Fundamentals of Nursing 10th Edition Potter Perry Test Banks, Exams of Nursing

Download Fundamentals of Nursing 10th Edition Potter Perry Test Banks and more Exams Nursing in PDF only on Docsity! 1 w w w .te st ba nk ta nk .c o Fundamentals of Nursing 10th Edition Potter Perry Test Bank Chapter 1. Nursing Today MULTIPLE CHOICE 1. Contemporary nursing practice is based on knowledge generated through nursing theories. Florence Nightingales theory introduced the concept that nursing care focuses on: 1 Psychological needs 2 A maximal level of wellness 3 Health maintenance and restoration 4 Interpersonal interactions with the client ANS: 3 Florence Nightingale believed the role of the nurse was to put the clients body in the best state in order to remain free of disease or to recover from disease. Although Florence Nightingale may have addressed meeting the psychological needs of her clients, it is not the focus of her theory. The goal of Nightingales theory is to facilitate the bodys reparative processes by manipulating the clients environment. Florence Nightingale thought the human body had reparative properties of its own if it was cared for in a way to recover from disease. Her theory did not focus on achieving a maximal level of wellness. Florence Nightingale believed the nurse was in charge of the clients health. Although she interacted with her clients by reading to them, her theory of nursing care did not focus upon interpersonal interactions. DIF: A REF: 2 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 2. Nursing education programs in the United States may seek voluntary accreditation by the appropriate accrediting commission council of the: 1 National League for Nursing 2 American Nurses Association 3 Congress for Nursing Practice 4 International Council of Nurses ANS: 1 The National League for Nursing (NLN) is the professional nursing organization concerned with nursing education. The NLN provides accreditation to nursing programs that seek and meet the NLN accreditation requirements. The American Nurses Association (ANA) is concerned with the nursing profession and issues 2 affecting health care, including standards of care. The Congress for Nursing Practice is the part of the ANA concerned with determining the legal aspects of nursing practice, the public recognition of the importance of nursing, and the impact of trends in health care on nursing practice. The International Council of Nurses (ICN) is concerned about issues of health care and the nursing profession, including the provision of an international power base for nurses. DIF: A REF: 8 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 3. The minimum educational requirement for a nurse practitioner is: 1 Diploma in nursing 2 Masters in nursing 3 Doctorate in nursing 4 Baccalaureate in nursing ANS: 2 A masters degree is nursing is required to become a nurse practitioner. Diploma programs in nursing require 3 years of education after which the graduate may become a registered nurse, but not a nurse practitioner. Doctoral programs focus on the application of research findings to clinical practice. The doctoral degree is beyond the masters degree. The baccalaureate degree program generally requires 4 years of study in a college or university, after which the graduate may become a registered nurse, not a nurse practitioner. DIF: A REF: 8 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 4. A group that lobbies at the state and federal level for advancement of nursings role, economic interest, and health care is the: 1 State Board of Nursing 2 American Nurses Association 3 American Hospital Association 4 National Student Nurses Association ANS: 2 The American Nurses Association (ANA) hires lobbyists at the state and federal level to promote the advancement of health care and the economic and general welfare of nurses. State Boards of Nursing primarily focus on licensure of nurses within their own state. The American Hospital Association does not focus on nurses economic issues and the 5 living, including ones employment. A physical therapist is responsible for the patients musculoskeletal system. A physical therapist may use exercises as an intervention to improve a clients mobility. A respiratory therapist provides treatment to preserve or improve pulmonary function. A physicians assistant performs tasks usually done by physicians and works under the direction of a supervising physician. DIF: C OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 9. The Goldmark Report concluded that: 1 Nursing roles and responsibilities required clarification 2 A theory-based curriculum was necessary for accreditation 3 Nursing education programs must be affiliated with universities 4 Increased financial support should be provided for nursing education ANS: 4 In 1923 the Goldmark Report identified the need for increased financial support to university- based schools of nursing. The National Commission on Nursing and Nursing Education Report of 1965 recommended that nursing roles and responsibilities be clarified in relation to other health care professionals. In 1975 the National League for Nursing required theory-based curriculum for accreditation. The Brown Report of 1948 concluded that all nursing education programs should be affiliated with universities and should have their own budgets. DIF: A REF: 3 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 10. In 1893 Lillian Wald and Mary Brewster made significant contributions to the nursing profession through their work involving the: 1 Henry Street Settlement in New York 2 First training school in Toronto, Canada 3 Training school at Johns Hopkins in Baltimore 4 Development of the American Journal of Nursing ANS: 1 In 1893 Lillian Wald and Mary Brewster opened the Henry Street Settlement, which was the first community health service for the poor. The first nurses training school in Canada was founded in St. Catherines, Ontario, in 1874. 6 In 1894 Isabel Hampton Robb was the first superintendent of the Johns Hopkins Training School in Baltimore, Maryland. Isabel Hampton Robb was one of the original founders of the American Journal of Nursing. DIF: A REF: 3 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 11. To obtain a certification in a specialty area, the nurse will have to complete: 1 A request for state approval 2 A graduate degree in nursing 3 An examination and the minimum practice requirements 4 A general examination given to all nurses seeking certification ANS: 3 Set minimum practice requirements are based on the certification the nurse is seeking. After passing the initial examination, the nurse maintains certification by ongoing continuing education and clinical or administrative practice. Individual states do not grant certification by request. Certification in a specialty area requires passing the examination for certification in that area and meeting minimum practice requirements. A masters degree in nursing is not required for certification in a specialty area. A specialized examination is given according to the specific area of nursing practice in which certification is being sought. DIF: A REF: 9 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 12. In the ANA Standards of Professional Performance, which one of the following is a specific measurement criterion for The nurses decisions and actions on behalf of clients are determined in an ethical manner? 1 Acts as client advocate 2 Participates in the collection of client data 3 Seeks experiences to maintain clinical skills 4 Consults with appropriate health care providers ANS: 1 As a client advocate, the nurse protects the clients human and legal rights and provides assistance in asserting those rights if the need arises. Performing in the role of patient advocate fulfills a measurement criterion for the professional performance standard of ethics. Participating in data collection is a measurement criterion for the professional performance 7 standard of quality of practice. The nurse who seeks experiences to maintain clinical skills is fulfilling a measurement criterion for the professional performance standard of education. Consulting with health care providers is a measurement criterion for the professional performance standard of collaboration. DIF: A REF: 7 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 13. In looking at the nineteenth century, the growth of professional nursing was stimulated by: 1 The Civil War 2 Federal legislation 3 Florence Nightingale 4 The womens suffrage movement ANS: 1 The Civil War stimulated the growth of nursing in the United States. Nurses were in demand to tend to the soldiers of the battlefield. Throughout history, nurses and their professional organizations have lobbied for health care legislation to meet the needs of clients. However, legislation was not responsible for the growth of nursing in the nineteenth century. Although Florence Nightingale had great impact on the practice of nursing, she was not the cause for the growth of nursing in the United States during the nineteenth century. The womens movement has encouraged nurses to seek greater autonomy and responsibility in providing care, and has caused female clients to seek more control of their health and lives. The womens movement was not responsible for the growth of nursing in the nineteenth century. DIF: A REF: 3 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 14. Which of the following educational activities is an example of in-service education? 