TEST BANK Fundamentals of Nursing 11TH Edition by Potter Perry PDF, Exams of Nursing

Download TEST BANK Fundamentals of Nursing 11TH Edition by Potter Perry PDF and more Exams Nursing in PDF only on Docsity! Fundamentals of Nursing 11th Edition by Potter Perry Test Bank Chapter 01: Nursing Today Potter: Fundamentals of Nursing, 11th 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) 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) 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) 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 stressor, contribute to compassion fatigue. Physical and mental exhaustion describes burnout only. DIF:Understand (comprehension) 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) OBJ:Discuss 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) OBJ:Discuss 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) OBJ:Discuss 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) 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) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Evaluation MSC: Management of Care 15. A nurse is using a guide that provides principles of right and wrong to provide care to patients. Which guide is the nurse using? a. Code of ethics b. Standards of practice c. Standards of professional performance d. Quality and safety education for nurses ANS: A The code of ethics is the philosophical ideals of right and wrong that define the principles you will use to provide care to your patients. The standards of practice describe a competent level of nursing care. The ANA Standards of Professional Performance describe a competent level of behavior in the professional role. Quality and safety education for nurses addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments. DIF:Understand (comprehension) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Implementation MSC: Management of Care 16. A graduate of a baccalaureate degree program plans to start working as a registered nurse (RN) in the emergency department. Which action must the nurse take first? a. Obtain certification for an emergency nurse. b. Pass the National Council Licensure Examination. c. Take a course on genomics to provide competent emergency care. d. Complete the Hospital Consumer Assessment of Healthcare Providers Systems. ANS: B Currently, in the United States, the most common way to become a registered nurse (RN) is through completion of an associate degree or baccalaureate degree program. Graduates of both programs are eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) to become registered nurses in the state in which they will practice. Certification can be obtained after passing the NCLEX and working for the specified amount of time. Genomics is a newer term that describes the study of all the genes in a person and interactions of these genes with one another and with that person’s environment. Consumers can also access Hospital Consumer Assessment of Healthcare Providers Systems (HCAHPS) to obtain information about patients’ perspectives on hospital care. DIF:Remember (knowledge) OBJ:Compare and contrast the educational programs available for professional registered nurse (RN) education. TOP: Implementation MSC: Management of Care 17. While providing care to a patient, the nurse is responsible, both professionally and legally, for the appropriateness and proper execution of the care. Which concept does this describe? a. Autonomy b. Accountability c. Patient advocacy d. Patient education ANS: B 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) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Evaluation MSC: Management of Care Chapter 02: Health Care Delivery System Potter: Fundamentals of Nursing, 11th 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) OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. TOP: Planning MSC: Management of Care 2. A nurse is teaching the staff about integrated health care systems. Which model of care should the nurse include in the teaching about seam-less care delivery? a. Affordable Care Act b. Hospital Value–Based Purchasing c. Bundled Payments for Care Improvements d. The patient-centered medical home model ANS: D Basically, two types of integrated health care systems are found: an organizational structure that follows economic imperatives (such as combining financing with all providers, from hospitals, clinics, and physicians to home care and long-term care facilities) and a structure that supports an organized care delivery approach (coordinating care activities and services into seamless functioning). The patient-centered medical home model is an example of an integrated health care system that strengthens the physician-patient relationship with coordinated, goal-oriented, individualized care. All the other options are more related to the financial accessibility of health care. DIF:Understand (comprehension) OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. TOP: Teaching/Learning MSC: Management of Care 3. A nurse is teaching a family about health care plans. Which information from the nurse indicates a correct understanding of the Affordable Care Act? a. A family can choose whether to have health insurance with no consequences. b. Primary care physician payments from Medicaid services can equal Medicare. c. Adult children up to age 26 are allowed coverage on the parent’s plan. d. Quality hospital outcome scores are tied directly to patient satisfaction. ANS: C The Affordable Care Act ties payment to organizations offering Medicare Advantage plans to the quality ratings of the coverage they offer. If hospitals perform poorly in quality scores, they receive lower payments for services. Quality outcome measures include patient satisfaction, more effective management of care by reducing complications and readmissions and improving care coordination. All individuals are required to have some form of health insurance by 2014 or pay a penalty through the tax code. Primary care physician payments for Medicaid services increased to equal Medicare payments. Implementation of insurance regulations prevents private insurance companies from denying insurance coverage for any reason and from charging higher premiums based on health status and gender. DIF:Remember (knowledge) OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. TOP: Teaching/Learning MSC: Management of Care 4. A nurse is caring for a patient in the hospital. When should the nurse begin discharge planning? a. When the patient is ready. b. Close to the time of discharge. c. Upon admission to the hospital. d. After an order is written/prescribed. ANS: C Discharge planning begins the moment a patient is admitted to a health care facility. When the patient is ready may be too late. Close to the time of discharge and after an order is written/prescribed are too late to help the transition of patient care from the hospital to home or other care facility. DIF:Remember (knowledge) OBJ:Discuss the role of nurses in various health care settings. TOP: Planning MSC: Management of Care 5. The nurse is applying for a position with a home care organization that specializes in spinal cord injury. In which type of health care facility does the nurse want to work? a. Secondary acute b. Continuing c. Restorative d. Tertiary ANS: C 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. Restorative care includes cardiovascular and pulmonary rehabilitation, sports medicine, spinal cord injury programs, and home care. Secondary acute care involves emergency care, acute medical-surgical care, and radiological procedures. Continuing care involves assisted living, psychiatric care, and older-adult day care. Tertiary care includes intensive care and subacute care. DIF:Understand (comprehension) OBJ:Discuss the role of nurses in various health care settings. TOP: Implementation MSC: Management of Care 6. A nurse provides immunization to children and adults through the public health department. Which type of health care is the nurse providing? a. Primary care b. Preventive care 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) OBJ:Summarize the six levels of health care. TOP: Implementation MSC: Health Promotion and Maintenance 7. In order to receive payment for care provided, nursing centers must comply with requirements outlined in what federal legislation? a. Omnibus Budget Reconciliation Act b. Medicare Act c. Medicaid Act d. Affordable Care Act ANS: A Nursing centers must comply with the Omnibus Budget Reconciliation Act of 1987 and its minimum requirements for nursing facilities to receive payment from Medicare and Medicaid. The Affordable Care Act ties payment to organizations offering Medicare Advantage plans to the quality ratings of the coverage they offer. DIF:Understand (comprehension) Nursing-sensitive outcomes are patient outcomes and nursing workforce characteristics that are directly related to nursing care such as changes in patients’ symptom experiences, functional status, safety, psychological distress, registered nurse (RN) job satisfaction, total nursing hours per patient day, and costs. Medicare-qualified hospitals had physician- supervised utilization review (UR) committees to review the admissions and to identify and eliminate overuse of diagnostic and treatment services ordered by physicians caring for patients on Medicare. DIF:Understand (comprehension) OBJ:Discuss the features of an integrated health care system. TOP: Implementation MSC: Management of Care 13. Which finding indicates the best quality improvement process? a. Staff identifies the wait time in the emergency department is too long. b. Administration identifies the design of the facility’s lobby increases patient stress. c. Director of the hospital identifies the payment schedule does not pay enough for overtime. d. Health care providers identify the inconsistencies of some of the facility’s policy and procedures. ANS: A The quality improvement process begins at the staff level, where problems are defined by the staff. It is not identified by administration, the hospital director, or health care providers. DIF:Apply (application) OBJ:Discuss the features of an integrated health care system. TOP: Evaluation MSC: Management of Care 14. A nurse is providing home care to a home-bound patient treated with intravenous (IV) therapy and enteral nutrition. What is the home health nurse’s primary objective after providing necessary care? a. Screening b. Education c. Dependence d. Counseling ANS: B Health promotion and education are traditionally the primary objectives of home care, yet at present most patients receive home care because they need nursing care. Screening is preventive care. The home health nurse focuses on patient and family independence. Counseling is through psychiatric care. DIF:Understand (comprehension) OBJ:Discuss the nursing implications regarding issues facing the health care system. TOP: Planning MSC: Management of Care 15. A nurse hears a co-worker state that anybody could be a nurse since it is so automated with infusion devices and electronic monitoring; technology is doing the work. What is the nurse’s best response? a. ―Technology use has to be combined with nursing judgment.‖ b. ―The focus of effective nursing care is technology.‖ c. ―If it’s so easy, why don’t you do it?‖ d. ―That is true in the twentieth century.‖ ANS: A In many ways, technology makes work easier, but it does not replace nursing judgment. Technology does not replace your critical eye and clinical judgment. Most importantly, it is essential to remember that the focus of nursing care is not the machine or the technology; it is the patient. Using ―why‖ is not beneficial when communicating with others. Agreeing with the statement furthers misconceptions. DIF:Apply (application) OBJ:Explain approaches nurses can use to improve patient satisfaction. TOP: Communication and Documentation MSC: Management of Care 16. A nurse is completing a minimum data set. Which area is the nurse working? 