hat partnerships and collaborations exist for your model?


For this paper, you will develop an innovative nursing care delivery model for a vulnerable population, care specialty, and setting in the United States OR a low income global country that reflects nurse managed care, collaboration, care across settings, and technology.

For your paper, it is easiest to focus on one (1) population, one (1) health issue/disease, and one (1) type of setting within a country. Be specific. If you use a low income country, name your low income country (see list at the end of this) and adjust your model to the disease(s) and conditions found within that country. Consider that low income countries will not have access to the same level of facilities, technology related to diagnostics and communication, medications, and the health care professionals found in the U.S.

–A vulnerable population include low income children & adults; elderly; homeless; migrants; immigrants; racial & ethnic minorities, people with chronic health or terminal conditions/diseases (or any group at risk for obtaining appropriate health care).

-A care specialty include preventative care; primary care; acute care; chronic care; palliative or end-of-life care (including the targeting of any disease or condition that results in a health risk).

-A setting include rural or urban community housing and/or clinic; school; specialty unit in a hospital; emergency room; health provider office; armed services facility; rehabilitation facility; hospice facility; ambulatory health care center; client home; nursing home; short term stay housing (or any setting where a vulnerable client/patient population is available for care).


African Republic Algeria


Dem Rep of Congo Ethiopia

Ghana Madagascar Malawi Mozambique Niger Senegal Sierra Leone South Africa Uganda Zambia Zimbabwe

Bolivia Ecuador Guatemala Haiti Nicaragua Peru

Afghanistan Egypt

Iraq Morocco Somalia Sudan Yemen

Bangladesh North Korea Myanmar Nepal


Title of Paper (top of page 2, centered) Innovative Nursing Care Delivery: [Name of Your Model]

PAPER HEADING: Introduction [Level 1] What is your model’s population, setting, care specialty, and your model’s goal(s) and/or purpose(s)? For example, are you targeting a particular group or disease/condition? Choose a name for your model and include it in your paper title.

PAPER HEADING: Description of the [Name of Your Model] [Level 2] You are welcome to use your creativity in the model–develop your own or base it on an existing model. For ideas, start with the articles found with the assignment, textbook (Global Health 101) scenarios, or do literature searches on the internet. However, be sure that the model is nurse-led or nurse-managed. Registered nurses have authority to make decisions regarding nursing diagnoses, interventions, and referrals. Registered nurse practitioners have additional authority related to medical diagnoses and interventions (prescriptions).

Be sure to include the themes crucial to meeting the challenges of the future: nurse- managed care, collaboration, continuity of care and technology in describing your model. Be aware of cost-effectiveness; you could develop the “Cadillac” of models, but no one would consider implementing it because the cost would be too high.

Nurse led and nurse managed health care. [Level 3] How is your model nurse managed? Were nurses instrumental in the development and implementation of your model? Are nurses consulted and/or make decisions re: budget, personnel, and the communication, referral, and evaluation processes?

Partnerships and collaboration. [Level 3] What partnerships and collaborations exist for your model? Are they at the professional level (i.e., social workers, nutritionists, community leaders) and/or the organizational level (home health care agencies, public health departments, hospitals)?

Continuity of care across settings. [Level 3] What happens when a patient/client moves to a different setting, i.e., home, hospital, hospice, clinic, emergency room, etc. How is communication handled so the patient/family needs are consistently met when moved across settings?

Technology. [Level 3] What technology is used? Is it low-technology (basic assessment tools, screening tests) or high-technology (i.e, patient diagnostic, monitoring, and/or data processing systems) or a combination of both?

PAPER HEADING: Development/Implementation Team for the [Name of Your Model] [Level 2] Your team is important to carry out model’s goal(s). Depending on your model and setting, your team may include other registered nurses, nurse practitioners, community workers, nurse assistants, licensed practical nurses, nutritionists, physical therapists, occupational therapists, dentists, social workers, community leaders, psychologists, clergy, administrators, informatics technicians, physicians (if physicians are part of the team, they should function as consultants, not “captain of the ship”). Include your team members and briefly discuss their functions in carrying out the model goal(s)/purposes(s). How would communication and referrals be handled? Again–think about the cost effectiveness–could ancillary staff (nurse assistants, trained community workers) be used just as effectively?

PAPER HEADING: Evaluation of [Name of Your Model]: Outcome Measurement [Level 2] After implementation of the model, what outcomes would you measure Would you look at cost comparisons and/or savings? Patient satisfaction? Staff satisfaction? Fewer ER visits and/or re-hospitalizations? Decreased incidence of a particular disease/condition? Increased number of therapies? Increased knowledge of a disease or intervention?

For outcomes, be specific on what, who, when and how. For example, if you do a survey:

What type of survey is it (i.e., satisfaction, data gathering)?

