Final Nursing Exam Study Guide

Study Guide for Final Exam

Health promotion and maintenance –
stages,

Primary prevention includes health promotion, wellness education programs, immunizations, hearing protection in occupational settings, training to develop good body mechanics, and health screening for prostate, breast, and colon cancer. Final Nursing Exam Study Guide
Secondary prevention is provided in the home, health care facility, or skilled nursing facility.
Tertiary prevention aims to help patients achieve as high a level of functioning as possible.
The HPM describes the multidimensional nature of people as they interact within their environment to pursue health (Pender, 1996; Pender et al., 2015). The model focuses on the following three areas: (1) individual characteristics and experiences; (2) behavior-specific knowledge and affect; and (3) behavioral outcomes, in which the patient commits to or changes a behavior.
Nursing incorporates health promotion activities, wellness education, and illness prevention activities rather than simply treating illness.
Health promotion activities help maintain or enhance health.
Wellness education teaches patients how to care for themselves.
Illness prevention activities protect against health threats and thus maintain an optimal level of health.

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health disparities,

health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage”
People in marginalized groups are more likely to have poor health outcomes and die at an earlier age
Social determinants of health to explain the complexity of these interactions (McGovern et al., 2014). According to the World Health Organization (2013), social determinants of health are “the conditions in which people are born, grow, live, work and age…shaped by the distribution of money, power and resources at global, national, and local levels.” Income and wealth, family and household structure, social support, education, occupation, discrimination,

Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by: Final Nursing Exam Study Guide

vulnerable populations

Immigrants
Poor and homeless
Abused
Substance abusers
Mentally ill
Older adults

Healthy People 2020 & WHO (purpose, definitions)

Goals are to increase life expectancy and quality of life, and to eliminate health disparities through improved delivery of health care services
Occurs in community settings
Involves acute & chronic care
Enhances individuals’ capacity for self-care
Promotes autonomy in decision making
Uses critical thinking skills
Reduces costs for the patient by providing care near homes
Requires knowledge of family theory, communication, group dynamics, and cultural diversity
Multilevel intervention –

Tier III – intensive intervention
Tier II – targeted small group instruction
Tier I – core intrustional program

Maslow’s hierarchy of needs and prioritization

Management of care – key components of nursing, cultural influences

Team nursing developed in response to the severe nursing shortage following World War II.
Total patient care delivery was the original care delivery model developed during Florence Nightingale’s time. This model disappeared in the 1930s and became popular again during the 1970s and 1980s, when the number of RNs increased.
The primary nursing model of care delivery was developed to place RNs at the bedside and improve the accountability of nursing for patient outcomes and professional relationships among staff members. The model became more popular in the 1970s and early 1980s as hospitals began to employ more RNs. Primary nursing supports a philosophy regarding nurse and patient relationships.
Case management is a care management approach that coordinates and links health care services to patients and their families while streamlining costs and maintaining quality. Final Nursing Exam Study Guide

Theorists (Erikson) – normal development and assessment findings (health risks for each stage)

Stage 1: Trust versus mistrust
(birth to 1 year)

An infant’s successful resolution of this stage requires a consistent caregiver who is available to meet his needs. From this basic trust in parents, an infant is able to trust in himself, in others, and in the world (Hockenberry and Wilson, 2015). The formation of trust results in faith and optimism.

Stage 2: Autonomy versus shame and doubt
(1 to 3 years)

A toddler develops his or her autonomy by making choices. Choices typical for the toddler age-group include activities related to relationships, desires, and playthings.
A toddler who successfully masters this stage achieves self-control and willpower.

Stage 3: Initiative versus guilt
(3 to 6 years)

Fantasy and imagination allow them to further explore their environment. Also at this time they are developing their superego, or conscience. Conflicts often occur between a child’s desire to explore and the limits placed on his or her behavior. These conflicts sometimes lead to feelings of frustration and guilt.
Successful resolution of this stage results in direction and purpose. Teaching a child impulse control and cooperative behaviors helps a family avoid the risks of altered growth and development.

