Nurs Final Exam Ch 10

Chapter 10: Being Specificity Multiple Choice 1. The author describes the patient journey as driving down a country road and somehow getting lost. At that moment and time, all that is needed is clear directions about how to get to your destination, not about types of entertainment in the area. The same is true for patients. Accordingly, a part of each nursing assessment should include: a. Patient’s need for information and level of understanding b. Detailed overview of disease process c. Specific examples from other patients with same disease d. Nurse’s feelings about newest treatment modality ANS: A Assessment of patient’s need for information and level of understanding helps the nurse choose the right amount of detail and appropriate language level (Black, 2014). 2. Which statement, if made by the nurse, could positively affect the course of the patient’s situation by suggestibility? a. < Breastfeeding will provide time to bond with your baby.= b. < Breastfeeding will take longer than giving your baby a bottle.= c. < You will need to be careful about taking medications while breastfeeding.= d. < Breastfeeding mothers can develop infections that are serious.= ANS: A The placebo effect is language or expectations of a nurse that positively affect the course of the patient’s illness by suggestibili ty, and the nurse is sending a positive message (e.g., increased time for bonding). When considering bottle preparation, storage, and cleanup, it is inaccurate to say that breastfeeding will take more time. The nocebo effect can occur when a nurse sends a negative message through choice of language, words, or tone of voice that produces negative responses (e.g., breastfeeding takes time, limits medication options, and causes infections). 3. The nurse instructs the nursing assistant to obtain temperatures on four patients and report abnormal findings immediately. Two hours later the nurse discovers that one of the patients had a fever that was not reported. The nurse is upset with the nursing assistant. Which statement, if made by the nurse, is concrete and specifically explains the nurse’s feelings? a. < I am not dissatisfied with your performance, because we all make mistakes.= b. < You must have misunderstood. I wanted to know about any elevated temperatures.= c. < I am disappointed because you did not follow my directions.= d. < You have made me so angry. Why did you not report the fever to me?= ANS: C When communicating feelings clearly and specifically, the individual must choose the descriptor that exactly conveys the intended emotion. Adding a rationale for the feeling enhances the sincerity of the message. If the emotion is one of feeling upset, the term < disappointed= is clear and specific. The descriptor < not dissatisfied= is the opposite of the feeling of < upset.= The descriptor < angry= is a much stronger feeling than < upset.= The statement < you must have misunderstood= does not convey the nurse’s feelings about the situation. 4. A teacher at a local elementary school asks a nurse to talk to the students about nutrition. Which response by the nurse is most appropriate? a. < I will teach the students how to read nutrition labels.= b. < What would you like the students to learn about nutrition?= c. < The students need to know about the consequences of obesity.= d. < I will enjoy teaching the students everything I know about nutrition.= ANS: B It is important to focus on the aspects of nutrition that the teacher wants the students to know and that are most important for them. The nurse should not assume the students need to learn about nutrition labels or obesity. Comprehensive nutrition information may waste time, be irrelevant, or focus on material that is too frightening or too advanced. 5. The nurse cares for a patient who complains of back pain. Which question should the nurse ask to obtain specific information about the back pain? a. < Would you like medication for the pain?= b. < What have you been doing in the last few days?= c. < Do you have a family history of osteoporosis?= d. < What do you think caused the back pain?= ANS: D To obtain specific information, the nurse must specifically ask for it (e.g., ask the patient about possible causes for the pain). It is more appropriate for the nurse to initially ask for the patient’s perspective than about specific causes (e.g., osteoporosis or activity). The nurse should assess before taking action (e.g., offering pain medication); the intervention does not provide specific information about the back pain. 6. The hospital nurse educator develops an educational session for staff nurses on how to clearly record data in a patient’s electronic medical record. Which key point should the nurse educator include in the teaching plan? (Select all that apply) a. A patient who is at high risk for falls will require more frequent documentation. b. The nurse should avoid labels (e.g., good, drug seeking, and lazy) to describe patients. c. Detailed and specific documentation is only required if a malpractice suit is expected. d. Each entry by the nurse in the electronic medical record should be clear and concise. e. Documentation cannot be used to determine reimbursement for healthcare services. f. Exact statements (in quotations) from patients are more accurate than paraphrasing. ANS: A, B, D, F The complexity of the health problems and the level of risk posed by patients, by their condition, or by the use of medical, nursing, or other therapies dictate the detail and frequency of documentation. The higher the risk to which a particular patient is exposed, the more comprehensive, in depth, and frequent should be the nursing recordings. Effective recording shuns bias, avoiding tendencies to prejudge or label patients. Avoidance of a malpractice suit is a valid reason for documentation to be detailed and specific, but documentation should be detailed and specific for every patient. Clear, concise documentation is vital for every entry into the electronic medical record. Careful documentation affects the ability of a healthcare agency to be reimbursed for services. Effective documentation tends toward quantitative expression, avoiding vague generalizations.