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Brunner And Suddarths Textbook Of Medical Surgical Nursing 14th Edition Hinkle

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BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK

Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 3

Chapter 01: Health Care Delivery and Evidence-Based Nursing Practice

1. The public health nurse is presenting a health promotion class to a group of new mothers. How should the nurse best define health?

  1. A)  Health is being disease free.
  2. B)  Health is having fulfillment in all domains of life.
  3. C)  Health is having psychological and physiological harmony.
  4. D)  Health is being connected in body, mind, and spirit.

Ans: D

Feedback:

The World Health Organization (WHO) defines health in the preamble to its constitution as a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. The other answers are incorrect because they are not congruent with the WHO definition of health.

2. A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What is one characteristic the nurse would cite as necessary to possess to be an effective nurse?

  1. A)  Sensitivity to cultural differences
  2. B)  Team-focused approach to problem-solving
  3. C)  Strict adherence to routine
  4. D)  Ability to face criticism

Ans: A

Feedback:

To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must be culturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strict adherence to routine are not characteristics needed to be an effective nurse. The ability to handle criticism is important, but to a lesser degree than cultural competence.

3. With increases in longevity, people have had to become more knowledgeable about their health and the professional health care that they receive. One outcome of this phenomenon is the development of organized self-care education programs. Which of the following do these programs prioritize?

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BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK

Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 4

  1. A)  Adequate prenatal care
  2. B)  Government advocacy and lobbying
  3. C)  Judicious use of online communities
  4. D)  Management of illness

Ans: D

Feedback:

Organized self-care education programs emphasize health promotion, disease prevention, management of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and Internet activities are secondary.

4. The home health nurse is assisting a patient and his family in planning the patients return to work after surgery and the development of postsurgical complications. The nurse is preparing a plan of care that addresses the patients multifaceted needs. To which level of Maslows hierarchy of basic needs does the patients need for self-fulfillment relate?

  1. A)  Physiologic
  2. B)  Transcendence
  3. C)  Love and belonging
  4. D)  Self-actualization

Ans: D

Feedback:

Maslows highest level of human needs is self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment does not relate directly to them.

5. The view that health and illness are not static states but that they exist on a continuum is central to professional health care systems. When planning care, this view aids the nurse in appreciating which of the following?

  1. A)  Care should focus primarily on the treatment of disease.
  2. B)  A persons state of health is ever-changing.

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6.

A) B) C) D) Ans:

BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK

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C) D) Ans:

A person can transition from health to illness rapidly.
Care should focus on the patients compliance with interventions. B

Feedback:

By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a persons state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. The other answers are incorrect because patient care should not focus just on the treatment of disease. Rapid declines in health and compliance with treatment are not key to this view of health.

A group of nursing students are participating in a community health clinic. When providing care in this context, what should the students teach participants about disease prevention?

It is best achieved through attending self-help groups.
It is best achieved by reducing psychological stress.
It is best achieved by being an active participant in the community. It is best achieved by exhibiting behaviors that promote health.
D

Feedback:

Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach that disease prevention is best achieved through attending self-help groups, by reducing stress, or by being an active participant in the community, though each of these activities is consistent with a healthy lifestyle.

A nurse on a medical-surgical unit has asked to represent the unit on the hospitals quality committee. When describing quality improvement programs to nursing colleagues and members of other health disciplines, what characteristic should the nurse cite?

These programs establish consequences for health care professionals actions. These programs focus on the processes used to provide care.
These programs identify specific incidents related to quality.
These programs seek to justify health care costs and systems.

7.

A) B) C) D)

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Ans: B

Feedback:

Numerous models seek to improve the quality of health care delivery. A commonality among them is a focus on the processes that are used to provide care. Consequences, a focus on incidents, and justification for health care costs are not universal characteristics of quality improvement efforts.

8. Nurses in acute care settings must work with other health care team members to maintain quality care while facing pressures to care for patients who are hospitalized for shorter periods of time than in the past. To ensure positive health outcomes when patients return to their homes, what action should the nurse prioritize?

  1. A)  Promotion of health literacy during hospitalization
  2. B)  Close communication with insurers
  3. C)  Thorough and evidence-based discharge planning
  4. D)  Participation in continuing education initiatives

Ans: C

Feedback:

Following discharges that occur after increasingly short hospital stays, nurses in the community care for patients who need high-technology acute care services as well as long-term care in the home. This is dependent on effective discharge planning to a greater degree than continuing education, communication with insurers, or promotion of health literacy.

9. You are admitting a patient to your medical unit after the patient has been transferred from the emergency department. What is your priority nursing action at this time?

  1. A)  Identifying the immediate needs of the patient
  2. B)  Checking the admitting physicians orders
  3. C)  Obtaining a baseline set of vital signs
  4. D)  Allowing the family to be with the patient

Ans: A

Feedback:

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Among the nurses important functions in health care delivery, identifying the patients immediate needs and working in concert with the patient to address them is most important. The other nursing functions are important, but they are not the most important functions.

10. A nurse on a postsurgical unit is providing care based on a clinical pathway. When performing assessments and interventions with the aid of a pathway, the nurse should prioritize what goal?

  1. A)  Helping the patient to achieve specific outcomes
  2. B)  Balancing risks and benefits of interventions
  3. C)  Documenting the patients response to therapy
  4. D)  Staying accountable to the interdisciplinary team

Ans: A

Feedback:

Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes. Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient achieve outcomes is paramount.

11. Staff nurses in an ICU setting have noticed that their patients required lower and fewer doses of analgesia when noise levels on the unit were consciously reduced. They informed an advanced practice RN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalized patients. How does this demonstrate a role of the APRN?

  1. A)  Involving patients in their care while hospitalized
  2. B)  Contributing to the scientific basis of nursing practice
  3. C)  Critiquing the quality of patient care
  4. D)  Explaining medical studies to patients and RNs

Ans: B

Feedback:

Research is within the purview of the APRN. The activity described does not exemplify explaining studies to RNs, critiquing care, or involving patients in their care.

