disease/ Example: Depending on one's culture, illness can either be viewed as a punishment from God or caused from biomedical reasons What is transcultural nursing? a comparative study of cultures to understand their similarities and differences Break down the Mnemonic "LEARN" Listen, Explain, Acknowledge, Recommend, Negotiate Break down the Mnemonic "RESPECT" Rapport, Empathy, Support, Partnership, Explanations, Cultural Competence, Trust What are the social determinants of health? conditions in which people are born, grow, live, work and age, shaped by the distribution of money, power, and resources at global, national, and local levels Health care disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by: A. bias B. stereotyping C. prejudice D. all of the above D. all of the above (bias, stereotyping, and prejudice) Discuss how developmental theory impacts the health and care of the adult patient. Developmental theory provides a basis for nurses to assess and understand the responses seen in their patients. • Humans continue to develop throughout their lives. Development is not limited to childhood and adolescence; persons grow and develop throughout their life span. Intimacy vs. Isolation (Young Adult) Erikson's stage in which individuals form deeply personal relationships, marry, begin families. This stage determines if one wants to pursue marriage, teaches commitment, and helps people understand that they can be loved/wanted. Intimacy: a close familiar, and usual affectionate/loving personal relationship with another person. Ex: Jack & Rose from the titanic. Isolation: the state in which people lose or don't have communication and cooperation with others. Absence of intimacy can result in isolation. One may feel lonely, unloved, or unwanted. A young adult may have commitment issues if stage is unsuccessful Describe physical and psychosocial changes of the young adult patient. Physical - Growth is completed by the age of 20 Psychosocial - lifestyle, career, sexuality, childbearing cycle, types of families, parenthood, alternative family, singlehood, and emotional health (ability to address/resolve personal & social tasks) Identify health risks of the young adult patient. Family history, intimate partner violence, personal hygiene habits, violent death & injury, substance abuse, unplanned pregnancies, sexually transmitted infections, environmental/occupational forces, and human trafficking Generativity vs. Self-Absorption (Middle Adult) In adulthood ones focus shifts from independent goals to working productively with others. What you contribute is the primary focus. "Making your mark" or giving your wisdom to younger generations Describe physical and psychosocial changes of the middle adult patient. Physical - Gray hair, vision loss, wrinkles Psychosocial - expected events (children moving out), sandwich generation, career transition, sexuality (erectile dysfunction/menopause), family psychosocial events (marital changes, singlehood, family transitions, caring of aging parents) Integrity vs. Despair (Older Adult) Erikson's final stage in which those near the end of life look back and evaluate their lives Identify common myths and stereotypes about older adults. Older adults are: - ill, disabled, and unattractive - forgetful, confused, rigid, boring, and unfriendly - unable to learn and understand new information - not interested in sex or sexual activities Discuss nursing implications associated with the health maintenance and prevention of the adult patient. - Participation in screening activities - Regular exercise - Weight reduction (if overweight) - Eating a low-fat, well-balanced diet - Moderate alcohol use - Regular dental visits - Smoking cessation - Immunizations activities to socialize Functional Changes Functional status in older adults includes the day-to-day activities of daily living (ADLs) involving activities within physical, psychological, cognitive, and social domains. Changes are usually linked to illness or to disease and degree of chronicity. Performance of ADLs is a sensitive indicator of health or illness. Occupational and physical therapists are your best resources for a comprehensive assessment. BADLs (basic activities of daily living) wash, dress, toilet, using gait assistance devices, and feed self IADLs (instrumental activities of daily living) using a telephone, cooking, grocery shopping, taking medications, banking/financing, accessing transportation, laundry, house cleaning Discuss common sensory changes that normally occur with aging. Sensory changes include presbycusis, cerumen, tinnitus, peripheral neuropathy, presbyopia, cataracts, glaucoma, macular degeneration, aphasia, etc. presbycusis aggressive hearing disorder (specifically w/high pitch noises) ***low & slow Cerumen ear wax Tinnitus ringing in the ears Peripheral neuropathy numbness and tingling in extremities Presbyopia difficulty w/seeing near objects Cataracts cloudy opaqueness of the ocular lense Mascular degeneration loss of central vision Snellen Chart used to measure visual acuity Aphasia (receptive, expressive) Receptive - difficulty understanding speech Expressive - deficit/absent speech Discuss ways to maintain a safe environment for patients with sensory deficits. dimmed lighting, reduce noise, create quiet zones, reduce clutter, limit sensory overload stimuli, assess potential home hazards A patient with glaucoma is being discharged from the hospital. When teaching the patient and family ways to improve home safety, the nurse tells the family to: A. use throw rugs to prevent tripping B. paint the floor black and white to improve perception C. install extra incandescent lighting D. install handrails painted the same color as the walls C. install extra incandescent lighting Functions of sleep Physiological and psychological restoration Maintenance of biological functions Compare and contrast the sleep requirements of different age-groups. Neonates - 16hrs/day Infants - 8-10hrs at night for a total of 15hrs/day Toddlers - 12hrs/day Preschoolers - 12hrs/night School Age - 9-10hrs/night Adolescents - 7.5hrs/night Young Adults - 6-8.5hrs/night Middle & Older Adults - total number of hours declines What are physical illnesses associated with sleep deprivation Hypertension Early morning awakening & fatigue Respiratory Disorders Nocturia Pain Restless leg syndrome (RLS) GI Issues (ex: Heart Burn) Sleep Disorders insomnia, narcolepsy, sleep apnea, sleep deprivation, and parasomnias Insomnia recurring problems in falling or staying asleep Sleep apnea a disorder in which the person stops breathing for brief periods while asleep Narcolepsy A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times. Sleep deprivation a sufficient lack of restorative sleep over a cumulative period so as to cause physical or psychiatric symptoms and affect routine performance or tasks Parasomnias Abnormal behaviors such as nightmares, sleepwalking, bed-wetting, etc. that occur during sleep. During rounds on the night shift, you note that a patient stops breathing for 1 to 2 minutes several times during the shift. This condition is known as: A. Cataplexy B. Insomnia C. Narcolepsy D. Sleep Apnea D. Sleep Apnea Consequences of poor sleep - Hypertension, Heart Disease, Heart Failure - Stroke - Obesity - Diminished immune function - Developmental disorders such as alterations in growth hormone - Reproduction disorders due to disruption in hormonal regulation - Increased mortality Identify nursing interventions designed to promote normal sleep cycles for patients of adult patients. - Good sleep hygiene - Good sleep environment - Reviewing personal behaviors - Consistent bedtime and awakening time - Good dietary habits - Regular exercise (avoiding 2-3hrs before bedtime) - Pharmacological approaches last Factors that influence sleep -drugs and substances -lifestyle -usual sleep patterns -emotional stress -environment -exercise and fatigue -food and caloric intake Assessment of Sleep - Sources for sleep assessment come from the patient and family, also sleep history of the patient Explain the concept of self-care in nursing practice. Nurses empower patients by providing information to enhance wellness and reduce the risk for illness and encourage autonomy by enhancing self-care skills TJC's Speak Up Tips Speak up if you have questions or concerns. Pay attention to the care you get. Educate yourself about your illness. Ask a trusted family member or friend to be your advocate. Know which medicines you take and why. Use a health care organization that has been carefully evaluated. Participate in all decisions about your treatment. Identify the purposes of patient education. Patient Education - a process of assisting people to learn health related behaviors so that they can incorporate these behaviors into everyday life Purposes - To help individuals, families, or communities achieve OPTIMAL levels of health Teaching vs. Learning Teaching - An interactive process that promotes learning Learning - The purposeful acquisition of knowledge, skills, behaviors, and attitudes Identify the role of the nurse in patient education. - Teach information that the patient and the family need to make informed decisions regarding their care - Determine what patients need to know - Identify when patients are ready to learn Describe the domains of learning. 1. Cognitive (Understanding)- Includes all intellectual behaviors and requires thinking. 2. Affective (Attitudes)- Deals with expression of feelings and accepting of attitudes, opinions, or values. 3. Psychomotor (Motor Skills)- Involves acquiring skills that require integration of mental and muscular activity. Define health literacy. the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health Health literacy includes: - patient's reading and mathematics skills - comprehension - decision making and functioning skills with regard to health care Identify risk factors and defining characteristics for low health literacy. Risk factors - Elderly (65+), Minorities, Immigrants, People w/low income, People with chronical mental and/or physical health conditions Defining characteristics - inaccurate follow through of instruction, inaccurate performance on test, inappropriate behavior (hysterical, hostile, agitated, and apathetic), asking questions, sensory perceptions deficits Eliminating disparities in the health status of people from diverse racial, ethnic, and cultural backgrounds has become one of the two most important priorities of Healthy People 2020 because populations with health disparities have... A. Increased incidence of disease. B. Lower levels of morbidity. C. Lower mortality rates. D. Decreased incidence of disease. Answer: A. Increased incidence of disease. Explanation/Rationale: Populations with health disparities have a significantly increased incidence of disease or increased morbidity and mortality when compared with the general population. When asked to describe the differences between ethnicity and race, what should the student nurse explain? A. Ethnicity refers to a shared identity, whereas race is limited to biological attributes. B. Ethnicity and race are actually the same and are based in cultural norms. C. Ethnicity can be understood only through an ethic worldview. D. Race refers to a shared identity, whereas ethnicity is limited to biological attributes. Answer: A. Ethnicity refers to a shared identity, whereas race is limited to biological attributes. Explanation/Rationale: Ethnicity refers to a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics. Ethnicity is different from race, which is limited to the common biological attributes shared by a group such as skin color or blood type. In any intercultural encounter, there is an insider or native perspective (ethic worldview) and an outsider's perspective (ethic worldview). Ethnicity is best understood by those who are