Semester 2 final exam Question from Amanda Eberhart.docx - Health Disparities Concept 54 Health Disparities Giddens Concepts for Nursing Practice 2nd

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Unformatted text preview: Health Disparities Concept 54: Health Disparities Giddens: Concepts for Nursing Practice, 2nd Edition MULTIPLE CHOICE 1. The nurse is caring for a Chinese patient diagnosed with cancer who is suffering from pain, yet refuses analgesia administration. What type of health disparities is this patient exhibiting? a. Avoidable and acceptable b. Avoidable and unacceptable c. Unavoidable and acceptable d. Unavoidable and unacceptable ANS: B Health disparities that are avoidable and unacceptable unfortunately occur in healthcare settings and these are the targets of interventions. For example, a disparity in cancer pain management exists between Asians and Whites. This difference is attributable to Asian cultural values and attitudes related to cancer pain and pain medication distinguished from the cultural values of Whites. The disparity is avoidable if Asian cancer patients are adequately educated and instructed on cancer pain management strategies including pain medication and complementary and alternative medicine. Also, this disparity is unacceptable because this gives an unnecessary burden of pain to Asian cancer patients that could be easily managed by using existing strategies. REF: Page 504 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 2. An experienced nurse tells the student nurse, “I have found that most Hispanic immigrants live in unsanitary conditions but are hard workers.” How should the student nurse best classify this statement? a. Stereotyping b. Prejudice c. Discrimination d. Misinformed ANS: A Stereotyping often leads to biased clinical decision-making. Stereotyping refers to the process by which people use social categories (e.g., gender or race/ethnicity) in acquiring, processing, and recalling information about others. Both implicit and explicit negative attitudes and stereotypes of healthcare providers significantly shape interactions with patients, influence how information is recalled, and guide expectations and inferences in systematic ways. Stereotyping often occurs subconsciously, unlike prejudice or discrimination. Prejudice, which refers to unjustified negative attitudes based on a person’s group membership, is another source of biased clinical decision-making. Discrimination refers to the actual mistreatment of individuals based on race, gender, ethnicity, etc. The nurse is not misinformed as the nurse has practiced for some time and made a statement based on observation and experience. REF: Page 506 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 3. Which type of health disparities are most frequently encountered by nurses in clinical and community settings? a. Avoidable and acceptable b. Avoidable and unacceptable c. Unavoidable and acceptable d. Unavoidable and unacceptable ANS: B Although there are many types of health disparities, the avoidable and unacceptable health disparities are the ones that healthcare providers, including nurses, frequently encounter in clinical and community settings. Furthermore, these are the health disparities that healthcare providers need to target to intervene. REF: Page 504 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 4. The nurse is caring for diverse population groups at a health clinic. Which of the following patients demonstrates a potential health disparity group? a. A 26-year-old woman who is receiving follow-up after a car accident. b. A 30-year-old immigrant who does not speak English. c. A 28-year-old man who needs a tetanus booster. d. A 12-month-old with an appointment for immunizations. ANS: B Poor health literacy skills are an example of a health disparity that limits an individual’s ability to access or communicate about health care needs. Patients who are receiving needed care are not experiencing a gap between health need and actual care. REF: Page 506 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 5. Which is the best strategy the nurse manager should include when working to reduce health care disparities on a medical-surgical unit? a. Less diverse workforce b. Increase interpreter availability c. Authoritarian leadership d. Annual staff training ANS: B Key elements are cultural competence that can reduce health disparities include: a diverse workforce; interpreter availability; finding common ground versus authoritarian leadership; frequent staff training and updating staff as needed throughout the year. REF: OBJ: Page 506 |Page 507 NCLEX® Client Needs Category: Safe and Effective Care Environment a. b. c. d. 6. A new nurse requires further teaching when failing to identify which practice as a health disparity? Annual mammogram Early prenatal care Blood pressure screening Frequent fast food meals ANS: D Preventive care, screening, and health promotion activities are not considered health disparities. Examples include