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Chapter 1: Evidence-Based Assessment Study Guide Questions: 1. The steps of the diagnostic reasoning process are listed below. Consider the clinical example given for “cue recognition,” and fill in the remaining diagnostic reasoning steps. Stage Example 1. Cue recognition

1. A.J., a 62 year old man, appears pale, diaphoretic, and anxious

1. Hypothesis Formation

2. He could be experiencing chest pains

2. Data Gathering

3. Run some asculating tests, take his vital signs, check pulse, ask him questions that are related to chest pain

3. Hypothesis Evaluation

4. Evaluate the data gathered during the tests to determine where AJ is experiencing chest pains

2. One of the critical-thinking skills is identifying assumptions. Explain how the following statement contains an assumption. How would you get the facts in this situation? “Ellen, you have to break up with your boyfriend. He is no good for you.” This statement appears to be judgemental and assume that Ellen’s boyfriend is how this situation will be resolved. Instead, the facts should be considered without any assumptions in order to avoid overlooking any important information 3. Another critical thinking skill involves validation, or checking the accuracy and reliability of data. Describe how you would validate the following data. Mr. Quinn tells you his weight this morning was 165 lb. -Ask Mr. Quinn to step back onto the scale to validate his weight he told you and the weight listed on your chart. The primary counselor tells you Ellen is depressed and angry about being admitted to residential treatment in the clinic -Validate the counselors statement with ellen and ask her open ended questions. When ausculating the heart, you hear a blowing, swooshing sound between the first and second heart sounds. -Ask an experienced colleague to compare the heart sounds 4. List the barriers to evidence based practice. Both on the individual level and the organizational level

Individiual- n  urses lack the research skills in evaluating quality research studies, they are isolated from other colleagues that are more knowledgeable, and they lack the confidence to implement change. Organizational- n  urses lack the time to read research, healthcare institutions lack library research, organizational support for EBP is lacking 4. Subjective data vs. Objective data (S/O) a. Complaint of a sore shoulder: S b. Unconscious: O c. Blood in the urine: O d. Family has just moved to a new area: S e. Dizziness: S f. Sore throat: S g. Earache: S h. Weight gain: O 5. Data Collection types (Complete/focused/follow-up/emergency) a. OxyContin overdose: emergency b. Ambulatory, apparently well individual who presents at outpatient with a rash: focused c. First visit to a health care provider for a checkup: complete d. Recently placed on antihypertensive medicine: follow up 6. Discuss the impact that racial and cultural diversity of individuals has on the U.S. health care system. Close to 50% of the U.S. population consists of different racial and cultural groups. Many have specific healthcare needs that need to be addressed. 7. List three different healthcare interactions you have had with another person from another culture (positive or negative) what should’ve been done differently? a. Working at CVS as a pharm tech I met an older individual who did not speak english and was having a hard time communicating how to get her prescription. I used google translate to communicate effectively with her and I thought that it was a positive experience b. Also as a pharm tech I interacted with a trans individual. I called him/her by his/her real name and it caused the customer to become upset. I should have not used pronouns when speaking to my customer and been more aware of the situation. c. My pharmacist at CVS is russian speaking and he would often explain to me that different customers want their prescription handed to them in a specific way because of their cultural backgrounds. I found this very interesting and it helped me gain the respect of those customers who eventually were able to get more comfortable with me. 9. Using one sentence, describe your health state.

I am a young adult who is attending nursing school. I have a good group of friends in the area and I am surrounded by a good support system which keeps me happy. I have no underlying medical conditions.