a part of that ethnicity and have an "emic" worldview. When performing a thorough psychosocial assessment on a young adult, what must the nurse realize? A. Having a job is the best way to relieve stress. B. Although psychologically disturbing, stress does not lead to physical illness. C. Change is inevitable and is not a factor in stress-related illness. D. Psychosocial health is often related to job and family stress. Answer: D. Psychosocial health is often related to job and family stress. Explanation/Rationale: The psychosocial health concerns of the young adult are often related to job and family stressors. If stress is prolonged and the patient is unable to adapt to the stressor, health problems will develop. Job assessment also includes conditions and hours, duration of employment, changes in sleep or eating habits, and evidence of increased irritability or nervousness. When a patient seeks health care and presents stress-related symptoms, the nurse needs to assess for the occurrence of a life change event. When choosing an appropriate topic for a young adult health fair, the nurse ranks which topic as least relevant? A. Unplanned pregnancies B. Menopause and climacteric factors C. Smoking cessation D. Alcohol and drug use Answer: B. Menopause and climacteric factors Explanation/Rationale: The onset of menopause and the climacteric affect the sexual health of the middle adult, not the young adult. Unplanned pregnancies are a continued source of stress that can result in adverse health outcomes for the mother (young adult), infant, and family. Smoking is a well-documented risk factor for pulmonary, cardiac, and vascular diseases in smokers and in individuals who receive secondhand smoke and constitutes a health risk for the young adult. Substance abuse directly or indirectly contributes to mortality and morbidity in young adults. Which of the following statements by a new graduate nurse should be corrected by an experienced nurse? A. "Most older patients are ill and disabled. That's why we care for so many of them in the hospital." B. "Older adults are many times still interested in sexual relations." C. "Patients over age 65 are still lifelong learners." D. "Many older adult patients remain independent enough to live alone." Answer: A. "Most older patients are ill and disabled. That's why we care for so many of them in the hospital." Explanation/Rationale: Although many experience chronic conditions or have at least one disability that limits their performance of activities of daily living, in 2004, 37.4% of noninstitutionalized older adults assessed their health as excellent or very good. Older adults do report continued enjoyment of sexual relationships. Although changes in vision or hearing and reduced energy and endurance sometimes affect the process of learning, older adults are lifelong learners. Most older adults live in noninstitutional settings with family members or alone. Which teaching strategy is best to utilize with older adult patients? A. Provide several topics of discussion at once to promote independence and making choices. B. Avoid uncomfortable silences after questions by helping patients complete their statements. C. Ask patients to recall past experiences that correspond with their interests. D. Speak in a high pitch to help patients hear better. Answer: C. Ask patients to recall past experiences that correspond with their interests. Explanation/Rationale: Teaching strategies include the use of past experiences to connect new learning with previous knowledge, focusing on a single topic to help the patient concentrate, giving the patient enough time in which to respond because older adults' reaction times are longer than those of younger persons, and keeping the tone of voice low; older adults are able to hear low sounds better than high-frequency sounds. What is the best suggestion a nurse could make to a family requesting help in selecting a local nursing center? A. Suggest choosing a nursing center that is as sanitary as possible. The closer the center is to hospital standards, the better. B. Have family members evaluate nursing home staff according to their ability to get tasks done efficiently. C. Make sure that nursing home staff members get patients out of bed every day for the entire day. D. Explain that it is probably best for the family to visit the center and inspect it personally. Answer: D. Explain that it is probably best for the family to visit the center and inspect it personally. Explanation/Rationale: An important step in the process of selecting a nursing home is to visit the nursing home. The nursing home should not feel like a hospital. It is a home, a place where people live. Members of the nursing home staff should focus on the person, not the task. Residents should be out of bed and dressed according to their preferences, not staff preferences. The nurse best supports the patient dealing with bioethical issues by... A. Explaining the drawbacks of the issue. B. Providing physical care. C. Serving as a patient advocate. D. Serving as a spiritual counselor. Answer: C. Serving as a patient advocate. Explanation/Rationale: Nurses should feel empowered through their roles as primary patient advocates to voice their morality in the face of a new century that promises sweeping changes in health care delivery. Nurse must speak in support of patient choice and self-determination in the era of managed care. Nurses must monitor legislation that affects health care and study current issues. A nurse is using different strategies to meet older patients' psychosocial needs. Match the strategy the nurse is using to its description. Strategy: - Therapeutic Communication - Reality Orientation - Reminiscence - Validation Therapy - Body Image Description: - Offering help with grooming and hygiene - Listening to the patient's past recollections - Improving level of awareness - Respecting the older adult's uniqueness