Implementing Nursing Care Paper Essay

Implementing Nursing Care Paper

1. The nurse enters a patient’s room and finds that the patient
was incontinent of liquid stool. The patient has recurrent
redness in the perineal area, and there is concern that he is
developing a pressure ulcer. The nurse cleanses the patient,
inspects the skin, and applies a skin barrier ointment to the
perineal area. She calls the ostomy and wound care specialist
and asks that he visit the patient to recommend skin care
measures. Which of the following describe the nurse’s actions?
(Select all that apply.)
1. The application of the skin barrier is a dependent care
measure.
2. The call to the ostomy and wound care specialist is an
indirect care measure.

3. The cleansing of the skin is a direct care measure.
4. The application of the skin barrier is a direct care measure.
2. During the implementation step of the nursing process, a
nurse reviews and revises the nursing plan of care. Place the
following steps of review and revision in the correct order:
1. Review the care plan.
2. Decide if the nursing interventions remain appropriate.
3. Reassess the patient.
4. Compare assessment findings to validate existing nursing
diagnoses.
3. A nurse checks a physician’s order and notes that a new medication was ordered. The nurse is unfamiliar with the medication. A nurse colleague explains that the medication is an
anticoagulant used for postoperative patients with risk for
blood clots. The nurse’s best action before giving the medication is to:
1. Have the nurse colleague check the dose with her before
giving the medication.
2. Consult with a pharmacist to obtain knowledge about the
purpose of the drug, the action, and the potential side
effects.
3. Ask the nurse colleague to administer the medication to her
patient.
4. Administer the medication as prescribed and on time.
4. When does implementation begin as the fourth step of the
nursing process?
1. During the assessment phase
2. Immediately in some critical situations
3. After the care plan has been developed
4. After there is mutual goal setting between nurse and patient
5. Before consulting with a physician about a patient’s need for
urinary catheterization, the nurse considers the fact that the
patient has urinary retention and has been unable to void on
her own. The nurse knows that evidence for alternative measures to promote voiding exists, but none has been effective,
and that before surgery the patient was voiding normally. This
scenario is an example of which implementation skill?
1. Cognitive
2. Interpersonal
3. Psychomotor
4. Consultative
6. The nurse enters a patient’s room, and the patient asks if he
can get out of bed and transfer to a chair. The nurse takes
precautions to use safe patient handling techniques and transfers the patient. This is an example of which physical care
technique?
1. Meeting the patient’s expressed wishes
2. Indirect care measure
3. Protecting a patient from injury
4. Staying organized when implementing a procedure
7. In which of the following examples is a nurse applying critical
thinking attitudes when preparing to insert an intravenous
(IV) catheter? (Select all that apply.)
1. Following the procedural guideline for IV insertion
2. Seeking necessary knowledge about the steps of the procedure from a more experienced nurse
3. Showing confidence in performing the correct IV insertion
technique
4. Being sure tha

Implementing Nursing Care Paper Essay

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