Test Bank for Fundamentals of Nursing 9th Edition - Potter Perry, Exams of Nursing

Download Test Bank for Fundamentals of Nursing 9th Edition - Potter Perry and more Exams Nursing in PDF only on Docsity! Fundamentals of Nursing 9th Edition Chapter 01: Nursing Today Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. Which nurse most likely kept records on sanitation techniques and the effects on health? a. Florence Nightingale b. Mary Nutting c. Clara Barton d. Lillian Wald ANS: A Nightingale was the first practicing nurse epidemiologist. Her statistical analyses connected poor sanitation with cholera and dysentery. Mary Nutting, Clara Barton, and Lillian Wald came after Nightingale, each contributing to the nursing profession in her own way. Mary Nutting was instrumental in moving nursing education into universities. Clara Barton founded the American Red Cross. Lillian Wald helped open the Henry Street Settlement. DIF:Understand (comprehension)REF:5 OBJ: Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Evaluation MSC: Health Promotion and Maintenance 2. The nurse prescribes strategies and alternatives to attain expected outcome. Which standard of nursing practice is the nurse following? a. Assessment b. Diagnosis c. Planning d. Implementation ANS: C In planning, the registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. During assessment, the registered nurse collects comprehensive data pertinent to the patient’s health and/or the situation. In diagnosis, the registered nurse analyzes the assessment data to determine the diagnoses or issues. During implementation, the registered nurse implements (carries out) the identified plan. DIF:Understand (comprehension)REF:2 OBJ: Discuss the development of professional nursing roles. TOP: Planning MSC:Management of Care 3. An experienced medical-surgical nurse chooses to work in obstetrics. Which level of proficiency is the nurse upon initial transition to the obstetrical floor? a. Novice b. Proficient c. Competent d. Advanced beginner ANS: A A beginning nursing student or any nurse entering a situation in which there is no previous level of experience (e.g., an experienced operating room nurse chooses to now practice in home health) is an example of a novice nurse. A proficient nurse perceives a patient’s clinical situation as a whole, is able to assess an entire situation, and can readily transfer knowledge gained from multiple previous experiences to a situation. A competent nurse understands the organization and specific care required by the type of patients (e.g., surgical, oncology, or orthopedic patients). This nurse is a competent practitioner who is able to anticipate nursing care and establish long-range goals. A nurse who has had some level of experience with the situation is an advanced beginner. This experience may only be observational in nature, but the nurse is able to identify meaningful aspects or principles of nursing care. DIF:Apply (application)REF:2 OBJ: Discuss the development of professional nursing roles. TOP: Evaluation MSC:Management of Care 4. A nurse assesses a patient’s fluid status and decides that the patient needs to drink more fluids. The nurse then encourages the patient to drink more fluids. Which concept is the nurse demonstrating? a. Licensure b. Autonomy c. Certification d. Accountability ANS: B Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. To obtain licensure in the United States, the RN candidate must pass the NCLEX-RN®. Beyond the NCLEX-RN®, the nurse may choose to work toward certification in a specific area of nursing practice. Accountability means that you are responsible, professionally and legally, for the type and quality of nursing care provided. interprofessional teams, fostering open communication, mutual respect, and shared decision making. DIF:Understand (comprehension)REF:7 | 8 OBJ: Describe the roles and career opportunities for nurses. TOP: Evaluation MSC:Management of Care 9. A nurse has compassion fatigue. What is the nurse experiencing? a. Lateral violence and intrapersonal conflict b. Burnout and secondary traumatic stress c. Short-term grief and single stressor d. Physical and mental exhaustion ANS: B Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress. Compassion fatigue may contribute to what is described as lateral violence (nurse-nurse interactions, not intrapersonal). Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue. Stressors, not a single stressor, contribute to compassion fatigue. Physical and mental exhaustion describes burnout only. DIF:Understand (comprehension)REF:6 OBJ: Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Assessment MSC: Health Promotion and Maintenance 10. A patient is scheduled for surgery. When getting ready to obtain the informed consent, the patient tells the nurse, “I have no idea what is going to happen. I couldn’t ask any questions.” The nurse does not allow the patient to sign the permit and notifies the health care provider of the situation. Which role is the nurse displaying? a. Manager b. Patient educator c. Patient advocate d. Clinical nurse specialist ANS: C As a patient advocate, the nurse protects the patient’s human and legal rights, including the right of the patient to understand procedures before signing permits. Although nurses can be educators, it is the responsibility of the surgeon to provide education for the patient in preparation for surgery, and it is the nurse’s responsibility to notify the health care provider if the patient is not properly educated. Managers coordinate the activities of members of the nursing staff in delivering nursing care, and clinical nurse specialists are experts in a specialized area of nursing practice in a variety of settings. DIF:Apply (application)REF:3 OBJ: Describe the roles and career opportunities for nurses. TOP: Evaluation MSC:Management of Care 11. The patient requires routine gynecological services after giving birth to her son, and while seeing the nurse-midwife, the patient asks for a referral to a pediatrician for the newborn. Which action should the nurse-midwife take initially? a. Provide the referral as requested. b. Offer to provide the newborn care. c. Refer the patient to the supervising provider. d. Tell the patient that is not allowed to make referrals. ANS: B The practice of nurse-midwifery involves providing independent care for women during normal pregnancy, labor, and delivery, as well as care for the newborn. After being apprised of the midwifery role, if the patient insists on seeing a pediatrician, the nurse-midwife should provide the referral. The supervising provider is an obstetric provider, not a pediatrician. A nurse-midwife can make referrals. DIF:Analyze (analysis)REF:4 OBJ: Describe the roles and career opportunities for nurses. TOP: Implementation MSC:Management of Care 12. The nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). Which activity is appropriate for a CRNA? a. Manages gynecological services such as PAP smears b. Works under the guidance of an anesthesiologist c. Obtains a PhD degree in anesthesiology d. Coordinates acute medical conditions ANS: B Nurse anesthetists provide surgical anesthesia under the guidance and supervision of an anesthesiologist, who is a physician (health care provider) with advanced knowledge of surgical anesthesia. Nurse practitioners, not CRNAs, manage self-limiting acute and chronic stable medical conditions; certified nurse-midwives provide gynecological services such as routine Papanicolaou (Pap) smears. The CRNA is an RN with an advanced education in a nurse anesthesia accredited program. A PhD is not a requirement. DIF:Understand (comprehension)REF:4 OBJ: Describe the roles and career opportunities for nurses. TOP: Implementation MSC:Management of Care 13. A nurse teaches a group of nursing students about nurse practice acts. Which information is most important to include in the teaching session about nurse practice acts? a. Protects the nurse b. Protects the public c. Protects the provider d. Protects the hospital ANS: B The nurse practice acts regulate the scope of nursing practice and protect public health, safety, and welfare. They do not protect the nurse, provider, or hospital. DIF:Understand (comprehension)REF:10 OBJ: Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Teaching/Learning MSC: Management of Care 14. A bill has been submitted to the State House of Representatives that is designed to reduce the cost of health care by increasing the patient-to-nurse ratio from a maximum of 2:1 in intensive care units to 3:1. What should the nurse realize? a. Legislation is politics beyond the nurse’s control. b. National programs have no bearing on state politics. c. The individual nurse can influence legislative decisions. d. Focusing on nursing care provides the best patient benefit. ANS: C Nurses can influence policy decisions at all governmental levels. One way is to get involved by participating in local and national efforts. This effort is critical in exerting nurses’ influence early in the political process. Legislation is not beyond the nurse’s control. National program can have bearing on state politics. The question is focusing on legislation and health care costs, not nursing care. DIF:Analyze (analysis)REF:9 ANS: B Benner’s levels of proficiency are as follows: novice, advanced beginner, competent, proficient, and expert. DIF:Understand (comprehension)REF:2 OBJ: Discuss the development of professional nursing roles. TOP: Teaching/Learning MSC:Management of Care MULTIPLE RESPONSE 1. A nurse is preparing a teaching session about contemporary influences on nursing. Which examples should the nurse include? (Select all that apply.) a. Human rights b. Affordable Care Act c. Demographic changes d. Medically underserved e. Decreasing health care costs ANS: A, B, C, D Multiple external forces affect nursing, including the need for nurses’ self-care, Affordable Care Act (ACA) and rising (not decreasing) health care costs, demographic changes of the population, human rights, and increasing numbers of medically underserved. DIF:Understand (comprehension)REF:6 OBJ: Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Teaching/Learning MSC: Management of Care 2. After licensure, the nurse wants to stay current in knowledge and skills. Which programs are the most common ways nurses can do this? (Select all that apply.) a. Master’s degree b. Inservice education c. Doctoral preparation d. Continuing education e. National Council Licensure Examination retakes ANS: B, D Continuing education programs help nurses maintain current nursing skills, gain new knowledge and theory, and obtain new skills reflecting the changes in the health care delivery system. Inservice education programs are provided by a health care facility to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can help the nurse stay current. Master’s degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. National Council Licensure Examination retakes are not to keep current; this test is taken to enter RN practice. DIF:Understand (comprehension)REF:10 OBJ: Describe educational programs available for professional registered nurse (RN) education. TOP:Teaching/LearningMSC:Management of Care 3. A nurse wants to become an advanced practice registered nurse. Which options should the nurse consider? (Select all that apply.) a. Patient advocate b. Nurse administrator c. Certified nurse-midwife d. Clinical nurse specialist e. Certified nurse practitioner ANS: C, D, E Although all nurses should function as patient advocates, “advanced practice nurse” is an umbrella term for an advanced clinical nurse such as a certified nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or certified nurse-midwife. A nurse administrator is not an example of advanced practice. DIF:Understand (comprehension)REF:4 OBJ: Describe the roles and career opportunities for nurses. TOP: Teaching/Learning MSC:Management of Care 4. The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses. The orthopedic unit has agreed to “float” two of its nurses to the oncology unit if oncology can “float” a nursing assistant to the orthopedic unit to help with obtaining vital signs. Which concepts does this situation entail? (Select all that apply.) a. Autonomy b. Informatics c. Accountability d. Political activism e. Teamwork and collaboration ANS: A, C, E Staffing is an independent nursing intervention and is an example of autonomy. Along with increased autonomy comes accountability or responsibility for outcomes of an action. When nurses work together this is teamwork and collaboration. Informatics is the use of information and technology to communicate, manage knowledge, mitigate error, and support decision making. Political activism usually involves more than day-to-day activities such as unit staffing. DIF:Analyze (analysis)REF:3 | 8 OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices.TOP:EvaluationMSC:Management of Care Chapter 02: The Health Care Delivery System Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. The nurse is caring for a patient whose insurance coverage is Medicare. The nurse should consider which information when planning care for this patient? a. Capitation provides the hospital with a means of recovering variable charges. b. The hospital will be paid for the full cost of the patient’s hospitalization. c. Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost. d. Medicare will pay the national average for the patient’s condition. ANS: C In 1983, Congress established the prospective payment system (PPS), which grouped inpatient hospital services for Medicare patients into diagnosis-related groups (DRGs), each of which provides a fixed reimbursement amount based on assigned DRG, regardless of a patient’s length of stay or use of services. Capitation means that providers receive a fixed amount per patient or enrollee of a health care plan. DRG reimbursement is based on case severity, rural/urban/regional costs, and teaching costs, not national averages. DIF:Understand (comprehension)REF:15 OBJ: Compare the various methods for financing health care. TOP: Planning MSC:Management of Care 2. A nurse is teaching the staff about managed care. Which information should the nurse include in the teaching session? c. Restorative care d. Continuing care ANS: B Preventive care includes immunizations, screenings, counseling, crisis prevention, and community safety legislation. Primary care is health promotion that includes prenatal and well-baby care, nutrition counseling, family planning, and exercise classes. Restorative care includes rehabilitation, sports medicine, spinal cord injury programs, and home care. Continuing care is assisted living and psychiatric care and older-adult day care. DIF:Understand (comprehension)REF:17 OBJ: Discuss the types of settings that provide various health care services. TOP: Implementation MSC: Health Promotion and Maintenance 7. A nurse is following the PDSA cycle for quality improvement. Which action will the nurse take for the letter “A”? a. Act b. Alter c. Assess d. Approach ANS: A There are many models for quality improvement and performance improvement. One model is the PDSA cycle: plan, do, study, and act. “A” does not stand for alter, assess, or approach. DIF:Understand (comprehension)REF:27 OBJ:Describe the components of a quality improvement program. TOP:ImplementationMSC:Management of Care 8. The nurse is trying to determine how well a certain health plan compares with other health plans. To gather this type of data, which information will the nurse utilize? a. Pew Health Professions Commission b. Healthcare Effectiveness Data and Information Set (HEDIS) c. American Nurses Credentialing Center (ANCC) Magnet Recognition Program d. Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) ANS: B Health plans throughout the United States rely on the Healthcare Effectiveness Data and Information Set (HEDIS) as a quality measure. HEDIS compares how well health plans perform key areas: quality/effectiveness of care, access to care, and patient satisfaction with the health plan and doctors. The Pew Health Professions Commission, a national and interdisciplinary group of health care leaders, recommended 21 competencies for health care professionals in the twenty-first century. The Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey developed to measure patient perceptions of their hospital experience. The Magnet Recognition Program recognizes health care organizations that achieve excellence in nursing practice. DIF:Understand (comprehension)REF:24 OBJ: Explain the impact of quality and safety initiatives on delivery of health care. TOP:AssessmentMSC:Management of Care 9. An older adult patient has extensive wound care needs after discharge from the hospital. Which facility should the nurse discuss with the patient? a. Hospice b. Respite care c. Assisted living d. Skilled nursing ANS: D An intermediate care or skilled nursing facility offers skilled care from a licensed nursing staff. This often includes administration of IV fluids, wound care, long-term ventilator management, and physical rehabilitation. A hospice is a system of family-centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness. Respite care is a service that provides short-term relief or “time off” for people providing home care to an individual who is ill, disabled, or frail. Assisted living offers an attractive long-term care setting with an environment more like home and greater resident autonomy. DIF:Apply (application)REF:20-21 OBJ: Discuss the types of settings that provide various health care services. TOP:Teaching/LearningMSC:Management of Care 10. A nurse working in a community hospital’s emergency department provides care to a patient having chest pain. Which level of care is the nurse providing? a. Continuing care b. Restorative care c. Preventive care d. Tertiary care ANS: D Hospital emergency departments, urgent care centers, critical care units, and inpatient medical- surgical units provide secondary and tertiary levels of care. Patients recovering from an acute or chronic illness or disability often require additional services (restorative care) to return to their previous level of function or reach a new level of function limited by their illness or disability. Continuing care is available within institutional settings (e.g., nursing centers or nursing homes, group homes, and retirement communities), communities (e.g., adult day care and senior centers), or the home (e.g., home care, home-delivered meals, and hospice). Preventive care is more disease oriented and focused on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs. DIF:Apply (application)REF:18 OBJ: Discuss the types of settings that provide various health care services. TOP:ImplementationMSC:Management of Care 11. A nurse is teaching about the effects of globalization. Which information should the nurse include in the teaching session? a. Increased spread of communicable diseases b. Increased homogeneous mix of nursing staff c. Decreased poverty and increased “health tourism” d. Decreased urbanization as populations shift to the suburbs ANS: A Although globalization of trade, travel, and culture has improved the availability of health care services, the spread of communicable diseases such as tuberculosis and severe acute respiratory syndrome (SARS) has become more common. In an effort to improve the quality of care, health care institutions are recruiting nurses from around the world to work in the United States, forcing hospitals to better understand and work with nurses from different cultures. Poverty is still deadlier than any disease and is the most frequent reason for death in the world today. The growth of urbanization also is currently affecting the world’s health. Improved communication, easier air travel, and easing of trade restrictions are making it easier for people to engage in “health tourism.” DIF:Understand (comprehension)REF:26 OBJ: Discuss the implications that changes in the health care system have on nursing. TOP:Teaching/LearningMSC:Management of Care a. Nursing center b. Psychiatric facility c. Rehabilitation center d. Adult day care center ANS: A Nurses who work in a nursing center (nursing home or nursing facility) are required to complete a minimum data set on each patient. Minimum data set is not needed for psychiatric, rehabilitation, or adult day care centers. Patients who suffer emotional and behavioral problems such as depression, violent behavior, and eating disorders often require special counseling and treatment in psychiatric facilities. Rehabilitation restores a person to the fullest physical, mental, social, vocational, and economic potential possible. Patients require rehabilitation after a physical or mental illness, injury, or chemical addiction. Adult day care centers provide a variety of health and social services to specific patient populations who live alone or with family in the community. Services offered during the day allow family members to maintain their lifestyles and employment and still provide home care for their relatives. DIF:Understand (comprehension)REF:21 OBJ: Explain the role of nurses in different health care delivery settings. TOP:ImplementationMSC:Management of Care MULTIPLE RESPONSE 1. Which government-instituted programs should the nurse include in a teaching session about controlling health care costs? (Select all that apply.) a. Professional standards review organizations b. Prospective payment systems c. Diagnosis-related groups d. Third-party payers e. “Never events” ANS: A, B, C The federal government, the biggest consumer of health care, which pays for Medicare and Medicaid, has created professional standards review organizations (PSROs) to review the quality, quantity, and costs of hospital care. One of the most significant factors that influenced payment for health care was the prospective payment system (PPS). Established by Congress in 1983, the PPS eliminated cost-based reimbursement. Hospitals serving patients who received Medicare benefits were no longer able to charge whatever a patient’s care cost. Instead, the PPS grouped inpatient hospital services for Medicare patients into diagnosis-related groups (DRGs). In 2011, the National Quality Forum (not a government facility) defined a list of 29 “never events” that are devastating and preventable. Through most of the twentieth century, few incentives existed for controlling health care costs. Insurers or third-party payers paid for whatever health care providers ordered for a patient’s care and treatment. DIF:Understand (comprehension)REF:15 OBJ: Explain the various methods for financing health care. TOP: Teaching/Learning MSC:Management of Care 2. A nurse is teaching the staff about the Institute of Medicine competencies. Which examples indicate the staff has a correct understanding of the teaching? (Select all that apply.) a. Use informatics. b. Use transparency. c. Apply globalization. d. Apply quality improvement. e. Use evidence-based practice. ANS: A, D, E The Institute of Medicine competencies include: Provide patient-centered care; work in interdisciplinary teams; use evidence-based practice; apply quality improvement; and use informatics. Transparency is included in the 10 rules of performance in a redesigned health care system, not a competency. While globalization is important in health care, it is not a competency. DIF:Understand (comprehension)REF:23 OBJ: Explain the impact of quality and safety initiatives on delivery of health care. TOP:Teaching/LearningMSC:Management of Care 3. A nurse is evaluating care based upon the nursing quality indicators. Which areas should the nurse evaluate? (Select all that apply.) a. Patient satisfaction level b. Hospital readmission rates c. Nursing hours per patient day d. Patient falls/falls with injuries e. Value stream analysis for quality ANS: B, C, D The American Nurses Association developed the National Database of Nursing Quality Indicators (NDNQI) to measure and evaluate nursing-sensitive outcomes with the purpose of improving patient safety and quality care. Nursing quality indicators include the following: Hospital readmission rates, nursing hours per patient day, and patient falls/falls with injuries. While every major health care organization measures certain aspects of patient satisfaction, it is not a nursing quality indicator. Value stream analysis is a method that focuses on improvement of processes in a health care institution. DIF:Apply (application)REF:25 OBJ: Discuss opportunities for nursing within the changing health care delivery system. TOP:EvaluationMSC:Management of Care 4. A nurse is working in a health care organization that has achieved Magnet status. Which components are indicators of this status? (Select all that apply.) a. Empirical quality results b. Structural empowerment c. Transformational leadership d. Exemplary professional practice e. Willingness to recommend the agency ANS: A, B, C, D The American Nurses Credentialing Center (ANCC) established the Magnet Recognition Program to recognize health care organizations that achieve excellence in nursing practice. The five components are Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovation, and Improvements; and Empirical Quality Results. Willingness to recommend the hospital/agency is a component of the Hospital Consumer of Assessment of Healthcare Providers and Systems survey. DIF:Understand (comprehension)REF:24-25 OBJ: Discuss opportunities for nursing within the changing health care delivery system. TOP:AssessmentMSC:Management of Care MATCHING A nurse is teaching about the different types of health care plans. Match the correct information to the type of health care plans the nurse should include in the