1 A workshop given at a nursing convention on malpractice 2 A program on new cardiac medications provided at a local hospital 3 Credit courses in communication offered at the community college 4 Noncredit courses on nursing issues available through the internet ANS: 2 10 TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance/Programs 17. The nurse is best able to provide quality care that benefits both client and family by: 1 Incorporating caring into the practice 2 Making the client the center of the practice 3 Integrating the science and art of nursing into the practice 4 Being knowledgeable of the institutions standards of practice ANS: 3 Nursing is an art and a science. As a professional nurse you will learn to deliver care artfully with compassion, caring, and a respect for each clients dignity and personhood. As a science, nursing is based on a body of knowledge that is continually changing with new discoveries and innovations. When you integrate the science and art of nursing into your practice, the quality of care you provide to your clients is at a level of excellence that benefits clients and their families. Caring is one part of the art of nursing. While the client is the focus of nursing practice, this focus is not the main contributor to quality care. Standards of care provide guidelines for the delivery of client care. Awareness of the standards does not guarantee quality care. DIF: C REF: 2 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 18. Which of the following statements best reflects Nightingales nursing philosophy on health maintenance and restoration? 1 Did all the clients eat a good breakfast? 2 What is the client rating his pain level after his medication? 3 Have any clients developed a nosocomial infection last month? 4 Is anyone interested in volunteering to mentor our new graduates? ANS: 3 Florence Nightingale studied and implemented methods to improve battlefield sanitation, which ultimately reduced illness, infection, and mortality (Cohen, 1984). Today nurses are active in determining the best practices for skin care management, pain control, nutritional management, and care of older adults. Infection control and its impact on disease prevention was a major outcome of her contributions to nursing. Awareness of the connection between hospital-acquired infections (nosocomial) and nursing practice is the best example of her nursing philosophy. 11 Nutritional management and its impact on client health, while important does not reflect the best option offered. Pain management while a vital client concern does not represent the best option offered While volunteering is certainly reflected in Nightingales practice it is not the best option offered. DIF: C REF: 2-3 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance/Disease Prevention 19. The twentieth century is recognized for which of the following nursing concepts? 1 Code of Nursing Ethics 2 Hospital-based nursing care 3 Specialized nursing textbooks were adopted. 4 Formalized university-based nursing education ANS: 4 In the early twentieth century a movement toward a scientific, research-based defined body of nursing knowledge and practice was evolving. Nurses began to assume expanded and advanced practice roles. Mary Adelaide Nutting was instrumental in the affiliation of nursing education with universities. In 1990 the American Nurses Association established the Center for Ethics and Human Rights. Nursing in hospitals expanded in the late nineteenth century. Isabel Hampton Robb helped found the Nurses Associated Alumnae of the United States and Canada in 1896. This organization became the American Nurses Association (ANA) in 1911. She authored many nursing textbooks, including Nursing: Its Principles and Practice for Hospital and Private Use (1894), Nursing Ethics (1900), and Educational Standards for Nurses (1907), and was one of the original founders of theAmerican Journal of Nursing (AJN). DIF: A REF: 4 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment 20. The best example of the impact of the womens movement on health care is: 1 Improvement in breast cancer survival rates 2 Insurance coverage for well-woman check-ups 3 Women subjects to be included in all appropriate health research projects 4 A single, teenage mother receiving Women, Infants, and Children (WIC) benefits ANS: 3 12 The womens movement brought about many changes in society as women increasingly demanded economic, political, occupational, and educational equality. As a result, there is greater sensitivity to the health care needs of women and the role of women in health care research. There are emerging health care specialties dealing with the needs of women. These new specialties expand from the traditional obstetrical specialty and address issues ranging from well- womens examinations, to oncological subspecialties, to the management of menopause. Because of the prior lack of female subjects in biomedical research, the federal government now requires studies to routinely include women in research, unless specific exception criteria are met. For example, research focusing on management of prostatic cancer is an exception. Improved survival rates for female-oriented cancers is evident because of emphasis being placed on research. While important, increased insurance coverage is not the best option available because this action would be directly driven by research findings. While important, increased federal funding for female-oriented benefits does not represent the best option available because this action would be directly driven by research findings. DIF: C REF: 4 OBJ: Analysis TOP: Nursing Process: Comprehension MSC: NCLEX test plan designation: Health Promotion and Maintenance 21. The human rights movement most directly impacts nursing practice because: 1 Nurses act as advocates for all clients 2 Clients require someone to focus on their needs 3 Caring for clients is the focus of nursing practice 4 Everyone deserves to be treated fairly and with respect ANS: 1 Client advocacy is a nursing responsibility. The human rights movement changed the way society views the rights of all of its members, including minorities, clients with terminal illness, pregnant women, and older adults. Many groups have special health care needs, and nursing responds by respecting the human rights of all clients and their right to quality care. Nurses advocate the rights of all clients. Clients do require someone to focus on their needs; advocacy is a responsibility of the nurse but the concept of the nurse as an advocate was established well before the human rights movement. Caring for clients is the focus of nursing practice, but caring physically and emotionally for a client as a nursing responsibility was established well before the human rights movement. Everyone deserves to be treated fairly and with respect. The realization of that truth was impacted by the human rights movement; however, this option does not directly relate to nursing. DIF: C REF: 4-5 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Coordinated Care 22. Nurses are caring for clients from a variety of cultures primarily as a result of: 15 5 Providing literature on smoking cessation to client families 6 Presenting a nursing workshop on the care of diabetic ulcers ANS: 1, 2, 4, 5 Nursing responds to this greater concern for health promotion by providing programs in the community such as health fairs and wellness programs; educational programs for specific diseases; and client and family teaching activities in hospitals, clinics, primary care facilities, and other health care settings. While admirable, organizing a benefit for cancer research is not an activity directed towards health promotion and wellness but rather towards research that will benefit the population as a whole rather than specific individuals. Presenting a workshop on a specific nursing intervention is not an activity directed toward health promotion and wellness but rather towards professional development of the nurses. DIF: A REF: 5 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance/Programs 2. Changes in recent population demographics that have impacted the delivery of nursing care include the following: (Select all that apply.) 