mammograms, prenatal care, and blood pressure checks. Frequent fast food meals, containing high fat content, is considered a health disparity due to possible lack of money or access to healthy meals. REF: OBJ: Page 504 |Page 505 NCLEX® Client Needs Category: Safe and Effective Care Environment 7. first? a. b. c. d. Before beginning work on a culturally diverse hospital unit, the nurse should perform which action Improve self-awareness of one’s own biases Attend an anti-discrimination rally or march Build rapport and trust with the patients Take a foreign language class ANS: A Before working with culturally diverse groups, the nurse should first identify own biases and assumptions in order to objectively and competently care for patients. Attending a rally or march may not raise awareness of various biases. The nurse should establish rapport and trust when working with patients, after self-awareness is appreciated. Taking a foreign language may be helpful; however the first step is self-awareness. REF: Page 506 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 8. The nurse who has been hired to work on an oncology unit identifies which group of women as being at highest risk of developing breast cancer? a. African b. Caucasian c. Asian d. Hispanic ANS: C Breast cancer is the most common cancer in Asian women in the U.S., but Asian women have relatively lower rates of breast cancer screening than African American and white women in the U.S. Furthermore, disparities in breast cancer screening reportedly result from: low income, lack of a local mammography center, lack of transportation to a mammography center, lack of a usual healthcare provider, lack of a recommendation from a healthcare provider to get mammography screening, lack of awareness of breast cancer risks and screening methods, and cultural and language differences. REF: Page 506 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment MULTIPLE RESPONSE 1. A healthcare provider whose native country is India is explaining the treatment plan to a patient. The patient tells the nurse she is having trouble understanding the provider but is embarrassed about asking to repeat the information over and over. The nurse should assess for which results due to this disparity in provider-patient communication? (Select all that apply.) a. Patient dissatisfaction b. Optimal health outcome c. Poor adherence d. Increased patient confidence e. Improved communication ANS: A, C When sociocultural differences between healthcare providers and patients are not appreciated or communicated effectively in clinical encounters, patient dissatisfaction, poor adherence, poorer health outcomes, and racial/ethnic disparities in healthcare easily happen. REF: Page 507 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment 2. The nurse in the immunization clinic should place emphasis on educating and reaching which groups about the disease preventing effects of immunizations? (Select all that apply.) a. Caucasian b. African American c. Low income d. Middle income e. High income ANS: B, C, D The 2013 National Healthcare Disparities Report documented that African American children or children from poor, lowincome, and middle-income households were less likely to receive all the recommended vaccinations compared with white children or children from high-income households in 2011. REF: Page 507 OBJ: NCLEX® Client Needs Category: Safe and Effective Care Environment Chapter 14: Delegation in the Clinical Setting Zerwekh: Evolve Resources for Nursing Today, 9th Edition MULTIPLE CHOICE a. b. c. d. 1. Which task could a staff nurse delegate to a certified nursing assistant (CNA)? Evaluating a patient’s response to pain Making rounds with a physician Feeding a stroke patient who has minimal dysphagia Assessing a patient’s central venous line site ANS: C Feeding a stroke patient who has minimal dysphagia is an appropriate delegation of a nursing intervention to a CNA. The nurse cannot delegate the task of assessing the patient or making rounds with the physician to the CNA. Nursing interventions such as assessment and evaluation of pain, management of central line sites, or performing tracheotomy or colostomy care are within the scope of professional nursing, as is making rounds with a physician. PTS: REF: TOP: MSC: 1 DIF: Cognitive Level: Application/Applying p. 306 |p. 308 OBJ: Delegate tasks successfully based on outcomes. Delegation in the clinical setting NCLEX®: Safe and effective care environment—management of care 2. The nurse has just given a patient an opioid medication for pain relief. Because the nurse must leave the unit for lunch and a 1-hour meeting, the task of evaluating the patient’s response to the pain medication must be delegated. To whom should the nurse delegate this responsibility? a. Nursing assistant b. Student nurse c. Licensed practical nurse d. Nurse manager ANS: D Evaluating the patient’s response to pain medication is an activity within the scope of the registered professional nurse (who in this