teaching session. a. Insurance for low-income families b. Federal insurance for people aged 65 and older c. Health maintenance focus to specific group of voluntarily enrolled people d. Services at a discount for companies under contract DIF:Apply (application)REF:33 OBJ: Differentiate community health nursing from community-based nursing. TOP: Implementation MSC: Health Promotion and Maintenance 4. A nurse is focusing on acute and chronic care of individuals and families within a community while enhancing patient autonomy. Which type of nursing care is the nurse providing? a. Public health b. Community health c. Community-based d. Community assessment ANS: C Community-based nursing involves acute and chronic care of individuals and families and enhances their capacity for self-care while promoting autonomy in decision making. Public health nursing focuses on the needs of a population. Community health nursing cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community assessment is the systematic data collection on the population, monitoring the health status of the population, and making information available about the health of the community. DIF:Understand (comprehension)REF:33 OBJ: Differentiate community health nursing from community-based nursing. TOP:ImplementationMSC:Management of Care 5. The community health nurse is administering flu shots to children at a local playground. What is the rationale for this nurse’s action? a. To prevent individual illness b. To prevent community outbreak of illness c. To prevent outbreak of illness in the family d. To prevent needs of the local population groups ANS: B The nurse is trying to prevent a community outbreak of illness. By focusing on subpopulations (children), the community health nurse cares for the community as a whole and considers the individual or the family as only one member of a group at risk. Community-based nursing, as opposed to community health nursing, focuses on the needs of the individual or family. Public health nursing focuses on meeting the population groups’ needs. DIF:Apply (application)REF:33 OBJ: Discuss the role of the community health nurse. TOP: Planning MSC:Health Promotion and Maintenance 6. A nurse attended a seminar on community-based health care. Which information indicates the nurse has a good understanding of community-based health care? a. It occurs in hospitals. b. Its focus is on ill individuals. c. Its priority is health promotion. d. It provides services primarily to the poor. ANS: C Community-based health care is a model of care that reaches everyone in the community (including the poor and underinsured), focuses on primary rather than institutional or acute care, and provides knowledge about health and health promotion and models of care to the community. Community- based health care occurs outside traditional health care institutions such as hospitals. DIF:Understand (comprehension)REF:31 OBJ: Explain the relationship between public health and community health nursing. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 7. A nurse is using the Healthy People 2020 to establish goals for the community. Which goal is priority? a. Reduce health care costs. b. Increase life expectancy. c. Provide services close to where patients live. d. Isolate patients to prevent the spread of disease. ANS: B The overall goals of Healthy People 2020 are to increase life expectancy and quality of life and eliminate health disparities through an improved delivery of health care services. It does not focus on reducing health care costs, providing services close to where patients live, or isolating patients to prevent the spread of disease. DIF:Understand (comprehension)REF:31 OBJ:Discuss the role of the nurse in community-based practice. TOP:PlanningMSC:Health Promotion and Maintenance 8. A nurse is working in community-based nursing. Which competency is priority for this nurse? a. Caregiver b. Collaborator c. Change agent d. Case manager ANS: A First and foremost is the role of caregiver. While collaborator, change agent, and case manager are important, they are not the priority. DIF:Apply (application)REF:35 OBJ: Describe the competencies important for success in community-based nursing practice. TOP:ImplementationMSC:Management of Care 9. A nurse observes an outbreak of lice in a certain school district. The nurse collects data and identifies a common practice of sharing lockers, caps, and hair brushes. The nurse shares the information with the school. Which community-based nursing competency did the nurse use? a. Educator b. Caregiver c. Case manager d. Epidemiologist ANS: D As an epidemiologist, you are involved in case finding, health teaching, and tracking incident rates of an illness (outbreak of lice). The nurse did not teach the students about lice. The nurse did not provide care for the lice. The nurse did not coordinate needed resources and services for a group of patient’s well-being (case manager). DIF:Apply (application)REF:37 OBJ: Describe the competencies important for success in community-based nursing practice. TOP: Implementation MSC: Safety and Infection Control 10. A nurse is providing screening at a health fair. Which finding indicates the person may be a vulnerable patient who is most likely to develop health problems? a. One who is pregnant b. Refuse to provide a referral to an abortion service. c. Provide referral to an abortion service. d. Delay referral to an abortion service. ANS: C As a counselor, the nurse is responsible for providing information, listening objectively, and being supportive, caring, and trustworthy and providing a referral to an abortion service. The nurse does not make decisions, like going to a “Right-to-Life” advocate, but rather helps the patient reach decisions that are best for him or her. To refuse to provide a referral or to delay referral would not be supportive of the patient’s decision. DIF:Apply (application)REF:37 OBJ: Describe the competencies important for success in community-based nursing practice. TOP: Implementation MSC: Psychosocial Integrity 15. Before a patient with beginning stage of Alzheimer’s disease is discharged, the community- based nurse is making a visit to the patient’s home. The patient’s daughter and family live in the home with the patient. What is the major focus of this visit? a. Teach the family how to monitor blood pressure. b. Demonstrate techniques for providing care. c. Stress to the family how difficult it will be to provide care at home. d. Encourage the family to send the patient to an extended care facility. ANS: B The role of the community health nurse, when dealing with patients with Alzheimer’s disease, is to maintain the best possible functioning, protection, and safety for the patient. The nurse should demonstrate to the primary family caregiver techniques for dressing, feeding, and toileting the patient while providing encouragement and emotional support to the caregiver. Monitoring blood pressure is not necessary for an Alzheimer’s patient; blood pressure would be for a patient with hypertension. The nurse should protect the patient’s rights and maintain family stability, not encourage placement in an extended care facility. DIF:Apply (application)REF:36 OBJ: Describe the competencies important for success in community-based nursing practice. TOP:ImplementationMSC:Management of Care 16. While conducting a community assessment, the nurse seeks data on the average household income and the number of residents on public assistance. In doing so, the nurse is evaluating which component of a community assessment? a. Structure b. Population c. Social system d. Welfare system ANS: A Economic status is part of the community structure. Population would involve age and gender distribution, growth trends, density, education level, and ethnic or religious groups. The welfare system is part of the social system that also includes the education, government, communication, and health systems. DIF:Understand (comprehension)REF:38 OBJ: Describe elements of a community assessment. TOP: Assessment MSC:Health Promotion and Maintenance 17. The nurse uses statistics on increased incidence of communicable disease to influence legislatures to pass a bill for mandatory vaccinations to enroll in school. Which type of nursing will the nurse use in this process? a. Public health nursing b. Community-based nursing c. Community health nursing d. Vulnerable population nursing ANS: A A public health nurse understands factors that influence health promotion and health maintenance, the trends and patterns influencing the incidence of disease within populations, environmental factors contributing to health and illness, and the political processes used to affect public policy. Community health nursing is nursing practice in the community, with the primary focus on the health care of individuals, families, and groups within the community. Community-based nursing care takes place in community settings such as the home or a clinic, where the focus is on the needs of the individual or family. While there is no specific vulnerable population nursing, all types of nursing should care for these populations. DIF:Analyze (analysis)REF:33 OBJ: Explain the relationship between public health and community health nursing. TOP:EvaluationMSC:Health Promotion and Maintenance MULTIPLE RESPONSE 1. A community-based nursing is working with a family. For which key areas will the nurse need a strong knowledge base? (Select all that apply.) a. Family theory b. Communication c. Group dynamics d. Cultural diversity e. Individual-centered care ANS: A, B, C, D With the individual and family as the patients, the context of community-based nursing is family- centered care (not individual-centered care) within the community. This focus requires a strong knowledge base in family theory, principles of communication, group dynamics, and cultural diversity. The nurse leans to partner with patients and families, not just with individuals. DIF:Understand (comprehension)REF:34 OBJ:Discuss the role of the nurse in community-based practice. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 2. Which community-based nursing activities indicate the nurse is working in the role of educator? (Select all that apply.) a. Offers prenatal classes b. Offers a child safety program c. Offers to defend patients’ decisions d. Offers creative solutions to local problems e. Offers coordinate resources after discharge ANS: A, B Prenatal classes, infant care, child safety, and cancer screening are just some of the health education programs provided in a community practice setting. Offers to defend patients’ decisions is the role of patient advocate. Offers creative solutions to local problems indicates a change agent. Collaborator will offer to coordinate resources after discharge. DIF:Apply (application)REF:37 OBJ: Describe the competencies important for success in community-based nursing practice. TOP: Teaching/Learning MSC: Health Promotion and Maintenance a. Orem’s theory is useful in designing interventions to promote self-care. b. Orem’s theory focuses on cultural issues that may affect compliance. c. Orem’s theory allows for reduction of anxiety with communication. d. Orem’s theory helps nurses manipulate the patient’s environment. ANS: A When applying Orem’s theory, a nurse continually assesses a patient’s ability to perform self-care and intervenes as needed to ensure that the patients meet physical, psychological, sociological, and developmental needs. According to Orem, people who participate in self-care activities are more likely to improve their health outcomes. Leiniger’s culture care theory focuses on culture diversity and provides culturally specific nursing care. According to Peplau, nurses help patients reduce anxiety by converting it into constructive actions, using therapeutic communication. Nightingale’s grand theory is a patient’s environment can be manipulated by nurses to restore a patient to health. DIF:Apply (application)REF:47-48 OBJ: Explain the influence of nursing theory on a nurse’s approach to practice. TOP:EvaluationMSC:Management of Care 3. A nurse is testing meditation for migraine headaches and the expected outcome of care when performing this intervention. Which type of theory is the nurse using? a. Grand b. Prescriptive c. Descriptive d. Middle-range ANS: B A prescriptive theory details nursing interventions (meditation) for a specific phenomenon (migraine headaches) and the expected outcome of the care. Grand theories are broad in scope and complex and require further specification through research; it does not provide guidance for specific nursing interventions. Descriptive theories do not direct specific nursing activities but help to explain patient assessment. A middle-range theory tends to focus on a concept found in a specific field of nursing, such as