12. Nurses now have the option to practice in a variety of settings and one of the fastest growing venues of practice for the nurse in todays health care environment is home health care. What is the main basis for

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the growth in this health care setting?

  1. A)  Chronic nursing shortage
  2. B)  Western focus on treatment of disease
  3. C)  Nurses preferences for day shifts instead of evening or night shifts
  4. D)  Discharge of patients who are more critically ill

Ans: D

Feedback:

With shorter hospital stays and increased use of outpatient health care services, more nursing care is provided in the home and community setting. The other answers are incorrect because they are not the basis for the growth in nursing care delivered in the home setting.

13. Nurses have different educational backgrounds and function under many titles in their practice setting. If a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by influencing the patient, the nurse, and the health care system, what would most accurately describe this nurses title?

  1. A)  Nursing care expert
  2. B)  Clinical nurse specialist
  3. C)  Nurse manager
  4. D)  Staff nurse

Ans: B

Feedback:

Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care (e.g., cardiovascular, oncology). They define their roles as having five major components: clinical practice, education, management, consultation, and research. The other answers are incorrect because they are not the most accurate titles for this nurse.

14. Nursing continues to recognize and participate in collaboration with other health care disciplines to meet the complex needs of the patient. Which of the following is the best example of a collaborative practice model?

A) The nurse and the physician jointly making clinical decisions.

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B) C) D) Ans:

15.

A) B) C) D) Ans:

The nurse accompanying the physician on rounds. The nurse making a referral on behalf of the patient. The nurse attending an appointment with the patient. A

Feedback:

The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public. The other answers are incorrect because they are not examples of a collaborative practice model.

A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslows hierarchy of needs, what dimension of care should the nurse consider primary in importance when caring for a dying patient?

Spiritual Social Physiologic Emotional C

Feedback:

Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied to the various nursing models for assessment of a patients strengths, limitations, and need for nursing interventions. The other answers are incorrect because they are not of primary importance when caring for a dying patient, though each should certainly be addressed.

A nurse is planning a medical patients care with consideration of Maslows hierarchy of needs. Within this framework of understanding, what would be the nurses first priority?

Allowing the family to see a newly admitted patient Ambulating the patient in the hallway Administering pain medication

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16.

A) B) C)

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17.

A) B) C) D) Ans:

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D) Ans:

Teaching the patient to self-administer insulin safely

C

Feedback:

In Maslows hierarchy of needs, pain relief addresses the patients basic physiologic need. Activity, such as ambulation, is a higher level need above the physiologic need. Allowing the patient to see family addresses a higher level need related to love and belonging. Teaching the patient is also a higher level need related to the desire to know and understand and is not appropriate at this time, as the basic physiologic need of pain control must be addressed before the patient can address these higher level needs.

A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse provides care. This nurses compliance with the nurse practice act demonstrates adherence to which of the following?

National Council of Nursings guidelines for care

National League for Nursings Code of Conduct American Nurses Associations Social Policy Statement

Department of Health and Human Services White Paper on Nursing

C

Feedback:

Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply with the nurse practice act of the state in which they practice and to comply with the Code of Ethics for Nurses as spelled out by the ANA (2001) and the International Council of Nurses (International Council of Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not included in the ANAs white paper. The DHHS has not published a white paper on nursing nor has the NLN published a specific code of conduct.

Nursing is, by necessity, a flexible profession. It has adapted to meet both the expectations and the changing health needs of our aging population. What is one factor that has impacted the need for certified nurse practitioners (CNPs)?

The increased need for primary care providers The need to improve patient diagnostic services The push to drive institutional excellence

18.

A) B) C)

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D) The need to decrease the number of medical errors Ans: A

Feedback:

CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive additional focused training in primary care or acute care. CNPs help meet the need for primary care providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent with the CNP role, but these considerations are the not primary impetus for the increased role for CNPs.

19. A nurse is providing care for a patient who is postoperative day one following a bowel resection for the treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality improvement?

  1. A)  By liaising with the members of the interdisciplinary care team
  2. B)  By critically appraising the outcomes of care that is provided
  3. C)  By integrating the patients preferences into the plan of care
  4. D)  By documenting care in the electronic health record in a timely fashion

Ans: B

Feedback:

Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement activities.

20. Professional nursing expands and grows because of factors driven by the changing needs of health care consumers. Which of the following is a factor that nurses should reflect in the planning and provision of health care?

  1. A)  Decreased access to health care information by individuals
  2. B)  Gradual increases in the cultural unity of the American population
  3. C)  Increasing mean and median age of the American population
  4. D)  Decreasing consumer expectations related to health care outcomes

Ans: C

Feedback:

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The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewer school-age children and more senior citizens, many of whom are women.

The population has become more culturally diverse as increasing numbers of people from different national backgrounds enter the country. Access to information and consumer expectations continue to increase.

21. A public health nurse has been commissioned to draft a health promotion program that meets the health care needs and expectations of the community. Which of the following focuses is most likely to influence the nurses choice of interventions?

  1. A)  Management of chronic conditions and disability
  2. B)  Increasing need for self-care among a younger population
  3. C)  A shifting focus to disease management
  4. D)  An increasing focus on acute conditions and rehabilitation

Ans: A

Feedback:

In response to current priorities, health care must focus more on management of chronic conditions and disability than in previous times. The other answers are incorrect because the change in focus of health care is not an increasing need for self-care among our aging population; our focus is shifting away from disease management, not toward it; and we are moving away from the management of acute conditions to managing chronic conditions.

22. A community health nurse has witnessed significant shifts in patterns of disease over the course of a four-decade career. Which of the following focuses most clearly demonstrates the changing pattern of disease in the United States?

  1. A)  Type 1 diabetes management
  2. B)  Treatment of community-acquired pneumonia
  3. C)  Rehabilitation from traumatic brain injuries
  4. D)  Management of acute Staphylococcus aureus infections

Ans: A

Feedback:

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Management of chronic diseases such as diabetes is a priority focus of the current health care environment. This supersedes the treatment of acute infections and rehabilitation needs.