Answers: Therapeutic communication = Respecting the older adult's uniqueness Reality orientation = Improving level of awareness Reminiscence = Listening to the patient's past recollections Validation therapy = Accepting describing of patient's perspective Body image = Offering help with grooming and hygiene Match the activities listed with the appropriate functional level of ability: Activities: - Takes medications as prescribed - Balances the checkbook - Cleans the house - Uses a cane - Bathes daily - Dresses Self Functional Level of Ability: Instrumental activities of daily living (IADLs) OR Basic activities of daily living (BADLs) Answers: Takes medications as prescribed = for instrumental activities of daily living (IADLs) Balances the checkbook = for instrumental activities of daily living (IADLs) Cleans the house = for instrumental activities of daily living (IADLs) Uses a cane = for basic activities of daily living (BADLs) Bathes daily = for basic activities of daily living (BADLs) Dresses self = for basic activities of daily living (BADLs) A nurse is teaching a culturally diverse patient with a learning disability about nutritional needs. What must the nurse do first before starting the teaching session? A. Obtain pictures of food. B. Get an interpreter. C. Establish a rapport. D. Refer to a dietitian. Answer: C. Establish a rapport. Rationale: Establishing trust is important for all patients, especially culturally diverse and learning-disabled patients, before starting teaching sessions. Obtaining pictures of food, getting an interpreter, and referring to a dietitian all occur after rapport/trust is established. A patient tells the nurse that he experiences daytime fatigue even after 7-8 hours of sleep each night. What is the best assessment question for the nurse to ask? A. Have you tried getting 10 hours of sleep instead of 8 hours? B. How long are you in the rapid eye movement (REM) stage? C. Do you also have any recent lifestyle or behavior changes? D. Do any of your close relatives have any sleep disorders? Answer: C. Do you also have any recent lifestyle or behavior changes? Rationale: The best question to elicit the most pertinent information is "Do you also have any recent lifestyle or behavior changes?" The patient is getting 7-9 hours/sleep each night, which is expected for the average adult. The patient will not be able to recall an unconscious state such as REM sleep. The patient may have close relatives with sleep disorders but this does not necessarily affect the patient's own sleep habits. A nurse is assessing the health care disparities among population groups. Which area is the nurse monitoring? A. Accessibility of health care services B. Outcomes of health conditions C. Prevalence of complications D. Incidence of diseases Answer: A. Accessibility of health care services Rationale: While health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases and related complications, health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. The nurse learns about cultural issues involved in the patient's health care belief system and enables patients and families to achieve meaningful and supportive care. Which concept is the nurse demonstrating? A. Marginalized groups B. Health care disparity C. Transcultural nursing D. Culturally congruent care Answer: D. Culturally congruent care Rationale: The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a person's life patterns, values, and system of meaning, provides meaningful and beneficial nursing care. Marginalized groups are populations left out or excluded. Health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. Transcultural nursing is a comparative study of cultures in order to understand their similarities (culture that is universal) and the differences among them (culture that is specific to particular groups). A nurse is experiencing an ethical dilemma with a patient. Which information indicates the nurse has a correct understanding of the primary cause of ethical dilemmas? A. Unequal power B. Presence of conflicting values C. Judgmental perceptions of patients D. Poor communication with the patient Answer: B. Presence of conflicting values Rationale: Ethical dilemmas almost always occur in the presence of conflicting values. While unequal power, judgmental perceptions, and poor communication can contribute to the dilemma, these are not causes of a dilemma. Without clarification of values, the nurse may not be able to distinguish fact from opinion or value, and this can lead to judgmental attitudes. The nurse questions a health care provider's decision to not tell the patient about a cancer diagnosis. Which ethical principle is the nurse trying to uphold for the patient? A. Consequentialism B. Autonomy C. Fidelity D. Justice Answer: B. Autonomy Rationale: The nurse is upholding autonomy. Autonomy refers to the freedom to make decisions free of external control. Respect for patient autonomy refers to the commitment to include patients in decisions about all aspects of care. Consequentialism is focused on the outcome and is a philosophical approach. Justice refers to fairness and is most often used in discussions about access to health care resources. Fidelity refers to the agreement to keep promises. A nurse is teaching a patient about the Speak Up Initiatives. Which information should the nurse include in the teaching session? A. If you still do not understand, ask again. B. Ask a nurse to be your advocate or supporter. C. The nurse is the center of the health care team. D. Inappropriate medical tests are the most common mistakes. Answer: A. If you still do not understand, ask again. Rationale: If you still do not understand, ask again is part of the S portion of the Speak Up Initiatives. Speak up if you have questions or concerns. You (the patient) are the center of the health care team, not the nurse. Ask a trusted family member or friend to be your advocate (advisor