Stage 4: Industry versus inferiority
(6 to 11 years)
They learn to work and play with their peers. They thrive on their accomplishments and praise. Without proper support for learning new skills or if skills are too difficult, they develop a sense of inadequacy and inferiority. Children at this age need to be able to experience real achievement to develop a sense of competency. Erikson believed that an adult’s attitudes toward work are traced to successful achievement of this task
Stage 5: Identify versus role confusion
(puberty)

This stage, in which identity development begins with the goal of achieving some perspective or direction, answers the question, “Who am I?” Acquiring a sense of identity is essential for making adult decisions such as choice of a vocation or marriage partner. Each adolescent moves in his or her unique way into society as an interdependent member. There are also new social demands, opportunities, and conflicts that relate to the emergent identity and separation from family. Erikson held that successful mastery of this stage resulted in devotion and fidelity to others and to their own ideals (Hockenberry and Wilson, 2015). Elkind (1967) identified a notion of perceived invulnerability in adolescents that contributes to risk-taking behaviors.

Stage 6: Intimacy versus isolation
(young adult)

Erikson portrayed intimacy as finding the self and then losing it in another (Santrock, 2012a). If the young adult is not able to establish companionship and intimacy, isolation results because he or she fears rejection and disappointment

Stage 7: Generative versus self-absorption & stagnation (middle age)

Middle-age adults achieve success in this stage by contributing to future generations through parenthood, teaching, mentoring, and community involvement. Achieving generativity results in caring for others as a basic strength. Inability to play a role in the development of the next generation results in stagnation

Stage 8: Integrity versus despair
(old age)         

Older adults often engage in a retrospective appraisal of their lives. They interpret their lives as a meaningful whole or experience regret because of goals not achieved (Berger, 2011). Because the aging process creates physical and social losses, some adults also suffer loss of status and function (e.g., through retirement or illness). These external struggles are met with internal struggles such as the search for meaning in life. Meeting these challenges creates the potential for growth and the basic strength of wisdom (Figure 11-1).

Normal physical assessment changes throughout lifespan (review of concepts from HA class)
Develop a plan of care – nursing process Final Nursing Exam Study Guide

ADPIE
Collect data.
Cluster cues, make inferences, and identify patterns and problem areas.
Critically anticipate.
Be sure to have supporting cues before making an inference.
Knowing how to probe and frame questions is a skill that grows with experience.

Selection and labeling of nursing diagnoses

A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual and potential health problems or life processes that the nurse is licensed and competent to treat. What makes the nursing diagnostic process unique from medical diagnoses is having patients involved, when possible, in the process.
Selection of a nursing diagnosis provides the basis for choosing nursing interventions. Accurate diagnosis of patient problems ensures the selection of more effective and efficient nursing interventions.
Nursing diagnoses are listed according to the North American Nursing Diagnosis Association (NANDA). Selecting the correct nursing diagnosis on the basis of an assessment involves diagnostic expertise.
Assessment of patient’s health status:
Patient, family, and health care resources constitute database.
Nurse clarifies inconsistent or unclear information.
Critical thinking guides and directs line of questioning and examination to reveal detailed and relevant database.
n actual nursing diagnosis describes human responses to health conditions or life processes that exist in an individual, family, or community. Final Nursing Exam Study Guide
A risk nursing diagnosis describes human responses to health conditions or life processes that may develop in a vulnerable individual, family, or community.
A health promotion nursing diagnosis is a clinical judgment of a person’s, family’s, or community’s motivation, desire, and readiness to enhance well-being and actualize human health potential as expressed in their readiness to focus on specific health behaviors such as nutrition and exercise.