1 Increased birth rates 2 Increased life expectancy 3 Decreasing rural population 4 Expanding urban settlement 5 Advances in medical modalities 6 Availability of free public education ANS: 2, 3, 4 Demographic changes affect the population. Changes influencing health care in recent decades include the population shift from rural areas to urban centers; the increased life span; the higher incidence of chronic, long-term illness; and the increased incidence of diseases such as alcoholism and lung cancer. Nursing responds to such changes by exploring new methods to provide care, by changing educational emphases, and by establishing practice standards. Recent birth rates have declined. Advances in medical modalities and availability of free public education do not reflect changes in population demographics but rather health care advances and social services. Chapter 2. Health Care Delivery System MULTIPLE CHOICE 1. Regulatory interventions were initiated to reduce the rise in health care costs. These interventions include: 16 1 Prospective payment systems 17 2 State limits on health care fees 3 Federal guidelines for treatment 4 Court review of insurance coverage ANS: 1 As a means to reduce health care costs, in 1983 Congress established the prospective payment system in which hospitals are reimbursed a set dollar amount for each diagnosis-related group, regardless of the length of stay or use of services in the hospital. State limits on health care fees have not been used nationwide to reduce health care costs. Federal guidelines for treatment have not been used to reduce the cost of health care. Rather, the focus has been on financial reimbursement. Court review of insurance coverage has not been a primary intervention to lower health care costs. DIF: A REF: 16 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Management of Care 2. Levels of prevention are used by the nurse to provide a framework or guide for nursing interventions. Focus is based on the clients needs and the care or service that is provided. An example of a true health promotion service is a(n): 1 Aerobic dance class 2 Immunization clinic 3 Diabetic support group 4 Smoking cessation clinic ANS: 1 Examples of health promotion activities include exercise classes, prenatal care, well-baby care, nutrition counseling, and family planning. An immunization clinic is an example of an illness prevention service. A diabetic support group may be an example of a rehabilitation service to adapt to a change in lifestyle. A smoking cessation clinic may be a part of rehabilitation or offered as an illness prevention service. DIF: A REF: 19 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Management of Care 3. There are many types of health care delivery agencies. An example of a secondary level care agency is a: 1 School 20 under contract. Enrollees are limited to a list of preferred hospitals, physicians, and providers. An enrollee pays more out-of-pocket expenses for using a provider not on the list. A Medicare HMO is the same as a managed care organization (all care provided by a primary care physician) but designed to cover costs of senior citizens. Private insurance is the traditional fee-for-service plan where payment is computed after services are provided based on the number of services used. Third-party payment is when an entity (other than the client or health care provider) reimburses health care expenses. Third-party payers include insurance companies, governmental agencies, and employers. DIF: A REF: 18 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Management of Care 6. The Medicaid insurance program is best described as: 1 Acute care hospital insurance for the older adult population 2 A funded health care program for older and disabled persons 3 A state-regulated health care program for persons of low income 4 A fee-for-service insurance plan that supports preventive health care ANS: 3 Medicaid is a federally funded, state-operated program of medical assistance to people with low incomes. Individual states determine eligibility and benefits. This option describes Medicare. This option describes Medicare Part A. This option does not describe Medicaid. DIF: A REF: 18 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Management of Care 7. Quality health care is an innovative approach to delivering health care. The major factor for its success is that it: 1 Focuses on the nursing process 2 Uses outcomes to manage client care 3 Is used exclusively in the acute care setting 4 Allows a high degree of flexibility delivering the care ANS: 2 Health care providers are defining and measuring quality in terms of outcomes. An outcome is a 21 measure of what actually does or does not happen as a result of a process of care. 22 The focus in quality health care is on the outcome, not the process. Quality health care is not used exclusively in the acute care setting. It may be used in various health care settings. Because quality health care is based on achieving outcomes, it does not allow a high degree of flexibility for the nurse in delivering care. DIF: A REF: 27 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Management of Care 8. Case management is one strategy for coordinating health care services. What best describes this caregiving approach? 1 Continuity of care is the primary concern. 2 This focus of care may be more expensive. 3 The physician is the coordinator of client care. 4 It is designed to provide minimal to moderate levels of care. ANS: 1 With the case management model of care, the case manager coordinates the efforts of all disciplines to achieve the most efficient and appropriate plan of care. Continuity of care is of primary importance. If the efforts of all disciplines are well managed, repetition or delays may be avoided with a resultant shortened hospital stay. Therefore this focus of care may not be more expensive. The physician may or may not be the coordinator of client care. The case manager typically is a nurse or social worker. Case management is not entirely based on the level of care required. DIF: A REF: 21 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Management of Care/ Case Management 9. The payment mechanism that Medicare uses within its health care financing is: 1 Capitation 2 Fixed payments 3 Direct contracting 4 Prospective payment ANS: 2 Inpatient hospital services for Medicare clients are reimbursed a set amount for each DRG, regardless of the clients length of stay or use of services in the hospital. Capitation is the payment mechanism in which providers receive a fixed amount per enrollee of a 25 MSC: NCLEX test plan designation: Safe, Effective Care Environment/Management of Care 26 12. Which of the following is an appropriate referral for an older client who requires some assistance with daily activities within a partially protective environment? 1 Respite care 2 Extended care 3 Assisted living 4 Rehabilitative care ANS: 3 The appropriate response is assisted living. A group of residents live together, each resident having his or her own room, yet sharing dining and social activity areas. Respite care is a service that provides short-term relief for persons providing home care to the ill or disabled. An extended care facility provides intermediate medical, nursing, or custodial care for clients recovering from acute or chronic illness or disabilities. Rehabilitative care includes physical, occupational and speech therapy, and social services to help restore clients to their fullest ability. DIF: A REF: 20 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Management of Care 13. Discharge planning for clients begins: 1 After a diagnosis has been established 2 Once the long-term needs are identified 3 Upon admission to a health care facility 4 When the acute care therapies are completed ANS: 3 Discharge planning should begin at the time of admission to the hospital, using the strengths and resources of the client, providing resources to meet the clients limitations, and focusing on improving the clients long-term outcomes. The clients diagnosis does not have to be established before discharge planning can begin. Discharge planning should include preparation for long-term needs of the client. Acute care therapies may impact a clients discharge and should be a part of the plan from the beginning. DIF: A REF: 23 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment/Management of Care 14. A client states that she does not understand managed care organization (MCO) health insurance. The nurse responds most appropriately by explaining that the MCO: 27 1 Reimburses nursing home funding 30 3 Long-term care insurance 4 An extended care faculty ANS: 2 Medicaid is a federally funded, state-operated program that provides (1) health insurance to low- income families and (2) health assistance to low-income people with long-term care (LTC) disabilities. Chapter 3. Community-Based Nursing Practice MULTIPLE CHOICE 1. The student nurse is investigating different types of practice settings. In looking at community health nursing, the student recognizes that it: 1 Is the same as public health nursing 2 Focuses on the incidence of disease 3 Requires graduate-level educational preparation 4 Includes direct care and services to subpopulations ANS: 4 Community health nursing strives to safeguard and improve the health of populations in the community as well as providing direct care services to subpopulations within a community. Public health nursing is concerned with trends and patterns influencing the incidence of disease within populations. A community health nurse may be involved in direct client care for disease within a community. Public health nursing focuses on the needs of populations. Community health nursing has a broader focus, with an emphasis on the health of a community. The community health nurse merges public health knowledge with nursing theory. The community health nurse considers the needs of populations and is prepared to provide direct care services to subpopulations within a community. Nurses who become expert in community health practice may have advanced nursing degrees, yet the baccalaureate-prepared generalist also can become quite competent in formulating and applying population-focused assessments and interventions. DIF: A REF: 34 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment 2. As a community health nurse assisting the client and family with nutritional needs the nurse should first: 1 Identify for the client the best foods to buy 2 Purchase foods at the lowest cost for the client 3 Ask the client and family what they think they should eat 4 Provide information on stores with the most reasonable pricing 31 ANS: 3 32 With the goal of helping clients assume responsibility for their own health care, the community health nurse must assess a clients learning needs and readiness to learn within the context of the individual, the systems the individual interacts with, and the resources