Who would you survey (i.e., staff, patients, administrators)?

When would you do the survey (i.e., time period; pre/post tests)?

How would you conduct the survey (handout, mailing, computer analysis)?

Explain the benefits to interprofessional research collaboration to improve patient health outcomes.

150 words 1 reference nursing journals within 5 years, response to a peer DB

Identify a clinical problem within the nurse’s practice setting related to patient care.

In the Neonatal Intensive Care Unit (NICU) there are many opportunities for skin breakdown. Because the patients are babies unable to control their bodily function they wear diapers. As a result the babies are at risk for skin breakdown. This skin breakdown if left untreated may result in infection. Skin breakdown may also occur if the babies are not repositioned, infrequent changes of the oxygen saturation probe, and/or electrodes. However, the greatest risk for skin breakdown is diaper rash.

Develop a research question utilizing the PICO format.

The PICO format is a research method; which, stands for patient or population of interest, intervention, control or comparison, and outcome of Interest” (p. 1).

P – Skin breakdown in neonates

I – Frequent skin assessments, proper cleaning of skin with diaper changes, and placement of protective barrier/occlusive ointment.

C – Assessmentof skin,knowledge of prescribed medications (as some medications i.e. Ampicillin are irritating to the skin when excreted through waste), use of sterile water and gauze opposed to chemically treated baby wipes.

O – Decrease occurrence of skin breakdown and infection, reduce patient pain levels, and improve overall patient outcomes.

Determine how the research question could guide the nurse’s search of the literature to address the issue to implement a change in practice.

According to Yensen (2013), “once students or researchers have formulated a well-structured question, they are in a better position to search the literature f or sources and evidence in which to ground and support their original PICO question. (McKeon, & McKeon, 2015, p. 1).” In this instance the PICO format allows the research participants to clearly identify skin breakdown as the issue of concern. Furthermore, recognizing the possible causes of skin breakdown enables research on those causes including alternatives and interventions. Finally, understanding desired outcomes affords researchers the ability to test theories and monitor results for success.

Explain the benefits to interprofessional research collaboration to improve patient health outcomes.

The writer believes collaborative research is vital to the successful collection of information and implementation of changes to current practice.

Which client should the nurse identify as being at greatest risk for atrial fibrillation?


Question 1

A nursing student wants to know why clients with chronic obstructive pulmonary disease tend to be polycythemic. What response by the nurse instructor is best?

a. It is due to side effects of medications for bronchodilation.

b. It is from overactive bone marrow in response to chronic disease.

c. It combats the anemia caused by an increased metabolic rate.

d. It compensates for tissue hypoxia caused by lung disease.

Question 2

A nurse assesses a client who had a myocardial infarction and is hypotensive. Which additional assessment finding should the nurse expect?

a. Heart rate of 120 beats/min

b. Cool, clammy skin

c. Oxygen saturation of 90%

d. Respiratory rate of 8 breaths/min

Question 3

A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure?

a.“I have been drinking more water than usual.”

b.“I am awakened by the need to urinate at night.”

c.“I must stop halfway up the stairs to catch my breath.”

d.“I have experienced blurred vision on several occasions.”

Question 4

A nurse assesses clients on a cardiac unit. Which client should the nurse identify as being at greatest risk for the development of left-sided heart failure?

a. A 36-year-old woman with aortic stenosis

b. A 42-year-old man with pulmonary hypertension

c. A 59-year-old woman who smokes cigarettes daily

d. A 70-year-old man who had a cerebral vascular accident

Question 5

A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain how it works. What response by the nurse is best?

a. “It inhibits thrombin.”

b. “It inhibits fibrinogen.”

c. “It thins your blood.”

d. “It works against vitamin K.”

Question 6

A client undergoing hemodynamic monitoring after a myocardial infarction has a right atrial pressure of 0.5 mm Hg. What action by the nurse is most appropriate?

a. Level the transducer at the phlebostatic axis.

b. Lay the client in the supine position.

c. Prepare to administer diuretics.

d. Prepare to administer a fluid bolus.

Question 7

A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition?

a. Sinus tachycardia

b. Speech alterations

c. Fatigue

d. Dyspnea with activity

Question 8

A client has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best?

a.“Do you have trouble affording your medications?”

b.“Most people with hypertension do not have symptoms.”

c.“You are lucky; most people get severe morning headaches.”

d.“You need to take your medicine or you will get kidney failure.”

Question 9

A client received tissue plasminogen activator (t-PA) after a myocardial infarction and now is on an intravenous infusion of heparin. The client’s spouse asks why the client needs this medication. What response by the nurse is best?

a.“The t-PA didn’t dissolve the entire coronary clot.”

b.“The heparin keeps that artery from getting blocked again.”

c.“Heparin keeps the blood as thin as possible for a longer time.”

d.“The heparin prevents a stroke from occurring as the t-PA wears off.”

