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Terms in this set [30]
A respiratory therapist is working with pediatric patients with cystic fibrosis. When the therapist asks the nurse about treatment guidelines for the patient, the nurse refers the therapist to a clinical pathway algorithm.
Which describes the goal of this algorithm?
Ensure standardization of
care provided across clinical disciplines.
-Reason: Clinical pathways developed as algorithms are designed to standardize care provided across clinical disciplines; thus, this best describes the goal of these pathways. They are also intended to improve the quality of care and outcomes.
The nurse is working for a facility that requires the use of a column framework for planning care.
Information in which column of the plan of care is best
derived from and supported by research evidence?
Nursing interventions
Reason: A column plan of care uses columns to categorize data for each phase of the nursing process. When writing nursing interventions, the nurse may be required to write a rationale for selecting a particular nursing intervention. This generally requires citing research-based evidence.
The nurse has been using a standardized care plan to
guide care for a patient hospitalized following open heart surgery. The patient is not married and lives with his 85-year-old mother who has unstable diabetes and congestive heart failure.
Which nursing diagnosis would require the nurse to create an individual plan to supplement the standardized plan?
Caregiver Role Strain, Risk for
Reason: Standardized care plans are used for predictable, commonly occurring problems related to a specific diagnosis. In
this scenario, caregiver role strain due to age of mother and presence of multiple health issues would create potential problems that would not necessarily be common to all patients post-surgery and would require development of an individualized care plan
The nursing team is reviewing the possible use of clinical pathways to guide care for patients on the pulmonary care unit. One of the team members asks how the number of columns is determined for
the clinical pathway.
Which response by the team facilitator provides the best explanation?
Preset diagnosis-related groups [DRGs] determine the number of days allowed for this diagnosis and thus the number of columns.
Reason: Preset diagnosis-related groups [DRGs] determine the number of days allowed for a specific diagnosis. Each column represents a day; thus, this would be the best response to this question.
The
nurse auditor is reviewing several patient charts to evaluate the effectiveness of the nursing care provided.
Which information should the auditor look for that demonstrates nursing accountability and is essential for evaluation?
Date the plan was written and initiating nurse's signature
The nurse is creating a column plan of care.
Which information should the nurse place in the intervention column for a
diabetic patient with a slow-healing foot wound?
Obtain a dietary consult for the patient.
Reason: Obtaining a dietary consult for the patient would be considered a nursing intervention and would be placed in that column.
The nurse is creating a plan of care for a patient with complex health problems, including sepsis.
Which action should the nurse take to focus nursing care and support the best patient
outcomes?
Prioritize three to five nursing diagnoses.
Reason: When creating a nursing care plan, it is important to list only three to five nursing diagnoses to help the nurse focus on nursing care that provides the best outcomes.
The nurse is providing care for a new patient admitted with heart failure [HF]. The facility in which the nurse works has purchased a set of standardized plans for use.
Which is
a benefit of using a standardized plan for this patient versus generating an individual plan?
A standardized plan is more time efficient and includes a common set of interventions for a patient with HF.
Reason: The use of standardized plans is more time efficient than generating a single plan for patients with the same diagnosis. Standardized plans include a common set of interventions for the specified diagnosis. They do not account for all possibilities
and should only be used for predictable, commonly occurring problems.
The nurse is using a clinical pathway to provide care to a patient hospitalized with pneumonia.
While reviewing the clinical pathway, the nurse would note that the columns organize care in which manner?
Each column represents a day of care.
Reason: A clinical pathway is usually organized with a column for each day, listing the
interventions that should be carried out and the patient outcomes that should be achieved on that day. There are as many columns on the multidisciplinary care plan as the preset number of days allowed for the patient's diagnosis-related group [DRG]. The columns do not represent different health disciplines, nursing diagnoses, or expected patient responses.
The nurse is describing the three-column plan of care.
Which description by the nurse
provides an accurate description?
"The three-column plan has no assessment column and combines goals/desired outcomes and evaluation into one column."
Reason: A column plan of care generally has four columns: nursing diagnosis, goals/desired outcomes, nursing interventions, and evaluation.
The nurse has created a nursing plan of care for a patient with an intellectual disability who is hospitalized for a
surgical procedure.
Which nursing intervention reinforces the patient's individuality and sense of control?
Allow the patient to wear pajamas from home as per patient request.
In which column in a plan of care should the nurse place this information: "Patient will walk 100 feet two times each shift"?
Goals/desired outcomes
During
a discussion of clinical pathways with a recent nursing graduate, the nurse preceptor mentions the use of diagnosis-related groups [DRGs] as the basis for clinical pathways. The new nurse asks what the DRGs are used for.
Which information should the nurse preceptor provide to the new nurse?
DRGs determine the number of preset days allowed for care for patients with that specific medical diagnosis.
Reason: DRGs determine the preset number of days allowed
for the patient's diagnosis. They are not used to determine specific nursing interventions; specific nursing interventions are not included in clinical pathways.
The nurse is completing the admission process for a patient scheduled for a radical prostatectomy.
Which should the nurse provide to the patient to help him best understand what to expect in terms of time frames, actions, and results related to this procedure?
Patient-specific clinical pathway
Reason: Patient-specific clinical pathways help patients understand what to expect in terms of time frames, actions, and results as related to diagnosis-related groups [DRGs].
The nurse has just admitted a 72-year-old patient for total hip replacement to a unit that utilizes clinical pathways. The patient is otherwise healthy, and recovery is expected to progress normally.
How will the clinical
pathway for this patient be initiated?
The healthcare provider will write an order for the appropriate clinical pathway for this patient.
Reason: Clinical pathways are initiated by healthcare provider order. They are not initiated by the physical therapist or the nurse independently.