available for support. Asking the client about what foods he or she thinks should be eaten may help the nurse assess the clients level of knowledge regarding nutrition as well as the clients food preferences. It also enables the client to become a participant in his or her care. Telling the client what foods to buy does not encourage the client to assume responsibility for managing his or her health care. The nurse should first assess the resources available, and then encourage the client to do his or her own shopping. Providing information on food sources and stores with reasonable pricing may be appropriate after the nurse has determined what information the client requires to meet nutritional needs. DIF: C REF: 40 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 3. Which one of the following clients from a vulnerable population currently appears to be at the greatest risk? 1 A physically abused client in a shelter 2 A schizophrenic client in outpatient therapy 3 An older adult taking medication for hypertension 4 A substance abuser who shares drug paraphernalia ANS: 4 A client with substance abuse has health and socioeconomic problems. These clients frequently may avoid health care for fear of judgmental attitudes by health care providers and concern over being turned in to criminal authorities. An abused client in a shelter has sought protection so currently should be at less risk. Although considered to be a member of a vulnerable population, the older adult who takes medication for a chronic disease, such as hypertension, is taking measures to maintain health. A schizophrenic client in outpatient therapy is currently at less risk because he or she is receiving treatment. DIF: C REF: 36 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 4. A client with a history of a gastrointestinal disorder eats a well-balanced diet that keeps his GI symptoms suppressed. Which level of prevention corresponds to his dietary management? 1 Health promotion 2 Primary prevention 3 Tertiary prevention 35 4 Observing locations where services, such as water sanitation, are provided ANS: 4 When assessing the structure or locale of a community, the nurse should travel around the neighborhood or community and observe its design; the location of services, such as water and sanitation; and the locations where residents congregate. Collecting demographic data on age distribution would be an assessment of the communitys population. Visiting neighborhood schools to review health records is an example of assessing a social system within a community. Interviewing clients to determine the cultural composition of subgroups is an example of assessing the population within a community. DIF: A REF: 41 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 7. To facilitate change within a community, the nurse working as an effective change agent should: 1 Inform community members how to effectively manage their health needs 2 Work with clients and groups to select alternative health care sites and treatments 3 Formulate decisions for individual clients regarding their health care options 4 Provide instruction in the way the community should address health issues ANS: 2 As a change agent, the nurse seeks to implement new and more effective approaches to problems. The nurse creates change by working with and empowering individuals and their families to solve problems or to become instrumental in changing aspects affecting their health care. Telling community members how to manage their health care needs may meet resistance. It also does not enable clients and their families to take responsibility for their health care. Making decisions for clients does not enable individuals to assume responsibility for their health care decisions. The community-based nurse acting as a change agent may be an excellent resource for health information to members of the community. Ultimately; however, the community members will take an active role to create change for themselves and will assume responsibility for their health care decisions. DIF: A REF: 39-40 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 36 8. The client is being discharged from an acute care facility following a total hip replacement. She will need follow-up for her rehabilitation and exercise plan. In addition to a home health care nurse, what referral should be discussed? 1 Dietitian 2 Social worker 3 Physical therapist 4 Respiratory therapist ANS: 3 Directing clients to appropriate resources and improving continuity of care require the nurse to know those resources well. A physical therapist is responsible for the clients movement system and is likely to be needed following hip replacement surgery. A social worker may or may not be necessary. A dietitian may or may not be necessary. A respiratory therapist would not be necessary unless the client experienced a respiratory complication or had a preexisting respiratory condition. DIF: A OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 9. The nurse recognizes which of the following as the largest contributing factor for the rise in the need and use of home care? 1 Government funding of the home care setting has increased greatly. 2 Clients are more acutely ill when discharged from the acute care facility. 3 There are 7 days/week services for the elderly in home care agencies. 4 The existence of more single-income families has increased the need for their elderly relatives to receive care in the home. ANS: 2 Because hospital stays are being shortened to control health care costs, clients are returning home more acutely ill. This is the largest contributing factor for the rise in the need and use of home care. Government funding of home care is not the largest contributing factor for the rise in the need and use of home care. There are 7 days/week services for the elderly in a variety of settings, such as in acute care or long-term care, not just in the home care setting. Being able to provide daily services for the elderly in the home care setting is not the largest contributing factor for the rise in the need and use of home care. The existence of more single-income 37 families is not the largest contributing factor for the rise in the need and use of home care. DIF: C REF: Chapter 2, 22 OBJ: Analysis 40 thighs, a red rash on both neck and face, and poor personal hygiene, in addition to edema of the left ankle. The nurse should first realize that this client is at risk for: 1 Physical abuse and assault 2 Drug addiction relating to pain 3 Communicable immune disorders 4 Hospitalization due to mental disorder ANS: 1 When a client has a severe mental illness such as schizophrenia there are multiple health and socioeconomic problems you will need to explore. Many clients with pervasive mental illnesses are homeless or live in poverty. In addition, mentally ill clients are at greater risk of abuse and assault. This clients reported foot injury and observable bruising support the possibility of abuse/ assault. While drug abuse may be a consideration, it does not represent the best option offered for this item because there is not indication that the client is drug seeking. Contacting communicable diseases is a risk factor for such a client but it does not represent the best option offered for this item because there are several factors that may indicate abuse/assault. Hospitalization may be required but it does not represent the best option offered for this item because there is no indication that the client is experiencing a psychiatric crisis. DIF: C REF: 37 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 15. A community nurse has identified a need for educational programming among the residents of an assistive living facility dealing with osteoarthritis. The best example of such programming is: 1 Planning the best exercise program for you. 2 Recognizing how arthritis has affected your life. 3 Proper self administration of antiinflammatory medication 4 Be an informed consumerdont fall for false arthritis cures. ANS: 4 Thorough assessment and appropriate community based interventions provide an opportunity to improve the lifestyle and quality of life of older adults in general. The focus is on broad-based needs not specific client needs. Answer 4 offers information applicable to the entire resident population diagnoses with osteoarthritis. DIF: C REF: Chapter 2, 19 OBJ: Analysis TOP: Nursing Process: Planning/Implementation MSC: NCLEX test plan designation: Health Promotion and Maintenance 16. A homeless client has presented in the ED with a bacterial infection in a hand wound. The 41 nurse has cleansed and dressed the wound, and an initial dose of an antibiotic has been 42 administered. The client will need the antibiotic prescription filled and a dressing change in 3 days. In order to ensure that the client will receive the appropriate follow-up care, the nurse must first act as the clients: 1 Educator 2 Advocate 3 Caregiver 4 Counselor ANS: 2 Client advocacy perhaps is more important today because of the confusion surrounding access to health care services. Your clients often need someone to help them walk through the system, identify where to go for services and tell them how to reach the individuals with the appropriate authority, what services to request, and how to follow through with the information they received. The role of the educator is to help the client assume responsibility for his or her own health care. This client has been educated to the needs related to caring for the infection but needs the nurse advocate to assist with facilitating