Relationship of critical thinking and evaluation

Interpretation: Be orderly in data collection. Look for patterns to categorize data (e.g., nursing diagnoses [see Chapter 17]). Clarify any data you are uncertain about.
Analysis: Be open-minded as you look at information about a patient. Do not make careless assumptions. Do the data reveal what you believe is true, or are there other options?
Inference: Look at the meaning and significance of findings. Are there relationships between findings? Do the data about the patient help you see that a problem exists?
Evaluation: Look at all situations objectively. Use criteria (e.g., expected outcomes, pain characteristics, learning objectives) to determine results of nursing actions. Reflect on your own behavior.
Explanation: Support your findings and conclusions. Use knowledge and experience to choose strategies to use in the care of patients.
Self-regulation: Reflect on your experiences. Identify ways that you can improve your own performance. What will make you believe that you have been successful?
Level 1 is Basic: At the basic level, nurses think concretely on the basis of a set of rules or principles, following a step-by-step process without deviation from the plan. Following a procedure step by step without adjusting to a patient’s unique needs is an example of basic critical thinking.
Level 2 is Complex: Complex critical thinking analyzes and examines choices independently. Nurses learn to think beyond and synthesize knowledge. In complex critical thinking, a nurse learns that alternative and perhaps conflicting solutions exist.
Level 3 is Commitment: Commitment is the third level of critical thinking. Nurses anticipate needs and make choices without assistance from others.

Abuse and neglect
Cultural considerations, complementary and alternative therapies (invasive vs. non-invasive options)

Complementary therapies are therapies used in addition to or together with conventional treatment recommended by a person’s health care provider. As the name implies, complementary therapies complement conventional treatments. Many of them such as therapeutic touch contain diagnostic and therapeutic methods that require special training. Others such as guided imagery and breathwork are easily learned and applied. Complementary therapies also include relaxation; exercise; massage; reflexology; prayer; biofeedback; hypnotherapy; creative therapies, including art, music, or dance therapy; meditation; chiropractic therapy; and herbs/supplements (Lindquist et al., 2014). Another term that is used to describe interventions used in this fashion, particularly by licensed health care providers, is integrative therapies. Final Nursing Exam Study Guide
Alternative therapies sometimes include the same interventions as complementary therapies; but they become the primary treatment (Table 33-1). For example, a person with chronic pain uses yoga to encourage flexibility and relaxation at the same time that nonsteroidal antiinflammatory or opioid medications are prescribed. Both sets of interventions are based on conventional pathophysiology and anatomy while acknowledging the mind-body connection that contributes to the physiological pain response.
Several therapies are always considered alternative because they are based on completely different philosophies and life systems than those used by allopathic medicine. These are identified by the NIH/NCCIH as whole medical systems and include practices such as traditional Chinese medicine (TCM), Ayurveda, and naturopathy

Nursing presence and caring

Providing presence is a person-to-person encounter conveying a closeness and sense of caring. Presence involves “being there” and “being with.” “Being there” is not only a physical presence; it also includes communication and understanding. Nursing presence is the connectedness between the nurse and the patient

Triage

Routine screening to promote health and wellness
To determine eligibility for:
Health insurance
Military service
A new job
To admit a patient to a hospital or long-term care facility

 
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The nursing profession

Nursing as a profession
Historical influences
Florence Nightengale:

First practicing epidemiologist
Organized first school of nursing
Improved sanitation in battlefield hospitals
Her practices remain a basic part of nursing today

The growth of nursing in the United States:

Clara Barton founded the American Red Cross.
Dorothea Lynde Dix – was the supervisor of female nurses in the Union Army.
Mother Bickerdyke – organized ambulance service, supervised nurses, and searched for abandoned, wounded soldiers on the battlefield.
Harriet Tubman – Tubman was a prominent female in the Underground Railroad movement to free slaves.
Mary Mahoney – was the first professionally educated African-American. She may be one of the first proponents of better relationships between cultures and races and respect for individuals regardless of background, race, color, or religion.
Isabel Hampton Robb – helped found the American Nurses Association in 1911. She was an influential author with the following titles:
Nursing: Its Principles and Practice for Hospital and Private Use; Nursing Ethics; and Educational Standards for Nurses. She was one of the original founders of the American Journal of Nursing. Final Nursing Exam Study Guide
Lillian Wald and Mary Brewster: Henry Street Settlement –

In 1893, nursing expanded in the community owing to the influence of Lillian Wald and Mary Brewster. Nurses working in the settlement they established were some of the first to demonstrate autonomy in practice because they frequently encountered situations that required quick and innovative problem solving and critical thinking without the supervision or direction of a health care provider.

