Fundamentals of Care Final Exam Study Guide | Questions and Answers (Complete Solutions)

Fundamentals of Care Final Exam Study Guide | Questions and Answers (Complete Solutions) The ____________________ is classified as a systematic, patient-centered framework for providing care. Nursing Process The phases of nursing process include: 1.) Assessment 2.) Diagnosis 3.) Planning 4.) Implementation 5.) Evaluation During the assessment phase of the nursing process, subjective and objective data is collected. Assessment During the _________________ phase of the nursing process, data is analyzed and a nursing diagnosis is made. Diagnosis During the _________________ phase of the nursing process, SMART goals are made in order to prioritize the care needed for the patient. Planning During the _____________________ phase of the nursing process, nursing interventions are performed. Implementation During the __________________ phase of the nursing process, the nurse will determine if the goals were met or revise a plan as needed. Evaluation Comparing the patient's response to the planned goals can be classified as _______________________. Evaluating Outcomes Types of nursing actions include: 1.) Independent 2.) Dependent 3.) Interdependent 4.) Collaborative 5.) Technical 6.) Legal and Ethical 7.) Cognitive 8.) Interpersonal A _______ in nursing is a civil wrong or wrongful act—intentional or unintentional—committed by a nurse that causes harm, injury, or violation of a patient's rights. Tort ____________ in nursing is classified as a threat of harm or unwanted touching Assault ____________ in nursing is classified as the actual unwanted physical contact. Battery In nursing, _____________ is the threat of harm that causes a patient to fear for their safety, while _____________ is the actual, intentional, and non-consensual touching of a patient. Assault / Battery _________________ in nursing is the failure to act as a reasonably prudent nurse, or by providing care that falls below the accepted standard of practice, resulting in patient harm. Negligence __________________ is classified as professional negligence that causes patient harm. Malpractice Key legal principles that all healthcare professionals should follow include: 1.) Following standards of care 2.) Practicing within scope 3.) Understanding proper documentation 4.) Having legal protection Safe practices of a Novice RN include: 1.) Asking for help when uncertain of something 2.) Following policies and procedures 3.) Using checklists and protocols The QSEN competencies acronym stands for what? The Quality and Safety Education for Nurses QSEN Competencies include: 1.) Patient-Centered Care 2.) Teamwork and Collaboration 3.) Evidence-Based Practice 4.) Quality Improvement 5.) Safety 6.) Informatics Patient-Centered Nursing Characteristics include: 1.) Respecting patient values and preferences 2.) Shared decision-making 3.) Advocacy 4.) Cultural humility 5.) Therapeutic communication Cultural awareness and self-reflection in nursing involves: 1.) Examining personal biases 2.) Avoiding stereotyping 3.) Using cultural assessment tools Pain considerations that nurses should know include: 1.) Pain is subjective 2.) Patient self-report is the gold standard Stages of Grief (Kübler-Ross) include (Select in order): 1.) Denial 2.) Anger 3.) Bargaining 4.) Depression 5.) Acceptance End-of-Life Care Options include: 1.) Hospice 2.) Palliative care 3.) Advance directives 4.) DNR/DNI Infectious Disease Precautions include: 1.) Hand hygiene 2.) Gloves 3.) Gowns 4.) Masks as needed Post-Operative Care includes: 1.) Preventing further complications from occurring 2.) Coughing and deep breathing 3.) Incentive spirometer 4.) Leg exercises and early ambulation The 6 rights for Medication Administration include: 1.) Right patient 2.) Right medication 3.) Right dose 4.) Right route 5.) Right time 6.) Right documentation Documentation Guidelines include: 1.) Being accurate 2.) Being timely 3.) Being objective 4.) Charting only what you observe and do Prioritization of Care Use ABCs (Airway, Breathing, Circulation) and Maslow's Hierarchy Levels of Nursing Practice include: 1.) Certified Nursing Assistants (CNAs) 2.) Licensed Practical 3.) Vocational Nurses (LPNs/LVNs) 4.) Registered Nurses (RNs) 5.) Advanced Practice Registered Nurses (APRNs) 6.) Nurse Practitioners (NPs) Interdisciplinary Healthcare Teams may include: 1.) Registered Nurse (RN) 2.) Medical Doctor (MD) 3.) DO (Doctor of Osteopathic Medicine) 4.) Advanced Practice Registered Nurse (APRN) 5.) Physical Therapist (PT) 6.) Occupational Therapist (OT) 7.) Social Worker (SW) 8.) Pharmacist 9.) Chaplain 10.) Dietitian Workplace Violence may include: 1.) Verbal violence 2.) Sexual violence 3.) Physical violence 4.) Lateral violence _____________________ in healthcare is defined as any act or threat of physical violence, harassment, intimidation, or disruptive behavior, including verbal abuse and physical assault, that occurs at work. Workplace Violence Providing _______________ , ________________ care for patients across the spectrum of sexual orientations and gender identities is essential for positive health outcomes. Inclusive / Nonjudgmental Respecting ________________________ and _________________ ensures patients feel safe and welcomed, which