Answer Key  答案键

CHAPTER 1-THE EVOLUTION OF NURSING
第一章-护理的发展

Matching  匹配题

2. d
3. e
4. a
5. f
6. h
7. c
8. g
9. j
10. i

Multiple Choice  选择题

11. Answer 4: NAPNES would assist a nurse who is seeking information about LPN / LVN standards. The purposes of NAPNES and National Federation of Licensed Practical Nurses (NFLPN) are to:
    答案 4：NAPNES 将协助寻求有关 LPN / LVN 标准信息的护士。NAPNES 和国家执业护士联合会（NFLPN）的宗旨是：
    Set standards for practical/vocational nursing programs.
    为执业/职业护理项目设定标准。
    Promote and protect practical / vocational nursing.
    促进和保护执业/职业护理。
    Educate and inform the general public about practical / vocational nursing.
    教育和告知公众有关执业/职业护理的信息。
    For issues related to interpersonal conflict, the nurse would first attempt assertive communication with those who are bullying or harassing. If this is unsuccessful, it would be appropriate to go up the chain of command. Issues with nursing students can be reported to the nursing instructor or the education liaison. For job seeking, the nurse would use personal contacts, the Internet, or nurse recruiters.
    对于人际冲突相关的问题，护士首先会尝试与那些欺凌或骚扰他人的人进行自信的沟通。如果这不成功，则适当向上级汇报。与护理学生有关的问题可以报告给护理指导老师或教育联络员。求职时，护士会利用个人联系人、互联网或护士招聘人员。
12. Answer 4: Case management is a modified system to deliver care. The LPN/LVN assists the RN to achieve desired outcomes. The RN selects the clinical pathway and coordinates and plans patient care for individuals and groups of patients. Cross-training is another type of modified system of care. While cross-training is intended to expand the role of the employee, the LPN/LVN must not exceed scope of practice and cannot be expected to assume RN responsibilities.
    答案 4：个案管理是一种改良的护理系统。执业护士助理（LPN/LVN）协助注册护士（RN）实现预期的结果。注册护士选择临床路径，并协调和规划个人及群体患者的护理。交叉培训是另一种改良的护理系统。虽然交叉培训旨在扩展员工的角色，但执业护士助理不得超出其执业范围，也不能被期望承担注册护士的职责。
13. Answer 2: Long-term care facilities employ the majority of LPN/LVNs; however, hospitals,
    答案 2：长期护理机构雇佣了大多数执业护士助理；然而，医院、
    clinics, outpatient agencies, home health agencies, insurance companies, HCP offices, and the military services offer additional opportunities.
    诊所、门诊机构、家庭健康机构、保险公司、医疗保健提供者办公室以及军队服务也提供额外的机会。
14. Answer 1, 2, 4, 5: The LPN/LVN communicates findings to members of the health care team, demonstrates caring and empathy by using therapeutic communication skills with patients, administers care according to professional standards and collects data from multiple sources. The LPN/LVN would collaborate with the RN but would not independently create the care plan for a newly admitted patient.
    答案 1、2、4、5：执业护士（LPN/LVN）将发现结果传达给医疗团队成员，通过与患者使用治疗性沟通技巧表现出关怀和同理心，按照专业标准提供护理，并从多个来源收集数据。执业护士会与注册护士（RN）合作，但不会独立为新入院患者制定护理计划。
15. Answer 3: Reports indicate that challenges related to feelings of social isolation, stereotyping about men who choose nursing, nursing instructors’ inability to incorporate masculine styles of caring into the curriculum, and a lack of male role models in the profession may be to blame for the high attrition of male nursing students from nursing programs.
    答案 3：报告显示，男性护理学生从护理项目中高流失率的原因可能与社会孤立感、对选择护理职业男性的刻板印象、护理教师无法将男性化的关怀方式融入课程以及缺乏男性榜样有关。
16. Answer 4: Advance directives could include a health care power of attorney that states who should make health care decisions if the person is unable to make them. A “living will” outlines wishes about end-of-life care. Ideally, everyone should carefully consider advance directives and have discussions with family members, caregivers, and the health care team.
    答案 4：预先指示可能包括一份医疗授权书，说明如果本人无法做出医疗决定，谁应当代为决策。“生前遗嘱”则概述了关于临终关怀的意愿。理想情况下，每个人都应认真考虑预先指示，并与家人、护理人员及医疗团队进行讨论。
17. Answer 2: One of the primary problems of early nineteenth-century hospitals was poor hygienic practice. Hospitals were dirty and overcrowded and care was mostly given by untrained persons.
    答案 2：十九世纪早期医院的主要问题之一是卫生条件差。医院肮脏且过度拥挤，护理大多由未经培训的人士提供。
18. Answer 4: The population is aging rapidly and people with chronic illness are living longer. There is an increased need for nursing services for this growing segment of the population.
    答案 4：人口正在迅速老龄化，慢性病患者的寿命也在延长。对这一不断增长的人群护理服务的需求也在增加。
19. Answer 3: “Nightingale Nurses” improved patient care and advanced the practice of nursing through good hygiene, sanitation, patient observation, accurate recordkeeping, nutritional improvement, and the introduction and use of new equipment.
    答案 3：“南丁格尔护士”通过良好的卫生、消毒、病人观察、准确的记录、营养改善以及新设备的引入和使用，改善了病人护理并推动了护理实践的发展。
20. Answer 1: The four major concepts are nurse, patient, health, and environment.
    答案 1：四个主要概念是护士、病人、健康和环境。
21. Answer 4: Poverty, homelessness, and unemployment are barriers to accessing health care.
    答案 4：贫困、无家可归和失业是获得医疗服务的障碍。
22. Answer 2: Physiologic needs, such as eating and oxygenation, are the first priority according to Maslow.
    答案 2：根据马斯洛，生理需求，如进食和供氧，是首要任务。
23. Answer 4: Adolescence is time when love and belonging to a peer group are very important. Being part of a team is the best way to help him meet this need.
    答案 4：青春期是爱与归属同伴群体非常重要的时期。成为团队的一员是帮助他满足这一需求的最佳方式。
24. Answer 1, 3, 5: Patient can participate in smoking cessation; stress, weight, and alcohol intake reduction; and control over own body and health. Giving information about technology, new medications, and costs may be of interest to the patient, but these topics are less useful in helping the patient take an active role in her own health.
    答案 1、3、5：患者可以参与戒烟；减少压力、体重和酒精摄入；以及对自身身体和健康的控制。提供有关技术、新药物和费用的信息可能会引起患者兴趣，但这些话题在帮助患者积极参与自身健康方面的作用较小。
25. Answer 4: Unlicensed assistive personnel (UAP) are trained to assist patients with activities of daily living. The unit secretary orders supplies using electronic or hardcopy requisition forms. While the UAP or unit secretary can direct visitors, extreme caution should be used in giving out patient information. (Note to student: Even acknowledging that a patient has been admitted to the hospital can be viewed as a violation of confidentiality.) Taking vital signs is acceptable; however, the pharmacist generally restocks medications. Validating and interpreting are nursing responsibilities.
    答案 4：无执照辅助人员（UAP）经过培训，能够协助患者完成日常生活活动。病区秘书使用电子或纸质申请表订购物资。虽然 UAP 或病区秘书可以引导访客，但在提供患者信息时应格外谨慎。（给学生的提示：即使只是承认患者已被收治入院，也可能被视为违反保密规定。）测量生命体征是可以接受的；然而，药剂师通常负责补充药物。核实和解释是护理人员的职责。
26. Answer 2: Economical use of time and materials is the best way to contain costs for individual patients. Malpractice insurance does not help to contain costs. While it is appropriate to question the HCP about safety issues, it is not appropriate to question use of diagnostic testing. Diagnosis is an extremely complicated process, which requires an extensive knowledge about pathology. Referring patients to another clinic shifts the financial burden to another part of the health care system.
    答案 2：经济有效地利用时间和材料是控制单个患者费用的最佳方式。医疗事故保险并不能帮助控制费用。虽然质疑医疗保健提供者（HCP）关于安全问题是合适的，但质疑诊断测试的使用则不合适。诊断是一个极其复杂的过程，需要对病理学有广泛的了解。将患者转诊到其他诊所会将经济负担转移到医疗系统的其他部分。
27. Answer 1: Orem’s theory is based on helping the patient to attain self-care. Nightingale’s theory uses manipulation of the environment (i.e., patient’s pillows). Benner and Wrubel demonstrate caring by assisting the patient to cope. Parse’s theory encourages the patient to participate in the health experience.
    答案 1：奥瑞姆的理论基于帮助患者实现自我护理。南丁格尔的理论通过操控环境（例如患者的枕头）来实现护理。班纳和伍鲁贝尔通过协助患者应对困难来体现关怀。帕斯的理论鼓励患者参与健康体验。
28. Answer 1, 2, 3, 4, 6: Under the terms of this document, patients are assured that they can expect high-quality hospital care, a clean and safe environment, involvement in their care and the decision-making process, protection of privacy, help when leaving the hospital, and help with billing concerns. Patients cannot
    答案 1、2、3、4、6：根据本文件的条款，患者可以期待高质量的医院护理、清洁安全的环境、参与护理和决策过程、隐私保护、出院时的帮助以及账单问题的协助。患者不能
    always expect to get a private room with all amenities.
    总是期望获得配备所有设施的单人病房。
29. Answer 3: Health care workers are entitled to respect from patients and also expect patients to be responsible for their own behavior.
    答案 3：医护人员有权获得患者的尊重，同时也期望患者对自己的行为负责。
30. Answer 3: LPN/LVNs never independently alter the plan of care without the supervision of an RN.
    答案 3：执业护士/执业护士助理在没有注册护士监督的情况下，绝不会独立更改护理计划。
31. Answer 4: For primary prevention, the nurse would encourage wellness activities and preemptive screening programs such colonoscopy or glucose screening. Secondary prevention recognizes the presence of disease but seeks to reduce the impact of the condition by encouraging behaviors to promote health, such as dietary modification for recurrent hyperglycemia. Tertiary prevention is applied by managing care for those with serious health problems with the goal of improving the quality of life and reducing further loss of function.
    答案 4：对于一级预防，护士会鼓励健康活动和预防性筛查项目，如结肠镜检查或血糖筛查。二级预防认识到疾病的存在，但通过鼓励促进健康的行为来减少疾病的影响，例如针对反复高血糖的饮食调整。三级预防则通过管理严重健康问题患者的护理，旨在改善生活质量并减少功能进一步丧失。