Review Questions: 1. The concept of health and healing has evolved in recent years. What is the best description of health? C) Health depends on an interaction of mind, body, and spirit within the environment 2. What would be included in the database for a new patient admission to a surgical unit? D) All subjective and objective, and data gathered from a patient and the results of any laboratory or diagnostic studies completed 3. You are reviewing assessment data of a 45-year-old male patient and note pain of 8 on a scale of 10, labored breathing, and pale skin color on the electronic health record. This documentation is an example of: C) Data Cluster 4. A patient is in the emergency department with nausea and vomiting. What would you include in the database? B) A diet and GI history 5. A patient has recently received health insurance and would like to know how often he should visit the provider. How do you respond? C) "Your visits may vary, depending on your level of wellness." 6. You are reviewing concepts related to steps in the nursing process for determining prioritization and developing patient outcomes. To what are these actions attributed? A) Planning 7. Describe evidence-based nursing A) Combining clinical expertise with the use of nursing research to provide the best care for patients while considering the patient's values and circumstances 8. What can be determined when the nurse clusters data as a part of the critical-thinking process C) The nurse recognizes relevant information among the data

9. A patient says she is very nervous and nauseated, and she feels like she will vomit. This data would be what type of data? C) Subjective 10. The expert nurse differs from the movie nurse by acting without consciously thinking about the actions. This is referred to as: B) Intuition 11. What is considered a risk diagnosis C) Identifying potential problemls that the individual may develop 12. What would be included in a holistic model of assessment? C) A patient's perception of his or her health status 13. The nurse uses health promotion activities with a new patient. What would this focus include? D) The nurse would empower the patient to choose a healthier lifestyle 14. Give an example of objective data D) 2- x 5-cm scar present on the right lower forearm 15. During the evaluation phase of the nursing process, what action would be included? C) Including the patient and family members

Chapter 2: Cultural Assessment Study Guide Questions: 1. Describe the provisions of title VI of the Civil Rights Act of 1964. a. A federal law that mandates that when people with limited english proficiency (LEP) seek healthcare settings such as hospitals, daycare centers, nursing homes, clinics, and mental health care centers cannot be denied 2. Describe the rationale for providing culturally competent care a. Optimal patient care is achieved when the individualized care is culturally sensitive, appropriate and the nurse is culturally competent. 3. List the basic characteristics of culture a. Learned b. Shared

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c. Adapted d. Dynamic List and describes factors related to socialization a. Acculturation ( process of adapting to and acquiring another culture), b. Assimilation  (process by which a person develops a new cultural identity and becomes like members of the dominant culture, c. Biculturalism ( dual pattern of identification and often divided loyalty) List and define 3 major theories about how people view the cause of illness a. Biomedical: illnesses are born from cause and effect (Germ theory) b. Naturalistic: illnesses are caused from forces of nature that must be kept in balance c. Magicoreligious: illnesses and the world are dominated by supernatural forces Define the Ying and Yang theory of health and illness, and relate this to different types of foods. a. This is the basis of eastern of chinese medicine which health exists when all aspects of the person are in perfect balance i. Yin: represents the female, negative energy forces, darkness, emptiness, cold. Foods are cold ii. Yang: represents the male, positive energy forces, emitting warmth and fullness. Foods are hot iii. Foods are classified as hot and cold in this theory and are turned into yin and yang when metabolized in the body. Hot foods are eaten with cold illnesses and cold foods are eaten with hot illnesses Define the hot and cold theory of health and illness and relate this to different types of foods and illnesses a. Blood, phlegm, black bile, and yellow bile all regulate basic bodily functions and are described in terms of temperature, dryness, and moisture. This theory of health treats disease by adding or subtracting cold, heat, dryness, or wetness to restore the balance of the humors. b. Foods in this theory are classified in terms of hot or cold by their effects on the body List at 5 names for various folk healers and the culture they represent a. Braucher: this is a folk healer among the amish community who use herbs and tonics in their homes b. Espiritualista: this is a spiritualist amongst the hispanic community c. Herbalist: asian d. Shaman: native american e. Root worker: African American/Black Describe the five methods of complementary interventions a. Acupuncture b. Therapeutic touch c. Massage d. Biofeedback