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) OBJ:Discuss the role of nurses in various health care settings. TOP: Implementation MSC: 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) OBJ:Discuss the nursing implications regarding issues facing the health care system. 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) OBJ:Explain approaches nurses can use to improve patient satisfaction. TOP: Teaching/Learning MSC: 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 d. Focus on providing care in various community settings. ANS: A 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. In addition, the community health nurse provides direct care services to subpopulations within a community. Community-based nursing centers function as the first level of contact between members of a community and the health care system. Community-based nursing focuses on providing care in various community settings, such as the home or a clinic and involves acute and chronic care. DIF:Apply (application) OBJ:Contrast 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) OBJ:Contrast community health nursing from community-based nursing. TOP: Implementation MSC: 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) 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) 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 2030 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 2030 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) OBJ:Discuss the role of the nurse in community-based practice. TOP: Planning MSC: 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:Understand (comprehension) OBJ:Explain the competencies important for success in community-based nursing practice. TOP: Implementation MSC: 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 hairbrushes. 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:Understand (comprehension) 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. One who has excessive risks. c. One who has unlimited access to health care. d. One who uses nontraditional healing practices. ANS: B Vulnerable populations are the patients who are more likely to develop health problems as a result of excessive risks or limits in access to health care services or who are dependent on others for care. Pregnancy is not a cause of vulnerability, except in cases where the mother is an adolescent, is addicted to drugs, or is at high risk for other reasons. A person who has unlimited access to health care is not vulnerable. Frequently, the immigrant population practices nontraditional healing practices. Many of these healing practices are effective and complement traditional therapies. DIF:Analyze (analysis) OBJ:Identify characteristics of patients from vulnerable populations that influence the community-based nurse’s approach to care. TOP: Assessment MSC: Health Promotion and Maintenance 11. The instructor is teaching student nurses about identifying members of vulnerable populations when the nursing student asks, ―Why is it that not all poor people are considered members of vulnerable populations?‖ How should the nurse respond? a. ―All poor people are members of a vulnerable population.‖ b. ―Poor people are members of a vulnerable population only if they take drugs.‖ c. ―Poor people are members of a vulnerable population only if they are homeless.‖ d. ―Members of vulnerable groups frequently have a combination of risk factors.‖ ANS: D DIF:Understand (comprehension) OBJ:Identify 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) OBJ:Explain the relationship between public health and community health nursing. TOP: Evaluation MSC: 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) OBJ:Discuss the role of the nurse in community-based practice. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 2. Offering which community-based nursing activities indicates the nurse is working in the role of educator? (Select all that apply.) a. Prenatal classes b. A child safety program c. To defend patients’ decisions d. Creative solutions to local problems e. To 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) OBJ:Explain the competencies important for success in community-based nursing practice. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 3. A nurse is caring for vulnerable populations in a local community. Which patients will the nurse care for in this community? (Select all that apply.) a. A 47-year-old immigrant who speaks only Spanish b. A 35-year-old living in own home c. A 22-year-old pregnant woman d. A 40-year-old schizophrenic e. A 15-year-old rape victim ANS: A, D, E Individuals living in poverty, older adults, people who are homeless, immigrant populations, individuals in abusive relationships (rape), substance abusers, and people with severe mental illnesses (schizophrenic) are examples of vulnerable populations. Middle-aged people living in their own home are not an example of a vulnerable population. Pregnancy is not an example of a vulnerable population. DIF:Analyze (analysis) OBJ:Identify characteristics of patients from vulnerable populations that influence the community-based nurse’s approach to care. TOP: Implementation MSC: Psychosocial Integrity MATCHING A nurse is assessing a community. Match each community element the nurse will assess with the correct example. a. Education level b. Housing c. Government 1. Structure 2. Population 3. Social system 1. ANS: B DIF:Understand (comprehension) OBJ:Identify elements of a community assessment. TOP: Assessment MSC: Health Promotion and Maintenance 2. ANS: A DIF:Understand (comprehension) OBJ:Identify elements of a community assessment. TOP: Assessment MSC: Health Promotion and Maintenance 3. ANS: C DIF:Understand (comprehension) OBJ:Identify elements of a community assessment. TOP: Assessment MSC: Health Promotion and Maintenance Chapter 04: Theoretical Foundations of Nursing Practice Potter: Fundamentals of Nursing, 11th Edition MULTIPLE CHOICE 1. The nursing instructor is teaching a class on nursing theory. One of the students asks, ―Why do we need to know this stuff? It doesn’t really affect patients.‖ What is the instructor’s best response? a. ―You are correct, but we have to learn it anyway.‖ b. ―This keeps the focus of nursing narrow.‖ c. ―Theories help explain why nurses do what they do.‖ d. ―Exposure to theories will help you later in graduate school.‖ ANS: C Theories offer well-grounded rationales for how and why nurses perform specific interventions and for predicting and/or prescribing nursing care measures. Although nursing theory will help the nurse in graduate school, it is also an important basis for the nurse’s approach to daily patient care, and it expands scientific knowledge of the profession. DIF:Apply (application) OBJ:Explain how theory is used in nursing practice. TOP: Implementation MSC: Management of Care 2. The nurse is caring for a patient who does not follow the prescribed regimen for diabetes management. As a prescriber to Orem’s theory, the nurse interviews the patient in an attempt to identify the cause of the patient’s ―nonadherence.‖ What is the rationale for the nurse’s behavior? 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. Leininger’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. c. Third level d. Fourth level ANS: C The third level contains love and belonging needs, including family and friends. The first level includes physiological needs. The second level includes safety and security needs. The fourth level encompasses esteem and self-esteem needs. The fifth and final level is the need for self-actualization. DIF:Understand (comprehension) OBJ:Review selected shared theories from other disciplines. TOP: Implementation MSC: Psychosocial Integrity 9. A nurse is caring for pediatric patients and using the developmental theory to plan nursing care. What is the focus of this nurse’s care? a. Humans have an orderly, predictive process of growth and development. b. Humans respond to threats by adapting with growth and development. c. Humans respond with cognitive principles for growth and development. d. Humans have psychosocial domains to growth and development. ANS: A With developmental theory, human growth and development is an orderly predictive process that begins with conception and continues through death. Stress/adaptation theories describe how humans respond to threats by adapting in order to maintain function and life. Educational theories explain the teaching-learning process by examining behavioral, cognitive, and adult- learning principles. Psychosocial theories explain human responses within the physiological, psychological, sociocultural, developmental, and spiritual domains. DIF:Understand (comprehension) OBJ:Review selected shared theories from other disciplines. TOP: Evaluation MSC: Health Promotion and Maintenance 10. Upon assessment, the nurse notices that the patient’s respirations have increased, and the tip of the nose and earlobes are becoming cyanotic. The nurse finds that the patient’s pulse rate is over 100 beats per minute. According to Maslow’s hierarchy of needs, which patient need should the nurse address first? a. Self-esteem b. Physiological c. Self-actualization d. Love and belonging ANS: B Maslow’s hierarchy is useful in setting patient priorities. Basic physiological and safety needs are usually the first priority. After the physiological and safety needs are met, the nurse can move to love and belonging, self-esteem, and self-actualization. DIF:Apply (application) OBJ:Review selected shared theories from other disciplines. TOP: Implementation MSC: Management of Care 11. Which behavior demonstrated by a nurse indicates the nurse is using Nightingale’s theory to plan nursing care? a. Knows all about the disease processes affecting patients. b. Focuses on medication administration and treatments. c. Thinks about the patients and patients’ environments. d. Considers nursing knowledge and medicine the same. ANS: C Nightingale’s theory provides nurses with a way to think about patients and their environment. Nightingale’s concept of the environment was the focus of nursing care, and her firm conviction was that nursing knowledge is distinct from medical knowledge. Nightingale did not view nursing as limited to the administration of medications and treatments. DIF:Understand (comprehension) OBJ:Describe theory-based nursing practice. TOP: Planning MSC: Management of Care 12. The home health nurse listens to the patient’s concerns about having ―open-heart‖ surgery. The nurse explains the different surgical procedures and other options, like cardiac rehabilitation. After several visits, the patient wants cardiac rehabilitation. The nurse notifies the health care provider and sets up a referral. Which theory is the nurse using? a. Peplau’s theory b. Henderson’s theory c. Nightingale’s theory d. Orem’s self-care deficit theory 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:Understand (comprehension) OBJ:Determine how to apply different nursing theories in different patient situations. 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’s religious beliefs do not allow the use of 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:Understand (comprehension) OBJ:Determine how to apply different nursing theories in different patient situations. 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:Understand (comprehension) OBJ:Determine how to apply different nursing theories in different patient situations. 