or supporter), not a nurse. Medication errors are the most common health care mistakes, not inappropriate medical tests. A home health nurse is providing care to a middle-aged couple with children at home. The patient has a debilitating chronic illness. Which areas will the nurse need to assess? (Select all that apply.) A. Adherence to treatment and rehabilitation regimens B. Coping mechanisms of patient and family C. Need for community services or referrals D. Knowledge base of patient only E. Use of a doula for care Answers: ABC. Adherence to treatment and rehabilitation regimens, Coping mechanisms of patient and family, Need for community services or referrals Rationale: It would be important to also assess the developmental level of the children to plan for teaching. The assessment of a doula in this scenario would not be appropriate. ***This question was confusing. I answered B&D, but the answer only said B, yet it's a select all that apply...go with your gut When caring for a patient of a different culture, it is important for the nurse to understand that (Select all that apply.) A. The nurse should protect the patient from family intrusion in her health care decisions. B. Working within the established family hierarchy produces better outcomes. C. Women as primary caregivers make independent health decisions. D. Gender is a factor when it comes to role expectations. Answer: B. Working within the established family hierarchy produces better outcomes. Explanation/Rationale: Working with established family hierarchy prevents delays and achieves better patient outcomes. Nurses need to determine who has authority for making decisions within the family and how to communicate with the proper individuals. Do not assume that just because the woman is the primary caregiver, she will make decisions independently. Determine the family social hierarchy as soon as possible. Gender also differentiates role expectations. Which cultural variables are most likely to provide information about a patient's culture? (Select all that apply.) A. Ethnicity. B. Healing beliefs. C. Family systems. D. Respirations. E. Food choices. Answers: ABCE. Ethnicity, Healing beliefs, Family systems, Food choices. Explanation/Rationale: Respect cultural differences; remember that cultural differences influence a patient's behaviors. Consider the patient's health beliefs, relationships with family and ethnocultural groups. Respirations are a physiological data measurement, not a cultural data point. 5. Cultural desire: the motivation and commitment to caring that moves an individual to learn from others, accept the role of a learner, be open to and accepting of cultural differences, and build on cultural similarities. For a nurse, developing cultural competency is a dynamic process involving five interrelated components. List and define these components of cultural competency. Potter/Perry p. 120 & 121 1. Cultural awareness: an in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people. 2. Cultural knowledge: sufficient comparative knowledge of diverse groups, including the values, health beliefs, care practices, worldview, and bicultural ecology commonly found within each group. 3. Cultural skills: ability to assess social, cultural, and biophysical factors that influence patient treatment and care 4.Cultural encounters: cross-cultural interactions that provide opportunities to learn about other cultures and develop effective intercultural communication List components of a comprehensive cultural assessment. Potter/Perry p. 123 Health Beliefs & Practices, Faith-Based Influences & Special Rituals, Language & Communication, Parenting Styles & Family Roles, Sources of Support Beyond the Family, Dietary Practices Health Beliefs & Practices, Faith-Based Influences & Special Rituals, Language & Communication, Parenting Styles & Family Roles, Sources of Support Beyond the Family, Dietary Practices Be sensitive to and show respect for the differences in beliefs and values of others. Acceptance of and respect for the right and mores of all individuals. All clients have the right to be understood and respected despite their differences. By understanding the client's perspective, the nurse can be a better advocate for the client. From the Potter textbook, describe the LEARN Model technique. Potter/Perry p. 126 This technique assists the nurse to understand and engage with patients from a cultural perspective - cultural desire. LEARN: Listen to the patient's perception of the problem. Be non-judgmental and use encouraging comments, such as "Tell me more". Explain your perception of the problem. Acknowledge not only the differences between the two perceptions of the problem but also the similarities. Recognize the differences but build on the similarities. Recommendations must involve the patient. Negotiate a treatment plan, considering that it is beneficial to incorporate selected aspects of the patient's culture into the plan. You are a professional nurse caring for a non-English speaking client. What resources will you use to communicate with her? Potter/Perry p. 123-124, 126 Interpretive service to ensure meaningful access to health care for people with limited English proficiency and offer effective communication services for those who are deaf or hard of hearing. Provide language assistance services free of charge, notify patients both verbally and in writing of their right to receive language-assistance service, and take steps to provide auxiliary aids and services, including qualified interpreters, note takers, computer-aided transcription services, and written materials. Ensure the interpreters are competent in medical terminology and understand issues of confidentiality. Do not use family members or other healthcare providers Explain the term health care disparities and list contributors to this occurrence. Potter/Perry pg. 117 Healthcare disparities are particular health