1906: Mary Adelaide Nutting, first professor of nursing at Columbia University
Another important development in nursing history occurred when the Rockefeller Foundation approached Nutting, along with Lillian Wald and Annie Goodrich, to study nursing education. Their study, conducted in 1920 and published in 1923, concluded that nursing education needed financial support and should be centered in university schools of nursing.

Contemporary influences
Nursing practice
Professional organizations

The American Nurses Association (ANA) (2010) develops standards for nursing practice, policy statements, and similar resolutions. These standards outline the scope, function, and role of the nurse in practice.
The Joint Commission (TJC) (2014) requires accredited hospitals to have written nursing policies and procedures.
NANDA

Nursing theories
Grand

Broad in scope, complex, require specification

Middle-range

More limited in scope and less abstract

Descriptive

Describe phenomena, speculate on why phenomena occur, and describe the consequences of phenomena.

Prescriptive

Address nursing interventions for a phenomenon, and predict the consequence of a specific nursing intervention.

Nightengale

Nightingale was one of the first to develop a nursing theory (1860) that is still in use today. Her concept of the environment was the focus of nursing care, and her suggestion that nurses need not know all about the disease process differentiated nursing from medicine. The focus of nursing is on caring through the environment and helping the patient deal with the symptoms and changes in function related to an illness.
Nightingale did not view nursing as limited to the administration of medications and treatments, but rather, it is oriented toward providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition. Through observation and data collection, she linked the patient’s health status with environmental factors and initiated improved hygiene and sanitary conditions during the Crimean War. Nightingale’s “descriptive theory” provides nurses with a way to think about patients and their environment.

Peplau

Peplau’s theory focuses on interpersonal relations between the nurse, the patient, and the patient’s family and developing the nurse-patient relationship. The patient is an individual with a need, and nursing is an interpersonal and therapeutic process. In developing a nurse-patient relationship, the nurse can serve as a resource person, counselor, and surrogate.
The patient gains from this relationship by using available services to meet needs, and the nurse helps the patient reduce anxiety related to health care problems.
Peplau’s theory is unique: The collaborative nurse-patient relationship creates a “maturing force” through which interpersonal effectiveness meets the patient’s needs.

Henderson

Henderson defines nursing as “assisting the individual, sick or well, in the performance of those activities that will contribute to health, recovery, or a peaceful death, and that the individual would perform unaided if he or she had the necessary strength, will, or knowledge.” Henderson organized the theory into 14 basic needs of the whole person and includes phenomena from the following domains of the patient: physiological, psychological, sociocultural, spiritual, and developmental. Final Nursing Exam Study Guide
Framing nursing care around the needs of the individual allows you to use Henderson’s theory for a variety of patients across the life span and in multiple settings along the health care continuum.
Based on 14 activities, the belief that the nurse should assist the patient with meeting needs until they are able to do so independently

Orem

Orem defines self-care as a learned, goal-oriented activity directed toward the self in the interest of maintaining life, health, development, and well-being. Nursing care is necessary when the patient is unable to fulfill biological, psychological, developmental, or societal needs. The nurse assesses and determines why a patient is unable to meet these needs, identifies goals to assist the patient, intervenes to help the patient perform self-care, and evaluates how much self-care the patient is able to perform.
According to Orem’s theory, the goal of nursing is to enhance the patient’s ability to independently meet these needs.

Leninger

Leininger’s background in anthropology informed her theory. Human caring varies among cultures in its expressions, processes, and patterns. Societal structure factors such as the patient’s religion, politics, culture, and traditions are significant forces affecting care and influencing the patient’s health and illness patterns.
The major concept of Leininger’s theory is cultural diversity, and the goal of nursing care is to provide the patient with culturally specific nursing care. To provide care to patients of unique cultures, the nurse safely integrates the patient’s cultural traditions, values, and beliefs into the plan of care. Leininger’s theory recognizes the importance of culture and its influence on everything that involves the patient and providers of nursing care.
In addition, symptom expression differs among cultures.