can significantly reduce disparities in health care access and improve mental health outcomes. Self-Identified Gender / Pronouns During which phase of the nursing process does the nurse compare the patient's current health status with the desired outcomes defined earlier? Evaluation A nurse repositions a patient every two hours to prevent skin breakdown. This is an example of which type of nursing action? Independent __________________ actions require a specific order from a healthcare provider, such as administering a prescription medication. Dependent ________________________ actions are nurse-initiated interventions that do not require a provider's order and fall within the RN's scope of practice. Independent ______________________ actions involve collaboration with other members of the healthcare team, like physical therapists or dietitians. Interdependent Which legal term describes a nurse's failure to provide the same level of care that a reasonably prudent nurse would provide in a similar situation, resulting in no direct harm? Negligence A nursing student is unsure how to perform a complex dressing change. According to the guidelines for a safe novice RN, what is the most appropriate action? Ask a more experienced nurse for help with the task Which QSEN competency focuses on using data to monitor the outcomes of care processes and using improvement methods to design changes? Quality Improvement Which characteristic is essential for providing patient-centered care? Shared decision-making What is the primary goal of nursing self-reflection regarding cultural awareness? To examine personal biases According to Florence Nightingale's theory, what is the nurse's primary role in the healing process? Manipulating the environment to facilitate healing A patient reports a pain level of 8 out of 10, but their heart rate and blood pressure are within normal limits. Which action should the nurse take? Treat the patient's pain based on their self-report Which of the following is considered a physiological response to stress? Increased heart rate and blood pressure An adult patient who recently lost their job expresses concern about how they will provide for their family. This is an example of a disturbance in which component of self-concept? Role performance A patient diagnosed with terminal cancer tells the nurse, 'I'll start exercising and eating healthy if God will just let me live to see my grandson's graduation.' Which stage of grief is this? Bargaining How does palliative care differ from hospice care? Palliative care can be provided alongside curative treatments When applying standard precautions, which of the following is the most important action to prevent the spread of infection? Hand hygiene before and after patient contact A nurse encourages a post-operative patient to use an incentive spirometer every hour. What is the primary purpose of this intervention? To prevent atelectasis and pneumonia Which factor most significantly increases a patient's risk for developing a pressure injury? Immobility When performing perineal care for a female patient, what is the correct technique to prevent infection? Clean from front to back To prevent Catheter-Associated Urinary Tract Infections (CAUTIs), where should the nurse secure the urinary drainage bag? Below the level of the bladder on the bed frame A nurse is checking the 'Six Rights' of medication administration. Which of the following is included in these rights? Right route The provider orders 1 g of a medication. The pharmacy provides 500 mg tablets. How many tablets should the nurse administer? 2 tablets Which task is most appropriate for an RN to delegate to a Licensed Practical Nurse (LPN) or Unlicensed Assistive Personnel (UAP)? Obtaining vital signs on a stable patient What is the primary legal purpose of accurate and timely nursing documentation? To serve as evidence that standards of care were met A nurse receives a handoff report on four patients. Which patient should the nurse assess first? A patient complaining of shortness of breath Which of the following is a primary characteristic of an Associate Degree in Nursing (ADN) prepared RN compared to a BSN-prepared RN? The BSN curriculum includes more leadership and research When a nurse acts as a 'care manager' within an interdisciplinary team, what is their primary focus? Ensuring holistic patient needs are met through collaboration A nurse experiences 'lateral violence' in the workplace. What does this term specifically describe? Bullying or aggressive behavior between co-workers Which action demonstrates inclusive care for a patient who identifies as transgender? Using the name and pronouns the patient identifies with A patient with fecal incontinence is at high risk for which complication? Skin breakdown and infection Which nursing diagnosis phase involves analyzing collected data to identify actual or potential health problems? Diagnosis The ________________ phase of the nursing process focuses on the goals and interventions that follow the identification of the diagnosis. Planning The __________________ phase of the nursing process is strictly for gathering data. Assessment The ___________________ phase of the nursing process looks back at the outcome of the plan to see if the goals were met. Evaluation