23. The ANA has identified several phenomena toward which the focus of nursing care should be directed, and a nurse is planning care that reflects these priorities. Which of the nurses actions best demonstrates these priorities?

  1. A)  Encouraging the patients dependence on caregivers
  2. B)  Fostering the patients ability to make choices
  3. C)  Teaching the patient about nurses roles in the health care system
  4. D)  Assessing the patients adherence to treatment

Ans: B

Feedback:

The ANA identifies several focuses for nursing care and research, including the ability to make choices. The other answers are incorrect because they are not phenomena identified by the ANA.

24. The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels of health care. Which of the following activities are considered integral to the CNP role? Select all that apply.

  1. A)  Educating patients and family members
  2. B)  Coordinating care with other disciplines
  3. C)  Using direct provision of interventions
  4. D)  Educating registered nurses and practical nurses
  5. E)  Coordinating payment plans for patients

Ans: A,B,C

Feedback:

This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in home care and community nursing. Nurses help patients meet their needs by using direct intervention, by teaching patients and family members to perform care, and by coordinating and collaborating with other disciplines to provide needed services. The other answers are incorrect because NPs do not commonly perform education of nurses and they do not focus on matters related to payment.

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25. The ANA has identified central characteristics of nursing practice that are applicable across the wide variety of contexts in which nurses practice. A nurse can best demonstrate these principles by performing which of the following actions?

  1. A)  Teaching the public about the role of nursing
  2. B)  Taking action to control the costs of health care
  3. C)  Ensuring that all of his or her actions exemplify caring
  4. D)  Making sure to carry adequate liability insurance

Ans: C

Feedback:

The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANA does not identify teaching the public about nursing, controlling costs, or maintaining insurance as a central tenet of nursing practice.

26. A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched within the past decade. In this role, the nurse should prioritize which of the following activities?

  1. A)  Acting as a spokesperson for the nursing profession
  2. B)  Generating and disseminating new nursing knowledge
  3. C)  Diagnosing and treating health problems that have a predictable course
  4. D)  Helping patients to navigate the health care system

Ans: D

Feedback:

The CNL is a nurse generalist with a masters degree in nursing and a special background in clinical leadership, educated to help patients navigate through the complex health care system. The other answers are incorrect because they are not what nursing has identified as the CNL role.

27. Our world is connected by a sophisticated communication system that makes much health information instantly accessible, no matter where the patient is being treated. This instant access to health information has impacted health care delivery strategies, including the delivery of nursing care. What is one way the delivery of health care has been impacted by this phenomenon?

A) Brisk changes as well as swift obsolescence

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28.

A) B) C) D) Ans:

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B) C) D) Ans:

Rapid change that is nearly permanent
Limitations on the settings where care can be provided Increased need for social acceptance
A

Feedback:

The sophisticated communication systems that connect most parts of the world, with the capability of rapid storage, retrieval, and dissemination of information, have stimulated brisk change as well as swift obsolescence in health care delivery strategies. The other answers are incorrect because, although we have rapid change in the delivery of nursing care, it does not last a long time; it is evolving as health care itself evolves. Giving nursing care has not become easier, it becomes more complex with every change; and it does not need to be more socially acceptable; it needs to be more culturally sensitive.

With the changing population of health care consumers, it has become necessary for nurses to work more closely with other nurses, as when acute care nurses collaborate with public health and home health nurses. What nursing function has increased in importance because of this phenomenon?

Prescribing medication Performing discharge planning Promoting family involvement Forming collegial relationships B

Feedback:

The importance of effective discharge planning and quality improvement cannot be overstated. The other answers are incorrect because giving medication and family involvement in the patients care have not grown in importance. Making and maintaining collegial relationships has become a necessity in working in the health care delivery system. Effective discharge planning aids in getting patients out of the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting possible.

A nurse has integrated the principles of evidence-based practice into care. EBP has the potential to help the nurse achieve what goal?

Increasing career satisfaction Obtaining federal grant money

29.

A) B)

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C) D) Ans:

30.

A) B) C) D) Ans:

Ensuring high quality patient care

Enhancing the publics esteem for nursing

C

Feedback:

Quality improvement is the ultimate goal of EBP. Career satisfaction, public esteem, and grant money are not priorities.

A case manager has been hired at a rural hospital that has a combined medical-surgical unit. When defining this new role, which of the following outcomes should be prioritized by the hospitals leadership?

Decreased need for physician services Improved patient and family education Increased adherence to the principles of EBP Increased coordination of health services

D

Feedback:

Case management is a system of coordinating health care services to ensure cost-effectiveness, accountability, and quality care. The case manager coordinates the care of a caseload of patients through facilitating communication between nurses, other health care personnel who provide care, and insurance companies. Reducing the need for physician services is not a central goal. Education and EBP are consistent with case management, but they are not central to this particular role.

A hospitals current quality improvement program has integrated the principles of the Institute for Healthcare Improvement (IHI) 5 Million Lives Campaign. How can the hospital best achieve the campaign goals of reducing preventable harm and death?

By adhering to EBP guidelines
By reducing nurse-to-patient ratios and increasing accountability By having researchers from outside the facility evaluate care
By involving patients and families in their care planning

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31.

A) B) C) D)

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Ans: A

Feedback:

The 5 Million Lives Campaign posits that if evidence-based guidelines it advocated were voluntarily implemented by U.S. hospitals, 5 million lives would be saved from either harm or death over a two- year period. Nurse-to-patient ratios, family participation, and independent evaluation are not stated components of the campaign.

32. Over the past several decades, nursing roles have changed and expanded in many ways. Which of the following factors has provided the strongest impetus for this change?