differences among populations linked with social, economic, and/or environmental disadvantages (i.e., poor health status, disease risk factors, poor health outcomes, accessibility and quality of healthcare services). Contributors: Poor access to health care, inadequate resources, poor patient-provider communication, a lack of culturally competent care, fragmented delivery of care and inadequate access to language services Define culturally congruent care and give an example of providing culturally congruent care. Potter/Perry pg.116 Culturally congruent care is care that fits a person's life patterns, values, and system of meaning. The patterns and meanings are generated by the individual person. Sometimes these values and meanings are different from the professional healthcare system. Requires the nurse to be a learner and partner with patients to determine what is needed to provide meaningful and beneficial nursing care. Example - Adjust a medication dose schedule around the patient's lifestyle patterns, eating habits, sleep habits, and beliefs about medications. From Giddens, list and define 3 attributes of culture. Gidden pg. 30-31 Culture is learned: individual, socialization Changing & Adapting: changes as people adapt to environmental and technical innovations Shared beliefs, Values, and Behaviors: languages, rituals, customs, dietary practices, and manner of dress are overt attributes. Values, relationships to authority, social interactions, and gender roles are subtle attributes From Giddens, list and define 5 criteria of culture. Gidden pg. 30-31 Individualism vs Collectivism: Interdependent = Collectivistic; Independent =, Individualist Power Distance: a culture that values a more equal distribution of power has an expectation that their opinions will be heard and equally valued. In contrast, culture in which a greater power distance is observed, people are unlikely to overtly challenge or disagree with people in positions of authority Masculinity vs Femininity: describes gender roles Long-term versus short-term orientation: long term orientation would be evidenced by a patient who comes in for preventive care visits, receives all recommended screening tests and immunizations and is an active partner in care. A short-term orientation might be evidenced by the individual who seeks treatment for health care problems only when symptoms of illness become unbearable. Religiosity: varies on how much religion permeates one's day-to-day existence; organized and institutional practice association with particular beliefs A patient tells the nurse that he experiences daytime fatigue even after 7-8 hours of sleep each night. What is the best assessment question for the nurse to ask? Do you also have any recent lifestyle or behavior changes? The nurse is making rounds on the hospital unit and observes a patient sleeping. The patient's pulse and respiratory rates are slower than baseline. The nurse realizes the patient has most likely just entered which stage of non-rapid eye movement sleep? Stage 2 The nurse enters a patient's room and the patient startles easily and appears to jerk his arms and legs before awakening. Which stage of non-rapid eye movement sleep did the patient most likely awaken from? Stage 1 The nurse must awaken a patient from Stage 4 non-rapid eye movement sleep in order to prepare the patient for a procedure. The patient is disoriented. What is the nurse's best action? Re-assess the patient's orientation A patient complains of not being able to fall asleep at night and asks the nurse if there is a safe, non-prescription medication he can try. After consulting the healthcare provider, the nurse should recommend which naturally occurring hormone? Melatonin A mother tells the nurse she is concerned because her 8 month old infant sleeps all day and night and is only awake about 2-3 hours per day. What is the nurse's best response? "I recommend that you notify the child's pediatrician." The nurse is caring for a child with tonsillar enlargement. What is the nurse's priority concern? Low oxygen saturation If a person is under stress example of maladaptive behavior Psychological effect excessive sleeping insomnia high blood pressure ulcer low libido If you are a nurse working in the busy place how would you help yourself to cope with stress You are scheduled to many patients what should you do Talk to supervisor verbalize issues know your limits Public health nurse Entire population; promote health Community health nurse Particular community;promote health Community health nurse helps the Individual families and groups in the community Subpopulation Stroke or pregnant people in community and make a program to teach them as a group Vulnerable population Susceptible; older people, mentally ill, substance abusers, children and immigrants, people in poverty, people who are abused Vulnerable population you must Assess first,give culturally congruent care, pay attention to non verbal cues gestures and eye contact Do not give financial or legal advice instead Connect them to who can help then When making care plans remember that Every person or family have their own needs Community health nurse Raise funds, and link with the leaders of the community to get funding for nutritional programs and medical supplies No fridge Toxins spoil food Lack of running water Poor hygiene A community health nurse should Know the kind of neighborhood they're going to Assess environment Bad environment Bad health Case manager Connect them to the right people Patient advocate Refer to right people and speak for their rights Change agent Change or influence their life Collaborator Work with other people of the team example physical therapist and family Epidemiologist Tracking the rate of incident Heath teaching of how disease is spread Before dealing with a patient or family with loss death and grief Solidify your own beliefs and keep your composure Grief Emotional response