the care. As caregiver, the nurse manages and cares for the clients health. You apply the nursing process (see Unit III) in a critical thinking approach to ensure appropriate, individualized nursing care for specific clients and their families. This clients nursing care has been appropriated delivered and so that nursing role has been fulfilled. A counselor assists clients in identifying and clarifying health problems and in choosing appropriate courses of action to solve those problems. The client is first in need of assistance in dealing with the obstacles to the care of the identified probleminfection. DIF: C REF: 37-38 OBJ: Analysis TOP: Nursing Process: Implementation MSC: NCLEX test plan designation: Health Promotion and Maintenance 17. A nurse is discussing the need to use a specific cleansing agent when redressing an infected hand. The client prefers using, plain old soap and water. The nurse knows that the primary factor that will affect client compliance is: 1 The ease with which the client can use the special agent 2 The clients acceptance of the need for the specialized care 3 The availability and cost of the prescribed cleansing agent 4 The introduction of an incentive to prompt client to comply ANS: 2 Client must perceive the innovation or change as more advantageous than other alternatives or they will not make the change. Client education is essential in bringing about the change in attitude necessary for change. While the client is more likely to adapt the change if it is perceived as being easy, it is not the primary factor in achieving client compliance provided among the 45 2 The elderly gentleman who fell while disembarking from a bus 46 47 3 The child of itinerant workers who has a developed asthma 4 A client diagnosed with HIV who recently lost her insurance 5 A 15-year-old who was injured while at a public swimming pool 6 A retired service veteran who has a chronic psychiatric disorder ANS: 1, 3, 4 Community-based health care occurs outside traditional health care institutions, such as hospitals. It provides services for acute and chronic conditions to individuals and families with in the community (Stanhope and Lancaster, 2006). Some of these problems include an increase in homeless and immigrant populations, an increase in sexually transmitted diseases, underimmunization of infants and children, and life-threatening diseases (e.g., clients living with HIV and other emerging infections). All of these clients possess risk factors that are community based DIF: C REF: 40 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 2. A nurse working with clients at or below the poverty level recognizes that the life expectancy of these clients is lower than the general population because of: (select all that apply.) 1 Inadequate nutritional diets 2 High-risk work environments 3 Hazardous living environments 4 Addictive and abusive lifestyles 5 Predisposition to chronic diseases 6 Ineffective decision making abilities ANS: 1, 2, 3, 4 People who live in poverty are more likely to live in hazardous environments, work at high-risk jobs, eat less nutritious diets, abuse substances, and have multiple stressors in their life. When researchers compared the life expectancies of European Americans and African-Americans, the causes of the differences were related to low socioeconomic status rather than ethnicity. Predisposition to chronic disease in part is genetic in nature and research has confirmed no such link between poverty and chronic disease. Decision-making ability is not the only factor affecting decision making. Poverty negatively affects the individuals ability to access recourses and adds stressors such as finding shelter that can alter the decision-making process. 50 MSC: NCLEX test plan designation: Health Promotion and Maintenance 51 3. Which one of the four linkages of interest in the nursing paradigm refers to factors in the home or school? 1 Person 2 Health 3 Nursing care 4 Environment ANS: 4 Environment/situation includes all possible conditions affecting the client and the setting in which health care needs occur, such as the home, school, workplace, or community. Person refers to the recipient of nursing care, including individual clients, families, and the community. Health is the goal of nursing care. Nursing care refers to the diagnosis and treatment of human responses to actual or potential health problems (ANA, 1995). DIF: A REF: 45 OBJ: Knowledge TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 4. The nurse is working within a health care system that employs Neumans theory. A client is having difficulty breathing and requires oxygen and medication. Within Neumans theory, the nurse approaches the client to: 1 Achieve the 14 basic needs 2 Promote attainment of biological self-care requisites 3 Assist in physiological adaptation to internal changes 4 Strengthen the line of defenses at the secondary level of prevention ANS: 4 Neumans framework for practice included nursing actions as primary, secondary, or tertiary levels of prevention in caring for clients holistically. Secondary prevention strengthens internal defenses and resources by establishing priorities and treatment plans for identified symptoms. In Hendersons theory, nurses help the client to perform 14 basic needs. The goal of Orems theory is to promote attainment of self-care. Roys theory focuses on adaptation. 52 DIF: A REF: 49 OBJ: Comprehension 55 Determining a clients attitudes toward health behaviors follows a health-and-wellness theoretical model. Focusing on the response of a client to the process of growth and development is consistent with developmental theories. DIF: A REF: 47 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 7. While working on a postoperative unit, the nurse is applying the elements of the self-care theory. The nurse who assists the client to manage or attain self-care in wound management is using the theory developed by: 1 Imogene King 2 Dorothea Orem 3 Virginia Henderson 4 Florence Nightingale ANS: 2 The goal of Orems theory is to help the client perform self-care. The goal of Kings theory is to use communication to help the client reestablish positive adaptation to the environment. The goal of Hendersons theory is to work independently with other health care workers assisting the client to gain independence as quickly as possible. The goal of Nightingales theory is to facilitate the bodys reparative processes by manipulating the clients environment. DIF: A REF: 50 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 8. Martha Rogers theory has a framework for practice that includes the: 1 Manipulation of the clients environment 2 21 nursing problems within 4 major client needs 3 Seven categories of behavior and behavioral balance 4 Unitary human being in continuous interaction with the environment ANS: 4 56 The framework for practice according to Martha Rogers theory is the unitary human continuously changing and coexisting with the environment. Nightingales theory includes manipulation of the clients environment (i.e., appropriate noise, nutrition, hygiene, light, comfort, socialization, and hope) in the framework for practice. Abdellahs nursing theory includes 21 nursing problems within 4 major client needs in the framework for practice. Johnsons theory includes seven categories of behavior and behavioral balance in the framework for practice. DIF: A REF: 50 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 9. The nurse plans to apply a theory that focused on stress reduction. A theory proposed by which one of the following individuals should be selected? 1 Parse 2 Peplau 3 Neuman 4 Orlando ANS: 3 Stress reduction is the goal of the systems model of nursing practice according to Neumans theory. Parses theory focuses on indivisible beings and the environment co-creating health. Peplaus theory focuses on the interpersonal process as the maturing force for personality. Orlandos theory focuses on the interpersonal process to alleviate distress. DIF: A REF: 49 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 10. A similarity between the theories of Leininger and of Benner and Wrubel is: 1 Caring as a central focus 2 The clients adaptation to demands 3 An emphasis on the maximum level of wellness 4 Dynamic interpersonal communication ANS: 1 57 Leininger states that care is the essence of nursing and the dominant, distinctive, and unifying feature of nursing. Caring is also central to the theory of Benner and Wrubel, depicting personal concern as an inherent feature of nursing practice. The theories of Roy and Johnson focused on the clients adaptation to demands. Neumans theory places emphasis on achieving a maximum level of wellness. Abdellahs theory also addressed the person as a whole. Kings theory and Peplaus theory share a similarity with a focus on interpersonal communication. DIF: A REF: 50-51 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 11. The nurse is working with a client diagnosed with multiple sclerosis. The goal is that the client will be capable of living independently. The nursing theory that best supports this clients situation is: 1 Orems theory 2 Neumans theory 3 Abdellahs theory 4 Hendersons theory ANS: 1 According to Orem, the goal of nursing is to increase the clients ability to independently meet biological, psychological, developmental, or social needs. Neumans theory is concerned with the whole person. According to Neuman, the focus of nursing is on the variables affecting the clients response to a stressor. Abdellahs theory emphasizes the delivery of nursing