situation is the nurse manager). The licensed practical nurse can administer the pain medication. The student nurse could assist the professional nurse in the evaluation of the patient’s response to the pain medication; however, the nurse leaving the unit cannot delegate this responsibility to a student. This nursing intervention is outside the scope of practice of the nursing assistant. PTS: REF: TOP: MSC: 1 DIF: Cognitive Level: Application/Applying p. 308 OBJ: Delegate tasks successfully based on outcomes. Delegation in the clinical setting NCLEX®: Safe and effective care environment—management of care 3. The nurse has a full assignment. The charge nurse adds a newly admitted patient who will require close monitoring. Which task can the nurse delegate to the CNA who is co-assigned to the same patients? a. Teaching insulin self-administration b. Updating a care plan c. Evaluating goal attainment for a patient who is learning to walk with a below-the-knee prosthesis d. Bathing an unconscious patient ANS: D Bathing a patient is an appropriate nursing intervention within the role and responsibilities and scope of practice of the CNA. Teaching clients, updating nursing care plans, and evaluating patient responses to treatment plans are within the scope of practice of the registered professional nurse. PTS: REF: TOP: MSC: 1 DIF: Cognitive Level: Application/Applying p. 306 |p. 308 OBJ: Delegate tasks successfully based on outcomes. Delegation in the clinical setting NCLEX®: Safe and effective care environment—management of care 4. Based on the goal of making optimal use of the level of preparation of the licensed practical nurse (LPN), which task should the nurse (RN) delegate to the LPN? a. Assisting with a lumbar puncture b. Transporting a patient to the radiology department c. Restocking the sterile supplies d. Distributing afternoon nutrition supplements ANS: A Assisting with a procedure, such as a lumbar puncture, is within the scope of practice of the LPN. Transporting clients, restocking supplies, and distributing nutrition supplements are nursing interventions that can be carried out by a certified nursing assistant (CNA). PTS: REF: TOP: MSC: 1 DIF: Cognitive Level: Application/Applying p. 307 OBJ: Delegate tasks successfully based on outcomes. Delegation in the clinical setting NCLEX®: Safe and effective care environment—management of care 5. There is a temporary agency registered nurse assigned to the nursing unit. You have no knowledge of this nurse’s skills, and you want to assign the nurse to a patient who has a fresh tracheostomy. How should you handle this situation? a. Assign the nurse to the patient with the tracheostomy and hope for the best. b. Ask the nurse about his or her competency to care for the patient with the tracheostomy. c. Assign the patient to another nurse, and use the temporary agency nurse to do simple care tasks. d. Call the agency and ask for a nurse skilled in the care of a patient with a tracheostomy. ANS: B Float and temporary nurses should be asked about their competency at the beginning of a shift or assignment. Never assume that an individual knows something; be sure to ask. Delegation of an activity should always be followed by an anticipated response from that nurse as to whether or not he/she feels capable of performing the task. It would be appropriate to check on this nurse frequently to evaluate his/her delivery of care or to offer assistance. It would be okay to call the agency to verify the nurse’s skill competencies, but talking with the nurse would still be the first action. PTS: REF: TOP: MSC: 1 DIF: Cognitive Level: Application/Applying p. 312 OBJ: Understand and apply the five rights of delegation in nursing practice. Delegation in the clinical setting NCLEX®: Safe and effective care environment—management of care a. b. c. d. 6. What would be the best example of delegation? Transferring to another nurse the responsibility of caring for a patient requiring a blood transfusion Providing guidance to an LPN to hang blood on a patient Assigning a series of nursing unit tasks to the certified nursing assistant Assisting a new nurse to understand the rules and regulations of the Nurse Practice Act ANS: A Transferring to another nurse the responsibility of caring for a patient requiring a blood transfusion is the best example of delegation. Delegation involves transferring to a competent nurse a specific task or responsibility for nursing care. The person who delegated the responsibility maintains responsibility for following guidelines for appropriate delegation. Providing guidance to an LPN and explaining to a new nurse about the Nurse Practice Act would be teaching and/or supervision rather than delegating a specific task or responsibility. Assigning to a CNA certain tasks is not delegation because there is no transferring of a specific task or responsibility of nursing care to that person. PTS: REF: TOP: MSC: 1 DIF: Cognitive Level: Application/Applying p. 302 OBJ: Define the operational terms