e. Reflexology

Review Questions: 1. Which statement best describes religion? A) An organized system of beliefs concerning the cause, nature, and purpose of the universe 2. The major factor contributing to the need for cultural care is: C) Demographic change 3. The term culturally competent implies that the nurse: D) Understands the cultural context of the patient's situation 4. You are the triage nurse in the emergency department and perform the initial intake assessment on a patient who does not speak English. Based on your understanding of linguistic competence, which action would present as a barrier to effective communication? C) Providing the patient with a paper and pencil so that he or she can write down the answers to the questions you are going to ask 5. Which culture would describe illness as hot and cold imbalance? C) Hispanic-American heritage 6. Of what does the patient believe the amulet is protective? A) The evil eye 7. Which statement best illustrates the difference between religion and spirituality? B) Religion is characterized by identification of a higher being shaping one's destiny while spirituality reflects an individual's perception of one's life having worth or meaning 8. The first step to cultural competency by a nurse is to: D) Understand your own heritage and its basis in cultural values 9. Which statement is true in regards to pain? B) The cultural background of a patient is important in a nurse's assessment of that patient's pain 10. Which factor is identified as a priority influence on a patient health status? A) Poverty

11. Which statement is most appropriate to use when initiating an assessment of cultural beliefs with an older American Indian patient? D) What cultural or spiritual beliefs are important to you? 12. Which statement best describes ethnocentrism? C) The tendency to view your own way of life as the most desirable 13. Which category is appropriate in a cultural assessment? D) Health-related beliefs 14. Which health belief practice is associated with patients who are of American Indian heritage? B) Believing the forces of nature must be kept in natural balance 15. Which statement best reflects the Magicoreligious causation of illness? C) Belief in the struggle between good adn evil is reflected in the regulation of health and illness

Chapter 3: The Interview Study Guide Questions: 1. List the 8 items of information that should be communicated to the client concerning the terms or expectations of the interview. - Time and place of the interview and succeeding physical examination. - Introduction of yourself and a brief explanation of your role. - The purpose of the interview. - How long it will take - Expectation of participation for each person - Presence of any other people (e.g., family, other health professionals, students). - Confidentiality and to what extent it may be limited. - Any costs to the client 2. Describe the points to consider in preparing the physical setting for the interview. - Room temperature at a comfortable level. - Sufficient lighting. - Reduction of noise. - Removal of distracting objects/equipment. - Distance between self and patient at 4 to 5 feet. - Arrange equal status seating. - Arrange face to face positioning. 3. List the pros and cons of note-taking during the interview. Cons:

• It breaks eye contact too often. • It shifts your attention away from the person, diminishing his or her sense of importance. • Recording everything a person says may cause you to ask him or her to slow down, or the person may slow his or her tempo to allow for you to take notes (client's natural mode of expression is lost) • It impedes your observation of the client's nonverbal behavior. • It is threatening to the client during the discussion of sensitive issues (e.g., alcohol and illicit drug use, number of sexual partners, or incidence of abuse). Pros: ● It provides accurate details of hospitalizations, and review of body systems 4. Contrast open ended vs. closed questions, and explain the purpose of each during the interview - Open ended:  it is general and asks for narrative information. It remains unbiased which encourages the patient to express him/herself fully - Closed ended:  asks for specific information that cause a one or two word answer (yes/no). Unlike open ended questions this kind of question limits the patients anwsers. Helps to elicit specific information that can be used to fill out data from open ended questions. Can provide facts such as past medical history or facts during the review of systems 5. List the 9 types of examiner responses that could be used during the interview, and give a short example of each. ● Facilitate: general clue Encourages client to go on. ○ Examples: "go-on," shifting forward, nodding. ● Silence: listening. provides you a chance to notice nonverbal cues. ○ Examples: waiting for response without interruption, sitting quietly ● Empathy: care. allows person to feel accepted. ○ Examples: This must be very hard for you... ● Clarification: repeat, Useful when person's word choice is confusing. Summarize person's words, simplify the statement, and ensure that you are on the right track. ○ Example: ... is that correct. ● Reflection:  echoes client's words by repeating part of what person has just said. Can help express feeling. Mirroring clients words can help elaborate. ○ Example: Client its hard having to stay in bed during my pregnancy. I have kids at home I'm worried about. ○ Response: You feel worried and anxious about your children? ● Confrontation:  clarifying inconsistent info. Focusing the clients attention on an observed behavior, action, or feeling. ○ Example: you look or you sound.... you said this but now you say this... clarify differences in nonverbal and verbal.