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:Understand (comprehension) OBJ:Determine how to apply different nursing theories in different patient situations. TOP: Implementation MSC: Health Promotion and Maintenance DIF:Understand (comprehension) OBJ:Review selected shared theories from other disciplines. TOP: Caring MSC: Psychosocial Integrity Chapter 05: Evidence-Based Practice Potter: Fundamentals of Nursing, 11th Edition MULTIPLE CHOICE 1. A nurse uses evidence-based practice (EBP) to provide nursing care. What is the best rationale 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) 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 non-research evidence. Evidence-based care improves quality, safety, patient outcomes, and nurse satisfaction while reducing costs. DIF:Understand (comprehension) 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) OBJ:Explain 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) OBJ:Summarize 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) OBJ:Explain 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. Agency for Healthcare Research and Quality (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:Understand (comprehension) OBJ:Explain 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? a. A true PICOT question regardless of the number of elements b. A true PICOT question because the intervention comes before the control c. Not a true PICOT question because the comparison comes after the intervention d. Not a true PICOT question because the time is not designated ANS: A A meaningful PICOT question can contain only a P and O: How do patients with breast cancer (P) rate their quality of life (O)? Note that a well-designed PICOT question does not have to follow the sequence of P, I, C, O, and T. The aim is to ask a question that contains as many of the PICOT elements as possible. DIF:Analyze (analysis) OBJ:Develop a PICOT question. TOP: Evaluation MSC: Management of Care 8. A nurse is reviewing literature for an evidence-based practice study. Which study should the nurse use for the most reliable level of evidence that uses statistics to show effectiveness? a. Meta-analysis b. Systematic review c. Single random controlled trial d. Control trial without randomization ANS: A The main difference is that in a meta-analysis the researcher uses statistics to show the effect of an intervention on an outcome. In a systematic review, no statistics are used to draw conclusions about the evidence. A single random controlled trial (RCT) is not as conclusive as a review of several RCTs on the same question. Control trials without randomization may involve bias in how the study is conducted. DIF:Analyze (analysis) OBJ:Summarize the levels of evidence available in the literature. 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) 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 injury 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:Understand (comprehension) OBJ:Compare the similarities and differences between evidence-based practice, research, and performance improvement. TOP: Implementation MSC: Management of Care 16. A nurse identifies a clinical problem with pressure injuries. 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) 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 The last step of evidence-based practice (EBP) is to share the outcomes of EBP changes with others. Changes must be evaluated before the outcomes are shared. Once communicated, changes should be put in place as the committee deems reasonable (i.e., either hospital wide or as a pilot study). Waiting should not be an option unless the results are not to the committee’s liking. DIF:Apply (application) OBJ:Discuss how nurses apply evidence in practice. TOP: Implementation MSC: Management of Care 18. A nurse is developing a care delivery outcomes research project. Which population will the nurse study? a. Nurses b. Patients c. Administrators d. Health care providers ANS: B Similar to the expected outcomes you develop in a plan of care, a care delivery outcome focuses on the recipients of service (e.g., patient, family, or community) and not the providers (e.g., nurse or physician/health care provider). Administrators are not recipients of service. DIF:Understand (comprehension) OBJ:Elaborate on how nursing research improves nursing practice. TOP: Implementation MSC: Management of Care 19. A nurse is implementing an evidence-based practice project regarding infection rates. After reviewing research literature, which other evidence should the nurse review? a. Quality improvement data b. Inductive reasoning data c. Informed consent data d. Biased data ANS: A When implementing an evidence-based practice project, it is important to first review evidence from appropriate research and quality improvement data. Inductive reasoning is used to develop generalizations or theories from specific observations; this study needs specifics. Informed consent is not data but a process and form that subjects must sign before participating in research projects/studies. Biased data is based on opinions; facts are needed for this study. DIF:Understand (comprehension) OBJ:Compare the similarities and differences between evidence-based practice, research, and performance improvement. TOP: Implementation MSC: Management of Care 20. A nurse is using the research process. Place in order the sequence that the nurse will follow. 1. Analyze results. 2. Conduct the study. 3. Identify clinical problem. 4. Develop research question. 5. Determine how study will be conducted. a. 3, 4, 5, 2, 1 b. 4, 3, 5, 2, 1 c. 3, 5, 4, 2, 1 d. 4, 5, 3, 2, 1 ANS: A The steps of the research process are as follows: (1) identify area of interest or clinical problem, (2) develop research question(s)/hypotheses, (3) determine how study will be conducted, (4) conduct the study, and (5) analyze results of the study. DIF:Understand (comprehension) OBJ:Discuss the steps of the research process. TOP: Implementation MSC: Management of Care MULTIPLE RESPONSE 1. The nurse is preparing to conduct research that will allow precise measurement of a phenomenon. Which methods will provide the nurse with the right kind of data? (Select all that apply.) a. Surveys b. Phenomenology c. Grounded theory d. Evaluation research 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) OBJ:Elaborate on 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. c. Mental health d. Not seeing family members ANS: B According to Maslow, in all cases an emergent physiological need takes precedence over a higher-level need. Nutrition is a physiological need and should be addressed first. Anxiety, mental health, and not seeing family members (need for love and belonging) are all higher- level needs. DIF:Analyze (analysis) OBJ:Discuss the health belief, health promotion, basic human needs, and holistic health models to understand the relationship between patients’ attitudes toward health and health practices. TOP: Implementation MSC: Management of Care 5. The patient is reporting moderate incisional pain that was not relieved by the last dose of pain medication. The patient is not due for another dose of medication for another 2 1/2 hours. The nurse repositions the patient, asks what type of music the patient likes, and sets the television to the channel playing that type of music. Which health care model is the nurse using? a. Health belief model b. Holistic health model c. Health promotion model d. Maslow’s hierarchy of needs ANS: B The holistic health model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions such as music therapy. The health belief model addresses the relationship between a person’s beliefs and behaviors. The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions. The basic human needs model believes that the extent to which basic needs are met is a major factor in determining a person’s level of health. Maslow’s hierarchy of needs is a model that nurses use to understand the interrelationships of basic human needs. DIF:Apply (application) OBJ:Discuss the health belief, health promotion, basic human needs, and holistic health models to understand the relationship between patients’ attitudes toward health and health practices. TOP: Implementation MSC: Management of Care 6. A nurse is assessing internal variables that are affecting the patient’s health status. Which area should the nurse assess? a. Perception of functioning b. Socioeconomic factors c. Cultural background d. Family practices ANS: A Internal variables include a person’s developmental stage, intellectual background, perception of functioning, and emotional and spiritual factors. External variables influencing a person’s health beliefs and practices include family practices, socioeconomic factors, and cultural background. DIF:Understand (comprehension) OBJ:Identify variables influencing health, health beliefs, and health practices. TOP: Assessment MSC: Health Promotion and Maintenance 7. The nurse is admitting a patient diagnosed with uncontrolled diabetes mellitus. It is the fourth time the patient is being admitted in the last 6 months for high blood glucose levels. 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 adherence. b. A person’s adherence 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 adherence 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) OBJ:Identify variables influencing health, health beliefs, and health practices. TOP: Implementation MSC: Health Promotion and Maintenance 8. 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) OBJ:Discuss health promotion, wellness, and illness prevention activities. TOP: Implementation MSC: Health Promotion and Maintenance 9. 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) OBJ:Compare the three levels of preventive care. TOP: Implementation MSC: Health Promotion and Maintenance 10. 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:Understand (comprehension) OBJ:Compare the three levels of preventive care. TOP: Evaluation MSC: Management of Care 11. 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 DIF:Understand (comprehension) OBJ:Analyze variables influencing illness behavior. TOP: Evaluation MSC: Health Promotion and Maintenance 17. The patient had a colostomy placed 1 week ago. When approached by the nurse, the patient and their spouse refuse to talk about it and reject the opportunity 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:Understand (comprehension) OBJ:Describe the effect of illness on patients and families. TOP: Evaluation MSC: Psychosocial Integrity 18. A patient diagnosed with chronic emphysema (lung disease) states ―I would be better off dead.‖ The nurse learns that the patient, has recently become unemployed because of oxygen dependency. The patient’s spouse will have to go to work to support the family. 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) OBJ:Describe the effect of illness on patients and families. TOP: Implementation MSC: Psychosocial Integrity 19. 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) OBJ:Analyze variables influencing illness behavior. 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) OBJ:Compare and contrast nonmodifiable and modifiable risk factors that threaten health. 