The nurse works on a cardiopulmonary stepdown unit that uses standardized care plans for patients.
In which patient scenario
would a standardized plan of care be most appropriate?
A patient 2 days post-stroke, with vital signs within normal limits, has begun the rehabilitation program.
Reason: Standardized care plans are used for predictable, commonly occurring problems for a specific diagnosis. In this case, a patient post-stroke who has begun the rehabilitation program would fit these criteria.
A peer tells a new nurse that there
is a standardized plan that can be used for a patient diagnosed with diabetes. The nurse asks the peer how standards of care can be helpful in developing a plan of care for this patient.
Which response by the peer best answers this question?
"A standardized plan is a set of common interventions that can be individualized for patients with the same diagnosis, which is different from standards of care."
Reason: A standardized plan specifies the nursing
care for a group of patients with common needs, whereas standards of care set benchmarks for nursing performance expectations, including evidence of competent and effective clinical decision making that reflects professional behavior. Thus, stating that they are different would be the best response.
The nurse is delegating assignments to unlicensed assistive personnel [UAPs] on a medical-surgical unit.
When making assignments, which is the best
resource for the nurse to use as a guide?
Nursing plan of care for each patient
Reason: Nursing plans of care can provide the nurse with a guide when assigning nursing staff to care for each patient because they provide a plan to meet the unique needs of each patient.
The nurse is creating a legend for a concept map.
At which point in the development of the concept map should this activity
occur?
At the beginning of the concept-map development.
Reason: The legend for the concept map is the first step in the process of developing a concept map. It is not done at the end; after determination of the number of data clusters needed; or once data clusters, nursing diagnoses, and nursing interventions have been created.
The nurse is providing care for a 3-year-old hospitalized child. As the nurse
creates the nursing plan of care, the family informs the nurse that they usually give the toddler a warm bath every night before bed.
How should the nurse best address this in the nursing plan of care?
Allow the family to provide a warm bath in the evening as allowed by the provider.
Reason: When possible, the plan should be customized to include patient preferences and choices. This helps to reinforce the patient's individuality and sense of control.
Teaching the family that the toddler must adjust to the hospital routine and providing the bath per unit protocol does not address the family's preferences and choices for their toddler.
The nurse is creating a nursing plan of care for a patient admitted for surgery.
Which headings should the nurse use as the pre- and postoperative nursing plan of care is created?
Assessment, nursing diagnoses, goals/desired
outcomes, nursing interventions, evaluation.
Reason: Headings for nursing care plans generally follow the nursing process phases and should include the following: "Assessment," "Nursing Diagnoses," "Goals/Desired Outcomes," "Nursing Interventions," and "Evaluation."
The nurse is creating a patient concept map for a simulation scenario.
Which should the nurse do first when creating the concept map?
Develop
a legend for the concept map.
Reason: When creating a concept map, the nurse would first develop a legend by assigning shapes and colors for each nursing process phase and for the other categories of patient information. Gathering and sorting significant clusters of assessment data, looking at the assessment data [including both subjective and objective], and putting a shape with patient information and the priority medical diagnosis in the middle of the paper would follow development of the
legend.
The nurse admitting a patient asks the family if they would be available to help provide information to support the development of the nursing plan of care. The family asks the nurse what a nursing plan of care is.
Which response by the nurse answers this question?
"The nursing plan of care helps to organize information about the patient's nursing care and ensures appropriate, individualized
treatment."
Reason: A nursing plan of care organizes information about a patient's or family's care. It may include multiple nursing diagnoses [three to five are recommended], which helps the nurse to focus on nursing care that provides the best patient outcomes.
The nurse is creating a concept map for a patient.
Which guideline should be followed when preparing a concept map?
Following the sequence of the
nursing process.
Reason: One guideline to follow when creating a concept map is to follow the sequence of the nursing process.
A healthcare team member accesses a patient's nursing plan of care because the nurse is currently unavailable.
Which patient outcome is enhanced by this action?
Continuity of care
Reason: The ability of all healthcare team members to access the nursing plan of care enhances
communication, resulting in continuity of care.
The nurse is creating a concept map to guide a plan of care for a patient with multiple health problems. The nurse is using paper and pencil to create the map because the nurse is not comfortable with using the computer for this activity.
How could the nurse easily improve the readability of the map?
Use colored pencils or markers.
Reason: use of different
colored pencils is appropriate to help to delineate specific areas of the map.
The nurse is struggling to see the "whole picture" when caring for a patient with very complex needs.
Which method for developing the plan of care should the nurse consider?
Concept map
Reason: Concept maps can help the nurse to visualize and analyze relationships among clinical data, thus helping them view patient problems
holistically.
Which process can be used to visualize relationships among clinical data and help to prioritize meeting patient needs?
Concept map
Reason: A concept map is a visual representation of a nursing plan of care in a patterned diagram with data and ideas; it helps to provide a visual guide for analyzing relationships among clinical data to help prioritize meeting patient needs.
The nurse is creating a concept map for a patient with multiple health problems.
After creating clusters of assessment data, which should the nurse complete next to prioritize patient needs?
Determine the priority nursing diagnosis for each cluster; use lines to connect them to the clusters.
Reason: After creation of clusters of the subjective and objective assessment data, the nurse determines priority nursing diagnoses that
are relative to each of the clusters. The nurse then draws connecting lines between the diagnoses and assessment data, which helps to prioritize patient needs.
A healthcare team on an orthopedic unit is discussing ways to reduce cost, increase efficiency, and improve patient outcomes while collaboratively providing care.
Which approach to care would be most useful in guiding daily, multidisciplinary care for the patient population on this
unit?
Clinical pathway
Reason: A clinical pathway is a standardized, evidence-based, multidisciplinary plan that outlines care for patients with common, predictable health problems; thus, the team would select this approach.
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