  1. A)  The need to decrease the cost of health care
  2. B)  The need to improve the quality of nursing education
  3. C)  The need to increase the number of nursing jobs available
  4. D)  The need to increase the public perception of nursing

Ans: A

Feedback:

The role of the nurse has expanded to improve the distribution of health care services and to decrease the cost of health care. The other answers are incorrect because the expansion of roles in nursing did not occur to improve education, increase the number of nursing jobs, or increase public perception.

33. Advanced practice nursing roles have grown in number and in visibility in recent years. What characteristic sets these nurses apart from the registered nurse?

  1. A)  Collaboration with other health care providers
  2. B)  Education that goes beyond that of the RN
  3. C)  Advanced documentation skills
  4. D)  Ability to provide care in the surgical context

Ans: B

Feedback:

There is wide variety in APRN roles. However, a commonality is that they require education beyond that of the professional RN. All nurses collaborate with other health care providers to provide nursing care to

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their patients. Advanced documentation skills are not what sets advanced practice nurses apart from the staff nurse. RNs have the ability to provide care in the operating room.

34. CNPs are educated as specialists in areas such as family care, pediatrics, or geriatrics. In most states,

what

right do CNPs have that RNs do not possess? Perform health interventions independently
Make referrals to members of other health disciplines Prescribe medications
Perform surgery independently
C

A) B) C) D) Ans:

35. A team of community health nurses are planning to draft a proposal for a program that will increase the communitys alignment with the principles contained in the Healthy People 2020report. Which of the following activities would best demonstrate the priorities identified in this report?

  1. A)  Addressing determinants of health such as clean environments and safety in the community
  2. B)  Lobbying for increased funding to the county hospital where many residents receive primary care
  3. C)  Collaborating with health professionals in neighboring communities to pool resources and increase efficiencies
  4. D)  Creating clinical placements where nursing students and members of other health disciplines can gain experience in a community setting

Ans: A

Feedback:

Healthy People 2020 addresses social determinants of health such as safety and the state of the environment. This report does not specifically address matters such as hospital funding, nursing education, or resource allocation.

36. A nurse is aware that an increasing emphasis is being placed on health, health promotion, wellness, and self-care. Which of the following activities would best demonstrate the principles of health promotion?

Feedback:

In most states, nurse practitioners have prescriptive authority. Surgery is beyond the CNP scope of practice and all professional nurses may perform interventions and make certain referrals.

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  1. A)  A discharge planning initiative between acute care and community care nurses
  2. B)  Collaboration between several schools of nursing in an urban area
  3. C)  Creation of a smoking prevention program undertaken in a middle school
  4. D)  Establishment of a website where patients can check emergency department wait-times

Ans: C

Feedback:

Smoking prevention is a clear example of health promotion. Each of the other listed activities has the potential to be beneficial, but none is considered health promotion.

37. A group of nursing students are learning about recent changes in the pattern of disease in the United States. Which of the following statements best describes these current changes?

  1. A)  Infectious diseases continue to decrease in incidence and prevalence.
  2. B)  Chronic illnesses are becoming increasingly resistant to treatment.
  3. C)  Most acute, infectious diseases have been eradicated.
  4. D)  Most, but not all, communicable diseases are declining.

Ans: D

Feedback:

Although some infectious diseases have been controlled or eradicated, others are on the rise. Antibiotic resistance is a more serious problem in acute, not chronic, illnesses.

38. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) are evaluating a large, university medical center according to core measures. Evaluators should perform this evaluation in what way?

  1. A)  By auditing the medical centers electronic health records
  2. B)  By performing focus groups and interviews with care providers from numerous disciplines
  3. C)  By performing statistical analysis of patient satisfaction surveys
  4. D)  By comparing the centers patient outcomes to best practice indicators

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Ans: D

Feedback:

Core measures are used to gauge how well a hospital gives care to its patients who are admitted to seek treatment for a specific disease or who need a specific treatment as compared to evidence-based guidelines and standards of care. Benchmark standards of quality are used to compare the care or treatment patients receive with the best practice standards. Patient satisfaction is considered, but this is not the only criterion.

39. Leadership of a medical unit have been instructed to integrate the principles of the Quality and Safety Education for Nurses (QSEN) competency of quality improvement. What action should the units leaders take?

  1. A)  Provide access to online journals and Web-based clinical resources for nursing staff.
  2. B)  Use flow charts to document the processes of care that are used on the unit.
  3. C)  Enforce continuing education requirements for all care providers.
  4. D)  Reduce the use of chemical and physical restraints on the unit.

Ans: B

Feedback:

One of the quality improvement skills is to use tools, such as flow charts and cause-effect diagrams, to make processes of care explicit. Each of the other listed actions has the potential to benefit patients and care givers, but none is an explicit knowledge, skill, or attitude associated with this QSEN competency.

40. The IOM Report Health Professions Education: A Bridge to Quality issued a number of challenges to the educational programs that teach nurses and members of other health professions. According to this report, what activity should educational institutions prioritize?

  1. A)  More clearly delineate each professions scope of practice during education
  2. B)  Move toward developing a single health curriculum that can be adapted for any health profession
  3. C)  Include interdisciplinary core competencies into curricula
  4. D)  Elicit input from patients and families into health care curricula

Ans: C

Feedback:

BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK

Test Bank – Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 21

Health Professions Education: A Bridge to Quality challenged health professions education programs to integrate interdisciplinary core competencies into their respective curricula to include patient-centered care, interdisciplinary teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. This report did not specify clearer definitions of scope of practice, patient input, or a single curriculum.