Interpretation: l inks events, implies cause. based on conclusion. may e incorrect but helps prompt further discussion ○ Example: It seems when you have this... this happens... assuming an emotion. ● Explanation: i nforming, factual and objective info. ○ Example: you may not, telling what to do, rules. ● Summary: condenses facts and validates what was discussed. signals the end of interview. both client and examiner are active participants. ○ Example: review facts. allow client to make corrections. 6. List the 10 traps of interviewing, and give a short example of each. ● Providing false assurance or reassurance ○ “don’t worry; I’m sure you will be just fine.” ● Giving unwanted advice ○ “If I were you I would…” ● Using authority ○ “Doctor or nurse knows best” ● Using avoidance language ○ “passed on” or “has gone to a better place” ● Distancing ○ “there is a lump in the left breast” ● Using professional jargon ○ “I see that you are quite hypertensive right now ” ● Using leading or biased questions ○ “you don’t drink alcohol do you?” ● Talking too much ○ Not letting the patient get a word in ○ allow the patient to express himself, listen more than you talk ● Interrupting ○ shows impatience or boredom. Give a second of space between the end of the client speaking and your next statement. ● Using “why” questions ○ “why did you not seek medical attention sooner” 7. State at least 7 nonverbal behaviors that interviewer could make. ● physical appearance ● posture ● gestures ● facial expressions ● eye contact. ● voice ● touch 8. State a useful phrase to use as a closing when ending the interview - “Is there anything else you would like to mention?” - Leave the interview gracefully and give the patient the final opportunity for self-expression ●

9. Discuss special considerations when interviewing an older adult. - Address the patient by his/her proper surname (avoid uisng their first name unless told) - Avoid elderspeak (diminutives, shortened sentences, slow speech rate, simple vocabulary, and changing the pitch of your voice) - You may need to break the interview into more than one session, covering the most important data first - Adjust the pace of the interview (appropriate periods of silence, avoid hurrying, allow more time for the interview) - Consider physical limitations (face the person with impaired hearing directly so my mouth and face is fully visible… do not shout) - Wheelchair consideration: move the chair in an appropriate position - Keep in mind that touch is an important non verbal skill to older people 10. How would you modify your interviewing technique when working with a hearing-impaired person? - Ask the person their preferred form of communication (singing, lipreading, or writing) - If a person has hearing aids make sure that they are using them properly Assume intelligence - Do not marginalize - Use resources (find an interpreter) - Face the person directly - Use nonverbal cues 11. Formulate a response you would make to a client who has spoken in a sexually aggressive way. - Never acceptable within therapeutic nurse–patient relationship - Be clear that you will not tolerate any sexual advances - “I am uncomfortable with the manner in which you are communicating to me. I would like to remain professional and please ask you to stop speaking inappropriately” 12. List at least 5 points to consider when using an interpreter during an interview. - Can influence content - May not be culturally aware - May not use same dialect - Ideal: trained interpreter - Consents always require

Review Questions: 1. The practitioner, entering the examining room to meet a patient for the first time, states: "Hello, I'm M.M., and I'm here to gather some information from you and to perform your examination. This will take about 30 minutes. D.D. is a student working with me. If it's all right with you, she will remain during the examination." Which of the following must be added to cover all aspects of the interview contract? a. A statement regarding confidentiality, patient costs, and the expectations of each person. 2. _______ is exhibiting an accurate understanding of the other person's feelings within a communication context. a. Empathy

3. You conduct an admission interview. Because you are expecting a phone call, you stand near the door. Which would be a more appropriate approach? B. Have someone else answer the phone so you can give your patient your full attention 4. A patient asks the nurse, "May I ask you a question?" This is an example of: C. A closed question 5. Which statement best describes interpretation as a communication technique? D. Interpretat...