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) OBJ:Discuss the nurse’s role in risk-factor modification and changing health behaviors. TOP: Implementation MSC: Health Promotion and Maintenance 3. A nurse is teaching about the goals of Healthy People 2030. Which information should the nurse include in the teaching concerning what leading health indicator (LHI)? (Select all that apply.) a. Food insecurity b. Healthcare costs c. Adolescent obesity d. Suicide prevention e. Illness care ANS: A, C, D The current publication, Healthy People 2030, promotes a society in which all people live long, healthy lives. Healthy People 2030 identifies leading health indicators (LHIs) (e.g., household food insecurity and hunger; homicides; suicides; children and adolescents with obesity), which are high-priority health issues in the United States. Healthy People sets objectives to help the United States increase its focus on health promotion and disease prevention (instead of illness care). Healthcare costs while impactful are not identified as a Healthy People 30 LHI. DIF:Understand (comprehension) OBJ:Explain how Healthy People guides public health goals for Americans. TOP: Teaching/Learning MSC: Health Promotion and Maintenance Chapter 07: Caring in Nursing Practice Potter: Fundamentals of Nursing, 11th Edition MULTIPLE CHOICE 1. A nurse is caring for a patient in pain. Which nursing approach is priority? a. Patient- centered b. Technology-centered c. High tech-centered d. Family-centered ANS: A It is important to preserve a patient-centered approach to patient care for all aspects of nursing, whether the care focuses on pain management, teaching self-care, or basic hygiene measures. While technology, high tech, and family are important, they are not the priority. DIF:Understand (comprehension) OBJ:Discuss the role that caring plays in building the nurse-patient relationship. TOP: Implementation MSC: Psychosocial Integrity 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) OBJ:Explain how an ethic of care influences nurses’ decision making. TOP: Implementation MSC: 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) 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:Understand (comprehension) OBJ:Describe ways to express caring through presence and touch. TOP: Caring MSC: Psychosocial Integrity 10. The patient has a terminal diagnosis and is very near death. When the nurse assesses 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) 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? a. Inserts a catheter. b. Rubs a patient’s back. c. Prevents a patient from falling. d. Administers an injection. ANS: B Caring touch is the way a nurse holds a patient’s hand, gives a back massage, or gently positions a patient. Touch that occurs when tasks are being performed, such as insertion of a catheter or administering an injection, is known as ―task-oriented touch.‖ Touch used to protect the patient (holding and bracing a patient to avoid a fall) or nurse (withdraws from tension-filled situations) is known as ―protective touch.‖ DIF:Understand (comprehension) OBJ:Describe ways to express caring through presence and touch. TOP: Caring MSC: Basic Care and Comfort 12. The nurse is caring for a patient who has been sullen and quiet for the past 3 days. Suddenly, the patient says, ―I’m really nervous about surgery tomorrow, but I’m more worried about how it will affect my family.‖ What should the nurse do first? a. Assure the patient that everything will be all right. b. Tell the patient that there is no need to worry. c. Listen to the patient’s concerns and fears. d. Inform the patient a social worker is available. ANS: C Listening to the meaning of what a patient says helps create a mutual relationship. Assuring and telling a patient not to worry are not truly listening; these do not convey listening. Although contacting a social worker could be an appropriate measure for this patient, the nurse should first listen to what the patient is saying. DIF:Apply (application) OBJ:Examine the therapeutic benefit of listening to patients. TOP: Implementation MSC: Psychosocial Integrity 13. The patient is about to undergo a certain procedure and has voiced concern about outcomes and prognosis. The nurse caring for the patient underwent a similar procedure and stops to listen. Which response by the nurse may be most beneficial? a. ―I had a similar procedure and I can tell you what I went through if you want.‖ b. ―I think you’ll be all right, but, of course, there are no sure guarantees.‖ c. ―I don’t think you have anything to worry about. They do lots of these.‖ d. ―I can call the doctor and cancel the procedure, if you are really concerned.‖ ANS: A When an ill person chooses to tell his story, it involves reaching out to another human being. Telling the story implies a relationship that develops only if the clinician exchanges his or her stories as well. Professionals do not routinely take seriously their own need to be known as part of a clinical relationship. Yet, unless the professional acknowledges this need, there is no reciprocal relationship, only an interaction. Offering false reassurances and cliches, telling not to worry, or offering to cancel the procedure does not open up that relationship and dismisses the patient’s concerns. DIF:Apply (application) OBJ:Examine the therapeutic benefit of listening to patients. TOP: Communication and Documentation MSC: Psychosocial Integrity 14. In making rounds, the nurse meets a patient for the first time. The nurse asks the patient when they usually take their morning medications. What does knowing the patient allow the nurse to do? a. Choose the most appropriate time to give the medication. b. Know what information to put on the medication error report form. c. Explain to the patient that the medication will not be given at the usual time. d. Evaluate whether or not the patient is taking the medication correctly at home. ANS: A ―Knowing the patient‖ is at the core of the process nurses use to make clinical decisions. Knowing when the patient normally takes the medication will allow the nurse to keep the patient on as near normal a schedule as possible. Nothing in this question infers that the patient will not get the medications on time or that a medication error report will need to be completed. Although the nurse can evaluate whether or not the patient is taking the medication correctly at home, the main purpose, within this scenario, is to determine the most appropriate time to administer the medication. DIF:Apply (application) OBJ:Explain the relationship between knowing a patient and clinical decision making. TOP: Caring MSC: Basic Care and Comfort MULTIPLE RESPONSE 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. b. ―I’ll have the hospital’s Social Services consult with you about community services that can help you.‖ c. ―Private insurance is likely to cover most or all of the expense of your medication and testing supplies costs.‖ d. ―I will help you learn to minimize your stress so that your blood sugar remains at a healthy level.‖ ANS: A People who have diabetes spend an average of 2.3 times more than what people without diabetes spend on their health care. Type 2 diabetes is often preventable or can be managed effectively with lifestyle modifications (e.g., dietary changes, regular exercise) and so the nurse can provide education and support that both improves health and decreases health care costs. Private insurance is likely to provide some but not all financial support for the needed medical supplies and medication. The remaining options are appropriate but not focused on improving health as a way of decreasing health care costs. DIF:Apply (application) OBJ:Summarize ways to reduce the financial impact of chronic illnesses on individuals and society. TOP: Evaluation MSC: Physiological Adaptation 3. The nurse will suggest the BRCA1/2 mutation screening for a patient after identifying what assessment finding? a. Being treated for asthma b. First pregnancy at age 18 c. Recent breast reduction surgery d. Family history of ovarian cancer ANS: D Genetic testing is available for individuals at high risk for developing certain breast and colon cancers. Women with a strong family history of breast, ovarian, tubal, or peritoneal cancer may benefit from genetic testing for a BRCA1/2 mutation. There is no known association between this mutation and any of the other stated situations. DIF:Apply (application) OBJ:Identify genetic and environmental factors and their influence on the development of chronic illness.TOP: Implementation MSC: Physiological Adaptation 4. A cancer survivor is in the intensive care unit (ICU). Some of the patient’s family is from out of town and would like to see the patient even though it is not ―official‖ visiting hours. The patient is anxious to see family members. The nurse allows the family to visit. What is the rationale for the nurse’s actions? a. The nurse disagrees with the established time for visiting. b. The nurse realizes that the patient is dying. c. The nurse feels there is no real reason to have limited visiting hours. d. The nurse believes that the visit will help relieve psychological stress. ANS: D Survivors who have social and emotional support systems are likely to have less psychological distress. Relationships are critical for cancer survivors. The nurse does not necessarily have problems with the standard visiting hours. Not enough information is provided to indicate that the patient is near death, and not all patients in the ICU are dying. DIF:Apply (application) OBJ:Explain the psychosocial effects that living with a chronic illness has on patients and their families. TOP: Implementation MSC: Psychosocial Integrity 5. A nurse is taking a history of a patient with a chronic illness. Which assessment is priority? a. Fatigue b. Vision c. Dehydration d. Blood pressure ANS: A Fatigue is among the most frequent and distressing complaints of people with a chronic illness. Vision, dehydration, and blood pressure are not as frequently reported. DIF:Apply (application) OBJ:Discuss the physical limitations that patients with chronic illnesses frequently experience. TOP: Assessment MSC: Physiological Adaptation 6. What statement by the patient demonstrates an understanding of the risks involved when it is determined that the patient’s father carries the gene associated with Lynch Syndrome? a. ―I know I’ll develop colon cancer during my lifetime.‖ b. ―I’m scheduled for genetic screening early next week.‖ c. ―Lynch Syndrome is responsible for trigger a very rare form of cancer.‖ d. ―It’s comforting to know that this cancer generally tends to skip a generation.‖ ANS: B Because Lynch Syndrome is one of the more common hereditary cancer syndromes and because early detection improves survival, genetic screening for this type of colon cancer should be offered to first-degree family members to inform them of the potential risk of developing this cancer. If family members screen positive, more frequent screening for this disease increases the chance of early detection and early treatment to decrease death from this form of colon cancer. A family history of this gene does not confirm that the associated cancer will develop nor is there research to support a skipping of generations. DIF:Apply (application) OBJ:Identify genetic and environmental factors and their influence on the development of chronic illness.TOP: Evaluation 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 when she states, ―I can’t continue therapy; it’s asking too much of my family.‖ What is the nurse’s best action in this situation to help address the patient’s risk for nonadherence to treatment? a. Help find or develop an educational program for the patient and family. b. Encourage the patient to continue with the prescribed chemotherapy. c. Support the spouse and children by acknowledging their stressors. d. Suggest that the woman needs to focus on her needs first. ANS: A A patient’s social support from family and friends is an essential component to patient adherence. 