The __________________ phase of the nursing process occurs when the nurse interprets data to formulate specific nursing diagnoses. Diagnosis Which of the following is a key element of a SMART goal in the planning phase? Measurable A nurse provides a patient with information about the risks and benefits of a procedure before they sign a form. This supports which ethical and legal principle? Informed Consent What is the most central theme or focus in nursing according to most theorists? The Person (Patient) A patient is grieving and says, 'I can't believe this is happening to me. There must be a mistake in the test results.' Which stage are they in? Denial Which nursing intervention is most effective in preventing deep vein thrombosis (DVT) in a post-operative patient? Early ambulation and leg exercises Which of the following is an example of objective data? Blood pressure reading of 140/90 mmHg A nurse is teaching a patient about urinary tract infection (UTI) prevention. Which instruction should be included? Wipe from front to back after using the toilet Which stage of the nursing process involves performing the interventions that were decided upon during planning? Implementation A patient refuses to take their prescribed blood pressure medication. What is the nurse's most appropriate first action? Explore the reasons why the patient is refusing Which of the following describes a 'dependent' nursing action? Administering 2 mg of Morphine through an IV When documentation is completed in a patient's chart, which of the following practices is correct? Chart only objective findings and specific actions Which component of the nursing process involves prioritizing patient problems using frameworks like Maslow's Hierarchy of Needs? Planning What is the 'Gold Standard' for assessing a patient's pain? The patient's self-report A nurse is caring for a patient from a different culture. What is the most effective way to provide culturally sensitive care? Ask the patient about their specific cultural beliefs and practices According to the Kübler-Ross model, which stage of grief involves the individual feeling profound sadness and withdrawal from life? Depression A nurse is preparing to perform a procedure on a patient. Which action violates the principle of preventing battery? Performing the procedure after the patient says 'no' In Maslow's Hierarchy of Needs, which of the following must be addressed first according to the prioritization of care? Physiological needs (Oxygen, fluids) Which of the following is a key element of Florence Nightingale's theory regarding cleanliness? Frequent hand washing and clean bedding Which of the following is considered an intentional tort? Battery When identifying a patient's risk for falls, which of the following factors should the nurse assess? History of falls and current medications Which of the following is a primary focus of informatics in the QSEN competencies? Using technology to manage data and support decision-making skills among healthcare professionals A nurse is determining whether a patient's pain has decreased after administering an analgesic 30 minutes ago. Which phase of the nursing process is the nurse currently performing? Evaluation A nurse is caring for a patient who refuses a scheduled bath. The nurse threatens to restrain the patient if they do not comply. Which legal tort has the nurse committed? Assault Which of the following nursing actions is categorized as an independent intervention? Repositioning a patient every two hours to prevent skin breakdown According to the nursing metaparadigm, which component is often considered the most central to the practice of nursing? The Person A novice nurse is unsure how to perform a specific sterile dressing change that is new to them. What is the most appropriate action according to safe practice guidelines? Ask an experienced nurse for assistance and guidance When applying the Quality and Safety Education for Nurses (QSEN) competencies, which action best demonstrates 'Informatics'? Using the electronic health record to track a patient's trending laboratory results Florence Nightingale's theory focuses primarily on the impact of which factor on patient healing? Physical environment A patient reports feeling 'sharp, stabbing' pain in their abdomen. The nurse notes the patient is smiling and talking with visitors. Which principle should guide the nurse's pain assessment? The patient's self-report is the gold standard for pain assessment During a period of high stress, a patient experiences an increased heart rate and dilated pupils. Which type of stress reaction is this patient exhibiting? Physiological A patient who has recently lost their spouse tells the nurse, 'I will go to church every day if I can just have one more year with them.' Which stage of Kübler-Ross's grief is this patient experiencing? Bargaining Which of the following is a primary goal of palliative care? Optimizing quality of life by managing symptoms and providing support A nurse is preparing to provide perineal care to a female patient. To prevent infection, in which direction should the nurse wipe? Front to back An RN is planning care for a stable patient on a medical-surgical unit. Which task is most appropriate to delegate to an unlicensed assistive personnel (UAP)?