Pharmacology and the Nursing Process, 8e

pharmacology-and-the-nursing-process-8e

Cherry 6th Edition – Contemporary Nursing (0323101097)

cherry-6th-edition-contemporary-nursing-0323101097-400x495

Interpersonal Relationships: Professional Communication Skills for Nurses, 7e ISBN-13: 978-0323242813

interpersonal-relationships-professional-communication-skills-for-nurses-7e-isbn-13-978-0323242813

Holland/Adams/Brice, Core Concepts in Pharmacology 4th Edition Test Bank ISBN13: 9780133449938

core concepts in pharmacology

 

Nursing today transition and trends 8 edition test bank ISBN-13: 978-1455732036

nursing today transition and trends 8 edition

Fundamental of nursing for Taylor 8th edition ISBN-13: 978-1451185614

fundamental of nursing tylor

Fundamentals of Nursing, 9th Edition ISBN: 9780323327404

fundamental of nursing 9 edition potter and perry

Anderson’s Nursing Leadership, Management, and Professional Practice For The LPN/LVN In Nursing School and Beyond 5th Edition ISBN-13: 978-0803629608

Anderson's Nursing Leadership, Management, and Professional Practice For The LPN:LVN

Chapter 1: Historical Perspective and Current Trends

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. The nursing student predominantly uses knowledge about the history of nursing for what purpose?

1.

To understand the professional choices open to the student

2.

To prevent making medication errors in practice

3.

To determine what geographical area is the best place to practice

4.

To reduce the cost of delivering quality healthcare

____ 2. The nurse is working in an underdeveloped country and observes the natives lighting ritual fires and pounding on primitive drums around the sick person to promote recovery. The nurse interprets this behavior as indicating the natives believe illness results from what?

1.

Pathogens and genetics

2.

Evil spirits

3.

Tides and planets

4.

Plants and animals

____ 3. The person credited with making a written record of healthcare practices and removing the mythical aspect of healthcare is who?

1.

Hammurabi

2.

Florence Nightingale

3.

Hippocrates

4.

Apollo

____ 4. Who served as the first public health nurses, caring for the sick and the poor?

1.

The Presbyterian Church

2.

Salerno

3.

Jewish scholars

4.

Convent deaconesses

____ 5. What is a crucial issue the nurse working in the late industrialization era would need to address in order to promote health?

1.

Reducing spread of infection

2.

Reducing sedentary lifestyle

3.

Teaching proper use of medications

4.

Teaching use of car seats

____ 6. What types of skills would a nursing student learn while attending Kaiserworth Deaconess Institution in 1836?

1.

Administering immunizations

2.

Assisting in surgery

3.

Washing and changing bed linens

4.

Developing a plan of care

____ 7. The nurse demonstrates Florence Nightingale’s theory of nursing with what intervention?

1.

Respecting the patient’s culture and incorporating cultural needs in the plan of care

2.

Promoting good health and treating those who are ill in a holistic manner

3.

Understanding how to motivate people to practice a healthy lifestyle and reduce risks

4.

Teaching other nurses how to deliver the highest quality of nursing care.

____ 8. What action performed by the nurse directly resulted from the contribution made by Linda Richards?

1.

Using an antiseptic before administering an injection

2.

Exploring the psychosocial needs of the patient

3.

Documenting patient care in the medical record

4.

Listening to a patient describe his or her condition

____ 9. After graduating from nursing school, the graduate takes a licensure examination as the result of what nurse’s contribution?

1.

Florence Nightingale

2.

Mary Adelaid Nutting

3.

Lavinia L. Dock

4.

Isabel Hampton Robb

____ 10. In addition to caring for the sick, what other skills would the first LPN students learn when attending the Ballard School in New York in 1893?

1.

Political advocacy

2.

Homemaking

3.

Communication

4.

Carpentry

____ 11. The nurse responds to an alarm on a pulse oximeter and sees the patient’s oxygen saturation is reading 38%. The nurse observes the patient, noting a respiratory rate of 12 breaths per minute, pink mucous membranes, and easy regular respirations. The nurse concludes the pulse oximeter is not reading accurately. Whose theory of nursing is this nurse demonstrating?

1.

Annie Goodrich

2.

Lillian D. Wald

3.

Florence Nightingale

4.

Linda Richards

____ 12. What statement describes Florence Nightingale’s beliefs about nursing?

1.

Practicing nurses should be licensed.

2.

Promotion of good health and treating the ill are nursing priorities.

3.

Nurses could simultaneously have a career and a marriage.

4.

Organisms cause infection.

____ 13. What was Mary Eliza Mahoney’s contribution to nursing?

1.

She organized the first visiting nurse association.

2.

She founded the American Journal of Nursing.

3.

She founded the National League of Nursing.

4.

She worked for the acceptance of African Americans into the nursing profession.

____ 14. What professional organization was the first to focus on licensed practical nurses (LPNs)?

1.

National Association for Practical Nurse Education and Services (NAPNES)

2.

National Federation of Licensed Practical Nurses (NFLPN)

3.

National League for Nursing (NLN)

4.

American Nurses Association (ANA)

____ 15. What statement accurately describes the NFLPN?

1.

It represents both registered nurses (RNs) and LPNs.

2.

It represents LPNs/LVNs only.

3.

It is open to anyone interested in nursing.

4.

It is open to anyone in the healthcare field.

____ 16. What organizations represent only LPNs/LVNs?

1.

ANA and NLN

2.

NFLPN and NLN

3.

NAPNES and NFLPN

4.

NAPNES and ANA

____ 17. The nurse working in mental health nursing honors what historical nurse for working to improve care of the mentally ill?

1.

Clara Barton

2.

Florence Nightingale

3.

Dorothea Dix

4.

Lillian D. Wald

____ 18. What is the difference between the LPN and LVN nursing title?

1.

LPNs have a longer educational program than LVNs.

2.

LVNs and LPNs have the same duties and skills, just different titles.

3.

LVNs are able to perform venipuncture and LPNs cannot.

4.

LPNs are working toward an RN license while LVNs are not.

____ 19. What mythical god was believed to promote healthcare in ancient times?

1.

Apollo

2.

Zeus

3.

Isis

4.

Ares

____ 20. What factor has had the greatest impact on the current nursing shortage?

1.

Later age of women having children

2.

Fewer women being born

3.

Overall unemployment rate

4.

More employment options for women

____ 21. What health condition is classified as a World Health Organization priority and a focus of health promotion for nurses?

1.

HIV

2.

MRSA

3.

Natural disasters

4.

