Question 1

Which activit(ies) would be appropriate for a nurse working in ambulatory care to engage in to demonstrate professional image and strength? Select all that apply.&#10;A)Using each encounter with an individual to develop a therapeutic relationship&#10;B)Attending continuing education sessions for skill development&#10;C)Displaying a self-confident, optimistic demeanor&#10;D)Emphasizing the superiority of nursing within the team&#10;E)Creating a safe environment for individuals and staff

Accepted Answer

Various activities can help to advance the image and strength of professional nurses. These include the therapeutic relationships nurses establish with individuals and families, especially since encounters tend to be short and targeted to specific interventions; a commitment to continuous learning, skill development, and implementation of evidence-based practice; professional comportment or how nurses perceive themselves, refer to themselves, and use language that impacts their professional image such that expressions of self-confidence, optimism, and compassion evoke respect from both colleagues and individuals; collaboration and partnership with all team members; and the ability to create and manage a safe environment of care for individual and staff.

Question 2

An older adult with a history of heart failure and type 2 diabetes comes to the infusion center this morning to start intravenous (IV) antibiotic therapy for an infected wound via a peripheral device. When caring for this individual, which area(s) would be crucial for the nurse to consider related to the planned therapy? Select all that apply.

A)Individual's history of heart failure and diabetes
B)Individual's current living situation
C)Current status of the individual's veins
D)Individual's current cognitive function
E)Condition of the skin at the intended insertion site

Individual's history of heart failure and diabetes
Current status of the individual's veins
Condition of the skin at the intended insertion site

Accepted Answer

Successful infusions in the older adult require considerations for chronic conditions (in this case the individual's history of heart failure and diabetes), physical changes including veins that can be more difficult to access, thin or thickened skin, and drug considerations related to hepatic and renal changes. The individual's current living situation and cognitive level may be important but would not necessarily impact the planned therapy.

Question 3

A nurse working in a diagnostic and therapeutic center is conducting a presentation for a local community group about the center and the types of services provided there. The nurse determines that the presentation was successful based on which statement by the group?

A)"The center would not be the place if we need to get medicine for a procedure."
B)"If a problem comes up when the clinic is closed, this would be the place to go."
C)"If we need an x-ray or test, we can have it done at the center."
D)"This would be the best place to use if we need to get a blood transfusion."

"If we need an x-ray or test, we can have it done at the center."

Accepted Answer

Diagnostic and therapeutic centers can include a wide range of services. They allow for outpatient procedures to determine/evaluate health conditions and, when appropriate, provide related treatment. Imaging and radiologic services, procedures for pain relief, gastrointestinal and cardiovascular procedures, and dermatology are just a few of the services provided. In some cases, individuals may be given sedating medications for their diagnostic procedure. An urgent care center would be appropriate for problems that arise "after hours"; an infusion center would be an appropriate ambulatory setting for administering a blood transfusion.

Question 4

A nurse is providing palliative home-based care to an individual. Which area would likely be a priority for the nurse?&#10;A)Timely symptom management&#10;B)Continuity between care settings&#10;C)Immediate problem identification&#10;D)Health condition evaluation

Accepted Answer

Palliative home-based services have evolved to address gaps in care identified for adults and children with advanced medical illness. These gaps may include lack of timely access for symptom management, inadequate preparation of individuals and caregivers, lack of comprehensive services without self-navigation and substantial effort, and inadequate caregiver support. A diagnostic and therapeutic center allows for outpatient procedures to determine and evaluate health conditions.

Question 5

A nurse working as a PC RN in an adult primary care organization demonstrates competency in this role by focusing on which area(s)? Select all that apply.&#10;A)Health literacy&#10;B)Goal-setting&#10;C)Behavior change&#10;D)Adherence support&#10;E)Care across the life span

Accepted Answer

Although a universal set of PC RN competencies has not been adopted, general competencies for the PC RN include critical thinking, flexibility, triage, care coordination and care management, education and coaching, focusing on areas of ensuring health literacy, goal-setting, adherence support, and behavioral change management, highlighted by competencies in self-management support and motivational interviewing. Age-specific competencies also may be required in practices that see the full age range; however, this would not be necessary for an adult practice setting.

Question 6

A primary care registered nurse is working with an individual to affect behavior change to promote better management of the individual's chronic condition. Which skill would the nurse most likely use?&#10;A)Virtual visits&#10;B)Teleheath triage&#10;C)Education&#10;D)Primary prevention

Accepted Answer

Although telehealth triage, virtual visits, and primary prevention are all components of the primary care registered nurse role, providing education is fundamental to support behavioral change. This is accomplished through ensuring individual-centered techniques and approaches (written, audio, visual, and other educational methods), along with confirming individuals' understanding and health literacy with regard to chronic illnesses or other individual-specific challenges.

Question 7

A primary care registered nurse is providing care within the nurse's scope of practice based on best practices. The nurse is implementing which action?&#10;A)Standing order&#10;B)Delegated order&#10;C)Clinical decision support system&#10;D)Protocol

Accepted Answer

Protocols are sets of actions that generally fall within the scope of registered nursing practice. They allow the nurse to implement care based on best practices, without requiring a provider's order. A standing order is one that allows PC RNs to use an algorithm or other written instructions to carry out clinical care on a provider's behalf for individuals who meet specific criteria. Providers may also create delegated orders for a specific individual, which should include all relevant information and specific treatment guidelines for the nurse to follow for that particular person. Delegated orders differ from standing orders in their focus; a standing order may apply to any individual who fits the population covered by that standing order, as described earlier. A delegated order is employed for a specific individual, either for a one-time event or for an ongoing medical need for that individual. Clinical decision support systems (CDSS) describe data tools that assist a care team member in making a decision about an individual's care whether it is planned care such as routine cancer screening or something that is condition specific such as foot checks or retinal screening for all individuals with diabetes.

Deck 8: Primary Care and Episodic Care