uncertainty, incontinence, social support, quality of life, and caring, rather than reflect on a wide variety of nursing care situations. DIF:Apply (application)REF:44 OBJ:Describe types of nursing theories.TOP:Implementation MSC:Management of Care 4. The nurse researcher is evaluating whether holding pressure at an injection site after injecting the anticoagulant enoxaparin will reduce bruising at the injection site. This study involves a prescriptive theory. What is the nurse’s rationale for involving a prescriptive theory? a. It explains why bruising occurs. b. It is broad in scope and complex. c. It tests a specific nursing intervention. d. It reflects a wide variety of nursing care situations. ANS: C Prescriptive theories detail nursing interventions for a specific phenomenon and the expected outcome of the care but it does not explain why. Grand theories are broad in scope and complex and focus on a wide variety of nursing care situations. DIF:Apply (application)REF:44 OBJ: Describe types of nursing theories. TOP: Planning MSC: Management of Care 5. A nurse is using nursing theory and the nursing process simultaneously to plan nursing care. How will the nurse use nursing theory and the nursing process in practice? a. Nursing theory can direct how a nurse uses the nursing process. b. Nursing theory requires the nursing process to develop knowledge. c. Nursing theory with the nursing process has a minor role in professional nursing. d. Nursing theory combined with the nursing process is specific to certain ill patients. ANS: A Nursing theory can direct how a nurse uses the nursing process. Integration of theory into practice (nursing process) serves as the basis for professional nursing. The nursing process provides a systematic process for the delivery of care, not the knowledge component of the discipline. Useful theories are adaptable to different patients and to all care settings. DIF:Understand (comprehension)REF:44-45 OBJ: Describe the relationship among nursing theory, the nursing process, and patient needs. TOP:ImplementationMSC:Management of Care 6. The nurse views the patient as an open system that needs help in coping with stressors. Which theorist is the nurse using? a. King b. Levine c. Neuman d. Johnson ANS: C Neuman views a patient as being an open system that is in constant energy exchange with the environment that the nurse must help cope with stressors. King views a patient as a unique personal system that is constantly interacting/transacting with other systems that the nurse helps with goal attainment. Levine believes nurses promote balance between nursing interventions and patient participation to assist in conserving energy needed for healing. Johnson perceives patients as a collection of subsystems that forms an overall behavioral system focusing on balance. DIF:Apply (application)REF:46 OBJ: Review selected nursing theories. TOP: Evaluation MSC: Management of Care 7. The nurse is caring for a patient diagnosed with essential hypertension. The health care provider prescribes blood pressure medication that the nurse administers. The nurse then monitors the patient’s blood pressure for several days to help determine effectiveness. Which system component is the nurse evaluating? a. Input b. Output c. Content d. Feedback ANS: B Output is the end product of a system and, in the case of the nursing process, it is defined as whether the patient’s health status improves or remains stable as a result of nursing care. Input consists of the data that come from a patient’s assessment. Feedback serves to inform a system about how it functions. Content is the product and information obtained from the system. DIF:Apply (application)REF:45 OBJ: Review selected shared theories from other disciplines. TOP: Evaluation MSC:Management of Care 8. A patient is admitted with possible methicillin-resistant Staphylococcus aureus (MRSA) and is placed in isolation until cultures can be obtained and declared noninfectious. During the isolation process, the nurse encourages family visits. Which level of Maslow’s hierarchy of needs is the nurse promoting when the family is encouraged to visit? a. First level ANS: A Peplau’s theory focuses on the individual, the nurse, and the interactive process or nurse-patient relationship. The nurse serves as a resource person, counselor, and surrogate. Henderson’s theory focuses on helping the patient with activities that the patient would perform unaided if he or she were able. Nightingale viewed nursing not as limited to the administration of medications and treatments but rather as oriented toward providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition. The goal of Orem’s theory is to help the patient perform self-care. DIF:Apply (application)REF:45 OBJ:Review selected nursing theories.TOP:Implementation MSC: Psychosocial Integrity 13. The nurse is caring for a patient who is actively bleeding. The health care provider prescribes blood transfusions. The patient is a Jehovah’s Witness and does not want blood products. The nurse contacts the health care provider to request alternative treatment. Which theory is the nurse using? a. Roy’s theory b. Leininger’s theory c. Watson’s theory d. Orem’s theory ANS: B The goal of Leininger’s theory is to provide the patient with culturally specific nursing care that integrates the patient’s cultural traditions, values, and beliefs into the plan of care. The goal of Roy’s model is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependence domains. Watson’s theory believes that the purpose of nursing action is to understand the interrelationship between health, illness, and human behavior. The goal of Orem’s theory is to help the patient perform self-care. DIF:Apply (application)REF:48 OBJ:Review selected nursing theories.TOP:Implementation MSC:Management of Care 14. The patient is terminally ill and is receiving hospice care. The nurse cares for the patient by bathing, shaving, and repositioning him. The patient would like a Catholic priest called to provide the Sacrament of the Sick. The nurse places a call and arranges for the priest’s visit. Which theory does this nurse’s care represent? a. Roy’s theory b. Watson’s theory c. Henderson’s theory d. Orem’s self-care deficit theory ANS: C Henderson defines nursing as assisting the patient with 14 activities (hygiene, positioning) until patients can meet these needs for themselves—or assist patients to have a peaceful death. Roy’s model is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependence domains. Watson’s theory believes that the purpose of nursing is to understand the interrelationship between health, illness, and human behavior. The goal of Orem’s theory is to help the patient perform self-care. DIF:Apply (application)REF:46 OBJ: Review selected nursing theories. TOP: Evaluation MSC: Management of Care 15. The patient is newly diagnosed with diabetes and will be discharged in the next day or so. The nurse is teaching the patient how to draw up and self-administer insulin. Which nursing theory is the nurse utilizing? a. Watson’s theory b. Orem’s theory c. Roger’s theory d. Henderson’s theory ANS: B The goal of Orem’s theory is to help the patient perform self-care. In Watson’s theory, the nurse is concerned with promoting and restoring health and preventing illness. Roger’s theory considers caring as a fundamental component of professional nursing practice and is based upon 10 curative factors. Henderson defines nursing as assisting patients with 14 activities until patients can meet these needs for themselves. DIF:Apply (application)REF:47-48 OBJ:Review selected nursing theories.TOP:Implementation MSC:Health Promotion and Maintenance 16. A nurse is conducting research about the needs of depressed patients. The nurse writes the following: Depression is a patient reporting a score above 7 on the Hamilton Depression Rating Scale. What did the nurse write? a. Operational definition b. Conceptual definition c. Paradigm d. Concept ANS: A Operational definitions state how concepts are measured (Hamilton Depression Rating Scale). Theoretical or conceptual definitions simply define a particular concept, much like what can be found in a dictionary, based on the theorist’s perspective (a mood disorder causing severe sadness and apathy). A paradigm is a pattern of beliefs used to describe a discipline’s domain. Think of concepts as ideas and mental images, like depression is a concept. DIF:Analyze (analysis)REF:42 OBJ: Describe theory-based nursing practice. TOP: Evaluation MSC:Management of Care 17. Which action indicates the nurse is using the nursing process in patient care? a. Generates nursing knowledge for use in nursing practice. b. Conceptualizes an aspect of nursing to predict nursing care. c. Develops nursing care as a specific, distinct phenomenon. d. Delivers nursing care using a systematic approach. ANS: D The nursing process provides a systematic approach for the delivery of nursing care. Theory generates nursing knowledge for use in practice; the nursing process is not a theory. A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care. An interdisciplinary theory explains a phenomenon specific to the discipline that developed the theory. DIF:Analyze (analysis)REF:44 OBJ: Describe the relationship among nursing theory, the nursing process, and patient needs. TOP:EvaluationMSC:Management of Care 18. A nurse is using theoretical knowledge in nursing practice to provide patient care. Which nursing behavior is an example of theoretical knowledge? a. Reads about different concepts b. Reflects on clinical experiences c. Combines the art and science of nursing Chapter 05: Evidence-Based Practice Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse uses evidence-based practice (EBP) to provide nursing care. What is the bestrationale for the nurse’s behavior? a. EBP is a guide for nurses in making clinical decisions. b. EBP is based on the latest textbook information. c. EBP is easily attained at the bedside. d. EBP is always right for all situations. ANS: A Evidence-based practice (EBP) is a guide for nurses to structure how to make appropriate, timely, and effective clinical decisions. A textbook relies on the scientific literature, which may be outdated by the time the book is published. Unfortunately, much of the best evidence never reaches the bedside. EBP is not to be blindly applied without using good judgment and critical thinking skills. DIF:Understand (comprehension)REF:52 OBJ: Discuss the benefits of evidence-based practice. TOP: Evaluation MSC:Management of Care 2. In caring for patients, what must the nurse remember about evidence-based practice (EBP)? a. EBP is the only valid source of knowledge that should be used. b. EBP is secondary to traditional or convenient care knowledge. c. EBP is dependent on patient values and expectations. d. EBP is not shown to provide better patient outcomes. ANS: C Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience. Although these sources have value, it is important to learn to rely more on research evidence than on nonresearch evidence. Evidence-based care improves quality, safety, patient outcomes, and nurse satisfaction while reducing costs. DIF:Understand (comprehension)REF:53 OBJ: Discuss the benefits of evidence-based practice. TOP: Implementation MSC:Management of Care 3. A nurse wants to change a patient procedure. Which action will the nurse take to easily find research evidence to support this change? a. Read all the articles found on the Internet. b. Make a general search of the Internet. c. Use a PICOT format for the search. d. Start with a broad question. ANS: C The more focused the question is, the easier it becomes to search for evidence in the scientific literature. The PICO format allows the nurse to ask focused questions that are intervention based. Inappropriately formed questions (general search or broad question) will likely lead to irrelevant sources of information. It is not beneficial to read hundreds of articles. It is more beneficial to read the best four to six articles that specifically address the question. DIF:Apply (application)REF:54 OBJ: Describe the steps of evidence-based practice. TOP: Implementation MSC:Management of Care 4. A nurse has collected several research findings for evidence-based practice. Which article will be the best for the nurse to use? a. An article that uses randomized controlled trials (RCT) b. An article that is an opinion of expert committees c. An article that uses qualitative research d. An article that is peer-reviewed ANS: A Individual RCTs are the highest level of evidence or “gold standard” for research. A peer-reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health problems and their perceptions of illness. It does not usually have the robustness of an RCT. Expert opinion is on the bottom of the hierarchical pyramid of evidence. DIF:Understand (comprehension)REF:55-56 OBJ: Explain the levels of evidence available in the literature. TOP: Assessment MSC:Management of Care 5. The nurse is reviewing a research article on a patient care topic. Which area should entice the nurse to read the article? a. Literature review b. Introduction c. Methods d. Results ANS: B The introduction contains information about its purpose and the importance of the topic to the audience who reads the article. The literature review or background offers a detailed background of the level of science or clinical information about the topic of the article. The methods or design section explains how a research study was organized and conducted. The results or conclusion section details the results of the study and explains whether a hypothesis is supported. DIF:Understand (comprehension)REF:56 OBJ:Describe the steps of evidence-based practice. TOP: Communication and Documentation MSC: Management of Care 6. The nurse is caring for a patient with chronic low back pain. The nurse wants to determine the best evidence-based practice regarding clinical guidelines for low back pain. What is the best database for the nurse to access? a. MEDLINE b. EMBASE c. PsycINFO d. AHRQ ANS: D The Agency for Healthcare Research and Quality (AHRQ) includes clinical guidelines and evidence summaries. MEDLINE includes studies in medicine, nursing, dentistry, psychiatry, veterinary medicine, and allied health. EMBASE includes biomedical and pharmaceutical studies. PsycINFO deals with psychology and related health care disciplines. DIF:Apply (application)REF:55 OBJ: Describe the steps of evidence-based practice. TOP: Implementation MSC:Management of Care 7. A nurse writes the following PICOT question: How do patients with breast cancer rate their quality of life? How should the nurse evaluate this question? When evidence is not strong enough to apply in practice, the next option is to conduct a pilot study to investigate the PICOT question. Dropping the idea would be counterproductive; insisting that management hire staff could be seen as a mandate and could produce negative results. Seeking employment at another institution most likely would not be the answer because most institutions operate under similar established guidelines. DIF:Apply (application)REF:57 OBJ: Discuss ways to apply evidence in practice. TOP: Implementation MSC:Management of Care 12. The nurse is trying to identify common general themes relative to the effectiveness of cardiac rehabilitation from patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. Which type of research is the nurse conducting? a. Nonexperimental research b. Experimental research c. Qualitative research d. Evaluation research ANS: C Qualitative research involves using inductive reasoning to develop generalizations or theories from specific observations or interviews. Evaluation and experimental research are forms of quantitative research. Nonexperimental descriptive studies describe, explain, or predict phenomena such as factors that lead to an adolescent’s decision to smoke cigarettes. DIF:Analyze (analysis)REF:60 OBJ: Explain how nursing research improves nursing practice. TOP: Implementation MSC:Management of Care 13. In conducting a research study, the nurse researcher guarantees the subject no information will be reported in any manner that will identify the subject and only the research team will have access to the information. Which concept is the nurse researcher fulfilling? a. Bias b. Confidentiality c. Informed consent d. The research process ANS: B Confidentiality guarantees that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. Biases are opinions that may influence the results of research. Informed consent means that research subjects (1) are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research; (3) have the power to voluntarily consent or decline participation; and (4) understand how confidentiality or anonymity is maintained. The research process is a broader concept that provides an orderly series of steps that allow the researcher to move from asking a question to finding the answer. DIF:Understand (comprehension)REF:61 OBJ: Discuss the steps of the research process. TOP: Implementation MSC:Management of Care 14. The nurse researcher is preparing to publish the findings and is preparing to add the limitations to the manuscript. Which area of the manuscript will the nurse researcher add this information? a. Abstract b. Conclusion c. Study design d. Clinical implications ANS: B During results or conclusions, the researcher interprets the findings of the study, including limitations. An abstract summarizes the purpose of the article with major findings. Study design involves selection of research methods and type of study conducted. The researcher explains how to apply findings in a practice setting for the type of subjects studied in the clinical implications section. DIF:Understand (comprehension)REF:56 OBJ: Discuss the steps of the research process. TOP: Implementation MSC:Management of Care 15. A nurse is trying to decrease the rate of falls on the unit. After reviewing the literature, a strategy is implemented on the unit. After 3 months, the nurse finds that the falls have decreased. Which process did the nurse institute? a. Performance improvement b. Peer-reviewed project c. Generalizability study d. Qualitative research ANS: A Performance improvement focuses on performance issues like falls or pressure ulcer incidence. A peer-reviewed article is reviewed for accuracy, validity, and rigor and approved for publication by experts before it is published. Generalizability is not a study/research; it is if the results of a study can be compared to other patients with similar experiences. This is a quantitative study, not a qualitative study. DIF:Apply (application)REF:57 OBJ: Explain the relationship between evidence-based practice and performance improvement. TOP:ImplementationMSC:Management of Care 16. A nurse identifies a clinical problem with pressure ulcers. Which step should the nurse take next in the research process? a. Analyze results. b. Conduct the study. c. Determine method. d. Develop a hypothesis. ANS: D After identifying an area of interest or clinical problem, the steps of the research process are as follows: Develop research question(s)/hypotheses; determine how the study will be conducted; conduct the study; and analyze results of the study. DIF:Apply (application)REF:61 OBJ: Discuss the steps of the research process. TOP: Implementation MSC:Management of Care 17. After reviewing the literature, the evidence-based practice committee institutes a practice change that bedrails should be left in the down position and hourly nursing rounds should be conducted. The results indicate over a 40% reduction in falls. What is the committee’s next step? a. Evaluate the changes in 1 month. b. Implement the changes as a pilot study. c. Wait a month before implementing the changes. d. Communicate to staff the results of this project. ANS: D e. Nonexperimental research ANS: A, D, E Experimental research, nonexperimental research, surveys, and evaluation research are all forms of quantitative research that allow for precise measurement. Phenomenology and grounded theory are forms of qualitative research. DIF:Understand (comprehension)REF:59-60 OBJ: Explain how nursing research improves nursing practice. TOP: Assessment MSC:Management of Care 2. Before conducting any study with human subjects, the nurse researcher must obtain informed consent. What must the nurse researcher ensure to obtain informed consent? (Select all that apply.) a. Gives complete information about the purpose b. Allows free choice to participate or withdraw c. Understands how confidentiality is maintained d. Identifies risks and benefits of participation e. Ensures that subjects complete the study ANS: A, B, C, D Informed consent means that research subjects (1) are given full and complete information about the purpose of a study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research and the implications of participation; (3) have the power of free choice to voluntarily consent or decline participation in the research; and (4) understand how the researcher maintains confidentiality or anonymity. Completion of the study is not needed for informed consent. DIF:Understand (comprehension)REF:61 OBJ: Discuss the steps of the research process. TOP: Implementation MSC:Management of Care 3. The nurse is reviewing nursing research literature related to a potential practice problem on the nursing unit. What is the rationale for the nurse’s action? (Select all that apply.) a. Nursing research ensures the nurse’s promotion. b. Nursing research identifies new knowledge. c. Nursing research improves professional practice. d. Nursing research enhances effective use of resources. e. Nursing research leads to decreases in budget expenditures. ANS: B, C, D Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively. Nursing research itself does not lead to a decrease in budget expenditures; however it does lead to using health care resources effectively. A promotion is not a direct result of nursing research. DIF:Understand (comprehension)REF:58 OBJ: Discuss priorities for nursing research. TOP: Implementation MSC:Management of Care Chapter 06: Health and Wellness Chapter 06: Health and Wellness Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse is teaching about the goals of Healthy People 2020. Which information should the nurse include in the teaching session? a. Eliminate health disparities in America. b. Eliminate health behaviors in America. c. Eliminate quality of life in America. d. Eliminate healthy life in America. ANS: A The nurse should include eliminating health disparities in America. Healthy People 2020 promotes a society in which all people live long, healthy lives. There are four overarching goals: (1) attain high- quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, healthy development, and healthy behaviors across all life stages. DIF:Understand (comprehension)REF:66 OBJ: List the four general Healthy People 2020 public health goals for Americans. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 2. A nurse is following the goals of Healthy People 2020 to provide care. Which action should the nurse take? a. Allow people to continue current behaviors to reduce the stress of change. b. Focus only on health changes that will lead to better local communities. c. Create social and physical environments that promote good health. d. Focus on illness treatment to provide fast recuperation. ANS: C Healthy People 2020 includes four goals, one of which is to create social and physical environments that promote good health for all. The goals do not include continuing current behaviors to reduce stress, focusing only on health changes for communities, or focusing on fast recuperation. DIF:Apply (application)REF:66 OBJ: List the four general Healthy People 2020 public health goals for Americans. TOP: Implementation MSC: Health Promotion and Maintenance 3. A nurse is using the World Health Organization definition of health to provide care. Which area will the nurse focus on while providing care? a. Making sure the patients are disease free b. Making sure to involve the whole person c. Making sure care is strictly personal in nature d. Making sure to focus only on the pathological state ANS: B The World Health Organization (WHO) defines health as a “state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.” Therefore, nurses’ attitudes toward health and illness should consider the total person, as well as the environment in which the person lives. All people free of disease are not necessarily healthy. Strictly personal and a focus only on pathological states do not correlate to WHO’s definition. DIF:Apply (application)REF:66 OBJ:Discuss the definition of health.TOP:Implementation MSC:Management of Care TOP:AssessmentMSC:Health Promotion and Maintenance 8. The nurse is admitting a patient with uncontrolled diabetes mellitus. It is the fourth time the patient is being admitted in the last 6 months for high blood sugars. During the admission process, the nurse asks the patient about employment status and displays a nonjudgmental attitude. What is the rationale for the nurse’s actions? a. External variables have little effect on compliance. b. A person’s compliance is affected by economic status. c. Employment status is an internal variable that impacts compliance. d. Noncompliant patients thrive on the disapproval of authority figures. ANS: B A person’s compliance with treatment is affected by economic status. A person tends to give a higher priority to food and shelter than to costly drugs or treatments. External variables can have a major impact on compliance. Employment status is an external variable, not an internal variable. A person generally seeks approval and support from social networks, and this desire for approval affects health beliefs and practices; noncompliance does not occur from thriving on disapproval of authority figures. DIF:Apply (application)REF:69-70 | 74 OBJ:Describe variables influencing health beliefs and practices. TOP: Implementation MSC: Health Promotion and Maintenance 9. The nurse is working on a committee to evaluate the need for increasing the levels of fluoride in the drinking water of the community. Which concept is the nurse fostering? a. Illness prevention b. Wellness education c. Active health promotion d. Passive health promotion ANS: D Fluoridation of municipal drinking water and fortification of homogenized milk with vitamin D are examples of passive health promotion strategies. With active strategies of health promotion, individuals are motivated to adopt specific health programs such as weight reduction and smoking cessation programs. Illness prevention activities such as immunization programs protect patients from actual or potential threats to health. Wellness education teaches people how to care for themselves in a healthy way. DIF:Understand (comprehension)REF:71 OBJ: Describe health promotion, wellness, and illness prevention activities. TOP: Implementation MSC: Health Promotion and Maintenance 10. The nurse is working in a clinic that is designed to provide health education and immunizations. Which type of preventive care is the nurse providing? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Risk factor prevention ANS: A Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Primary prevention includes health education programs, immunizations, and physical and nutritional fitness activities. Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration. While risk factor modification is an integral component of health promotion, it is not a type of preventive care. DIF:Understand (comprehension)REF:71 OBJ: Discuss the three levels of preventive care. TOP: Implementation MSC:Health Promotion and Maintenance 11. The patient is admitted to the emergency department of the local hospital from home with reports of chest discomfort and shortness of breath. The patient is placed on oxygen, has labs and blood gases drawn, and is given an electrocardiogram and breathing treatments. Which level of preventive care is this patient receiving? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: B Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities for healthy people. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration. DIF:Apply (application)REF:71 OBJ: Discuss the three levels of preventive care. TOP: Evaluation MSC:Management of Care 12. A patient is admitted to a rehabilitation facility following a stroke. The patient has right-sided paralysis and is unable to speak. The patient will be receiving physical therapy and speech therapy. Which level of preventive care is the patient receiving? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion ANS: C Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration. Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities. DIF:Apply (application)REF:72 OBJ: Discuss the three levels of preventive care. TOP: Evaluation MSC:Management of Care 13. Upon completing a history, the nurse finds that a patient has risk factors for lung disease. How should the nurse interpret this finding? a. A person with the risk factor will get the disease. b. The chances of getting the disease are increased. c. Risk modification will have no effect on disease prevention. d. The disease is guaranteed not to develop if the risk factor is controlled. ANS: B Because the patient has been alcohol free for 2 years, the patient is in the maintenance stage. These stages range from no intention to change (precontemplation), to considering a change within the next 6 months (contemplation), to making small changes (preparation), to actively engaging in strategies to change behavior (action), to maintaining a changed behavior (maintenance). DIF:Apply (application)REF:73 OBJ:Discuss risk factor modification and changing health behaviors. TOP:EvaluationMSC:Health Promotion and Maintenance 18. The patient had a colostomy placed 1 week ago. When approached by the nurse, the patient and spouse refuse to talk about it and refuse to be taught about how to care for it. How will the nurse evaluate this couple’s stage of adjustment? a. Shock b. Withdrawal c. Acceptance d. Rehabilitation ANS: B As the patient and family recognize the reality of a change, they become anxious and may withdraw, refusing to discuss it. This is an adaptive coping mechanism that assists the patient in making the adjustment. Initially, the patient may be shocked by the change. This is followed by withdrawal, acknowledgment, acceptance, and rehabilitation (ready to adapt to the change through use of colostomy bag). DIF:Analyze (analysis)REF:75 OBJ: Describe the effect of illness on patients and families. TOP: Evaluation MSC: Psychosocial Integrity 19. A patient has had emphysema (lung disease) for many years. When approached by the nurse, the patient states “I would be better off dead.” The patient supports the family, and now because of oxygen dependency the patient must quit work. The patient’s spouse will have to go to work. Which action should the nurse take? a. Develop a plan of care for the family. b. Contact psychiatric services for a referral. c. Assure the patient that things will work out. d. Focus the plan of care solely on maximizing patient function. ANS: A Because of the effects of chronic illness, family dynamics often change. The nurse must view the whole family as a patient under stress, planning care to help the family regain its maximal level of functioning and well-being. Psychiatric services may be a part of that plan but do not represent the entire plan. Offering false assurance is never acceptable. Focusing only on the patient will not help the family adjust. DIF:Apply (application)REF:75 OBJ: Describe the effect of illness on patients and families. TOP: Implementation MSC: Psychosocial Integrity 20. A nurse is teaching about the transtheoretical model of change. In which order will the nurse place the progression of the stages from beginning to end? 1. Action 2. Preparation 3. Maintenance 4. Contemplation 5. Precontemplation a. 5, 4, 2, 1, 3 b. 2, 5, 4, 3, 1 c. 4, 5, 3, 1, 2 d. 1, 5, 2, 3, 4 ANS: A The stages of change in the transtheoretical model of change include five stages. These stages range from no intention to change (precontemplation), considering a change within the next 6 months (contemplation), making small changes (preparation), and actively engaging in strategies to change behavior (action), to maintaining a changed behavior (maintenance stage). DIF:Understand (comprehension)REF:73 OBJ:Describe variables influencing health beliefs and practices. TOP: Teaching/Learning MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. Which areas should the nurse assess to determine the effects of external variables on a patient’s illness? (Select all that apply.) a. Patient’s perception of the illness b. Patient’s coping skills c. Socioeconomic status d. Cultural background e. Social support ANS: C, D, E External variables influencing a patient’s illness behavior include the visibility of symptoms, social group, cultural background, economic variables, accessibility of the health care system, and social support. Internal variables include the patient’s perceptions of symptoms and the nature of the illness, as well as the patient’s coping skills and locus of control. DIF:Understand (comprehension)REF:69 | 74 OBJ: Describe variables influencing illness behavior. TOP: Assessment MSC: Psychosocial Integrity 2. A nurse meets the following goals: helps a patient maintain health and helps a patient with an illness. Which factors assist the nurse in achieving these goals? (Select all that apply.) a. Understands the challenges of today’s health care system b. Identifies actual and potential risk factors c. Has coined the term “illness behavior” d. Minimizes the effects of illnesses e. Experiences compassion fatigue ANS: A, B, D Nurses are in a unique position to assist patients in achieving and maintaining optimal levels of health. Nurses understand the challenges of today’s health care system. Nurses can identify actual and potential risk factors that predispose a person or group to illness. Nurses who understand how patients react to illness can minimize the effects of illness and assist patients and their families in maintaining or returning to the highest level of functioning. Nurses did not coin the phrase “illness behavior.” While nurses can experience compassion fatigue, it does not help in meeting patient goals. DIF:Understand (comprehension)REF:65 OBJ: Discuss a nurse’s role in health and illness. TOP: Implementation MSC:Health Promotion and Maintenance MSC: Basic Care and Comfort 5. A nurse is using Watson’s model to provide care to patients. Which carative factor will the nurse use? a. Maintaining belief b. Instilling faith-hope c. Maintaining ethics d. Instilling values ANS: B Watson has 10 carative factors, one of which is instilling faith-hope. Maintaining belief is a caring process of Swanson’s theory. Ethics and values are important in caring but they are not examples of Watson’s carative factors. DIF:Understand (comprehension)REF:80-81 OBJ: Compare and contrast theories on caring. TOP: Caring MSC: Psychosocial Integrity 6. A nurse provides care that is receptive to patients’ and families’ perceptions of caring. Which action will the nurse take? a. Provides clear, accurate information b. Just performs nursing tasks competently c. Does as much for the patient as possible d. Focuses solely on the patient’s diagnosis ANS: A Research indicates caring behaviors of nurses from the patient’s/families’ perspective include the following: (1) Providing honest, clear, and accurate information; (2) asking permission before doing something to a patient; (3) helping patients do as much for themselves as possible; and (4) teaching the family how to keep the relative physically comfortable. Patients continue to value nurses’ effectiveness in performing tasks, but clearly patients value the affective dimension of nursing care. DIF:Understand (comprehension)REF:87 OBJ: Discuss the evidence that exists about patients’ perceptions of caring. TOP: Implementation MSC: Basic Care and Comfort 7. A nurse follows the “ethics of care” when working with patients. Which action will the nurse take? a. Becomes the patient’s advocate based on the patient’s wishes b. Makes decisions for the patient solely using analytical principles c. Uses only intellectual principles to determine what is best for the patient d. Ignores unequal family relationships since that is a personal matter for the family ANS: A An ethic of care places the nurse as the patient’s advocate, solving ethical dilemmas by attending to relationships and by giving priority to each patient’s unique personhood. An ethic of care is unique so that professional nurses do not make professional decisions based solely on intellectual or analytical principles. Instead, an ethic of care places “caring” at the center of decision making. Nurses who function from an ethic of care are sensitive to unequal relationships that lead to abuse of one person’s power over another—intentional or otherwise. DIF:Understand (comprehension)REF:83-84 OBJ:Explain how an ethic of care influences nurses’ decision making. TOP:ImplementationMSC:Management of Care 8. A nurse is providing presence to a patient and the family. Which nursing action does this involve? a. Focusing on the task that needs to be done b. Providing closeness and a sense of caring c. Jumping in to provide patient comfort d. Being there without an identified goal ANS: B Providing presence is a person-to-person encounter conveying closeness and a sense of caring. “Being there” seems to depend on the fact that a nurse is attentive to the patient more than the task. “Being with” means being available and at the patient’s disposal. If the patient accepts the nurse, the nurse will be invited to see, share, and touch the patient’s vulnerability and suffering. Jumping in may not be welcomed. Being there is something the nurse offers to the patient with the purpose of achieving some patient care goal. DIF:Understand (comprehension)REF:84 OBJ:Describe ways to express caring through presence and touch. TOP: Implementation MSC: Psychosocial Integrity 9. The patient is afraid to have a thoracentesis at the bedside. The nurse sits with the patient and asks about the fears. During the procedure, the nurse stays with the patient, explaining each step and providing encouragement. What is the nurse displaying? a. Providing touch b. Providing a presence c. Providing family care d. Providing a listening ear ANS: B The nurse’s presence helps to calm anxiety and fear related to stressful situations. Giving reassurance and thorough explanations about a procedure, remaining at the patient’s side, and coaching the patient through the experience all convey a presence that is invaluable to the patient’s well-being. Listening and touch can be part of the “presence” but are not its entirety. No family was involved in this scenario. DIF:Apply (application)REF:84 OBJ:Describe ways to express caring through presence and touch. TOP: Caring MSC: Psychosocial Integrity 10. The patient is terminal and very near death. When the nurse checks the patient and finds no pulse or blood pressure, the family begins sobbing and hugging each other. Some family members hold the patient’s hand. The nurse is overwhelmed by the presence of grief and leaves the room. What is the nurse demonstrating? a. Caring touch b. Protective touch c. Therapeutic touch d. Task-oriented touch ANS: B Protective touch is also a kind of touch that protects the nurse emotionally. A nurse withdraws or distances herself or himself from a patient when he or she is unable to tolerate suffering or needs to escape from a situation that is causing tension. Caring touch is a form of nonverbal communication that influences a patient’s comfort and security, enhances self-esteem, and improves mental well- being. Therapeutic touch is a type of alternative therapy for healing. Task-oriented touch is done when performing a task or procedure. DIF:Apply (application)REF:84 OBJ:Describe ways to express caring through presence and touch. TOP: Implementation MSC: Psychosocial Integrity 11. Which action indicates a nurse is using caring touch with a patient? 