Terrorism

____ 22. What trend in healthcare has only existed for the past decade and has changed nursing education to prepare student nurses for practice after graduation?

1.

Technology

2.

Cultural diversity

3.

HIV

4.

Nursing shortage

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 23. What factors are contributing to the nursing shortage? (Select all that apply.)

1.

Increased demand for nurses

2.

Shortage of nursing faculty

3.

Lack of nursing organizations

4.

Nurses leaving the profession due to poor working conditions

5.

Not enough interest in nursing

____ 24. The newly licensed LPN joins a professional organization for what benefits? (Select all that apply.)

1.

Opportunities to maintain current nursing knowledge

2.

Most facilities mandate membership before hiring a nurse.

3.

Organizations offer a way for the LPN’s voice to be heard regarding concerns.

4.

They advocate for the LPN in professional matters.

5.

It is a requirement for licensure in most states.

____ 25. In order to deliver the safest possible care, the nurse needs to understand what? (Select all that apply.)

1.

How to perform the procedure correctly

2.

Why the procedure is being performed

3.

How the procedure will affect the patient

4.

The cost of performing the procedure

5.

The equipment needed to perform the procedure

Chapter 1: Historical Perspective and Current Trends

Answer Section

MULTIPLE CHOICE

1.ANS:1

Understanding nursing history helps the nurse to better recognize the many choices available when choosing their own future path.

PTS:1REF:Chapter: 1OBJ:Objective: 1

KEY: Content Area: History | Integrated Processes: Communication and Documentation | Client Need: Safe, Effective Care Environment | Cognitive Level: Applying

2.ANS:2

A belief that disease was caused by evil spirits would result in lighting fires or candles and making loud noise to try to ward off the spirits.

PTS:1REF:Chapter: 1OBJ:Objective: 2

KEY:Content Area: History | Integrated Processes: Nursing Process | Client Need: Psychosocial Integrity | Cognitive Level: Analyzing

3.ANS:3

Hippocrates wrote the first medical textbook, outlining current healthcare practices and removed the mythical belief that Apollo was responsible for health. Hammurabi wrote a code of laws to protect the patient and define legal limitations of caregivers, Florence Nightingale introduced modern nursing during the Crimean War, and Apollo was a mythical God who was believed to control health and wellness.

PTS:1REF:Chapter: 1OBJ:Objective: 2

KEY: Content Area: History | Integrated Processes: Communication and Documentation | Client Need: Safe, Effective Care Environment | Cognitive Level: Understanding

4.ANS:4

Deaconesses from local convents acted as the first public health nurses, providing care for the sick and the poor based on the Christian belief in the importance of caring for one another.

PTS:1REF:Chapter: 1OBJ:Objective: 2

KEY: Content Area: History | Integrated Processes: Communication and Documentation | Client Need: Safe, Effective Care Environment | Cognitive Level: Understanding

5.ANS:1

Many deaths resulted from communicable diseases and lack of cleanliness in hospitals, so the nurse’s priority concern with health promotion would be reducing the spread of infection.

PTS:1REF:Chapter: 1OBJ:Objective: 2

KEY:Content Area: History | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance | Cognitive Level: Analyzing

6.ANS:3

Washing and changing bed linens, mopping floors, and housekeeping tasks were included as part of the nurse’s education. Immunizations did not exist at that time in history, and surgery was uncommon and very primitive with frequent poor outcomes. Thus assistants were rarely required and not part of nursing school. Plan of care considerations were not used until after the mid 1900s.

PTS:1REF:Chapter: 1OBJ:Objective: 2

KEY:Content Area: History | Integrated Processes: Teaching/Learning | Client Need: Safe, Effective Care Environment | Cognitive Level: Understanding

7.ANS:2

Nightingale believed the nurse’s primary responsibilities included promoting health and treating the ill.

PTS:1REF:Chapter: 1OBJ:Objective: 3

KEY: Content Area: History | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Applying

8.ANS:3

Linda Richards developed a system for recording details about patients and patient care. This system evolved into today’s documentation system.

PTS:1REF:Chapter: 1OBJ:Objective: 3

KEY: Content Area: History | Integrated Processes: Communication and Documentation | Client Need: Safe, Effective Care Environment | Cognitive Level: Applying

9.ANS:4

Isabel Hampton Robb fought for licensing examinations and registration to protect patients from incompetent nurses, in order to raise the standard of the profession.

PTS:1REF:Chapter: 1OBJ:Objective: 3

KEY:Content Area: History | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Applying

10.ANS:2

LPN students learned homemaking skills, because much of the patient care they provided was within the patient’s home.

PTS:1REF:Chapter: 1OBJ:Objective: 4

KEY:Content Area: History | Integrated Processes: Teaching/Learning | Client Need: Safe, Effective Care Environment | Cognitive Level: Understanding

11.ANS:3

Florence Nightingale promoted treating the patient based on the patient’s individual needs rather than treating the disease or, in this case, the machinery.

PTS:1REF:Chapter: 1OBJ:Objective: 3

KEY: Content Area: History | Integrated Processes: Communication and Documentation | Client Need: Safe, Effective Care Environment | Cognitive Level: Analyzing

12.ANS:2

One of Florence Nightingale’s strongest beliefs was that promoting good health and treating the ill were nursing priorities. Throughout her career, Nightingale implemented changes in the nursing practice to enhance the health of all who were ill.

PTS:1REF:Chapter: 1OBJ:Objective: 3

KEY:Content Area: History | Integrated Processes: Nursing Process | Client Need: Health Promotion and Maintenance | Cognitive Level: Understanding

13.ANS:4

Mary Eliza Mahoney was the first African American nurse in the United States. She spent her life working for the acceptance of African Americans into the nursing profession, and was also the organizer and the first president of the National Association for Colored Graduate Nurses.

PTS:1REF:Chapter: 1OBJ:Objective: 3

KEY: Content Area: History | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Understanding

14.ANS:1

NAPNES was the first professional organization to focus on LPNs. NAPNES is very active today, with continuing education opportunities and publications for LPNs. While NFLPN focuses on LPNs, they were not the first to do so. NLN and ANA focus on both RNs and LPNs.