Critical Thinking Activities
批判性思维活动

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下一代 NCLEX ${}^{\text{TM}}$${}^{\text{TM }}$^("TM "){ }^{\text {TM }} （NGN）

34. a. Answer 1 d, 2 i, 3 e, 4 c, 5 f, 6 a, 7 b, 8 g, 9 h: Registered nurse (RN)-provides direct patient care in the hospital and an RN from a home health agency would also be involved in the care of this patient.
    a. 答案 1 d，2 i，3 e，4 c，5 f，6 a，7 b，8 g，9 h：注册护士（RN）——在医院提供直接的病人护理，家庭健康机构的注册护士也会参与该病人的护理。
    LPN/LVN-works under the supervision of the RN in providing patient care. Physician or other HCPs-uses results of diagnostic testing and physical assessment to determine the medical diagnosis and prescribes treatment and medications. Social worker-provides counseling and referral to community resources. Physical therapist-teaches and monitors exercise and will assist this patient in learning techniques for safe ambulation, bending, and lifting.
    执业护士（LPN/LVN）——在注册护士的监督下提供病人护理。医生或其他医疗保健提供者——利用诊断测试和体格检查结果确定医疗诊断，并开具治疗方案和药物。社会工作者——提供咨询并转介社区资源。物理治疗师——教授并监督锻炼，协助病人学习安全行走、弯腰和搬运的技巧。
    Dietitian-provides nutritional counseling. Respiratory therapist-supervises oxygen administration and performs pulmonary assessments.
    营养师——提供营养咨询。呼吸治疗师——监督氧气管理并进行肺部评估。
    Unlicensed assistive personnel—assists the patient in the hospital and at home with bathing and other activities of daily living. Financial counselor-assists the patients in understanding the hospital bill and to make arrangements for paying out-ofpocket costs.
    无证助理人员——协助患者在医院和家中进行洗浴及其他日常生活活动。财务顾问——帮助患者理解医院账单并安排支付自费费用。