delegation, supervision, and accountability. Definition of delegation NCLEX®: Safe and effective care environment—management of care a. b. c. d. 7. What would be the best example of supervision? Assigning nursing care for a group of five patients to a nurse Following up with a CNA on the assigned task of ambulation and feeding two patients Assigning a urinary catheterization and collection of sterile culture to an LPN Scheduling the LPN to administer medications on the unit for the afternoon ANS: B Supervision is the provision of guidance, direction, and follow-up for the accomplishment of an assigned task. The nurse would follow up with the CNA to determine whether the tasks were completed and whether any problems occurred. Assigning nursing care for a group of patients or a specific procedure are examples of delegation, as is scheduling an LPN to administer medications. PTS: REF: TOP: MSC: 1 DIF: Cognitive Level: Application/Applying p. 302 OBJ: Define the operational terms delegation, supervision, and accountability. Definition of supervision NCLEX®: Safe and effective care environment—management of care a. b. c. d. 8. What are potential causes of performance inadequacies? The person to whom the task was assigned had appropriate educational qualifications to complete the task. The task was assigned to a person capable of carrying out the assignment. The person who delegated the task confirmed the recipient’s ability to perform the task. The person to whom the task was assigned did not understand what the task involved. ANS: D A potential cause of performance inadequacy would be where a person was assigned a task that he/she did not understand. A principle of delegation is that the person to whom the task is assigned should verify that he/she understands and can perform the task. When the person is capable, has appropriate educational qualifications, and the nurse has confirmed that person is able to perform the task, then there would be no performance inadequacy. PTS: REF: OBJ: TOP: MSC: 1 DIF: Cognitive Level: Comprehension/Understanding Critical Thinking Box 14.3 Understand and apply the five rights of delegation in nursing practice. Evaluating performance NCLEX®: Safe and effective care environment—management of care a. b. c. d. 9. Which of the following represents appropriate feedback for an assignment to an LPN? “Did you understand the assignment that you received in the staff report?” “Have you completed the urinary catheterization and care of the new patient?” “The patient in Room 430 looks much better, and you did a good job of making the patient comfortable.” “I know you are busy; however, you need to get caught up with your pain medications.” ANS: C Telling the LPN that he or she did a good job of making a patient comfortable is appropriate feedback on an assignment. Feedback is a process of informing someone of how well or how poorly a delegated task was performed. Asking understanding of an assignment or whether a procedure was performed is not giving feedback but determining if what is supposed to be done is understood or whether the task (urinary catheterization) has been completed. The pain medications may have been delegated; however, if this task was delegated, the feedback does not tell the LPN what he or she is doing right or wrong. PTS: REF: OBJ: TOP: MSC: 1 DIF: Cognitive Level: Application/Applying p. 309 Provide reciprocal feedback for the effective evaluation of the delegate’s performance. Providing feedback NCLEX®: Safe and effective care environment—management of care 10. The nurse needs to discuss a problem with the nursing assistant. The nursing assistant has left several rooms cluttered with trash and not cleaned appropriately. Which comment by the nurse would be the best way to approach the problem? a. “I checked on the four rooms you were assigned, and they are really a mess.” b. “Have you had a problem completing your work assignment today?” c. “All four of the patient rooms assigned to you today are messy with a lot of trash in them.” d. “Family members have been really upset today. Why have you not cleaned up the rooms assigned to you?” ANS: B Providing an open-ended question to determine if there was some difficulty with an assignment is an appropriate method to assess this situation. When correcting or telling a person that he/she did something wrong, it is best to start by giving that person an opportunity to provide some input into the situation. This can be accomplished by asking the nursing assistant if there was any problems completing the assignment today. Asking why-type questions can put the person on the defensive and does not allow the CNA to provide an explanation of why the rooms were cluttered. Telling the CNA that the rooms were cluttered and messy does not address the issue of how it occurred. PTS: REF: OBJ: TOP: MSC: 1 DIF: Cognitive Level: Application/Applying Critical Thinking Box 14.6 Provide reciprocal feedback for the effective evaluation of th...
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