to a loss Example: crying Mourning The outward social expressions of grief and behavior associated with loss Example: weakening, wearing black, candle light visuals Normal grief Common universal reaction characterized by complex emotional cognitive social physical behavioral and spiritual response to loss During normal grief the nurse should Stay and listen and give a therapeutic touch Marginal or unsupported grief Relationship with deceased person is not socially sanctioned Example: death of a gay partner, death of a pet, death of a mistress' married lover Complicated grief Person has a prolonged or significantly difficult time moving forward after a loss Example: loss associated with sudden or tragic death like sudden accident or suicide Complicated grief include Exaggerated grief, delayed grief and masked grief Complicated grief Takes time, can't continue normal living, can't work anymore During complicated grief a nurse should watch for Signs of suicide example: thank you notes, going from depression to euphoria, or passing remarks like "I am ready" Exaggerated grief Exhibits self-destructive behavior, obsessions or psychiatric disorders *suicide risk Exaggerated grief Dont eat or excessive eating, hysterical Delayed grief A persons grief response is unusually delayed or postponed because the loss to too overwhelming the person must avoid the full realization of the loss Delayed grief After they mourn, person who is preparing the funeral Masked grief Grieving person behaves in ways that interfere with normal functioning but is unaware of disruptive behavior as a result of the loss and ineffective grief resolution Masked grief Pretend everything is ok and nothing happen Example during the wake will play music Symptoms of normal grief Headache fatigue want to be alone over sensitive to noise insomnia or hypersomnia appetite disturbance chocking sensation Kubler Ross Stages of Dying Is for the patient and the family Stages of dying DABDA- denial, anger, bargaining, depression, acceptance Marital discourt Anger when one in a couple suffering from illness Worden grief task model Is for the patient's family members and has no bargaining because patent is already deceased Task 1 Accept the loss- accepting the person is gone and will not return Task 2 Experience the pain of grief Task 3 Adjust to the world without deceased. Fill I role of deceased Example deceased was soccer mom so dad become soccer dad Task 4 Emotionally relocate the deceased and move on with life. Example moms in a better place Factors influencing loss and grief coping strategies How they deal with loss and move on with life Factors influencing loss and grief human development Age and stage of development affect the grief response Example a two-year-old will think they are sleeping a 65-year-old would be hysteric Factors influencing loss and grief personal relationship The quality and meaning of the loss relationship influence the grief response Example Patrick from high school Factors influencing loss and grief nature of loss How they die Example rape disease accidents Factors influencing the loss and grief Socio economic status When people like financial educational resource the burden of loss multiply no money equals stress Other factors influencing the loss and grief Culture ethnicity spiritual and religious beliefs Palliative care Focuses on the prevention relief reduction or soothing of symptoms of disease disorder throughout the entire course of an illness dying with dignity Hospice care People with chronic diseases who have less than 6 to 12 months to live The use of therapeutic communication should include The use of open ended questions example how do you feel? Provide psychosocial care Give the patient the correct information about their condition the benefits and burdens of treatment options Promote dignity and self esteem A sense of dignity respect the patient Maintaining a comfortable and peaceful environment Promotes good sleep pattern and minimizes symptom severity Protect against abandonment and isolation Many patients with terminal illness are frayed of dying alone When a patient dies the nurse should immediately Elevates the head above the body to prevent from blood pooling Promote comfort in the terminally ill patient by Providing skin care as needed provide oral care optical lubricants and artificial tears for dry eyes apply a light film of lip balm for dryness Samples of nursing intervention Develop and open and caring relationship to active listening and a stab Lish trust and positive regard for patients in her grief and suffering Assist with end-of-life decision-making Example should life extending treatments be stopped if there appears to be little chance of recovery? Should artificial nutrition and hydration be provided when a patient is near death or no and no longer able to eat? How to facilitate morning Help the love ones except the loss is real, support the efforts to adjust to the lost,allow time to grieve, encourage new relationship, provide continuing support, be alert for signs of ineffective potentially harmful coping mechanisms such as alcohol and substance abuse Samples of nursing diagnosis Death anxiety beer grieving complicated grieving hopelessness Rationale of nursing intervention Decreases feelings of abandonment and believing that others are present gives hope and resources Why do we need to encourage patients to verbalize their fear Hope ceiling light in them and you're able to give therapeutic care Goal of community health nurse Remote health vaccine Therapeutic communication establishes Care trusts and ease pain Constipation Fiber grains Sympathetic nervous system Fight or flight response pupils dilate palpitationthen it goes to parasympathetic homeostasis Foods high in calcium Milk and cheese Liquid diet Tea broth juices Carbohydrate Diarrhea Stool forming foods; Banana brand Living will your wishes on topics such as resuscitation, desired