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. While the remaining options are relevant, none attempts to meet the needs of the patient as well as her family as does develop an educational program. DIF:Apply (application) OBJ:Anticipate the needs of family caregivers who care for patients with chronic disease. 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 will allow for early detection of additional cancers.‖ 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) OBJ:Explain the role of a nurse in preventing chronic illness through screening, education about healthy lifestyle, and public policy. TOP: Communication and Documentation MSC: Health Promotion and Maintenance 9. The nurse is caring for a patient diagnosed with diabetes. The family of the patient asks the nurse for resources about this chronic illness. What should the nurse do? a. Refer family members to the health care provider. b. Inform them that few options are currently 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) OBJ:Explain the role of a nurse in preventing chronic illness through screening, education about healthy lifestyle, and public policy. TOP: Implementation MSC: Psychosocial Integrity a. Delivery system design: Uses evidence-based care that is patient-centered, preventive in nature, and occurs in a variety of acute, outpatient, and community settings. b. Decision support: Used by health care providers to implement evidence-based guidelines, guide patient education, and encourage patients to participate in their care. c. Clinical information systems: Maintain and share patient health information among providers and patients to ensure effective communication and quality patient care. While important cost control is not an element of the Chronic Care Model. DIF:Understand (comprehension) OBJ:Explain the components of the Chronic Care Model and the importance of self-management within this model. TOP: Implementation MSC: Management of Care 2. A nurse is counseling a couple that is at risk for conceiving at child with an autosomal dominant genetic disorder. Which specific disorders will the nurse focus on during the discussion? (Select all that apply.) a. Cystic fibrosis b. Neurofibromatosis c. Sickle cell anemia d. Huntington’s chorea e. Familial hypercholesterolemia ANS: B, D, E Autosomal dominant disorders such as Huntington’s chorea, familial hypercholesterolemia, and neurofibromatosis occur when a person has one parent with the dominant genetic disorder or a new mutation in a gene occurs. Autosomal recessive disorders such as cystic fibrosis and sickle cell anemia occur most commonly when both parents are carriers of the recessive genetic disorder. DIF:Understand (comprehension) OBJ:Explain the role of a nurse in preventing chronic illness through screening, education about healthy lifestyle, and public policy. TOP: Caring MSC: Physiological Adaptation MATCHING A nurse is implementing the elements of the Chronic Care Model. Which example describes the various elements? a. Health System b. Delivery System Design c. Decision Support d. Clinical Information Systems e. Self-Management Support f. Community 1. Constantly attempts to improve the management of the chronic illness 2. Uses evidence-based care that is patient-centered and preventive in nature 3. Provides appropriate patient guided health education 4. Supports effective communication among providers and patient 5. Places the patient in the center of disease management 6. Helps develop partnerships to enhance effective patient care 1. ANS: A DIF:Understand (comprehension) OBJ:Explain the components of the Chronic Care Model and the importance of self-management within this model. TOP: Caring MSC: Management of Care 2. ANS: B DIF:Understand (comprehension) OBJ:Explain the components of the Chronic Care Model and the importance of self-management within this model. TOP: Caring MSC: Management of Care 3. ANS: C DIF:Understand (comprehension) OBJ:Explain the components of the Chronic Care Model and the importance of self-management within this model. TOP: Caring MSC: Management of Care 4. ANS: D DIF:Understand (comprehension) OBJ:Explain the components of the Chronic Care Model and the importance of self-management within this model. TOP: Caring MSC: Management of Care 5. ANS: E DIF:Understand (comprehension) OBJ:Explain the components of the Chronic Care Model and the importance of self-management within this model. TOP: Caring MSC: Management of Care 6. ANS: F DIF:Understand (comprehension) OBJ:Explain the components of the Chronic Care Model and the importance of self-management within this model. TOP: Caring MSC: Management of Care Chapter 09: Cultural Competence Potter: Fundamentals of Nursing, 11th Edition MULTIPLE CHOICE 1. A nurse is discussing the changing demographics of the US population. What is expected to be the fastest growing racial ethnic group by 2060? a. Hispanic b. Asian c. Multiracial d. Non-Hispanic Blacks ANS: C The changing demographics of the US population create challenges for the health care system and health care providers. By the year 2060, the percentage of racial and ethnic minority groups in the United States is expected to climb to 32% of the population. The fastest- growing racial ethnic group in the United States is people whose ancestry is from two or more races, and this group is projected to grow by 200%. The next fastest growing is the Asian population, which is projected to double, followed by the Hispanic population. DIF:Understand (comprehension) OBJ:Compare social and cultural influences in 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) OBJ:Compare social and cultural influences in 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:Understand (comprehension) OBJ:Discuss health disparity and the social determinants that affect it. TOP: Assessment MSC: 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. Effectively provides for multifaceted healthcare needs. 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 multifaceted context. Communicates effectively and speaking a different language indicates linguistic competence. Visiting a foreign country does not indicate cultural competence. DIF:Understand (comprehension) OBJ:Explain the concepts of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire in the cultural competence model. TOP: Implementation MSC: Psychosocial Integrity 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) OBJ:Summarize the roles that communication and self-examination play in developing cultural competence. 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 consistently received inferior care compared to high-income people. American Indians and Alaska Natives received worse care than Caucasians. DIF:Analyze (analysis) OBJ:Discuss health disparity and the social determinants that affect it. TOP: Evaluation MSC: Management of Care 12. A nurse is assessing culturally diverse population groups for the risk of suicide. Which assessment question will provide the most culturally relevant information? a. ―Is suicide common in your culture?‖ b. ―How is suicide viewed in your culture?‖ c. ―Has anyone here every considered suicide?‖ d. ―Do you know anyone who as committed suicide?‖ ANS: B Culturally congruent care or transcultural care emphasizes the need to provide cares based on the individual’s cultural beliefs, practices, and values; therefore, effective communication is a critical skill in culturally competent care and helps you engage a patient and family in respectful, patient-centered dialogue. Asking how the act of suicide is viewed provides information on the cultural values, beliefs, and practices of a culture. None of the other options provide that insight. DIF:Analyze (analysis) OBJ:Explain the concepts of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire in the cultural competence model. TOP: Assessment MSC: Health Promotion and Maintenance 13. A nurse is caring for a patient with limited English-speaking skills. What intervention should be implemented to best assist in educating the patient about their disease process? a. Request a trained medical interpreter. b. Provide information in graphic form when possible. c. Use handouts prepared in the patient’s native language. d. Ask that a family member be present during educational teaching. ANS: A The National Culturally and Linguistically Appropriate Services (CLAS) Standards include standards for communication and language assistance. The standards apply when you are caring for patients who have limited English proficiency and/or other communication needs. All United States health care organizations must provide language assistance resources (e.g., trained medical interpreters, qualified translators, telecommunication devices for the deaf) for individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services. None of the other options provides the best form of communication since they all are subject to misinterpretation and nursing evaluation. DIF:Apply (application) OBJ:Summarize the roles that communication and self-examination play in developing cultural competence. TOP: Caring MSC: Management of Care 14. A nurse is assessing a patient’s ethnic history. 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) OBJ:Explain the approaches to use in conducting a cultural nursing history and physical assessment. TOP: Assessment MSC: 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 with a chronic illness c. A patient with a college degree d. A patient with a high-school diploma ANS: B Many 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) OBJ:Elaborate on how teach-back helps a patient with limited health literacy. TOP: Assessment MSC: Health Promotion and Maintenance 16. A nurse implementing the principles of Intersectionality will focus on what patient characteristic? a. Values b. Illness c. Health d. Experiences ANS: D Intersectionality is a research and policy model used to study the complexities of people’s lives and experiences. Illness and health are outcomes viewed in respect to the patient’s experiences. The patient’s values and beliefs are formulated by their life experiences. DIF:Understand (comprehension) OBJ:Discuss health disparity and the social determinants that affect it. TOP: Planning MSC: Management of Care 17. A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of providing culturally congruent care? a. Provides care that fits the patient’s valued life patterns and set of meanings. b. Provides care that is based on meanings generated by predetermined criteria. c. Provides care that makes the nurse the leader in determining what is needed. d. Provides care that is the same as the values of the professional health care system. ANS: A The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person’s life patterns, values, and system of meaning. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Discovering patients’ cultural values, beliefs, and practices as they relate to nursing and health care requires you to assume the role of learner (not become the leader) and to partner with your patients and their families to determine what is needed to provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different from the values and meanings of the professional health care system. DIF:Apply (application) OBJ:Explain the concepts of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire in the cultural competence model. TOP: Implementation MSC: Psychosocial Integrity 18. A nurse is assessing the patient’s meaning of illness. Which area of focus by the nurse is priority? a. On the way a patient reacts to disease OBJ:Explain the concepts of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire in the cultural competence model. TOP: Assessment MSC: Management of Care 3. ANS: A DIF:Understand (comprehension) OBJ:Explain the concepts of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire in the cultural competence model. TOP: Assessment MSC: Management of Care 4. ANS: C DIF:Understand (comprehension) OBJ:Explain the concepts of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire in the cultural competence model. TOP: Assessment MSC: Management of Care 5. ANS: E DIF:Understand (comprehension) OBJ:Explain the concepts of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire in the cultural competence model. TOP: Assessment MSC: Management of Care Chapter 10: Family Dynamics Potter: Fundamentals of Nursing, 11th Edition MULTIPLE CHOICE 1. A nurse is assessing the family unit to determine their ability to adapt to the change required 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) OBJ:Discuss how the term family reflects family diversity. TOP: Assessment MSC: Psychosocial Integrity 2. A nurse reviews the current trends affecting today’s family. Which trend will the nurse find? a. More mothers are full time at home parents. 