1. A nurse cares for patients. Which areas does caring influence? (Select all that apply.) a. The way in which patients feel b. The way in which patients learn c. The way in which patients think d. The way in which patients study e. The way in which patients behave ANS: A, C, E Caring is a universal phenomenon that influences the ways in which people think, feel, and behave in relation to one another. How people learn and study involves other concepts such as teaching/learning. DIF:Understand (comprehension)REF:80 OBJ: Discuss the role that caring plays in building the nurse-patient relationship. TOP: Caring MSC: Psychosocial Integrity 2. Which actions by the nurse should be done in order to get to know the patient? (Select all that apply.) a. Avoid assumptions b. Focus on the patient c. Engage in a caring relationship d. Form the relationship very quickly e. Not address spiritual or higher needs ANS: A, B, C To know a patient means that the nurse avoids assumptions, focuses on the patient, and engages in a caring relationship with the patient that reveals information and cues that facilitate critical thinking and clinical judgments. Knowing develops over time as a nurse learns the clinical conditions within a specialty and the behaviors and physiological responses of patients. DIF:Understand (comprehension)REF:85 OBJ: Explain the relationship between knowing a patient and clinical decision making. TOP: Caring MSC: Psychosocial Integrity 3. Which actions by the nurse indicate compassion and caring to patients? (Select all that apply.) a. Saying “I’m here” b. Including the family in care c. Staying with the patient during a bedside test d. Relying on monitors and technology e. Refining work processes on the unit ANS: A, B, C Our patients tell us that a simple touch, a simple phrase, “I’m here,” or a promise to remain at the bedside represent caring and compassion. Caring for an individual cannot occur in isolation from that person’s family. As a nurse it is important to know the family almost as thoroughly as you know a patient. A reliance on technology and cost-effective health care strategies and efforts to standardize and refine work processes all undermine the nature of caring. DIF:Apply (application)REF:84 | 86 | 87 OBJ: Discuss the relationship of compassion to caring. TOP: Caring MSC: Psychosocial Integrity MATCHING Match the examples to the areas the nurse will promote connectedness for patient’s spirituality needs. a. Connection with others b. Connection with higher power c. Connection with oneself 1. Intrapersonally 2. Interpersonally 3. Transpersonally 1. ANS:CDIF:Understand (comprehension)REF:86 OBJ: Discuss the relationship of compassion to caring. TOP: Caring MSC: Psychosocial Integrity 2. ANS:ADIF:Understand (comprehension)REF:86 OBJ: Discuss the relationship of compassion to caring. TOP: Caring MSC: Psychosocial Integrity 3.ANS:BDIF:Understand (comprehension)REF:86 OBJ: Discuss the relationship of compassion to caring. TOP: Caring MSC: Psychosocial Integrity Chapter 08: Caring for the Cancer Survivor Chapter 08: Caring for the Cancer Survivor Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse is working on a cancer unit. The unit uses the National Coalition for Cancer Survivorship definition for a cancer survivor. Which definition will the nurse use? a. Been cancer free for 5 years after diagnosis b. Been cancer free for 3 years after diagnosis c. Had cancer and is declared cancer free d. Had cancer and extends until death ANS: D Cancer survivorship begins at the time of cancer diagnosis, includes treatment, and extends to the rest of the person’s life. Being cancer free for any length of time does not relate to the definition of a cancer survivor put forth by the National Coalition for Cancer Survivorship. DIF:Understand (comprehension)REF:90 OBJ: Discuss the concept of cancer survivorship. TOP: Implementation MSC: Physiological Adaptation 2. A nurse is providing follow-up care for cancer survivors. Which condition should the nurse most monitor for in these patients? a. Cancer b. Infection c. Weight gain d. Low blood pressure occurs with other long-term effects of cancer survival but does not occur with CRCI. Grief and nightmares occur with post-traumatic stress disorder. DIF:Apply (application)REF:92 OBJ: Describe the influence of cancer survivorship on patients’ quality of life. TOP: Assessment MSC: Physiological Adaptation 7. The nurse is caring for a young woman with breast cancer. The stress between the woman and spouse is obvious, as is anxiety among the children. What is the nurse’s best action in this situation? a. Help find or develop an educational program for the patient and spouse. b. Encourage the patient to agree with the spouse. c. Support the spouse, and explain that the spouse knows what is best. d. Take the children away and recommend foster care. ANS: A It is a nurse’s responsibility to educate (develop an educational program) cancer survivors and their families about the effects of cancer and cancer treatment. Spouses often do not know what to do to support the survivor, and they struggle with how to help; therefore, agreeing even if disagreeing does not help and the spouse does not always know what is best. Foster care is not necessary at this time. DIF:Apply (application)REF:95 OBJ: Discuss the effects that cancer has on the family. TOP: Implementation MSC: Psychosocial Integrity 8. The nurse is caring for a patient who is undergoing chemotherapy and radiation for cancer. The patient asks the nurse about the value of cancer screening when therapy is over. What is the nurse’s best response? a. “It should be done on an ongoing schedule.” b. “It is not something that should be discussed right now.” c. “It probably will not be needed since the cancer has been cured.” d. “It usually is not done but can be done if the patient wants peace of mind.” ANS: A Because survivors are at increased risk for developing a second cancer and/or chronic illness, it is important to educate them about lifestyle behaviors and the importance of participating in ongoing cancer screening and early detection practices. Lifelong cancer screening provides the opportunity to identify new cancers in early stages. Cancer screening should be discussed and should be done even if the cancer is cured. DIF:Apply (application)REF:96 OBJ:Explain the nursing implications related to cancer survivorship. TOP:Communication and Documentation MSC:Health Promotion and Maintenance 9. The nurse is caring for a patient diagnosed with cancer. The family of the patient asks the nurse for resources about the cancer. What should the nurse do? a. Refer family members to the health care provider. b. Inform them that few options are available. c. Maintain confidentiality by keeping silent. d. Provide the family with the information. ANS: D The nurse’s role is to tell patients and families about the different resources available so they can make informed choices. The physician is a resource, but the nurse can educate and help as well. There are numerous organizations that provide resources to cancer survivors. The nurse must maintain patient confidentiality, not resource confidentiality. DIF:Apply (application)REF:96 OBJ:Explain the nursing implications related to cancer survivorship. TOP: Implementation MSC: Psychosocial Integrity 10. The nurse is caring for a patient with known coronary artery disease who has recently been diagnosed with lung cancer. What should the nurse do? a. Focus the assessment solely on the cancer diagnosis since it is the newer diagnosis. b. Ask questions about cardiac symptoms and their relationship to the cancer. c. Ignore symptom management and focus on palliative care. d. Say nothing because cancer survivors dislike prying. ANS: B The nurse needs to consider not only the effects of cancer and its treatment but also how it will affect any other medical condition. For example, if a patient also has heart disease, how will the fatigue related to chemotherapy affect this individual? The nurse must focus on both, not just the cancer diagnosis. Nurses do not ignore symptom management; given the symptoms that a patient identifies, the nurse will explore each one to gain a complete picture of the patient’s health status. Saying nothing is inappropriate; patients will appreciate the nurse’s sensitivity and interest in their well- being. DIF:Apply (application)REF:94 OBJ:Explain the nursing implications related to cancer survivorship. TOP: Implementation MSC: Physiological Adaptation 11. The patient has lung cancer and voices concerns about cancer treatments affecting sexuality. What is the nurse’s best reply? a. “That is something to ask the health care provider.” b. “Chemotherapy will work in the lungs and should have no effect on sexuality.” c. “How cancer treatment affects sexuality depends on how active you are and your age.” d. “Sexual changes are common with cancer therapy. Let me get someone who can answer your questions.” ANS: D Cancer therapies have the potential to cause fatigue, apathy, nausea, vomiting, malaise, and sleep disturbances, all of which interfere with a patient’s sexual functioning. It helps if the nurse can develop a comfort level in acknowledging with patients that sexual changes are common at any age level. When patients begin to discuss their sexuality, be familiar with the expert resources in your institution (e.g., psychologist, social worker) available for patient referral. The issue should not be pushed onto the health care provider. DIF:Apply (application)REF:95 OBJ:Explain the nursing implications related to cancer survivorship. TOP: Communication and Documentation MSC: Psychosocial Integrity 12. The nurse is caring for a patient who has successfully undergone cancer therapy and will be discharged home soon. The patient is concerned about going home and not knowing what to do. Which information is the most valuable for the nurse to share with the patient? a. The nurse will develop a plan of care that will tell exactly what needs to be done. b. If any issues arise, call the health care provider and follow the instructions. c. Proper cancer treatment has been provided, and nothing else is required. d. There is a team that will provide support and care that may be needed. ANS: D a. Patients and caregivers share activities of care. b. Family provides most of the care because the patient is unable. c. Patients mostly care for self with caregivers in a standby role. 1. The self-caregiving pattern 2. The collaborative care pattern 3. The family caregiving pattern 1.ANS:CDIF:Understand (comprehension)REF:95 OBJ: Discuss the effects that cancer has on the family. TOP: Caring MSC: Psychosocial Integrity 2. ANS:ADIF:Understand (comprehension)REF:95 OBJ: Discuss the effects that cancer has on the family. TOP: Caring MSC: Psychosocial Integrity 3. ANS:BDIF:Understand (comprehension)REF:95 OBJ: Discuss the effects that cancer has on the family. TOP: Caring MSC: Psychosocial Integrity Chapter 09: Cultural Awareness Chapter 09: Cultural Awareness Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse is working at a health fair screening people for liver cancer. Which population group should the nurse monitor most closely for