Nokea
A resident of a long-term care facility refuses to eat until she has had her hair combed and her make-up applied. In this case, what patient need should have priority?
- A. the need to have nutrition
- B. the need to feel good about oneself
- C. the need to live in a safe environment
- D. the need for love from others
Correct Answer: B
Rationale: The patient's refusal to eat until her appearance is addressed indicates that her need to feel good about herself (B) is currently the priority.
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What is true of nursing responsibilities with regard to a physician-initiated intervention (physicians order)?
- A. Nurses do not carry out physician-initiated interventions.
- B. Nurses do carry out interventions in response to a physicians order.
- C. Nurses are responsible for reminding physicians to implement orders.
- D. Nurses are not legally responsible for these interventions.
Correct Answer: B
Rationale: Nurses are responsible for carrying out physician-initiated interventions (B) as part of their role.
A father runs into the emergency room with his 18 -month-old son in his arms. The father screams, Help, he is not breathing! The nursing diagnosis of Impaired Gas Exchange is what level of priority diagnosis?
- A. no priority
- B. low priority
- C. medium priority
- D. high priority
Correct Answer: D
Rationale: Impaired Gas Exchange in a non-breathing child is a life-threatening condition, making it a high-priority diagnosis (D).
Which of the following types of care plans is most likely to enable the nurse to take a holistic view of the patients situation?
- A. Kardex
- B. case management
- C. critical pathways
- D. concept map care plan
Correct Answer: D
Rationale: A concept map care plan (D) visually connects patient data, promoting a holistic view.
What name is given to tools that are used to communicate a standardized interdisciplinary plan of care for patients within a case management healthcare delivery system?
- A. Kardex care plans
- B. computerized plans of care
- C. clinical pathways
- D. student care plans
Correct Answer: C
Rationale: Clinical pathways (C) are tools used to communicate standardized interdisciplinary care plans.
A nurse is discharging a patient from the hospital. When should discharge planning be initiated?
- A. at the time of discharge from an acute healthcare setting
- B. at the time of admission to an acute healthcare setting
- C. before admission to an acute healthcare setting
- D. when the patient is at home after acute care
Correct Answer: B
Rationale: Discharge planning should begin at the time of admission (B) to ensure a smooth transition and continuity of care.