CHAPTER 2-LEGAL AND ETHICAL ASPECTS OF NURSING
第二章——护理的法律与伦理方面

Matching  匹配题

1. c
2. e
3. a
4. b
5. d

Multiple Choice  多项选择题

6. Answer 4: The student has initiated the nursepatient relationship and therefore has the duty to act. All students are cardiopulmonary resuscitation (CPR)-certified so the student has to perform the duty in a reasonable and prudent manner as would other nursing students. All of the other options are also likely to be necessary. (Note to student: Discuss this situation with your clinical instructor for advice about visiting patients during the preclinical preparation time.)
   答案 4：学生已经开始了护士与患者的关系，因此有责任采取行动。所有学生都持有心肺复苏术（CPR）证书，因此学生必须以合理和谨慎的方式履行职责，就像其他护理学生一样。其他选项也可能是必要的。（给学生的提示：在临床准备时间访问患者的情况，请与您的临床指导老师讨论以获取建议。）
7. Answer 4: A poor nurse-patient relationship increases the likelihood that the patient will seek legal action and harm has to occur for liability to be established. The family of the older patient could seek damages, but that is less likely if they understand that the nurse and facility will try their best to prevent falls but are unable to physically restrain patients for the purpose of preventing falls. The angry patient may report the nurse to the supervisor, but if no harm is sustained, then any legal action against the nurse will not be successful. The family who complained at 3:00 am may also be very angry. The nurse’s decision to wait must be based on comprehensive assessment of the patient to ascertain that there is nothing to warrant calling at 3:00 AM. Careful documentation is necessary. Making an incident report in all of these situations would be a good idea.
   答案 4：糟糕的护士-患者关系会增加患者寻求法律诉讼的可能性，而要确立责任必须发生伤害。老年患者的家属可以寻求赔偿，但如果他们理解护士和机构会尽最大努力防止跌倒，但无法为了防止跌倒而对患者进行身体约束，那么这种可能性就会降低。愤怒的患者可能会向主管举报护士，但如果没有造成伤害，那么针对护士的任何法律诉讼都不会成功。凌晨 3 点投诉的家属也可能非常愤怒。护士决定等待必须基于对患者的全面评估，以确定没有必要在凌晨 3 点呼叫。需要仔细记录。在所有这些情况下，填写事件报告都是一个好主意。
8. Answer 1, 2, 3, 4, 6: In a health care-related case, items may include policies and procedures, standards of care, medical records, assignment sheets, personnel files, equipment maintenance records, birth certificates, marriage certificates, medical bills, and other documents pertinent to the issues at hand. The UAP’s personal health records are confidential and unrelated to the patient’s case.
   答案 1、2、3、4、6：在与医疗保健相关的案例中，项目可能包括政策和程序、护理标准、病历、任务分配表、人员档案、设备维护记录、出生证明、结婚证、医疗账单以及与相关问题有关的其他文件。UAP 的个人健康记录是机密的，与患者的案例无关。
9. Answer 2: Early discharge and high levels of patient acuity require excellent discharge teaching so patients can perform self-care and self-monitoring and are therefore less likely to suffer harm. Being able to take a limited number of high-acuity patients would be ideal, but high acuity is the current trend. Having malpractice coverage is good if litigation occurs; however, insurance payouts may actually be contributing to the problem. Ensuring accountability of others is not possible.
   答案 2：早期出院和高患者病情严重度要求出色的出院指导，以便患者能够进行自我护理和自我监测，因此不太可能受到伤害。能够接收有限数量的高病情严重度患者是理想的，但高病情严重度是当前的趋势。如果发生诉讼，拥有医疗事故保险是有益的；然而，保险赔付实际上可能在助长问题。无法确保他人的责任。
10. Answer 1: Assess knowledge and readiness to perform. Barriers may include knowledge
    答案 1：评估知识和执行准备情况。障碍可能包括知识方面。
    deficit or feelings of anxiety or self-doubt. Going with her and observing performance and pulling her file would be appropriate after assessment. Directing someone to do a task that is beyond his or her ability and understanding is inappropriate supervision and the nurse would be liable for the UAP’s performance.
    赤字或焦虑感或自我怀疑。评估后，陪同她观察表现并查阅她的档案是合适的。指派某人执行超出其能力和理解范围的任务是不恰当的监督，护士将对 UAP 的表现负责。
11. Answer 2: The first action is to locate the RN in charge so that the blood can be started. HCPs can supervise nurses and they know the potential adverse reactions of blood products; however, they are generally less familiar with the policies and procedures related to the actual administration. Explaining the policy is appropriate, but the priority is patient care.
    答案 2：第一步是找到负责的注册护士，以便开始输血。医疗保健专业人员可以监督护士，他们了解血液制品的潜在不良反应；然而，他们通常对实际输血相关的政策和程序不太熟悉。解释政策是合适的，但优先考虑的是患者护理。
12. Answer 1, 2, 3, 4: Do not include any information that identifies the patient. Information such as the room number or the HCP’s name may seem harmless but including those details could lead to speculation about the patient’s identity. A clinical report must include information such as vital signs and medical condition. If in doubt, the clinical instructor should be consulted.
    答案 1、2、3、4：不要包含任何能识别患者身份的信息。诸如病房号或医疗保健专业人员姓名等信息看似无害，但包含这些细节可能导致对患者身份的猜测。临床报告必须包括生命体征和病情等信息。如有疑问，应咨询临床指导老师。
13. Answer 1: Patients must be at least 18 years old to give consent. If younger than 18, the exceptions are marriage; court-approved emancipation; self-supporting and living apart from parents; military service; or for sexually transmitted infections, alcohol or drug abuse, sexual assault, or family planning.
    答案 1：患者必须年满 18 岁才能给予同意。如果未满 18 岁，例外情况包括结婚；法院批准的解放；自给自足且与父母分开居住；服兵役；或针对性传播感染、酒精或药物滥用、性侵犯或计划生育。