liver cancer? a. Hispanic b. Asian Americans c. Non-Hispanic Caucasians d. Non-Hispanic African-Americans ANS: B While Asian Americans generally have lower cancer rates than the non-Hispanic Caucasian population, they also have the highest incidence rates of liver cancer for both sexes compared with Hispanic, non-Hispanic Caucasians, or non-Hispanic African-Americans. DIF:Apply (application)REF:101 OBJ: Describe cultural influences on health and illness. TOP: Assessment MSC:Health Promotion and Maintenance 2. A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this patient? a. There is a decreased frequency of morbidity. b. There is an increased incidence of disease. c. There is an increased level of health. d. There is a decreased mortality rate. ANS: B Populations with health disparities (immigrant with low income) have a significantly increased incidence of disease or increased morbidity and mortality when compared with the general population. Although Americans’ health overall has improved during the past few decades, the health of members of marginalized groups has actually declined. DIF:Understand (comprehension)REF:101-102 OBJ: Describe cultural influences on health and illness. TOP: Planning MSC:Management of Care 3. A nurse is assessing the health care disparities among population groups. Which area is the nurse monitoring? a. Accessibility of health care services b. Outcomes of health conditions c. Prevalence of complications d. Incidence of diseases ANS: A While health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases and related complications, health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. DIF:Apply (application)REF:102 OBJ:Describe health disparities and social determinants of health. TOP:AssessmentMSC:Health Promotion and Maintenance 4. A nurse is providing care to a patient from a different culture. Which action by the nurse indicates cultural competence? a. Communicates effectively in a multicultural context b. Functions effectively in a multicultural context c. Visits a foreign country d. Speaks a different language ANS: B Cultural competence refers to a developmental process that evolves over time that impacts ability to effectively function in the multicultural context. Communicates effectively and speaking a different language indicates linguistic competence. Visiting a foreign country does not indicate cultural competence. DIF:Apply (application)REF:103 OBJ: Describe steps toward developing cultural competence. TOP: Implementation MSC: Psychosocial Integrity 5. The nurse learns about cultural issues involved in the patient’s health care belief system and enables patients and families to achieve meaningful and supportive care. Which concept is the nurse demonstrating? a. Marginalized groups b. Health care disparity c. Transcultural nursing d. Culturally congruent care ANS: D The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a person’s life patterns, values, and system of meaning, provides meaningful and beneficial nursing care. Marginalized groups are populations left out or excluded. Health care disparities are differences among populations in the availability, accessibility, and quality of health care services TOP: Implementation MSC: Psychosocial Integrity 10. The nurse is caring for a Chinese patient using the Teach-Back technique. Which action by the nurse indicates successful implementation of this technique? a. Asks, “Does this make sense?” b. Asks, “Do you think you can do this at home?” c. Asks, “What will you tell your spouse about changing the dressing?” d. Asks, “Would you tell me if you don’t understand something so we can go over it?” ANS: C The Teach-Back technique asks open-ended questions, like what will you tell your spouse about changing the dressing, to verify a patient’s understanding. When using the Teach-Back technique do not ask a patient, “Do you understand?” or “Do you have any questions?” Does this make sense and do you think you can do this at home are closed-ended questions. Would you tell me if you don’t understand something so we can go over it is not verifying a patient’s understanding about the teaching. DIF:Apply (application)REF:110-111 OBJ:Discuss research findings applicable to culturally competent care. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 11. A nurse is using core measures to reduce health disparities. Which group should the nurse focus on to cause the most improvement in core measures? a. Caucasians b. Poor people c. Alaska Natives d. American Indians ANS: B To improve results, the nurse should focus on the highest disparity. Poor people received worse care than high-income people for about 60% of core measures. American Indians and Alaska Natives received worse care than Caucasians for about 30% of core measures. DIF:Analyze (analysis)REF:111 OBJ:Discuss research findings applicable to culturally competent care. TOP:EvaluationMSC:Management of Care 12. A nurse is designing a form for lesbian, gay, bisexual, and transgender (LGBT) patients. Which design should the nurse use? a. Use partnered rather than married. b. Use mother rather than father. c. Use parents rather than guardian. d. Use wife/husband rather than significant other. ANS: A Include LGBT-inclusive language on forms and assessments to facilitate disclosure, knowing that disclosure is a choice impacted by many factors. For example, provide options such as “partnered” under relationship status. For parents, use parent/guardian, instead of mother/father. Use neutral and inclusive language when talking with patients (e.g., partner or significant other), listening and reflecting patient’s choice. Remember that some LGBT patients are also legally married. DIF:Understand (comprehension)REF:105 OBJ: Discuss research findings applicable to equity-focused quality improvement. TOP:CaringMSC:Management of Care 13. A nurse is assessing population groups for the risk of suicide requiring medical attention. Which group should the nurse monitor most closely? a. Young bisexuals b. Young caucasians c. Asian Americans d. African-Americans ANS: A Gay, lesbian, and bisexual young people have a significantly increased risk for depression, anxiety, suicide attempts, and substance use disorders, being 4 times as likely as their straight peers to make suicide attempts that require medical attention. Caucasian youth, Asian Americans, and African-Americans are not as likely to attempt suicide resulting in medical attention. DIF:Understand (comprehension)REF:101 OBJ:Explain how the many facets of culture affect a health care provider’s ability to provide culturally congruent care.TOP:Assessment MSC:Health Promotion and Maintenance 14. A nurse is assessing a patient’s ethnohistory. Which question should the nurse ask? a. What language do you speak at home? b. How different is your life here from back home? c. Which caregivers do you seek when you are sick? d. How different is what we do from what your family does when you are sick? ANS: B An ethnohistory question is the following: How different is your life here from back home? Caring beliefs and practice questions include the following: Which caregivers do you seek when you are sick and How different is what we do from what your family does when you are sick? The language and communication is the following: What language do you speak at home? DIF:Understand (comprehension)REF:107 OBJ:Use cultural assessment to plan culturally competent care. TOP:AssessmentMSC:Health Promotion and Maintenance 15. A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy? a. A patient 35 years old b. A patient 68 years old c. A patient with a college degree d. A patient with a high-school diploma ANS: B About 9 out of 10 people in the United States experience challenges in using health care information. Patients who are especially vulnerable are the elderly (age 65+), immigrants, persons with low incomes, persons who do not have a high-school diploma or GED, and persons with chronic mental and/or physical health conditions. A 35-year-old patient and patients with high-school and college education are not identified in the vulnerable populations. DIF:Apply (application)REF:110 OBJ:Discuss research findings applicable to culturally competent care. TOP:AssessmentMSC:Health Promotion and Maintenance 16. A nurse works at a hospital that uses equity-focused quality improvement. Which strategy is the hospital using? a. Document staff satisfaction. a. Connect on a social level. b. Help the patient overcome barriers. c. Consciously attempt to suspend judgment. d. Stress that they will be working together to address problems. e. Know limitations in addressing medical issues across cultures. ANS: A, C The “R” in RESPECT stands for rapport and includes the following behaviors: connect on a social level; seek the patient’s point of view; and consciously attempt to suspend judgment. The “S” stands for support and includes the behavior of helping the patient overcome barriers. The “P” stands for partnership and includes the following behaviors: be flexible with regard to issues of control and stress that you will be working together to address medical problems. The “C” stands for cultural competence and includes the behavior of knowing your limitations in addressing medical issues across cultures. DIF:Apply (application)REF:109 OBJ:Discuss research findings applicable to culturally congruent care. TOP: Caring MSC: Psychosocial Integrity 3. A nurse is using the explanatory model to determine the etiology of an illness. Which questions should the nurse ask? (Select all that apply.) a. How should your sickness be treated? b. What do you call your problem? c. How does this illness work inside your body? d. What do you fear most about your sickness? e. What name does it have? ANS: B, C, E The questions for etiology include “What do you call your problem?” and “What name does it have?” Recommended treatment is asked by the question “How should your sickness be treated?” Pathophysiology is asked by the question “How does this illness work inside your body?” The course of illness is asked by the question “What do you fear most about your sickness?” DIF:Understand (comprehension)REF:108 OBJ:Use cultural assessment to plan culturally competent care. TOP:AssessmentMSC:Management of Care MATCHING A nurse is using Campinha-Bacote’s model of cultural competency to improve cultural care. Which actions describe the components the nurse is using? a. In-depth self-examination of one’s own background b. Ability to assess factors that influence treatment and care c. Sufficient comparative understanding of diverse groups d. Motivation and commitment to continue learning about cultures e. Cross-cultural interaction that develops communication skills 1. Cultural skills 2. Cultural desires 3. Cultural awareness 4. Cultural knowledge 5. Cultural encounters 1. ANS:BDIF:Understand (comprehension)REF:104-105 OBJ: Describe steps toward developing cultural competence. TOP: Assessment MSC:Management of Care 2. ANS:DDIF:Understand (comprehension)REF:104-105 OBJ: Describe steps toward developing cultural competence. TOP: Assessment MSC:Management of Care 3. ANS:ADIF:Understand (comprehension)REF:104-105 OBJ: Describe steps toward developing cultural competence. TOP: Assessment MSC:Management of Care 4. ANS:CDIF:Understand (comprehension)REF:104-105 OBJ: Describe steps toward developing cultural competence. TOP: Assessment MSC:Management of Care 5. ANS:EDIF:Understand (comprehension)REF:104-105 OBJ: Describe steps toward developing cultural competence. TOP: Assessment MSC:Management of Care Chapter 10: Caring for Families Chapter 10: Caring for Families Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A nurse is assessing the family unit to determine the family’s ability to adapt to the change of a member having surgery. Which area is the nurse monitoring? a. Family durability b. Family resiliency c. Family diversity d. Family forms ANS: B Family resiliency is the ability of the family to cope with expected and unexpected stressors; it’s the families’ ability to adapt to changes. Family diversity is the uniqueness of each family unit. Every person within a family unit has specific needs, strengths, and important developmental considerations. Family durability is a system of support and structure within a family that extends beyond the walls of the household. Family forms are patterns of people considered by family members to be included in the family. DIF:Apply (application)REF:117 | 122 OBJ: Discuss how the term family reflects family diversity. TOP: Assessment MSC: Psychosocial Integrity 2. A nurse reviews the current trends affecting the family. Which trend will the nurse find? a. Mothers are staying at home. b. Adolescent mothers usually live on their own. c. More grandparents are raising their grandchildren. d. Teenage fathers usually have stronger support systems. ANS: C