Question 10

The nurse is reviewing the lipid panel of a male client who has atherosclerosis. Which finding is most concerning?

a. Cholesterol: 126 mg/dL

b. High-density lipoprotein cholesterol (HDL-C): 48 mg/dL

c. Low-density lipoprotein cholesterol (LDL-C): 122 mg/dL

d. Triglycerides: 198 mg/dL

Question 11

A hospitalized client has a platelet count of 58,000/mm3. What action by the nurse is best?

a. Encourage high-protein foods.

b. Institute neutropenic precautions.

c. Limit visitors to healthy adults.

d. Place the client on safety precautions.

Question 12

A client is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the client to the bathroom and notes the client’s O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best?

a. Administer oxygen at 2 L/min.

b. Allow continued bathroom privileges.

c. Obtain a bedside commode.

d. Suggest the client use a bedpan

Question 13

A nurse is working with a client who takes atorvastatin (Lipitor). The client’s recent laboratory results include a blood urea nitrogen (BUN) of 33 mg/dL and creatinine of 2.8 mg/dL. What action by the nurse is best?

a. Ask if the client eats grapefruit.

b. Assess the client for dehydration.

c. Facilitate admission to the hospital.

d. Obtain a random urinalysis.

Question 14

While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop. Which action should the nurse take next?

a. Assess for symptoms of left-sided heart failure.

b. Document this as a normal finding.

c. Call the health care provider immediately.

d. Transfer the client to the intensive care unit.

Question 15

The nurse is evaluating a 3-day diet history with a client who has an elevated lipid panel. What meal selection indicates the client is managing this condition well with diet?

a. A 4-ounce steak, French fries, iceberg lettuce

b. Baked chicken breast, broccoli, tomatoes

c. Fried catfish, cornbread, peas

d. Spaghetti with meat sauce, garlic bread

Question 16

A client is in shock and the nurse prepares to administer insulin for a blood glucose reading of 208 mg/dL. The spouse asks why the client needs insulin as the client is not a diabetic. What response by the nurse is best?

a. “High glucose is common in shock and needs to be treated.”

b. “Some of the medications we are giving are to raise blood sugar.”

c. “The IV solution has lots of glucose, which raises blood sugar.”

d. “The stress of this illness has made your spouse a diabetic.”

Question 17

The nurse gets the hand-off report on four clients. Which client should the nurse assess first?

a. Client with a blood pressure change of 128/74 to 110/88 mm Hg

b. Client with oxygen saturation unchanged at 94%

c. Client with a pulse change of 100 to 88 beats/min

d. Client with urine output of 40 mL/hr for the last 2 hours

Question 18

A nurse cares for a client with right-sided heart failure. The client asks, “Why do I need to weigh myself every day?” How should the nurse respond?

a. “Weight is the best indication that you are gaining or losing fluid.”

b. “Daily weights will help us make sure that you’re eating properly.”

c. “The hospital requires that all inpatients be weighed daily.”

d. “You need to lose weight to decrease the incidence of heart failure.”

Question 19

A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?

a. “Make certain that your bath water is warm.”

b.“Avoid straining while having a bowel movement.”

c.“Limit your intake of caffeinated drinks to one a day.”

d.“Avoid strenuous exercise such as running.”

Question 20

A nurse is caring for a client after surgery. The client’s respiratory rate has increased from 12 to 18 breaths/min and the pulse rate increased from 86 to 98 beats/min since they were last assessed 4 hours ago. What action by the nurse is best?

a. Ask if the client needs pain medication.

b. Assess the client’s tissue perfusion further.

c. Document the findings in the client’s chart.

d. Increase the rate of the client’s IV infusion.

Question 21

An emergency room nurse obtains the health history of a client. Which statement by the client should alert the nurse to the occurrence of heart failure?

a. “I get short of breath when I climb stairs.”

b. “I see halos floating around my head.”

c. “I have trouble remembering things.”

d. “I have lost weight over the past month.”

Question 22

The health care provider tells the nurse that a client is to be started on a platelet inhibitor. About what drug does the nurse plan to teach the client?

a. Clopidogrel (Plavix)

b. Enoxaparin (Lovenox)

c. Reteplase (Retavase)

d. Warfarin (Coumadin)

Question 23

A nurse assesses a client’s electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation?

a. The client has hyperkalemia causing irregular QRS complexes.

b. Ventricular tachycardia is overriding the normal atrial rhythm.

c. The client’s chest leads are not making sufficient contact with the skin.

d. Ventricular and atrial depolarizations are initiated from different sites.