14. Answer 3: Policies about giving patient information over the phone will vary. For example, some facilities may not allow acknowledging that the patient is or is not there. Other facilities require that the patient have a list of people who are allowed to call for information. Another variation is that selected callers are given a phone code to reach the patient. The nurse should be familiar with hospital policy, because the policies are designed to specifically comply with Health Insurance Portability and Accountability Act (HIPAA).
    答案 3：通过电话提供患者信息的政策会有所不同。例如，有些机构可能不允许确认患者是否在场。其他机构要求患者有一份允许来电查询信息的人员名单。另一种情况是，选定的来电者会获得一个电话代码以联系患者。护士应熟悉医院政策，因为这些政策是专门为符合《健康保险携带与责任法案》（HIPAA）而设计的。
15. Answer 3: Alert the HCP so the child can be examined for occult injury. The other options may also be used to investigate the possibility of child abuse.
    答案 3：提醒医疗保健提供者（HCP），以便对儿童进行隐匿性伤害的检查。其他选项也可用于调查儿童虐待的可能性。
16. Answer 2: Good Samaritan laws offer limited liability, except in cases of gross negligence. A prudent nurse would know that moving a trauma victim could result in spinal cord injury. Initiating cardiopulmonary resuscitation, using available material to control bleeding
    答案 2：好撒马利亚人法案提供有限的责任保护，但严重疏忽的情况除外。一名谨慎的护士会知道移动创伤患者可能导致脊髓损伤。进行心肺复苏，利用现有材料控制出血
    and calling for help first are appropriate emergency actions.
    首先呼救是适当的紧急措施。
17. Answer 1: Being competent and compassionate are the best defenses. Knowing the legal definition may be helpful, but definitions are abstractions and the nurse’s day is full of realworld events. Obtaining malpractice insurance is likely to make the nurse feel better, but it does not decrease the chances of getting sued. Validating nursing actions with another nurse is always beneficial, but this is not a realistic option for minute-to-minute care.
    答案 1：具备能力和同情心是最好的防御。了解法律定义可能有帮助，但定义是抽象的，护士的工作日充满了现实世界的事件。购买医疗事故保险可能会让护士感觉更安心，但并不会降低被起诉的几率。与另一位护士确认护理行为总是有益的，但这对于每分钟的护理来说并不现实。
18. Answer 2: The nurse is assessing the wound during the dressing change and documentation should reflect the nurse’s attention to the standard of care. Documenting the type of dressing may be necessary for continuity of care and also for reimbursement. The other options are incorrect.
    答案 2：护士在换药过程中评估伤口，记录应反映护士对护理标准的关注。记录敷料类型可能对护理的连续性以及报销也很重要。其他选项均不正确。
19. Answer 4: Disciplinary defense insurance includes attorney; wage loss reimbursement; travel, food, and lodging expenses; and legal fees when the nurse has to go before the board of nursing for disciplinary action. The other types of insurance are for malpractice protection.
    答案 4：纪律辩护保险包括律师费；工资损失补偿；差旅、餐饮和住宿费用；以及护士因纪律处分需出庭护理委员会时的法律费用。其他类型的保险则是为了防止医疗事故。
20. Answer 4: Regardless of years of experience, nurses should always seek instruction and supervision for any unfamiliar procedures or practices. Asking to be reassigned could be an option if there is no time or personnel available to supervise the new nurse. Reviewing the procedure might be an option if the nurse is confident that the information is sufficient to ensure safe performance. Giving feedback about orientation might be useful to improve the orientation program, but it is not possible to cover all skills and all patient situations during orientation.
    答案 4：无论经验年限如何，护士在面对任何不熟悉的操作或做法时，都应寻求指导和监督。如果没有时间或人员来监督新护士，要求调岗可能是一个选择。如果护士有信心信息足够确保安全操作，复习该操作程序也可能是一个选择。对培训过程提供反馈有助于改进培训项目，但在培训期间不可能涵盖所有技能和所有患者情况。
21. Answer 1: First, assess the patient’s feelings by encouraging expression. The patient may not understand the advance directives or may have issues that were triggered by the discussion. The other options are also necessary.
    答案 1：首先，通过鼓励表达来评估患者的感受。患者可能不理解预先指示，或者讨论引发了某些问题。其他选项同样必要。
22. Answer 2: The patient’s living will is the best protection, because it reflects the patient’s wishes. Policies and procedures and the Joint Commission may contain general guidance about giving excellent care to patients, but will not offer any specific help in this situation. The Patient Self-Determination Act supports the use of living wills to define the individual’s choices about care and treatment.
    答案 2：患者的生前遗嘱是最好的保护，因为它反映了患者的意愿。政策和程序以及联合委员会可能包含关于为患者提供优质护理的一般指导，但在这种情况下不会提供任何具体帮助。《患者自决法案》支持使用生前遗嘱来定义个人关于护理和治疗的选择。
23. Answer 4: The nurse, the 13-year-old girl, and the mother all have very strong feelings about this emotional situation. First, the nurse must reflect on and assess own values and responses. The other options are likely to be necessary, but this will be a difficult process and other health care team members such as a social worker, family counselor, spiritual advisor, legal counsel, or obstetrician are likely to be involved.
    答案 4：护士、13 岁的女孩和母亲对这一情感复杂的情况都有非常强烈的感受。首先，护士必须反思并评估自己的价值观和反应。其他选项可能也是必要的，但这将是一个艰难的过程，其他医疗团队成员如社会工作者、家庭顾问、精神顾问、法律顾问或产科医生可能会参与其中。
24. Answer 1, 2, 3, 5: If the nurse observes another nurse being rude to a patient, the ethical thing to do would be to follow up so that patients are respected. Texting should not be used as an additional method of passing gossip among staff. The other options demonstrate ethical professional behavior.
    答案 1、2、3、5：如果护士观察到另一名护士对患者无礼，伦理上应当跟进以确保患者受到尊重。短信不应作为员工之间传递八卦的额外方式。其他选项体现了伦理的专业行为。