care for the whole person. According to Henderson, nurses help clients to perform 14 basic needs. DIF: A REF: 50 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 12. While the nurse realizes that the definition of health is unique to the client, the most universal factor is that health is: 1 Dynamic and ever-changing 2 Affected and managed by the nurse 3 Determined by internal and external forces 4 Perceived and defined by the individual 60 4 Preparing discharge teaching to reinforce proper finger-stick technique ANS: 4 If a nurse uses Orems theory in practice, the nurse assesses and interprets the data to determine the clients self-care needs, self-care deficits, and self-care abilities in the management of a disease. The theory then guides the design of individualized nursing interventions. While the other interventions are appropriate and will ultimately affect effective client self-care/ management of the diabetes, they are not the correct option because they are not directly involved in determining client self-care needs. DIF: C REF: 50 OBJ: Analysis TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 15. Swansons theory of caring is best demonstrated when the nurse: 1 Demonstrates efficiency when performing ordered treatments 2 Offers to stay with the client during a painful bedside procedure 3 Administers the clients pain medication promptly when requested 4 Frequently updates a family regarding a clients status during surgery ANS: 2 Swansons theory of caring defines five components of caring: knowing, being with, doing for, enabling, and maintaining belief. These components provide a foundation of knowledge for the direction and delivery of caring nursing practice. This theory provides a basis for identifying and testing nurse caring behaviors to determine if caring improves client health outcomes. Offering to stay with the client is an intervention directly reflected of being with the client. Efficiency is a component of caring but it is not the best option available because it is not exclusively directed toward Swansons theory. Administering pain medication promptly reflects effective nursing care as well as a clients right. It is a component of caring but it is not the best option available because it is not exclusively directed towards Swansons theory. Effective nursing care and caring for the family is important, but it is not the best option available because it is not directed towards the client. DIF: C REF: 46 OBJ: Analysis 61 TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 62 16. Which of the following responses observed in a client recently diagnosed with lung cancer is most directly addressed by the Neuman System Model? 1 The client asks for a consult with the hospital clergy. 2 The client is observed crying after his family has left for the day. 3 The client asks for pictures of his children to be brought to him in the hospital. 4 The client is heard saying, I trust my health team, and Ill do what they suggest. ANS: 2 Examples of phenomena of nursing include caring, self-care, and client responses to stress. In the Neuman Systems Model (1995), phenomena include all client responses, environmental factors, and nursing actions. Crying is reflective of a clients response to stress to a second level need (Maslows) and so is directly related to Neumans model. While consulting with clergy is reflective of a client need, it is higher on Maslows hierarchy and so not the best option available. While requesting family photos is reflective of a client need, it is higher on Maslows hierarchy and so not the best option available. The client stating that he/she will trust the health team is reflective of a client response, it is less reflective of a need and so not the best option available. DIF: C REF: 49 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 17. A client diagnosed with type 2 diabetes mellitus reports poor glucose control since starting her new stressful job. The nurse uses Neumans theory to focus on the: 1 Identification of new stressors and improve dietary choices 2 Acquisition of appropriate interpersonal communication skills 3 Learning of effective coping methods and relaxation techniques 4 Implementation of both aerobic and anaerobic exercise routines ANS: 1 65 3 A homeless clients fear that his belongings will be stolen while he is hospitalized 66 4 An asthmatic clients concern regarding the lack of insurance to pay for her medications ANS: 4 The second level of Maslows hierarchy includes safety and security needs, which involve physical and psychological security. The clients concern about securing the medication needed to minimize the potential for breathing problems has the highest priority of the options available. The fourth level encompasses esteem and self-esteem needs, which involve self-confidence, usefulness, achievement, and self-worth. Although important, a clients concern regarding her appearance would not have priority over the other options available. The third level contains love and belonging needs, including friendship, social relationships, and sexual love. Although important, a clients reaction to the loss of a loved one does not have priority over the other options available. The second level of Maslows hierarchy includes safety and security needs, which involve physical and psychological security. While the clients concern for the safety of his belongs is on the same level, it does not take priority over the client whose concern relates to potential breathing problems. DIF: C REF: Chapter 6, 72 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 21. Which of the following statements best expresses the primary goal of nursing practice? 1 To identify client needs in order to facilitate improved health and wellness 2 To tend to the physical and psychosocial needs of both the client and his family 3 To provide effective, research-based nursing care specifically tailored to each clients needs 4 To perform the required treatments and interventions directed towards client recovery from illness ANS: 3 Providing excellent, evidenced-based nursing care is an expectation for all nurses and the care they provide. Although other options are reflective of an appropriate nursing outcome, they are not the best descriptions of nursings primary goal. Chapter 5. Evidence-Based Practice 67 MULTIPLE CHOICE 70 3. The expected research role for the baccalaureate-prepared nurse is to: 1 Assume the role of a clinical expert 2 Acquire funding for research projects 3 Identify clinical nursing problems in practice 4 Develop methods of inquiry relevant to nursing ANS: 3 Nurses with a baccalaureate degree are prepared to read research critically and use existing standards to determine the readiness of the findings for clinical practice. They also participate in research activities through identification of clinical problems in nursing practice. Nurses with a masters degree assume the role of clinical expert and are able to create a climate in which research-based change can be implemented into practice. Doctorally-prepared nurses are responsible for acquiring funding for research from public and private sources. Doctorally-prepared nurses are prepared to design studies independently including the development of methods of inquiry relevant to nursing. PTS: 1 DIF: A REF: 55 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment 4. When a nurse researcher distributes an explanatory information sheet to subjects solicited for participation in her study, which of the following ethical principles that guide research is this researcher using? 1 Informed consent 2 Freedom from harm 3 Protection of subjects 4 Confidentiality of subjects ANS: 1 As a component of informed consent, research subjects are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment. Research aspects such as minimizing the risk to participants, allowing reasonable risk to participants in relation to anticipated benefits, and monitoring the research to ensure the safety of participants follow the ethical standard of freedom from harm. In the case of research, institutions have Health Information Portability and Accountability Act 71 (HIPAA) regulations that identify how protected health information of research subjects is to be 72 managed. The nurse researcher who follows HIPAA guidelines is following the principle of protection of subjects. Confidentiality guarantees that any information provided by the subject will not be reported in any manner that identifies the subject and will not be made accessible to people outside the research team. Describing how confidentiality is maintained is a component of informed consent. PTS: 1 DIF: A REF: 63 OBJ: Comprehension TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Safe, Effective Care Environment 5. The nurse takes on ethical responsibilities when conducting research with human subjects. Which of the following violates an ethical responsibility associated with informed consent? 1 Adhering to verbal and written agreements 2 Using data obtained before the initiation of the study 3 Explaining the possibility of unknown risks when appropriate 4 Providing alternatives, including the right of refusal and standard practices ANS: 2 Using data obtained before the initiation of the study would be a breach of privacy because the participant has not yet given informed consent for use of those data. Adhering to verbal and written agreements is central to informed consent and the implementation of ethical research. One component of informed consent is the inclusion of informing the research subject of the potential harm and benefits. This would include the risks to the subject (including financial risks) and the potential for no benefit. Within the consent document, the researcher must outline alternative methods of treatment and alternatives to participation, including the right to withdraw from the study at any given time. PTS: 1 DIF: A REF: 63 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment 6. Nurses need to become familiar with the elements of a research publication. A brief explanation of the type of measurement to be used is found in which section of a study? 