PTS:1REF:Chapter: 1OBJ:Objective: 5

KEY: Content Area: Nursing Organizations | Integrated Processes: Teaching/Learning | Client Need: Safe, Effective Care Environment | Cognitive Level: Remembering

15.ANS:2

The NFLPN is considered the official membership organization for the licensed practical nurse/licensed vocational nurse (LPN/LVN); therefore, only the LPN/LVN may join this organization.

PTS:1REF:Chapter: 1OBJ:Objective: 5

KEY: Content Area: Nursing Organizations | Integrated Processes: Teaching/Learning | Client Need: Safe, Effective Care Environment | Cognitive Level: Remembering

16.ANS:3

The two vocational LPN organizations are the National Federation for Licensed Practical Nurses (NFLPN) and the National Association for Practical Nurse Education and Service (NAPNES). Both the ANA and the NLN focus on both RNs and LPNs.

PTS:1REF:Chapter: 1OBJ:Objective: 5

KEY: Content Area: Nursing Organizations | Integrated Processes: Teaching/Learning | Client Need: Safe, Effective Care Environment | Cognitive Level: Remembering

17.ANS:3

Dorothea Dix championed the development of psychiatric hospitals, and her work also brought about improvement for prisoners in jails.

PTS:1REF:Chapter: 1OBJ:Objective: 3

KEY:Content Area: History | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Applying

18.ANS:2

Both LPNs and licensed vocational nurses (LVNs) are legally recognized and practice in diverse healthcare settings today. LVN education predominantly takes place in California and Texas, whereas LPN education is common in other geographic areas of the country.

PTS:1REF:Chapter: 1OBJ:Objective: 4

KEY:Content Area: Role of LPN | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Understanding

19.ANS:1

The primitive healthcare that was available was provided by males, except for the midwives, and was promoted by a belief in Apollo, the mythical Greek healer.

PTS:1REF:Chapter: 1OBJ:Objective: 2

KEY: Content Area: History | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Remembering

20.ANS:4

One reality of the nursing shortage is that the 21st century woman has more employment options than women had previously.

PTS:1REF:Chapter: 1OBJ:Objective: 6

KEY:Content Area: Trends | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Analyzing

21.ANS:1

The prevention and treatment of HIV is a World Health Organization priority. While MRSA is a focus of health promotion for nurses, it is the CDC that is focusing on reducing occurrence. The World Health Organization has not set natural disasters as a priority because they cannot be controlled, and it is not focused on reducing terrorism; nurses respond to terrorist events when they occur, but it is not a source of health promotion.

PTS:1REF:Chapter: 1OBJ:Objective: 6

KEY: Content Area: Trends | Integrated Processes: Caring | Client Need: Health Promotion and Maintenance | Cognitive Level: Remembering

22.ANS:1

The use of technology in healthcare has increased dramatically over the last decade, and has become a major consideration in nursing education.

PTS:1REF:Chapter: 1OBJ:Objective: 6

KEY:Content Area: Trends | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Analyzing

MULTIPLE RESPONSE

23.ANS:1, 2, 4

Aging Baby Boomers, people living longer, and the increasing complexity of healthcare have all increased the demand for nurses. Insufficient nursing faculty results in turning potential nursing students away from nursing programs because there aren’t enough educated faculty to teach them. Mandatory overtime, working holidays and weekends, long hours without breaks, and other working conditions can cause nurses to leave the profession. There is no lack of nursing organizations and this does not contribute to the nursing shortage, and there is no lack of interest in nursing but not everyone is designed to be a nurse.

PTS:1REF:Chapter: 1OBJ:Objective: 6

KEY: Content Area: Trends | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Understanding

24.ANS:1, 3, 4

Professional organizations provide lifelong learning opportunities for the LPN in the form of journals, seminars, and annual meetings. They also provide the LPN a voice for concerns and opinions, and they serve as an advocate for LPNs at the state and national level. Membership in a nursing organization is not usually a requirement for employment, but it can serve as a favorable indicator that the nurse is maintaining current knowledge. While ongoing education is required by some boards of nursing for licensure, there is no requirement the nurse belong to an organization.

PTS:1REF:Chapter: 1OBJ:Objective: 6

KEY: Content Area: Trends | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Understanding

25.ANS:1, 2, 3, 5

Understanding how to perform the procedure correctly is important if the nurse is to maintain safety. The nurse should never perform any procedure without understanding why it is being performed and what outcome is desired. The nurse is responsible for teaching the patient what to expect before the procedure is begun, so the nurse must understand how the procedure will impact the patient. The nurse will gather the equipment required to perform the procedure, therefore  needs to know what will and what might be needed. The nurse is not responsible for knowing the cost of the procedure.

PTS:1REF:Chapter: 1OBJ:Objective: 6

KEY:Content Area: QSEN | Integrated Processes: Caring | Client Need: Safe, Effective Care Environment | Cognitive Level: Applying

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Caring for Older Adults Holistically 5th Edition ISBN-13: 978-0803625006

Caring for Older Adults Holistically 5th Edition

Chapter 1: Holistic Caring

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. According to the 2002 U.S. Census, approximately how many Americans are older than age 65?

a.

5%

b.

20%

c.

12%

d.

2%

____ 2. Today, the average life expectancy is

a.

70.2 years

b.

75 years

c.

79 years for women and 72.9 for men

d.

longer for men than for women

____ 3. All of the following would be good explanations of “holistic nursing” except

a.

Holistic nursing focuses on the specific disease or disorder a person has in order to treat it effectively

b.

Holistic nursing aims to treat the whole person, not just a specific disease or disorder the person may have

c.

Holistic nursing focuses on the individual patient and uses many techniques such as empathetic listening, music, and imagery as well as specific clinical skills

d.

Holistic nursing weaves the technical skills of nursing with the social science skills that enhance communication and rapport between the nurse and the person receiving care

____ 4. The Science of Human Caring was developed by

a.