25. Answer 3: The supervisor should be presented with the facts. Theft is unethical and older residents are in an especially vulnerable position; thus, Nurse B is not giving good care. Talking to the residents or families will be part of the investigation that is conducted by the supervisor. The supervisor could recommend that both nurses seek assistance for values clarification.
    答案 3：应向主管呈现事实。盗窃是不道德的，年长的居民尤其处于脆弱的地位；因此，护士 B 没有提供良好的护理。与居民或家属交谈将是主管进行调查的一部分。主管可以建议两位护士寻求价值观澄清方面的帮助。
26. Answer 3: First, Nursing Student Orange would give Apple the opportunity to take responsibility to discuss the incident with the instructor. Using social media in this manner is unethical. It is also a HIPAA violation that could result in dismissal from the nursing program or a lawsuit. Details of patient care should only be shared with other health care workers who are involved in the direct care of the patient. If Student Apple refuses to inform the instructor, then Student Orange is ethically obligated to report this misconduct.
    答案 3：首先，护理学生 Orange 会给 Apple 机会，让其承担责任，与指导老师讨论此事件。以这种方式使用社交媒体是不道德的。这也是违反 HIPAA 规定，可能导致被护理项目开除或面临诉讼。患者护理的细节应仅与直接参与患者护理的其他医护人员分享。如果学生 Apple 拒绝告知指导老师，那么学生 Orange 有道德义务报告此不当行为。
27. Answer 4: The nurse should encourage the patient to express feelings and thoughts related to a situation without contributing personal opinions. The nurse must be aware of cultural differences and should avoid: (1) transferring personal expectations to patients; (2) making generalizations based on personal views; (3) assuming patients can understand what is being said just because they speak English; and (4) treating each patient the same.
    答案 4：护士应鼓励患者表达与某种情况相关的感受和想法，但不应加入个人意见。护士必须注意文化差异，并应避免：（1）将个人期望转嫁给患者；（2）基于个人观点进行概括；（3）仅因为患者会说英语就假设他们能理解所说内容；（4）对每位患者一视同仁。
28. Answer 4: Nonmaleficence means to do no harm. The nurse seeks to prevent harm from a high dose of medication by clarifying the prescription with the HCP. Providing care for all patients regardless of financial, social, or ethnic factors demonstrates the principle of justice. Advocating for the good of the patient
    答案 4：不伤害原则意味着不造成伤害。护士通过与医疗保健提供者核实处方，防止因药物剂量过高而造成伤害。无论患者的经济、社会或种族因素如何，提供护理体现了公正原则。为患者利益进行倡导
    demonstrates beneficence. Encouraging independent decision-making exemplifies the principle of autonomy.
    体现了行善原则。鼓励患者独立决策体现了自主原则。
29. Answer 1, 2, 4, 5, 6: The nurse must know the signs and symptoms of abuse, which are often hidden or subtle. Declines in health or physical abilities and loss of support and independence cause feelings of helplessness. The older adult may be reluctant to report abuse for fear of reprisal or loss of caregiver support. Age of caregiver does not a predict abuse.
    答案 1、2、4、5、6：护士必须了解虐待的迹象和症状，这些通常是隐藏的或微妙的。健康或身体能力的下降以及支持和独立性的丧失会导致无助感。老年人可能因害怕报复或失去护理者的支持而不愿报告虐待。护理者的年龄并不能预测虐待。
30. Answer 4: Careless handling of hard copies of notes, documents, charts, reports, etc., is a potential HIPAA violation because all patient information should be safeguarded. Only team members who are directly involved in a patient’s care should have access to information. The breakroom is for the nursing staff; however, there may be some people who are allowed to enter the breakroom (e.g., nursing students, housekeeping staff, friends or family of nursing staff) but are not involved in the direct care of the patient.
    答案 4：对纸质笔记、文件、图表、报告等的粗心处理可能违反 HIPAA 规定，因为所有患者信息都应受到保护。只有直接参与患者护理的团队成员才应有权访问信息。休息室是护理人员的专用场所；然而，可能有一些被允许进入休息室的人（例如护理学生、清洁人员、护理人员的朋友或家属），但他们并不直接参与患者的护理。
31. Answer 3: The nurse would offer to witness that the patient is signing the consent and is aware of the treatment, risks, alternatives, and consequences of accepting or rejecting care. The surgeon is required to disclose the risks or benefits involved with the treatment or procedure. Ideally, the nurse should accompany the surgeon during the explanation and the form should be signed at that time. If the surgeon is hostile or rejects the nurse’s offer of witnessing, the nurse would ask the charge nurse to clarify how nurses are dealing with the consent forms. It is possible that surgeons are explaining the procedures and the nurses are later assessing the patients’ understanding and contacting the surgeon if the patient has additional questions or needs clarification. If the patient has no questions, the nurse will then ask the patient to sign the form; however, this is not the best situation for the nurses. The nurse could also discuss the process with a nursing supervisor because the nurses may be at risk for practicing outside scope of practice. If a patient later claims misunderstanding, the involved nurse could be liable if the patient suffers harm from the procedure.
    答案 3：护士会主动见证患者签署同意书，并确认患者了解治疗内容、风险、替代方案以及接受或拒绝治疗的后果。外科医生有义务告知治疗或手术相关的风险和益处。理想情况下，护士应陪同外科医生进行说明，并在当时签署表格。如果外科医生态度敌对或拒绝护士的见证请求，护士应请主管护士澄清护士们如何处理同意书。可能的情况是外科医生先解释手术，护士随后评估患者的理解情况，并在患者有额外问题或需要澄清时联系外科医生。如果患者没有问题，护士会请患者签署表格；但这对护士来说并非最佳情况。护士也可以与护理主管讨论此流程，因为护士可能存在超出执业范围的风险。如果患者事后声称存在误解，且因手术受到伤害，相关护士可能会承担责任。
32. Answer 2: Battery is unlawfully touching another person without informed consent. The nurse who leaves a patient without giving handover report could be charged with abandonment, if the patient sustains harm.
    答案 2：未经知情同意，电池非法接触他人。护士如果在未交接病人情况的情况下离开病人，且病人因此受到伤害，可能会被控遗弃罪。