1 Results 2 Methods 3 Conclusion 75 2 Evaluation research 76 3 Correlational research 4 Experimental research ANS: 3 Correlational research explores the interrelationships among variables of interest (such as factors affecting client comfort) without any active intervention by the researcher. Historical research is designed to establish facts and relationships concerning past events. It would not use prospective groups of clients. Evaluation research tests how well a program, practice, or policy is working. In experimental research, the investigator controls the study variable and randomly assigns subjects to different conditions. PTS: 1 DIF: A REF: 62 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment 9. Which of the following research topics best lends itself to the experimental research process method? 1 The effects of therapeutic touch on a geriatric client diagnosed with Alzheimers disease 2 Prioritizing three nursing diagnoses for a newly admitted client with diabetes mellitus 3 Employing humor as an intervention with clients who are recovering from orthopedic surgery 4 Determining the blood pressure patterns of a client who recently experienced a cerebrovascular accident (i.e., stroke) ANS: 3 In experimental research, the investigator controls the study variable (use of humor) and randomly assigns subjects to different conditions (those who receive humor as an intervention, and those who do not). The effect of therapeutic touch on a geriatric client with Alzheimers disease lends itself to the nursing process as a nursing intervention to perhaps assist a client in meeting a goal of preventing social isolation. To use the experimental research process, there would have to be other clients involved (i.e., a group of clients with Alzheimers disease who receive therapeutic touch, and a group of clients with Alzheimers disease who do not receive therapeutic touch) to determine whether or not therapeutic touch had any effect. Prioritizing nursing diagnoses for client care is an example of using the nursing process. 77 Determining the blood pressure patterns of a client who recently had a cerebrovascular accident is a part of the assessment phase of the nursing process. In contrast to an experimental research study, no variable is being controlled by the nurse. PTS: 1 DIF: A REF: 62 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment 10. The nurse is looking at different strategies for learning and incorporating new information into practice. A strategy that uses problem-solving is demonstrated by: 1 Repeatedly practicing vital signs until competence is achieved 2 Seeking information from the nurse manager on the clients status 3 Reviewing Maslows hierarchy either in a textbook or on the internet 4 Trying different types of colostomy dressings for maximum therapeutic effect ANS: 4 Trying various ways of resolving clients health care needs or evaluating health care products, as in trying different types of colostomy dressings for maximum effect, is an example of the problem-solving strategy for knowledge acquisition. Practicing skills is an example of gaining experience to increase ones knowledge. Information-seeking is a strategy used to obtain knowledge from experts in a particular field. Reviewing Maslows hierarchy in a reference textbook or on the internet is another example of acquiring knowledge through information-seeking. PTS: 1 DIF: A REF: 55 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment 11. A nurse researcher has completed a study involving the use of intravenous analgesics for postsurgical discomfort. The description of the 16 clients used for the study would best be written in which part of the research report? 1 Results section 2 Methods section 3 Discussion section 4 Introduction section 80 1 What creates an increase in stress levels? 2 How often does the stress reaction occur? 3 What does guided imagery mean to clients? 4 If guided imagery is used, will stress levels be reduced? ANS: 4 Questioning whether stress will be reduced is an example of a predictive type of question because it connects stress reduction with the use of guided imagery. Asking what increases stress explores factors that impact a phenomenon. It is not a predictive type of question. Asking how often stress increases does not predict any outcome, but rather focuses on frequency of a response, which could be used in data collection. Asking what guided imagery means does not predict any type of outcome, but rather explores meaning in order to gain understanding. PTS: 1 DIF: A REF: 55 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Safe, Effective Care Environment 14. A nurse routinely uses therapeutic touch when caring for postoperative clients with incisional pain. Occasionally a client will show reluctance when the intervention is offered. The nurses best response in such a situation is to: 1 Research for alternative interventions that will be better received by the client 2 Suggest that the client allow the intervention just once before making a final decision 3 Respect the clients wishes and rely on pain medication to help with managing the pain 4 Inform the client that the intervention has been found to be effective during several research projects ANS: 1 Evidence-based practice is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinicians expertise and client preferences and values in making decisions about client care. If the client is not receptive to an intervention, the best nursing response is to search for an alternative evidence-based therapy that 81 the client will accept. 82 Suggesting the client allow intervention once before making a decision may be considered as long as there is no pressure placed on the client to accept the intervention, but it is not the best option provided because there is no guarantee that the client will be receptive to the intervention, and the problem regarding incisional pain would then go unaddressed. Chapter 6. Health and Wellness MULTIPLE CHOICE 1. When formulating a definition of health, the nurse should consider that health, within its current definition, is: 1 The absence of disease 2 A function of the physiological state 3 The ability to pursue activities of daily living 4 A state of well-being involving the whole person ANS: 4 When formulating a definition of health, a person should consider the total person, as well as the environment in which the person lives. Health generally implies a state of well-being that is ultimately defined in terms of the individual. Health is considered to be more than merely the absence of disease. The definition of health has broadened beyond the physiological state to include mental, social, and spiritual well-being. An individual who has the ability to pursue activities of daily living may not define himself or herself as being healthy. Life conditions such as environment, diet, and lifestyle practices may negatively impact ones health long before the person is unable to perform activities of daily living. DIF: A REF: 69 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 2. Which one of the following is the main, overarching goal for Healthy People 2010? 1 Reduction of health care costs 2 Elimination of health disparities 3 Investigation of substance abuse 4 Determination of acceptable morbidity rates ANS: 2 Two overarching goals for Healthy People 2010 are (1) to increase quality and years of healthy 85 2 Active strategy 3 Health beliefs 4 Negative health behavior ANS: 1 Risk factors are anything that increases the vulnerability of an individual or group to an illness or accident. This client is identifying the physical risk factor of genetic predisposition to heart disease. An example of an active strategy would be weight reduction or smoking cessation, where the client is actively involved in measures to improve their present and future levels of wellness. Health beliefs are a persons ideas, convictions, and attitudes about health and illness. An example of a health belief would be if the client stated, Heart disease runs in our family. I know I will have heart disease anyway, so why exercise? A negative health behavior is a behavior that may negatively impact ones health. An example of a negative health behavior would be consistently drinking alcohol in excess. DIF: A REF: 77 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 5. A client is discharged following a heart attack. In using the Stages of Health Behavior Change as a guide, the nurse recognizes that the client is most likely to begin to accept information on diet changes and an exercise program during which stage? 