Neuman model

In the Neuman model, the patient is the individual, group, family, or community. The system is composed of five concepts that interact: physiological, psychological, sociocultural, developmental, and spiritual. These concepts interact with both internal and external environmental factors and all levels of prevention (primary, secondary, and tertiary) to achieve optimal wellness. Neuman considers any internal and external factors as stressors that affect the patient’s stability and any or all of the five system concepts.
When you apply the Neuman systems model, you assess the stressor and the patient’s response to the stressor, identify nursing diagnoses, plan patient-centered care, implement interventions, evaluate the patient’s response, and determine whether the stressor is resolved.
Based on the theory that focuses on wellness and prevention of disease

Roy

According to Roy’s model, the goal of nursing is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependent relations during health and illness. The need for nursing care occurs when the patient cannot adapt to internal and external environmental demands. All individuals must adapt to the following demands: meeting basic physiological needs, developing a positive self-concept, performing social roles, and achieving a balance between dependence and independence.
The nurse determines which demands are causing problems for a patient and assesses how well the patient is adapting to them. Nurses direct care at helping the patient adapt to changes.
A nurse is caring for a patient who recently lost a limb in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following? – Roy

Watson

In Watson’s theory, nursing is concerned with promoting and restoring health and preventing illness. Watson designed the model around the caring process—assisting patients in attaining or maintaining health or dying peacefully. This caring process requires the nurse to be knowledgeable about human behavior and human responses to actual or potential health problems. The nurse also needs to know individual patient needs, how to respond to others, and strengths and limitations of the patient and family and those of the nurse. In addition, the nurse comforts and offers compassion and empathy to patients and their families.

King –

Based on the belief that nurses should work with patients to develop goals for care

Benner and wrubel

With Benner and Wrubel’s theory, caring is central to nursing and creates possibilities for coping, enables possibilities for connecting with and concern for others, and allows for giving and receiving help. Caring means that persons, events, projects, and things matter to people. It presents a connection and represents a wide range of involvement. This theory sees personal concern as an inherent feature of nursing practice. In caring for one’s patients, nurses help patients recover by noticing interventions that are successful and that guide future caregiving. Final Nursing Exam Study Guide

Legal principles
Risk management
For nursing
Statutory for nursing practice

Statutory laws include the Nurse Practice Act found in all states. The Nurse Practice Act describes and defines the legal boundaries of nursing practice in each state. The Nurse Practice Act of each state defines the scope of nursing practice and expanded nursing roles, sets education requirements for nurses, and distinguishes between nursing and medical practice.
Criminal laws are meant to prevent harm to society and to provide punishment for crimes. These are categorized as felonies or misdemeanors.

A felony is a serious offense that results in significant harm to another person or society
A misdemeanor is a crime that, although injurious, does not inflict serious harm
Civil laws protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur
Regulatory law, also known as administrative law, defines your duty to report incompetent or unethical nursing conduct to the Board of Nursing.
Common law results from judicial decisions concerning individual cases. Most of these revolve around negligence and malpractice.

The American Nurses Association (ANA) (2010) develops standards for nursing practice, policy statements, and similar resolutions. These standards outline the scope, function, and role of the nurse in practice.
In a malpractice lawsuit, a nurse’s actual conduct is compared to nursing standards of care to determine whether the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances.
The Joint Commission (TJC) (2014) requires accredited hospitals to have written nursing policies and procedures.
Patient Protection and Affordable Care Act (PPACA)

PPACA created a new Patient’s Bill of Rights that prohibited patients from being denied health care coverage because of prior existing conditions, limits on the amount of care for those conditions, and/or an accidental mistake in paperwork when a patient got sick.

The Patient Self-Determination Act (PSDA) enacted in 1991 requires health care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.
DNRs and Living Wills – Advanced directives
Uniform Anatomical Gift Act

An individual who is at least 18 years of age has the right to make an organ donation.

HIPPA – privacy law
Health Information Technology Act (HITECH)

HITECH expands the principles extended under the HIPAA, especially when a security breach of personal health information (PHI) occurs.