Critical Thinking Activities
批判性思维活动

33. a. Further assessment is needed to determine the underlying motivation for the action of these two nurses. It appears that Nurse A is reluctant to care for “those kinds of people” and the code specifies that the nurse should provide care without discrimination. Assessment of Nurse A’s behavior may reveal that she lacks the confidence or skills to care for AIDS patients; thus, additional training is needed. Possibly, the death of a close friend from AIDS may have created an emotional barrier and thus she may need grief counseling. Nurse B is attempting to help Nurse A, which is a laudable action; however, to maintain a high degree of personal and professional behavior, which is also part of the code of ethics, Nurse B should talk to Nurse A about the comment, rather than ignoring it.
    a. 需要进一步评估以确定这两名护士行为背后的动机。看起来护士 A 不愿意照顾“那类人”，而职业守则规定护士应无歧视地提供护理。对护士 A 行为的评估可能显示她缺乏照顾艾滋病患者的信心或技能，因此需要额外培训。也有可能是亲密朋友因艾滋病去世造成了情感障碍，因此她可能需要哀伤辅导。护士 B 试图帮助护士 A，这是值得赞扬的行为；然而，为了保持高度的个人和职业行为，这也是职业道德守则的一部分，护士 B 应当与护士 A 谈论该言论，而不是忽视它。
    b. Nurse B should initiate the process of values clarification, either by herself or with assistance from a counselor or supervisor. This process includes thinking about a belief or behavior, deciding its value, and incorporating the value into a response. Nurse B could talk directly to Nurse A to see if Nurse A is actually discriminating against a certain type of patient or if there is some other problem such as knowledge/ skills deficit. Nurse B may also decide to report Nurse A’s unethical behavior by following the appropriate chain of command, explaining the facts clearly, and documenting the incident objectively and accurately.
    b. 护士 B 应开始进行价值澄清的过程，可以独自进行，也可以寻求辅导员或主管的协助。该过程包括思考某种信念或行为，决定其价值，并将该价值融入回应中。护士 B 可以直接与护士 A 交谈，了解护士 A 是否真的对某类患者存在歧视，或者是否存在其他问题，如知识或技能不足。护士 B 也可以决定按照适当的指挥链报告护士 A 的不道德行为，清楚地说明事实，并客观准确地记录事件。
34. a. First, the nurse needs to involve other members of the health care team, such as the HCP and the psychiatric social worker. Physical causes for depression or changes in cognition should be investigated, as well as psychological causes of depression. A psychiatrist or psychiatric clinical nurse specialist should assess the patient for signs of suicide. If the patient is deemed of sound mind, then he has the right to refuse care. The Patient Self-Determination Act requires that institutions maintain written policies and procedures regarding advance directives (including the use of life support if the
    a. 首先，护士需要让医疗团队的其他成员参与进来，比如医疗保健提供者（HCP）和精神科社会工作者。应调查抑郁或认知变化的身体原因，以及抑郁的心理原因。精神科医生或精神科临床护士专家应评估患者是否有自杀迹象。如果患者被认为精神正常，那么他有权拒绝治疗。患者自决法案要求机构制定关于预先指示（包括患者无行为能力时使用生命支持）的书面政策和程序，患者接受或拒绝治疗的权利，以及充分参与医疗相关决策的权利。
    patient is incapacitated), the right to accept or refuse treatment, and the right to participate fully in health care-related decisions.
    患者自决法案要求机构制定关于预先指示（包括患者无行为能力时使用生命支持）的书面政策和程序，患者接受或拒绝治疗的权利，以及充分参与医疗相关决策的权利。
    b. When a patient refuses care, the nurse may experience a personal feeling of rejection. The nurse has to recognize that refusal of treatment is not a refusal of interaction or compassion. It may be difficult, but the nurse should continue to check on the patient as before and to spend as much time as before, but the focus may shift from task orientation to therapeutic communication. And of course, the patient always has the option to change his mind and accept selected elements of care.
    b. 当患者拒绝护理时，护士可能会感受到个人的被拒绝感。护士必须认识到，拒绝治疗并不等于拒绝互动或同情。虽然这可能很困难，但护士应继续像以前一样查看患者，并花费同样多的时间，只是关注点可能从任务导向转向治疗性沟通。当然，患者始终可以改变主意，接受部分护理内容。
    c. For nurses, this is an ethical dilemma. The refusal of heroic measures is often easier to accept because many nurses themselves do not want to be kept “alive by machines.” However, it seems cruel and inhuman if basic needs like food or hygiene are not provided. Nurses have worked for centuries trying to prevent pressure injuries and to improve patient outcomes. Nurses may also believe that immunization is partially for the protection of the individual, but also for “herd immunity.” Nurses are trained to be problem-solvers and doers. Doing nothing for the patient may seem difficult but remember that supporting the patient emotionally and psychologically is also a nursing function.
    c. 对护士来说，这是一个伦理困境。拒绝采取激进措施通常更容易被接受，因为许多护士自己也不希望被“机器维持生命”。然而，如果基本需求如食物或卫生得不到满足，则显得残酷且不人道。几个世纪以来，护士们一直致力于预防压疮并改善患者的治疗效果。护士们也可能认为免疫接种部分是为了保护个人，同时也是为了“群体免疫”。护士受过训练，擅长解决问题和执行任务。对患者无所作为可能显得困难，但请记住，情感和心理上的支持也是护理工作的一部分。
35. The nurse has gone up the chain of command and reported her concerns to the supervisor; however, the nurse could still be involved in a legal action if there is an occurrence where a patient is harmed. The nurse could report the conditions to the state board of nursing, but change is likely to come slowly, if at all. The nurse may opt to make personal notes or incident reports related to working conditions or discussions with supervisors.
    护士已经向上级主管报告了她的担忧；然而，如果发生患者受伤的情况，护士仍可能卷入法律诉讼。护士可以向州护理委员会报告这些情况，但改变可能会很缓慢，甚至根本不会发生。护士也可以选择做个人笔记或关于工作条件或与主管讨论的事件报告。

