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The nurse is caring for a patient with a new diagnosis of pneumonia and explains to the patient that together they will plan the patient's care and set goals for discharge. The patient asks: 'How is that different from what the doctor does?' Which response by the nurse is most appropriate?
- A. The role of the nurse is to administer medications and other treatments prescribed by your doctor.
- B. The nurse's job is to help the doctor by collecting data and communicating when there are problems.
- C. Nurses perform many of the procedures done by physicians, but nurses are here in the hospital for a longer time than doctors.
- D. In addition to caring for you while you are sick, the nurses will assist you to develop an individualized plan to maintain your health.
Correct Answer: D
Rationale: This response is consistent with the Canadian Nurses Association (CNA) definition of nursing. Registered nurses are self-regulated health care professionals who work autonomously and in collaboration with others. RNs enable individuals, families, groups, communities and populations to achieve their optimal level of health. RNs coordinate health care, deliver direct services, and support patients in their self-care decisions and actions in situations of health, illness, injury, and disability in all stages of life. The other responses describe some of the dependent and collaborative functions of the nursing role but do not accurately describe the nurse's role in the health care system.
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The nurse is caring for a patient who has left-sided paralysis as the result of a stroke and assesses a pressure injury on the patient's left hip. Which of the following is the most appropriate nursing diagnosis for this patient?
- A. Impaired physical mobility related to decrease in muscle control (left-sided paralysis)
- B. Risk for impaired tissue integrity as evidenced by insufficient knowledge about protecting tissue integrity
- C. Impaired skin integrity related to pressure over bony prominence (impaired circulation)
- D. Ineffective peripheral tissue perfusion related to sedentary lifestyle
Correct Answer: C
Rationale: The patient's major problem is the impaired skin integrity as demonstrated by the presence of a pressure injury. The nurse is able to treat the cause of impaired circulation and pressure over bony prominence by frequently repositioning the patient. Although left-sided weakness is a problem for the patient, the nurse cannot treat the weakness. The 'risk for' diagnosis is not appropriate for this patient, who already has impaired tissue integrity. The patient does have ineffective peripheral tissue perfusion, but the impaired skin integrity diagnosis indicates more clearly what the health problem is.
The nurse is caring for a patient who has been admitted to the hospital for surgery and tells the nurse, 'I do not feel right about leaving my children with my neighbour.' Which action should the nurse take next?
- A. Reassure the patient that these feelings are common for parents.
- B. Have the patient call the children to ensure that they are doing well.
- C. Call the neighbour to determine whether adequate childcare is being provided.
- D. Gather more data about the patient's feelings about the childcare arrangements.
Correct Answer: D
Rationale: Since a complete assessment is necessary in order to identify a problem and choose an appropriate intervention, the nurse's first action should be to obtain more information. The other actions may be appropriate, but more assessment is needed before the best intervention can be chosen.
The nurse is caring for a critically ill patient in the intensive care unit and plans an every-2-hour turning schedule to prevent skin breakdown. Which type of nursing function is demonstrated with this turning schedule?
- A. Dependent
- B. Cooperative
- C. Independent
- D. Collaborative
Correct Answer: D
Rationale: When implementing collaborative nursing actions, the nurse is responsible primarily for monitoring for complications of acute illness or providing care to prevent or treat complications. Independent nursing actions are focused on health promotion, illness prevention, and patient advocacy. A dependent action would require a physician order to implement. Cooperative nursing functions are not described as one of the formal nursing functions.
Which of the following would the nurse perform during the assessment phase of the nursing process?
- A. Obtains data with which to diagnose patient problems.
- B. Uses patient data to develop priority nursing diagnoses.
- C. Teaches interventions to relieve patient health problems.
- D. Assists the patient to identify realistic outcomes to health problems.
Correct Answer: A
Rationale: During the assessment phase, the nurse gathers information about the patient. The other responses are examples of the intervention, diagnosis, and planning phases of the nursing process.
When caring for patients using evidence-informed practice, which of the following does the nurse use?
- A. Clinical judgment based on experience
- B. Evidence from a clinical research study
- C. The best available evidence to guide clinical expertise
- D. Evaluation of data showing that the patient outcomes are met
Correct Answer: C
Rationale: Evidence-informed nursing practice is a continuous interactive process involving the explicit, conscientious, and judicious consideration of the best available evidence to provide care. Four primary elements are: (a) clinical state, setting, and circumstances; (b) patient preferences and actions; (c) best research evidence, and (d) health care resources. Clinical judgment based on the nurse's clinical experience is part of EIP, but clinical decision making also should incorporate current research and research-based guidelines. Evidence from one clinical research study does not provide an adequate substantiation for interventions. Evaluation of patient outcomes is important, but interventions should be based on research from randomized control studies with a large number of subjects.