Any health care professional who does not report suspected child abuse or neglect may be liable for civil or criminal legal action.
The Uniform Determination of Death Act of 1980 states that health care providers can use the cardiopulmonary definition or the whole brain definition to determine death
An autopsy or postmortem examination may be requested by the patient or patient’s family.
The Oregon Death With Dignity Act (1994) was the first statute that permitted physician-assisted suicide
A tort is a civil wrong made against a person or property

Assault is an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact. No actual contact is required for an assault to occur.
Battery is any intentional offensive touching without consent or lawful justification.
The tort of false imprisonment occurs with unjustified restraint of a person without a legal reason

Defamation of character is the publication of false statements that result in damage to a person’s reputation.
Slander occurs when one speaks falsely about another.
Libel is the written defamation of character.
Negligence is conduct that falls below the generally accepted standard of care of a reasonably prudent person. Final Nursing Exam Study Guide
Malpractice is one type of negligence and often referred to as professional negligence.

The nurse (defendant) owed a duty of care to the patient (plaintiff).
The nurse did not carry out or breached that duty.
The patient was injured and the nurse’s failure to carry out the duty caused the injury.

Key elements of consent:

The patient receives an explanation of the procedure or treatment.
The patient receives the names and qualifications of people performing and assisting in the procedure.
The patient receives a description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort.
The patient receives an explanation of alternative therapies to the proposed procedure/treatment and the risks of doing nothing.
The patient knows that he or she has the right to refuse the procedure/treatment without discontinuing other supportive care.
The patient knows that he or she may refuse the procedure/treatment even after the procedure has begun.

Abortion laws:

In Roe vs. Wade, court ruled that during the first trimester, a woman could end her pregnancy without state regulation because the risk of natural mortality from abortion is less than with normal childbirth.
During the second trimester, the state has an interest in protecting maternal health, and the state enforces regulations regarding the person performing the abortion and the abortion facility.
By the third trimester, when the fetus becomes viable, the state’s interest is to protect the fetus; thus, the state prohibits abortion except when necessary to save the mother.

Ethics
Nursing Codes
Ethics and philosophy
Terms and meaning for nursing

Respect for patient autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient’s independence.
Beneficence – positive action for others

The agreement to act with beneficence implies that the best interests of the patient remain more important than self-interest

nonmaleficence is the avoidance of harm or hurt. In health care, ethical practice involves not only the will to do good, but an equal commitment to do no harm.
Justice refers to fairness. It is used most often in discussions about access to health care resources, including the just distribution of resources
Fidelity – agreement to keep promises
patient autonomy refers to the commitment to include patients in decisions about all aspects of care as a way of acknowledging and protecting a patient’s independence
Deontology: proposes a system of ethics that is perhaps most familiar to health care practitioners. Deontology defines actions as right or wrong based on their “right-making characteristics,” such as fidelity to promises, truthfulness, and justice. Deontology depends on a mutual understanding of justice, autonomy, and goodness. But it still leaves room for confusion to surface. Final Nursing Exam Study Guide
Utilitarianism: A utilitarian system of ethics proposes that the value of something is determined by its usefulness. This philosophy is also known as consequentialism because its main emphasis is on the outcome or consequence of an action. A third term associated with this philosophy is teleology, from the Greek word telos, meaning “end,” or the study of ends or final causes. The greatest good for the greatest number of people is the guiding principle for determining right action in this system.
Feminist Ethics: Feminist ethics critiques conventional ethics such as deontology and utilitarianism. It looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal, or in which a point of view has become ignored or invisible. Writers with a feminist perspective tend to concentrate more on practical solutions than on theory. Feminist ethicists propose that the natural human urge to be influenced by relationships is a positive value.
Ethics of Care: The ethics of care and feminist ethics are closely related. Both promote a philosophy that focuses on understanding relationships, especially personal narratives. An early proponent of the ethics of care used the term the one-caring to identify the individual who provides care, and the cared-for to refer to the patient or patients. In adopting this language, the author hoped to emphasize the role of feelings.
Casuistry, or case-based reasoning, turns away from conventional principles of ethics as a way

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