Next-Generation NCLEX ${}^{\text{TM}}$${}^{\text{TM }}$^("TM "){ }^{\text {TM }} (NGN)
下一代 NCLEX ${}^{\text{TM}}$${}^{\text{TM }}$^("TM "){ }^{\text {TM }} （NGN）

CHAPTER 3-DOCUMENTATION  第三章-文档

d
i
f
j
g
h
b
c
a
e

Short Answer  简短回答

11. Home health care and long-term care documentation are directly related to
    家庭医疗和长期护理文档直接相关于
    reimbursement because patients’ eligibility and services provided by the nurses must be documented to justify payment by Medicare, Medicaid, or private insurance companies. The charting is not usually done on the same time schedule or with the same frequency as that of the acute care facility. An interdisciplinary approach must be documented in the notes along with evidence of compliance with state and federal regulations. For home health care, nurses carry written records with them or use a laptop computer to maintain patient documentation.
    报销因为必须记录患者的资格和护士提供的服务，以证明由医疗保险、医疗补助或私人保险公司支付的合理性。图表记录通常不会与急性护理机构的时间安排或频率相同。必须在记录中记录跨学科的方法，以及遵守州和联邦法规的证据。对于家庭护理，护士随身携带书面记录或使用笔记本电脑维护患者文档。

Table Activity  表格活动

12. See Table 3.1, Essential Elements of Documentation.
    参见表 3.1，文档的基本要素。

Multiple Choice  多项选择题

13. Answer 4: When making a late entry, the nurse would note it as a late entry and then proceed with the notation; for example, “Late entry
    回答 4：在进行迟录时，护士会将其标记为迟录，然后继续记录；例如，“迟录
    $$$$qquad\qquad ,” or as dictated by facility policy.
    $$$$qquad\qquad ，”或按照机构政策的规定。
14. Answer 2: In charting by exception, complete physical assessments, observations, vital signs, intravenous (IV) site and rate, and other pertinent data are charted at the beginning of each shift. During the shift, the only notes the nurse will make will be for additional treatments done or planned treatments withheld, changes in patient condition, and new concerns. Focus charting uses the nursing process and the focus is sometimes a current patient concern or behavior, and sometimes a significant change in patient status or behavior, or a significant event in the patient’s therapy. DARE (data [D], action [A], response and evaluation [R], and [E] education and patient teaching) is one acronym that is used in focus charting. Narrative charting is an abbreviated story form of patient care. It is used for both computerized and noncomputerized nurse’s notes and includes subjective and / or objective data, consultations, care and treatments, and response to therapy. Some facilities require a minimum of three entries and a flow sheet for narrative charting. In acute care facilities (e.g., hospitals) taking vital signs every 4 hours and increasing frequency as needed is common practice regardless of the documentation system that is used.
    答案 2：在例外记录法中，完整的体格检查、观察、生命体征、静脉输液（IV）部位和速度以及其他相关数据会在每个班次开始时记录。在班次期间，护士只会记录额外进行的治疗或计划中被取消的治疗、患者状况的变化以及新的关注点。重点记录法使用护理过程，重点有时是当前患者的关注点或行为，有时是患者状态或行为的显著变化，或患者治疗中的重大事件。DARE（数据[D]、行动[A]、反应和评估[R]、教育和患者教学[E]）是重点记录法中使用的一个缩略词。叙述性记录是患者护理的简略故事形式。它适用于计算机化和非计算机化的护士记录，包括主观和/或客观数据、会诊、护理和治疗以及对治疗的反应。一些机构要求叙述性记录至少有三条记录和一张流程表。 在急性护理机构（例如医院），无论使用何种文档系统，每 4 小时测量一次生命体征并根据需要增加频率是常见做法。
15. Answer $1,2,3,4$$1,2,3,4$1,2,3,41,2,3,4 : The five basic purposes for accurate and complete patient records are: (1) documented communication, (2) permanent record for accountability, (3) legal record of care, (4) teaching, and (5) research and data collection. The nurse would not interpret or discuss the HCP’s notes with the patient. If the patient does not understand the medical diagnosis, the nurse would assist the patient to formulate a list of questions and then contact the HCP to talk directly with the patient.
    答案 $1,2,3,4$$1,2,3,4$1,2,3,41,2,3,4 ：准确完整的病历记录有五个基本目的：（1）记录沟通，（2）作为责任的永久记录，（3）护理的法律记录，（4）教学，以及（5）研究和数据收集。护士不会向患者解释或讨论医疗保健提供者（HCP）的笔记。如果患者不理解医疗诊断，护士会协助患者列出问题清单，然后联系医疗保健提供者直接与患者沟通。
16. Answer 1: A peer review is an appraisal by professional coworkers of equal status. Peer review appraises the way an individual nurse conducts practice, education, or research. Journal articles frequently undergo peer review. Queries or clarification of orders or prescriptions should always occur if the nurse has a question. This is standard practice and nurse would not anticipate any type of review.
    答案 1：同行评审是由具有同等地位的专业同事进行的评价。同行评审评估个别护士在实践、教育或研究中的表现。期刊文章通常会经过同行评审。如果护士对医嘱或处方有疑问，应始终进行询问或澄清。这是标准做法，护士不会预期任何形式的评审。