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 More grandparents are raising their grandchildren. The majority of women work outside the home, and about 70% of mothers with children under the age of 18 are in the workforce. The majority of adolescent mothers continue to live with their families. Teenage fathers usually have poorer support systems and fewer resources to teach them how to parent. DIF:Understand (comprehension) OBJ:Examine current trends affecting the American family. TOP: Assessment MSC: Psychosocial Integrity 3. A spouse brings the children in to visit their mother in the hospital. The nurse asks how the family is doing. The husband states, ―None of her jobs are getting done, and I don’t do those jobs, so the house and the kids are falling apart.‖ How will the nurse interpret this finding? a. The family structure is resilient. b. The family structure is flexible. c. The family structure is hardy. d. The family structure is rigid. ANS: D A rigid structure specifically dictates who is able to accomplish different tasks and also limits the number of persons outside the immediate family allowed to assume these tasks. Resiliency helps to evaluate healthy responses when individuals and families are experiencing stressful events. An extremely flexible structure also presents problems for the family. There is sometimes an absence of stability that would otherwise lead to automatic action during a crisis or rapid change. Hardiness is the internal strength and durability of the family unit characterized by a sense of control over the outcome of life and an active, rather than passive, orientation in adapting to stressful events. DIF:Apply (application) OBJ:Explain how the relationship between family structure and patterns of functioning affects the health of individuals within the family and the family as a whole. TOP: Assessment MSC: Psychosocial Integrity 4. A nurse cares for the family’s as well as the patient’s needs using available resources. Which approach is the nurse using? a. Family as context b. Family as patient c. Family as system d. Family as caregivers ANS: C When you care for the family as a system, you are caring for each family member (family as context) and the family unit (family as patient), using all available environmental, social, psychological, and community resources. When you view the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.e., the patient’s family). When you view the family as patient, the family processes and relationships (e.g., parenting or family caregiving) are the primary focuses of nursing care. There is no approach for family as caregivers; rather, it is a term to describe family members caring for other family members usually at home. DIF:Understand (comprehension) OBJ:Compare nursing care that views family as context, family as patient, and family as a system and explain how these different perspectives influence nursing practice. TOP: Implementation MSC: Management of Care 5. A nurse is caring for a patient who needs constant care in the home setting and for whom most of the care is provided by the patient’s family. Which action should the nurse take to help relieve stress? a. Encourage caregiver to do as much as possible. b. Focus primarily on the patient. c. Point out weaknesses. d. Provide education. ANS: D Providing education to the family and caregiver helps relieve some of the stress of caregiving. Help the family focus on their strengths instead of on problems and weaknesses. While caregivers desire to care for the loved one, they often feel extreme pressure to do everything; therefore, encouraging the caregiver to do more will add stress. Focusing primarily on the patient will not be beneficial; the entire family is the patient. DIF:Apply (application) OBJ:Discuss the role of families and family members as caregivers. TOP: Implementation MSC: Psychosocial Integrity 6. A nurse is working with a patient. When the nurse asks about family members, the patient states that it includes my spouse, children, and aunt and uncle. How will the nurse describe this type of family? a. Nuclear b. Blended c. Extended d. Alternative ANS: C The extended family includes relatives (aunts, uncles, grandparents, and cousins) in addition to the nuclear family. The nuclear family consists of husband and wife (and perhaps one or more children). The blended family is formed when parents bring unrelated children from prior adoptive or foster parenting relationships into a new, joint living situation. Relationships include multi-adult households, ―skip-generation‖ families (grandparents caring for grandchildren), communal groups with children, ―nonfamilies‖ (adults living alone), cohabitating partners, and homosexual couples. DIF:Understand (comprehension) OBJ:Discuss factors that affect family forms and their impact on a family’s health. TOP: Assessment MSC: Psychosocial Integrity 7. An emergency department nurse is assessing a child that lives in a car with family members. Which area should the nurse assess closely? a. Ears b. Eyes c. Head d. Hands ANS: A b. Family as patient c. Family as system d. Family as caregiver ANS: A If only one family member receives nursing care, it is realistic and practical to use the approach ―family as context.‖ Although family nursing is based on the assumption that all people regardless of age are a member of some type of family form, the patient insists that there is no family. The nurse should investigate further. However, at this time, family as patient or as system is not appropriate. Family as caregiver is not an approach but rather is a term to describe a family member caring for another family member. DIF:Analyze (analysis) OBJ:Compare nursing care that views family as context, family as patient, and family as a system and explain how these different perspectives influence nursing practice. TOP: Evaluation MSC: Management of Care 13. The nurse is caring for an older-adult patient at home who requires teaching for dressing changes. The spouse and adult child are also involved in changing the dressing. Which statement by the nurse will most likely elicit a positive response from the patient and family? a. ―You’re doing that all wrong. Let me show you how to do it.‖ b. ―I don’t know who showed you how to change a dressing, but you’re not doing it right. Let me show you again.‖ c. ―You’re hesitant about changing the dressing like I was before I was shown an easier way; would you like to see?‖ d. ―I used to change the dressing the same way you are doing it: the wrong way. I’ll show you the right way to do it.‖ ANS: C When the nurse is confident and skillful instead of coming across as an authority on the subject, the patient’s/family’s defenses will be down, making the patient/family more willing to listen without feeling embarrassed. Respectful communication is necessary. Saying that you’re doing it wrong, you’re not doing it right, or the wrong way is not respectful or necessary. DIF:Analyze (analysis) OBJ:Discuss the role of families and family members as caregivers. TOP: Communication and Documentation MSC: Health Promotion and Maintenance 14. The nurse is providing discharge teaching for an older-adult patient who will need tube feedings at home. The spouse is the only source of care and states ―I will not be able to perform the feedings due to arthritis.‖ Which action should the nurse take? a. Obtain extra feeding supplies. b. Arrange for home care. c. Cancel the discharge. d. Teach the spouse. ANS: B Discharge planning with a family involves an accurate assessment of what will be needed for care at the time of discharge, along with any shortcomings in the home setting. If no one can do the feedings properly, the nurse will need to arrange for a home care service referral. Extra feeding supplies will not help the situation if the spouse cannot use them. Canceling the discharge is not an option. Teaching the spouse will not be effective since the spouse is unable to perform the feeding. DIF:Apply (application) OBJ:Utilize the nursing process to provide for the health care needs of the family. TOP: Implementation MSC: Management of Care MULTIPLE RESPONSE 1. A nurse is assessing for factors influencing family form. Which areas will the nurse include in the assessment? (Select all that apply.) a. Homelessness b. Domestic violence c. Presence of illness d. Changing economic status e. Rise of homosexual families ANS: A, B, C, D Families face many challenges today, including changing structures and roles related to the changing economic status of society. Some families experience challenges related to chronic illness and aging family members. Family caregiving, poverty, homelessness, and domestic violence create challenges for families. Homosexual families are not a threat facing the family; in fact, many homosexual couples now define their relationship in family terms. DIF:Understand (comprehension) OBJ:Examine current trends affecting the American family. TOP: Assessment MSC: Psychosocial Integrity 2. In addition to providing physical care, what roles does a caregiver assure when caring for a family member? (Select all that apply.) a. Emotional supporter b. Health care decision maker c. Financial monitor d. Advocate e. Family leader ANS: A, B, C, D Family caregivers also provide ongoing emotional support for their loved ones, making decisions about care options, being a patient advocate, and monitoring finances. The role of family leader is not necessary one that the caregiver assumes. DIF:Understand (comprehension) OBJ:Utilize the nursing process to provide for the health care needs of the family. TOP: Assessment MSC: Psychosocial Integrity MATCHING A nurse is focusing on the interactive processes of family life and is asking the patient questions. Match the questions the nurse will ask to the interactive process. a. Family Structure b. Family Functioning c. Developmental assessment 1. Who lives with you? 2. What aspects of your family do you enjoy the most? 3. How are problems solved? 