Question 24

A nurse caring for a client with sickle cell disease (SCD) reviews the client’s laboratory work. Which finding should the nurse report to the provider?

a. Creatinine: 2.9 mg/dL

b. Hematocrit: 30%

c. Sodium: 147 mEq/L

d. White blood cell count: 12,000/mm3

Question 25

A nurse assesses clients on a medical-surgical unit. Which client should the nurse identify as having the greatest risk for cardiovascular disease?

a. An 86-year-old man with a history of asthma

b. A 32-year-old Asian-American man with colorectal cancer

c. A 45-year-old American Indian woman with diabetes mellitus

d. A 53-year-old postmenopausal woman who is on hormone therapy

Question 26

A student nurse is assessing the peripheral vascular system of an older adult. What action by the student would cause the faculty member to intervene?

a. Assessing blood pressure in both upper extremities

b. Auscultating the carotid arteries for any bruits

c. Classifying capillary refill of 4 seconds as normal

d. Palpating both carotid arteries at the same time

Question 27

A nurse assesses a client after administering a prescribed beta blocker. Which assessment should the nurse expect to find?

a. Blood pressure increased from 98/42 mm Hg to 132/60 mm Hg

b. Respiratory rate decreased from 25 breaths/min to 14 breaths/min

c. Oxygen saturation increased from 88% to 96%

d. Pulse decreased from 100 beats/min to 80 beats/min

Question 28

A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this client’s medication administration record to prevent a common complication of this condition?

a. Sotalol (Betapace)

b. Warfarin (Coumadin)

c. Atropine (Sal-Tropine)

d. Lidocaine (Xylocaine)

Question 29

A nurse assesses an older adult client who has multiple chronic diseases. The client’s heart rate is 48 beats/min. Which action should the nurse take first?

a. Document the finding in the chart.

b. Initiate external pacing.

c. Assess the client’s medications.

d. Administer 1 mg of atropine.

Question 30

A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority?

a. Administer oxygen.

b. Apply an oximetry probe.

c. Give pain medication.

d. Start an IV line.

Question 31

A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right-sided heart failure?

a.“I sleep with four pillows at night.”

b.“My shoes fit really tight lately.”

c.“I wake up coughing every night.”

d.“I have trouble catching my breath.”

Question 32

A nursing student is caring for a client who had a myocardial infarction. The student is confused because the client states nothing is wrong and yet listens attentively while the student provides education on lifestyle changes and healthy menu choices. What response by the faculty member is best?

a.“Continue to educate the client on possible healthy changes.”

b.“Emphasize complications that can occur with noncompliance.”

c.“Tell the client that denial is normal and will soon go away.”

d.“You need to make sure the client understands this illness.”

Question 33

A client is receiving an infusion of tissue plasminogen activator (t-PA). The nurse assesses the client to be disoriented to person, place, and time. What action by the nurse is best?

a. Assess the client’s pupillary responses.

b. Request a neurologic consultation.

c. Stop the infusion and call the provider.

d. Take and document a full set of vital signs.

Question 34

A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best?

a.0.45% normal saline

b.0.9% normal saline

c. Dextrose 50% (D50)

d. Lactated Ringer’s solution

Question 35

A student is caring for a client who suffered massive blood loss after trauma. How does the student correlate the blood loss with the client’s mean arterial pressure (MAP)?

a. It causes vasoconstriction and increased MAP.

b. Lower blood volume lowers MAP.

c. There is no direct correlation to MAP.

d. It raises cardiac output and MAP.

Question 36

A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best?

a. Encourage high-protein Foods.

b. Perform a Hemoccult test on the client’s stools.

c. Offer Frequent oral care.

d. Prepare to administer cobalamin (vitamin B12).

Question 37

A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation?

a. A 45-year-old who takes an aspirin daily

b. A 50-year-old who is post coronary artery bypass graft surgery

c. A 78-year-old who had a carotid endarterectomy

d. An 80-year-old with chronic obstructive pulmonary disease

Question 38

A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best?

a. Give the client pain medication if it is time for another dose.

b. Instruct the client not to request pain medication too early.

c. Request the provider leave a prescription for a placebo.

d. Tell the client it is too early to have more pain medication.

Question 39

A nurse is caring for a client after surgery who is restless and apprehensive. The unlicensed assistive personnel (UAP) reports the vital signs and the nurse sees they are only slightly different from previous readings. What action does the nurse delegate next to the UAP?

a. Assess the client for pain or discomfort.

b. Measure urine output from the catheter.

c. Reposition the client to the unaffected side.

d. Stay with the client and reassure him or her.

Question 40

A nurse is assessing a dark-skinned client for pallor. What action is best?

a. Assess the conjunctiva of the eye.

b. Have the client open the hand widely.

c. Look at the roof of the client’s mouth.

d. Palpate for areas of mild swelling.