quality of life and end of life treatments including treatments you don't want to receive. This document is primarily between you and your doctor, and it advises them how to approach your treatment. Advanced directive in healthcare facility A power of attorney; giving or selecting someone as a proxy to carry out the living will Advance directive Advance directives are legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on. Living will a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive Definition: -Refers to the learned and shared beliefs, values, norms, and traditions of a particular group, which guide our thinking, decisions, and actions. Culture Definition: - Emphasizes the need to provide care based on an individual's cultural beliefs, practices, and values; therefore, effective communication is a critical skill in culturally competent care. Culturally congruent care Definition: - Critical to reducing health disparities and improving access to high-quality health care that is respectful and responsive to the needs of the divers patient. Cultural Respect. Which of the following is an example of a patient with a health disparity? (select all that apply) 1. A patient who has a homosexual sexual partner 2. A patient unable to access primary care services 3. A patient living with a chronic disease 4. A family who relies on public transportation 5. A patient who has had a history of smoking for 10 years 1, 3, and 5 A 35-year-old woman has Medicaid coverage for herself and two young children. She missed an appointment at the local health clinic to get an annual mammogram because she has no transportation. She gets the annual screening because her mother had breast cancer. Which of the following are social determinants of this woman's health? (select all that apply) 1. Medicaid Insurance 2. Annual Screening 3. Mother's history of breast cancer 4. Lack of transportation 5. Woman's age 1, 4, and 5 During a nursing assessment a patient displayed several behaviors. Which behavior suggests the patient may have a health literacy problem? 1. Patient has difficulty completing a registration form at the medical office 2. Patient asks for written information about a health topic 3. Patient speaks Spanish as primary language 4. Patient states unfamiliarity with a newly ordered medicine 1 Which explanation provided by the nurse is the most accurate meaning for "Providing culturally congruent care"? 1. It fits the patient's valued life patterns and set of meanings 2. It is the same set of values as those of the health care team member providing daily care 3. It holds one's own way of life as superior to those of others 4. It redirects the patient to a more socially expected set of values 1 A nurse working in a large occupational health clinic knows that many of the workers at her company are marginalized and at risk for poor health outcomes. Which of the following individuals are most likely to be marginalized? 1. Wives of the employees 2. The head supervisors of the company 3. Workers who have a high school education 4. Workers employed for less than a year at the company 3 Definition: - The study of what is right and wrong in our conduct. It concerns our obligations to individuals, groups and society Ethics Definition: - Refer to judgment about behavior, based on specific beliefs. Morals Definition: - The branch of ethics within the field of health care. Bioethics Definition: - Refers to the freedom from external control Autonomy Definition: - Refers to taking positive actions to help others. Fundamental to the practice of nursing and medicine and implies that the best interests of the patient remain more important than self-interest. Beneficence Definition: - The avoidance of harm or hurt Nonmaleficence Definition: - The fairness and the distribution of resources. The term is most often used in discussion about access to health care, including the just distribution of scarce services and resources. Justice Definition: - Faithfulness or the agreement to keep promises Fidelity Definition: - A set of guiding principles that all members of a profession accept Code of Ethics Definition: - The application of one's skills and knowledge for the benefit of another person Advocacy Definition: - Answering for your own actions. Helps ensure that your professional actions are explainable to your patients and your employer Accountability Definition: - The health care team's obligation to respect patient privacy and is a fundamental part of the trusting relationship Confidentiality Approach to Ethics: - Proposes a system of ethics that is perhaps most familiar to health care practitioners. Defines actions as right or wrong based on their adherence to rules and principles such as fidelity to promises, truthfulness, and justice Deontology Approach to Ethics: - A system of ethics that proposes that the value of something is determined by its usefulness. Measures the effect that an act will have. Utilitarianism Approach to Ethics: - Turns away from conventional principles of ethics as a way to determine best actions and focuses instead on the details of a situation. Casuistry Approach to Ethics: - Looks at the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal or in which a point of view has become ignored or invisible. Feminist Ethics Approach to Ethics: - Focuses on understanding relationships, personal narratives and the context in which ethical problems arise. Emphasizes the role of the decision maker in the situation Ethics of Care What are the steps in the resolution of an Ethical Dilemma? 1. Ask if it is an ethical problem 2. Gather information 3. Identify the ethical elements 4. Name the problem 5. Consider possible courses of action 6. Create and action plan 7. Evaluate the action plan The application of deontology does not always resolve an ethical problem. Which of the following statements best explains one of the limitations of deontology? 1. The em