1. ANS: A DIF:Analyze (analysis) OBJ:Utilize the nursing process to provide for the health care needs of the family. TOP: Assessment MSC: Psychosocial Integrity 2. ANS: C DIF:Analyze (analysis) OBJ:Utilize the nursing process to provide for the health care needs of the family. TOP: Assessment MSC: Psychosocial Integrity 3. ANS: B DIF:Analyze (analysis) OBJ:Utilize the nursing process to provide for the health care needs of the family. TOP: Assessment MSC: Psychosocial Integrity Chapter 11: Developmental Theories Potter: Fundamentals of Nursing, 11th Edition MULTIPLE CHOICE 1. When caring for a middle-aged adult exhibiting maladaptive coping skills, the nurse is trying to determine the cause of the patient’s behavior. Which information from a growth and development perspective should the nurse consider when planning care? a. Individuals have uniform patterns of growth and development. b. Culture usually has no effect on predictable patterns of growth and development. c. Health is promoted based on how many developmental failures a patient experiences. d. When individuals experience repeated developmental failures, inadequacies sometimes result. ANS: D If individuals have repeated development failures, inadequacies sometimes result and should be considered. Developmental failures could manifest with ineffective coping skills. However, when an individual experiences successes, health is promoted. Patients have unique patterns of growth and development that are not uniform. Nurses must consider the influence of culture and context on growth and development. DIF:Understand (comprehension) OBJ:Discuss theoretical underpinnings of growth and development. TOP: Planning MSC: Health Promotion and Maintenance DIF:Analyze (analysis) OBJ:Define and compare developmental theories. TOP: Evaluation MSC: Psychosocial Integrity 7. The nurse is teaching a young-adult couple about promoting the health and psychosocial development of their 8-year-old child. Which information from the parent indicates a correct understanding of the teaching? a. ―We will provide consistent, devoted relationships to meet needs.‖ b. ―We will limit choices and provide punishment for mistakes.‖ c. ―We will provide proper support for learning new skills.‖ d. ―We will instill a strong identity of who our child is.‖ ANS: C An 8-year-old-child would be in the industry versus inferiority stage of development. During this stage, the child needs to be praised (proper support) for accomplishments such as learning new skills. Developing a strong identity is part of the identity versus role confusion stage, usually occurring during puberty. During the autonomy versus shame and doubt stage, limiting choices and harsh punishment lead to feelings of shame and doubt. Providing consistent, devoted relationship to meet needs is usually a part of the trust versus mistrust stage. DIF:Analyze (analysis) OBJ:Define and compare developmental theories. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 8. A nurse is using Jean Piaget’s developmental theory to focus on cognitive development. Which area will the nurse assess in this patient? a. Latency b. Formal operations c. Intimacy versus isolation d. The postconventional level ANS: B Jean Piaget’s theory includes four stages in sequential order: sensorimotor, preoperational, concrete operations, and formal operations. Intimacy versus isolation is part of Erik Erikson’s psychosocial theory of development. Latency is stage 4 of Freud’s five-stage psychosexual theory of development. The postconventional level of reasoning is part of Kohlberg’s theory of moral development. DIF:Understand (comprehension) OBJ:Define and compare developmental theories. TOP: Assessment MSC: Health Promotion and Maintenance 9. A nurse is assessing a 17-year-old adolescent’s cognitive development. Which behavior indicates the adolescent has reached formal operations? a. Uses play to understand surroundings. b. Discusses the topic of justice in society. c. Hits other students to deal with environmental change. d. Questions where the ice is hiding when ice has melted in a drink. ANS: B Discussing the topic of justice demonstrates that the adolescent is concerned about issues that affect others besides self. In the formal operations period, as adolescents mature, their thinking moves to abstract and theoretical subjects. They have the capacity to reason with respect to possibilities. Hitting would be a common schema during the sensorimotor stage of development. Using play to learn about the environment is indicative of the preoperational stage. During the concrete operations stage (ages 6 to 12 years), children are able to coordinate two concrete perspectives in social and scientific thinking, such as understanding the difference between ―hiding‖ and ―melting.‖ DIF:Analyze (analysis) OBJ:Define and compare developmental theories. TOP: Evaluation MSC: Health Promotion and Maintenance 10. A nurse is caring for a 4-year-old patient. Which object will the nurse allow the child to play with safely to foster cognitive development? a. The pump administering intravenous fluids b. A book to read alone in a quiet place c. The blood pressure cuff d. A baseball bat ANS: C Children should be allowed to play with any equipment that is safe, like a blood pressure cuff. A 4-year-old child would be in the preoperational period of cognitive development. Children at this stage are still egocentric. Play is very important to foster cognitive development. The IV pump and bat are not safe pieces of equipment for a 4-year-old child to play with. A 4- year-old child is of preschool age and more than likely is not able to read yet. Also, the book does not allow for any human interaction and communication if he or she reads alone. DIF:Analyze (analysis) OBJ:Define and compare developmental theories. TOP: Planning MSC: Health Promotion and Maintenance 11. A patient follows all the instructions a nurse provides because the patient wants to be perceived as a ―good‖ patient. How should the nurse interpret this information according to moral development? a. The patient is in postformal thought reasoning. b. The patient is in postconventional reasoning. c. The patient is in preconventional reasoning. d. The patient is in conventional reasoning. ANS: D The patient is in conventional reasoning, specifically stage 3: Good Boy-Nice Girl Orientation. The patient wants to win approval from the nurse by ―being good.‖ Developmentalists proposed a fifth stage of cognitive (not moral) development termed postformal thought. Within this stage, adults demonstrate the ability to recognize that answers vary from situation to situation and that solutions need to be sensible. The person finds a balance between basic human rights and obligations and societal rules and regulations in the level of postconventional reasoning. Individuals move away from moral decisions based on authority or conformity to groups to define their own moral values and principles. Preconventional reasoning is the premoral level, in which there is limited cognitive thinking and the individual’s thinking is primarily egocentric. At this stage, thinking is mostly based on likes and pleasures. DIF:Apply (application) OBJ:Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Assessment MSC: Psychosocial Integrity 12. An 18-month-old patient is brought into the clinic for evaluation because the parent is concerned because the child hits siblings and says only ―No‖ when communicating verbally. Which recommendation by the nurse will be best for this situation? a. Assure the mother that the child is developmentally within specified norms. b. Encourage the mother to seek psychological counseling for the child. c. Consult the social worker because the child is hitting other children. d. Remove all toys from the child’s room until this behavior ceases. ANS: A Assure the mother that the child is displaying normal behavior. At 18 months, the child is in the sensorimotor period of development. Piaget describes hitting, looking, grasping, and kicking as normal schemas to deal with the environment. The social worker does not need to be consulted in this case nor is psychological counseling warranted, because the child is exhibiting normal behaviors. Play is an important part of all children’s development. Removing toys and the opportunity to play with them may actually hinder the child’s development. DIF:Analyze (analysis) OBJ:Discuss nursing implications for the application of developmental principles to patient care. TOP: Implementation MSC: Health Promotion and Maintenance 13. A formerly independent older adult becomes severely withdrawn upon admission to a nursing home. Which action should the nurse take first? a. Offer a reward to the patient for participation in all events. b. Encourage the patient to eat meals in the dining room with others. c. Allow the patient to incorporate personal belongings into the room. d. Advise the patient of the importance of attending mandatory activities. ANS: C The nurse should first allow the patient to actively participate in an independent activity (the patient was formerly independent), such as preparing the room with personal belongings. Erikson’s theory proposes that the older adult faces integrity versus despair. Offering a reward does not address the need for continued independence. Encouraging eating in the dining room would be a step after fixing the room since it does not address independence, and the question is asking for the first action. Advising the patient to attend all mandatory activities as the first intervention does not allow for the patient’s independence. Some activities may be mandatory, but by first allowing the patient to decorate room, the nurse is fostering independence and is helping the patient feel welcome and more at home, fostering integrity. DIF:Apply (application) c. 2, 3, 1, 5, 4 d. 2, 5, 1, 3, 4 ANS: D Erikson uses a psychosocial approach to development. The stages are as follows: trust versus mistrust, autonomy versus shame and doubt, initiative versus guilt, industry versus inferiority, and identity versus role confusion. DIF:Understand (comprehension) OBJ:Define and compare developmental theories. TOP: Caring MSC: Health Promotion and Maintenance MULTIPLE RESPONSE 1. A nurse is developing a plan of care concerning growth and development for a hospitalized adolescent. What interventions should the nurse implement? (Select all that apply.) a. Apply developmental theories when making observations of the adolescent’s patterns of growth and development. b. Compare the adolescent’s assessment findings versus normal findings. c. Recognize one’s own (the nurse’s) moral developmental level. d. Focus on one developmental theory for consistency. e. Apply a unidimensional life span perspective. ANS: A, B, C Today’s nurses need to be knowledgeable about several theoretical perspectives when working with patients. These theories form the basis for meaningful observation of an individual’s pattern of growth and development. They provide important guidelines for nurses to recognize deviations from the norm. Recognizing your own moral developmental level is essential in separating your own beliefs from those of others when helping patients with their moral decision-making process. No one theory successfully describes all the intricacies of human growth and development. Growth and development, as supported by a life span perspective, is multidimensional, not unidimensional. DIF:Apply (application) OBJ:Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Planning MSC: Health Promotion and Maintenance 2. A nurse is assessing temperaments of children. Which terms should the nurse use to describe findings? (Select all that apply.) a. The easy child b. The defiant child c. The difficult child d. The slow-to-warm up child e. The momma’s boy or daddy’s girl ANS: A, C, D Psychiatrists identified three basic classes of temperament: the easy child, the difficult child, and the slow-to-warm up child. There is no momma’s boy or daddy’s girl or defiant child. DIF:Understand (comprehension) OBJ:Apply developmental theories when planning interventions in the care of patients throughout the life span. TOP: Assessment MSC: Health Promotion and Maintenance Chapter 12: Conception Through Adolescence Potter: Fundamentals of Nursing, 11th Edition MULTIPLE CHOICE 1. A mother has delivered a healthy newborn. Which action is priority? a. Encouraging skin-to-skin contact as soon as possible after birth b. Keeping the newborn in the nursery during the first hour after delivery c. Avoid leaving the newborn alone with the mother during the first 8 hours after delivery d. Closely supervising the interaction between newborn and parents until the second hour after delivery ANS: A After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents’ and newborn’s need for close physical contact. Early parent-child interaction encourages parent-child attachment. Most healthy newborns are awake and alert for the first half-hour after birth. This is a good time for parent-child interaction to begin. No evidence in the scenario suggests that the baby cannot be left alone with the parents during the first 8 hours or that the baby should remain in the nursery during the first hour. DIF:Apply (application) OBJ:Discuss common physiological and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Implementation MSC: Health Promotion and Maintenance 2. A nurse teaches a new mother about the associated health risks to the infant. Which statement by the mother indicates a correct understanding of the teaching? a. ―I will feed my baby every 4 hours around-the-clock.