1 Action 2 Preparation 3 Maintenance 4 Contemplation ANS: 4 During the contemplation stage, the client is considering a change within the next 6 months. The client may be ambivalent initially, but will more likely accept information as he or she develops more belief in the value of change. During the action stage, the client is actively engaged in strategies to change behavior. During the preparation stage, the client is making small changes in preparation for a change in the next month. At this point, the client believes advantages outweigh disadvantages in behavior change. During the maintenance stage, the client has sustained change over time. 86 DIF: A REF: 78 OBJ: Knowledge 87 TOP: Nursing Process: Planning MSC: NCLEX test plan designation: Health Promotion and Maintenance 6. When assessing the external variables that influence a clients health beliefs and practices, the nurse must consider his: 1 Income status 2 Religious practices 3 Educational background 4 Reaction to the heart disease ANS: 1 External variables influencing a persons health beliefs and practices include family practices, cultural background, and socioeconomic factors, such as income. Economic variables may affect a clients level of health by increasing the risk for disease and influencing how or at what point the client enters the health care system. A persons compliance with the treatment to maintain or improve health is also affected by economic status. Religious practices are one way that people exercise spirituality. Spirituality is considered to be an internal variable. Educational background is an internal variable that can influence the health beliefs and practices of a client. An example of an internal variable that can influence health beliefs and practices of a client includes emotional factors, such as the reaction to heart disease. DIF: A REF: 74 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 7. A paraplegic client is admitted for an electrolyte imbalance. Based on the levels of prevention, the client is receiving care at the level of: 1 Health promotion 2 Primary prevention 3 Tertiary prevention 4 Secondary prevention ANS: 4 The secondary prevention level focuses on early diagnosis and prompt treatment as well as disability limitations. Adequate treatment for the electrolyte imbalance is sought to prevent further complications. 90 Excessive sunbathing is a lifestyle risk factor for skin cancer. 91 Obesity is a physiological risk factor. Overcrowded housing is an environmental risk factor. An industrial-based occupation is an environmental risk factor. DIF: A REF: 77-78 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 10. In the Health Belief Model, the nurse recognizes that the focus is placed on the: 1 Basic human needs for survival 2 Functioning of the individual in all dimensions 3 Relationship of perceptions and compliance with therapy 4 Multidimensional nature of clients and their interaction with the environment ANS: 3 In the Health Belief Model, the nurse focuses on the relationship between a persons beliefs and health behaviors. By focusing on the clients perceptions of health, the nurse is better able to understand and predict how a client will comply with health care therapies. Basic human needs for survival is a component of Maslows hierarchy of needs model. The nurse who focuses on the functioning of the individual in all dimensions is following a holistic health model. In the health promotion model, the nurse focuses on the multidimensional nature of clients and their interaction with the environment. DIF: A REF: 70 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 11. The client who recently received a kidney transplant is worried about her husband since he has taken over the physical tasks of running their home. The client is in the process of adapting to a change in: 1 Body image 2 Self-concept 3 Illness behavior 4 Family dynamics ANS: 4 92 The effects of illness on the client and family have created a change in family dynamics. Family dynamics is the process by which the family functions, makes decisions, gives support to individual members, and copes with everyday changes and challenges. Body image is the subjective concept of physical appearance. The client did not express concerns regarding body image. Self-concept is a mental self-image of strengths and weaknesses in all aspects of personality. The client did not express a change in self-concept. Illness behavior refers to how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system. The client did not express change in illness behavior. DIF: A REF: 81 OBJ: Comprehension TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 12. Client assessment provides the nurse with necessary information for the development of an effective plan of care. When determining the influence of an internal variable on the clients health status, the nurse will specifically look for: 1 Anxiety level present 2 Family remedies used 3 Location and type of occupation 4 Available health insurance coverage ANS: 1 Emotional factors, such as the clients degree of anxiety, is an internal variable that can influence the clients health status. An example of an external variable that can influence the clients health status is the use of family remedies. Socioeconomic factors, such as location and type of occupation, are external variables that can influence the clients health status. Available health insurance coverage is an example of an external socioeconomic factor that can influence the clients health status. DIF: C REF: 73-74 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 13. A nurse understands that illness behavior means: 95 1 My blood cholesterol is only a little high. 2 No one in my family is susceptible to the flu. 3 Ill just avoid the food that causes the problem. 4 By losing weight my blood pressure may come down. ANS: 4 The third componentthe likelihood that a person will take preventive actionresults from the persons perception of the benefits of and barriers to taking action. Preventive action may include lifestyle changes, increased adherence to medical therapies, or a search for medical advice or treatment. The second component is the individuals perception of the seriousness of the illness. The first component of this model involves the individuals perception of susceptibility to an illness. Increased incidence of chronic disease processes. DIF: C REF: 70 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 16. The goal of Penders Health Promotion theory is best reflected in which of the following nursing interventions? 1 Suggesting the client experience a variety of exercise routines before settling on the one to adapt 2 Arranging for a client to attend a support group for individuals who also have severe burn scars 3 Playing soft, classical music when a client diagnosed with Alzheimers becomes physically agitated 4 Providing a client with a history of stress-induced respiratory problems with detailed explanations regarding her care ANS: 1 Health-promoting behaviors should result in improved health, enhanced functional ability, and better quality of life. According to the Basic Human Needs model, certain human needs are more basic than others; that is, some needs must be met before other needs (i.e., fulfilling the physiological needs before the needs of love and belonging). Self-actualization is the highest expression of ones individual 96 potential and allows for continual discovery of self. Maslows model takes into account individual experiences, always unique to the individual. 97 Nurses using the holistic nursing model recognize the natural healing abilities of the body and incorporate complementary and alternative interventions, such as music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery, because they are effective, economical, noninvasive, nonpharmacological complements to traditional medical care. The holistic nursing model considers the emotional and spiritual well-being, as well as other dimensions of an individual, as important aspects of physical wellness. DIF: C REF: 71 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance 17. The nurse knows that the greatest internal factor to consider when educating an adult client concerning health promotion activities is the clients: 1 Emotional wellness 2 Developmental stage 3 Professed spirituality 4 Intellectual background ANS: 4 A persons beliefs about health are shaped in part by the persons knowledge, lack of knowledge, or incorrect information about body functions and illnesses; educational background; and past experiences. These variables influence how a client thinks about health. In addition, cognitive abilities shape the way a person thinks, including the ability to understand factors involved in illness and to apply knowledge of health and illness to personal health practices. The clients ability to understand and accept the importance of the teaching is the primary nursing consideration. The clients degree of stress, depression, or fear, for example, can influence health beliefs and practices. The manner in which a person handles stress throughout each phase of life will influence the way the person reacts to illness, but this option is not the best choice available. A persons thought and behavior patterns change throughout life. The nurse must consider the clients level of growth and development when using his or her health beliefs and practices as a basis for planning care, but the client has been identified as being adult and so the developmental stage has been determined. Spirituality is reflected in how a person lives his or her life, including the values and beliefs exercised, the relationships established with family and friends, and the ability to find hope and meaning in life. However, this is not the best option available. DIF: C REF: 23 OBJ: Analysis TOP: Nursing Process: Assessment MSC: NCLEX test plan designation: Health Promotion and Maintenance