Critical Thinking Activities
批判性思维活动

35. Sample #1: Day of month and time of entry are missing. “Good night” and “status unchanged” are empty, general phrases. There is one spelling error: escendially should be corrected to essentially. Rather than charting diamond ring and gold watch, use descriptive adjectives, such as clear, white, or yellow. Also, documenting that expensive items are being stored in the bedside table creates liability for theft or loss. Patient’s condition, the time, and the method of transportation to the cafeteria are missing. Sample #2: Generally charting for another nurse is not done. (Note to student: Charting the actions of another team member could potentially be done in an emergency situation where many tasks are simultaneously being performed and one nurse is the designated recorder.) “SSE” and “CC” are not approved abbreviations. There are two spelling errors: adominal distencion should be corrected to $ab$$ab$aba b dominal distention.
    样本#1：缺少日期和入院时间。“晚安”和“状态未变”是空泛的通用短语。有一个拼写错误：escendially 应改为 essentially。与其记录钻石戒指和金表，不如使用描述性形容词，如清晰、白色或黄色。此外，记录贵重物品存放在床头柜中会增加被盗或丢失的风险。缺少患者状况、时间和前往餐厅的交通方式。样本#2：通常不为其他护士记录。（给学生的提示：在紧急情况下，许多任务同时进行且一名护士被指定为记录员时，可能会记录其他团队成员的行为。）“SSE”和“CC”不是认可的缩写。有两个拼写错误：adominal distencion 应改为 $ab$$ab$aba b dominal distention。
    Sample #3: Time of entry is missing. Full assessment of pain is missing. Statement indicating blame, “HCP made error,” should not be used. Inappropriate follow-up action is recorded (i.e., the appropriate follow-up is to call
    样本#3：缺少入院时间。缺少对疼痛的全面评估。不应使用指责性的陈述，如“HCP 犯了错误”。记录了不恰当的后续措施（即，适当的后续措施是打电话）
    the HCP for clarification). Patient’s complaint about care and quoted remark should not appear in nurses’ notes (this type of information is documented in an incident report). Time of pain medication is missing and there is no note about response to medication. Signature of nurse is missing.
    （需向医疗保健提供者确认）。患者对护理的投诉和引用的言论不应出现在护士记录中（此类信息应记录在事件报告中）。缺少给药时间，且无关于用药反应的记录。护士签名缺失。
36. The electronic health record and hardcopy systems provide a permanent legal record of past and current medical and nursing problems, plans for care, care given, and the patient’s responses to various treatments. Both are used for cost reimbursement and quality assurance and improvement.
    电子健康记录和纸质系统提供了过去和当前医疗及护理问题、护理计划、所提供的护理以及患者对各种治疗反应的永久法律记录。两者均用于费用报销及质量保证和改进。

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下一代 NCLEX ${}^{\text{TM}}$${}^{\text{TM }}$^("TM "){ }^{\text {TM }} （NGN）

37. Answer a, c, d, e, f, h: Nurses must document all their services for payment (e.g., direct skilled care, patient instructions, skilled observations, and evaluation visits). The nurse must document in detail any procedures, treatments, or medications administered and response to these interventions. Patient education and demonstration of learning must be documented. Documentation must also reflect coordination of services by all members of the health care team and evidence of compliance with regulations. Comments made by the patient or daughter about the care or specific team members can be discussed by the team but would not be recorded to meet the requirements for Medicare, Medicaid, or other insurance. The daughter’s request for vacation coverage is understandable, but the family may have to pay out-of-pocket if the patient is ineligible for Medicare, Medicaid, or other insurance
    回答 a、c、d、e、f、h：护士必须记录所有服务以便付款（例如，直接的专业护理、患者指导、专业观察和评估访问）。护士必须详细记录任何执行的程序、治疗或用药及对这些干预的反应。患者教育和学习示范必须被记录。记录还必须反映所有医疗团队成员的服务协调情况以及遵守法规的证据。患者或其女儿对护理或特定团队成员的评论可以由团队讨论，但不会被记录以满足医疗保险、医疗补助或其他保险的要求。女儿提出的假期替代请求是可以理解的，但如果患者不符合医疗保险、医疗补助或其他保险的资格，家庭可能需要自费。
    coverage. The patient’s eligibility for home care must be thoroughly assessed and documented.
    必须对患者的居家护理资格进行彻底评估并记录。