‖ b. ―I need to leave the blankets off my baby to prevent smothering.‖ c. ―I need to remind friends who want to hold my baby to wash their hands.‖ d. ―I will throw away the bulb syringe now because my baby is breathing fine.‖ ANS: C Good handwashing technique is the most important factor in protecting the newborn from infection. You can help prevent infection by instructing parents and visitors to wash their hands before touching the infant. The nurse can help parents identify ways to meet needs by counseling them to feed their baby on demand rather than on a rigid schedule. Newborns are susceptible to heat loss and cold stress. Place the healthy newborn directly on the mother’s abdomen, covering with warm blankets. Removal of nasopharyngeal and oropharyngeal secretions remains a priority of care to maintain a patent airway; keeping the bulb syringe is important. DIF:Analyze (analysis) OBJ:Discuss common physiological and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 3. A nurse is working in the delivery room. Which action is priority immediately after birth? a. Maintaining an open airway b. Determining true gestational age c. Monitoring infant-parent interactions d. Promoting parent-newborn physical contact ANS: A Opening the airway is the priority. The most extreme physiological change occurs when the newborn leaves the utero circulation and develops independent respiratory functioning. Direct nursing care includes maintaining an open airway, stabilizing and maintaining body temperature, and protecting the newborn from infection. After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents’ and newborn’s need for close physical contact. Following a comprehensive physical assessment, the nurse assesses gestational age and interactions between infant and parents. DIF:Analyze (analysis) OBJ:Discuss common physiological and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Implementation MSC: Management of Care 4. A nurse is preforming a newborn assessment. Which assessment finding will cause the nurse to intervene immediately? a. Head molding b. A lack of reflexes c. Cyanotic hands and feet d. A soft, protuberant abdomen ANS: B A lack of reflexes must be addressed quickly. Assessment of these reflexes is vital because the newborn depends largely on reflexes for survival and in response to its environment. Molding, or overlapping of the soft skull bones, allows the fetal head to adjust to various diameters of the maternal pelvis and is a common occurrence with vaginal births. Normal physical characteristics include the continued presence of lanugo on the skin of the back; cyanosis of the hands and feet for the first 24 hours; and a soft, protuberant abdomen. DIF:Analyze (analysis) OBJ:Discuss common physiological and psychosocial health concerns during the transition of the child from intrauterine to extrauterine life. TOP: Assessment MSC: Health Promotion and Maintenance 5. A nurse performs an assessment on a 2-day old newborn about to be discharged. Which assessment finding will the nurse document as normal? a. Cyanosis of both the feet and hands b. Triangle-shaped anterior fontanel c. Sporadic motor movements d. Weight of 4800 g ANS: C Movements in the newborn are generally sporadic, but they are symmetric and involve all four extremities. Cyanosis of the hands and feet is normal for the first 24 hours, not 48 hours. when caregivers attempt to direct actions. Temper tantrums result when parental restrictions frustrate toddlers. DIF:Analyze (analysis) OBJ:Describe cognitive and psychosocial development from birth to adolescence. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 11. The nurse is observing a 2-year-old hospitalized patient in the playroom. Which activity will the nurse most likely observe? a. Seeking out same sex children to play with b. Participating as the leader of a small group activity c. Sitting beside another child while playing with blocks d. Separating building blocks into groups by size and color ANS: C The child sitting beside another child and playing is exhibiting parallel play, characteristic of a toddler. Participating as a group leader does not usually occur until around age 5. Preschoolers (ages 3 to 5) demonstrate their ability to think more complexly by classifying objects according to size or color. A 2-year-old child does not have this ability yet. Gender does not become a factor until the child reaches school-age when the child prefers same sex peers to opposite sex peers. DIF:Analyze (analysis) OBJ:Explain the role of play in the development of a child. TOP: Assessment MSC: Health Promotion and Maintenance 12. A nurse is communicating with a newly admitted teenaged patient. Which action should the nurse take? a. Avoid questioning the patient when observing a cigarette lighter lying on the bedside table. b. Complete the admission database as quickly as possible by asking yes and no questions. c. Look for meaning behind the patient’s words and actions. d. Ignore the patient’s withdrawn behavior. ANS: C Good communication skills are critical for adolescents. Look for meaning behind the adolescent’s words and actions. Following are some hints for communicating with adolescents: Do not avoid discussing sensitive issues. Asking questions about sex, drugs, and school opens the channels for further discussion. Ask open-ended questions. (Yes and no questions are closed-ended questions.) The nurse should inquire about a patient’s withdrawn behavior to seek out the meaning of such behaviors. Be alert to clues about adolescents’ emotional states. DIF:Understand (comprehension) OBJ:Describe cognitive and psychosocial development from birth to adolescence. TOP: Implementation MSC: Health Promotion and Maintenance 13. A nurse is caring for a preschooler. Which fear should the nurse most plan to minimize? a. Fear of bodily harm b. Fear of weight gain c. Fear of separation d. Fear of strangers ANS: A The greatest fear of preschoolers appears to be that of bodily harm; this is evident in children’s fear of the dark, animals, thunderstorms, and medical personnel. Toddlers who become ill and require hospitalization are most stressed by the separation from their parents. Persons with anorexia nervosa have an intense fear of gaining weight. By 8 months, most infants are able to differentiate a stranger from a familiar person and respond differently to the two. DIF:Understand (comprehension) OBJ:Describe cognitive and psychosocial development from birth to adolescence. TOP: Planning MSC: Health Promotion and Maintenance 14. A nurse is teaching a class about the effects of nutrition on fetal growth and development. A pregnant patient asks the nurse how much weight should normally be gained over the pregnancy. Which information should the nurse share with the patient? a. About 10 to 20 lb b. About 15 to 25 lb c. About 20 to 30 lb d. About 25 to 35 lb ANS: D The diet of a woman both before and during pregnancy has a significant effect on fetal development. For women who are at normal weight for height, the recommended weight gain is 25 to 35 lb over three trimesters. Weight gains of 10 to 20, 15 to 25, and 20 to 30 lb are too low. DIF:Understand (comprehension) OBJ:List ways to promote health during pregnancy. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 15. The nurse is caring for an infant. Which activity is most appropriate for the nurse to offer to the infant? a. Set of cards to organize and separate into groups b. Set of sock puppets with movable eyes c. Set of plastic stacking rings d. Set of paperback book ANS: C Adults and nurses facilitate infant learning by planning activities that promote the development of milestones and providing toys that are safe for the infant to explore with the mouth and manipulate with the hands such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes. Preschoolers demonstrate their ability to think more complexly by classifying objects according to size or color, making the cards more appropriate for them. Neither group is ready for paperback books. The sock puppet with movable eyes could create a choking hazard if one of the eyes comes off. DIF:Apply (application) OBJ:Explain the role of play in the development of a child. TOP: Implementation MSC: Health Promotion and Maintenance 16. A mother expresses concern because her 5-year-old child frequently talks about friends who don’t exist. What is the nurse’s best response to this mother’s concern? a. ―Have you considered a child psychological evaluation?‖ b. ―You should stop your child from playing electronic games.‖ c. ―Pretend play is a sign your child watches too much television.‖ d. ―It’s very normal for a child this age to have imaginary playmates.‖ ANS: D At age 5, some children have imaginary playmates. Imaginary playmates are a sign of health and allow the child to distinguish between reality and fantasy. The child does not need a psychological evaluation because this is normal behavior. Television, videos, electronic games, and computer programs help support development and the learning of basic skills. However, these should be only one part of the child’s total play activities. Pretend play is not a sign of watching too much television. DIF:Apply (application) OBJ:Explain the role of play in the development of a child. TOP: Communication and Documentation MSC: Health Promotion and Maintenance 17. A school nurse is encouraging children to play a game of kickball. Which group of children is the nurse most likely addressing? a. Infant b. Toddler c. Preschool d. School-aged ANS: D A game of kickball would be best suited for school-aged children because in this age-group, play involves peers and the pursuit of group goals. Although solitary activities are not eliminated, group play overshadows them. Younger children typically are not able to participate cooperatively in groups yet. Infants begin to play simple social games such as patty-cake and peek-a-boo. Toddlers engage in solitary play but also begin to participate in parallel play. Preschoolers playing together engage in similar if not identical activities; however, no division of labor or rigid organization or rules are observed. By the age of 5, the group has a temporary leader for each activity. DIF:Apply (application) OBJ:Explain the role of play in the development of a child. TOP: Evaluation MSC: Health Promotion and Maintenance 18. Which assessment finding of a school-aged patient should alert the nurse to a possible developmental delay? a. Verbalization of ―I have no friends‖ b. Absence of secondary sex characteristics