Nokea
Which patient statements identify qualities of nursing practice with high therapeutic value? 'My nurse:
- A. The nurses talk in language I can understand.
- B. The nursing staff helps me keep track of my medications.
- C. My nurse is willing to go to social activities with me.
- D. The staff lets me do whatever I choose without interfering.
- E. My nurses look at me as a whole person with different needs.
Correct Answer: A,B,E
Rationale: Each correct answer demonstrates caring is an example of appropriate nursing foci: communicating at a level understandable to the patient, using holistic principles to guide care, and providing medication supervision. The incorrect options suggest a laissez-faire attitude on the part of the nurse when the nurse should instead provide thoughtful feedback and help patients test alternative solutions or violate boundaries.
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A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the treatment team consult for information on more effective medications for this patient?
- A. Clinical algorithm
- B. Clinical pathway
- C. Clinical practice guideline
- D. International Statistical Classification of Diseases and Related Health Problems (ICD)
Correct Answer: A
Rationale: A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from large databases of information. These guidelines help the treatment team make decisions cognizant of an individual patient's needs, such as ethnic origin, age, or gender. A clinical pathway is a map of interventions and treatments related to a specific disorder. Clinical practice guidelines summarize best practices about specific health problems. The ICD classifies diseases.
Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, 'Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills.' Select the best response by the student interested in psychiatric nursing.
- A. Psychiatric nurses' practice in safer environments than other specialties and nurse-to-patient ratios are better because of the nature of patients' problems.
- B. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. I'm challenged by those situations.
- C. I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to continue them after I graduate.
- D. Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses. That appeals to me.
Correct Answer: B
Rationale: The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical and mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, similar to other specialties. Psychiatric nursing involves clinical practice, not simply documentation. Psychosocial pain is real and can cause as much suffering as physical pain.
A nurse says, 'When I was in school, I learned to call upset patients by name to get their attention; however, I read a descriptive research study that says that this approach does not work. I plan to stop calling patients by name.' Which statement is the best appraisal of this nurse's comment?
- A. One descriptive research study rarely provides enough evidence to change practice.
- B. Staff nurses apply new research findings only with the help from clinical nurse specialists.
- C. New research findings should be incorporated into clinical algorithms before using them in practice.
- D. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.
Correct Answer: A
Rationale: Descriptive research findings provide evidence for practice but must be viewed in relation to other studies before practice changes. One study is not enough. Descriptive studies are low on the hierarchy of evidence. Clinical algorithms use flowcharts to manage problems and do not specify one response to a clinical problem. Classic tenets of practice should change as research findings provide evidence for change.
A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the website's address most alerts the nurse that the site may have biased and prejudiced information?
- A. Address ends in '.org.'
- B. Address ends in '.com.'
- C. Address ends in '.gov.'
- D. Address ends in '.net.'
Correct Answer: B
Rationale: Financial influences on a site are a clue that the information may be biased. '.com' at the end of the address indicates that the site is a commercial one. '.gov' indicates that the site is maintained by a government entity. '.org' indicates that the site is nonproprietary; the site may or may not have reliable information, but it does not profit from its activities. '.net' can have multiple meanings.
In the shift-change report, an off-going nurse criticizes a patient who wears extremely heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy?
- A. This is a psychiatric hospital, so we expect our patients to behave bizarrely.
- B. Let's all show acceptance of this patient by wearing lots of makeup too.
- C. Your comments are inconsiderate and inappropriate. Keep the report objective.
- D. Our patients need our help to learn behaviors that will help them get along in society.
Correct Answer: D
Rationale: Accepting patients' needs for self-expression and seeking to teach skills that will contribute to their well-being demonstrate respect and are important parts of advocacy. The on-coming nurse needs to take action to prevent prejudice against the patient. Humor can be appropriate within the privacy of a shift report but not at the expense of respect for patients. Judging the off-going nurse in a critical way will create conflict.