Florence Nightingale

b.

Clara Barton

c.

Jean Watson

d.

Savage and Money

____ 5. The Science of Human Caring emphasizes all of the following except

a.

Transpersonal caring

b.

A focus on the person while you are with him or her

c.

Ensuring that all nonessential tasks, such as bathing, are given according to a strict schedule

d.

Reaching out to the patient, making eye contact, touching if appropriate, speaking softly

____ 6. Basic concepts of holistic nursing include

a.

Using your developed clinical expertise

b.

Developing a close relationship with the patient’s family members and significant others

c.

Remembering the personal intuition and creativity of patients in your nursing plan

d.

All of the above

____ 7. Most elderly people having a heart attack have

a.

Pain diffused over the entire chest area

b.

No pain

c.

Crushing sternal pain

d.

Pain on the left side of the chest and pain that radiates down the left arm

____ 8. Compared with the doses of medication given to a young adult, the doses given to an old-old person are usually

a.

Smaller

b.

Larger because the old-old person is probably sicker

c.

The same

d.

Minimal because the person is very old and probably near death

____ 9. What communication technique has been developed specifically for dealing with demented elderly persons?

a.

Cognitive therapy

b.

Validation therapy

c.

Geriatric Depression Scale

d.

MMSE (Mini-Mental Status Examination)

____ 10. Mr. Leopold is an 82-year-old man in your care. He has been diagnosed with liver cancer and has long-standing cardiovascular problems. He begins to scream at you and pushes his meal tray away. What would be an appropriate response?

a.

Take the meal tray and leave the room without saying anything

b.

Tell him to stop screaming in a loud voice

c.

Calmly ask him what he is upset about and listen carefully to him

d.

Call your supervisor

____ 11. You enter the room of Mrs. Brewster, an 87-year-old frail woman with congestive heart failure. As you enter, you say, “Good morning, dear. I’d like to bathe you now, honey.” Later, your supervisor reprimands you because your way of speaking to Mrs. Brewster was an example of

a.

Beneficence

b.

Paternalism

c.

Caring

d.

Malfeasance

____ 12. Mr. Johnson is recovering from abdominal surgery and complains of pain and asks for pain-relieving medication. What should be your first action?

a.

Ask him to rate the pain on a 1-to-10 scale, with 10 being the most severe pain

b.

Observe him and try to ascertain his level of pain

c.

Tell him he must tell his physician and that you can do nothing for him

d.

Tell him that the pain medication he had been given earlier should be controlling his pain

____ 13. The term “elite old” is used for people

a.

85 to 100 years old

b.

Older than 100 years

c.

75 to 84 years old

d.

65 to 74 years old

____ 14. Which of the following are key concepts in holistic nursing?

a.

Following physician instructions and follow-up with the physician

b.

Developing a relationship with family members of the patient

c.

Using what you have learned—your clinical experience

d.

All of the above

Chapter 1: Holistic Caring

Answer Section

MULTIPLE CHOICE

1.ANS:C

According to the census, 1 in 8 Americans was older than age 65 years in 2002. That corresponds to 12.5%. There were 20.8 million women and 14.8 million men older than age 65.

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

2.ANS:C

The average life expectancy has increased dramatically in the last 75 years—from 59.7 years in 1930 to 79 years for women and 72.9 years for men, according to the 2002 U.S. Census Bureau.

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

3.ANS:A

The word “holism” is derived from the Anglo-Saxon root “hal,” which means “whole” or “to heal.” Holistic nursing focuses on the whole person, not the person’s specific disease or disorder, and it employs many alternative therapies as well as specific clinical skills of modern medicine to help the patient.

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

4.ANS:C

The Science of Human Caring is a nursing philosophy developed by Dr. Jean Watson of the University of Colorado. This philosophy is taught worldwide and serves as the basis for teaching and caregiving. Florence Nightingale, known as the Mother of Modern Nursing, practiced holistic nursing long before the term was even used. Clara Barton served as an exemplary nurse during the Civil War, and Savage and Money have written on the concepts of holistic nursing.

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

5.ANS:C

It is important that essential tasks, such as giving medications, be done according to schedule, but if a patient is in distress, needs to talk, or needs answers, there should be some flexibility for nonessential tasks. The nurse needs to treat the whole person, not just give out drugs and see to it that certain grooming tasks are performed routinely.

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

6.ANS:D

The practice of holistic nursing includes following physicians’ orders, using your clinical expertise, respecting and drawing on a person’s knowledge of and intuition of his or her own body, and integrating significant others in the patient’s life into their care.

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

7.ANS:B

Most elderly people who have a heart attack do not have chest pain. The symptoms associated with chest pain, described in responses A, C, and D, are symptoms often found in younger people.

PTS: 1 KEY: Nursing Process Step: Assessment | Patient Care Area: Cardiovascular

8.ANS:A

Medication doses for a young or middle-aged person may overwhelm the systems of an elderly person with devastating results. As people age, their metabolism often slows, and there are many changes in body systems that can affect a drug’s absorption and excretion. Older people often require smaller drug dosages. For these reasons, responses B and C are incorrect. Response D is also wrong—and insensitive and uncaring.

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Medication

9.ANS:B

Validation therapy is a communication technique that has been developed specifically for dealing with demented elderly persons (including persons with Alzheimer’s disease). It focuses on accepting the person’s view of reality and age-appropriate behavior and can be used to calm a pacing, agitated older person. Responses C and D refer to tools used in neurological and psychological assessment. Cognitive therapy (response A), also known as cognitive behavioral therapy, is a method of treating many emotional and psychological problems, including anxiety, depression, and phobias.

PTS:1

KEY: Nursing Process Step: Implementation | Patient Care Area: Mental health, psychology

10.ANS:C

You should try to find out what is bothering him and ask specific questions—for example, is it the food? You should remember that he has been given a very serious and probably terminal diagnosis, and anger is understandable. There is a reason for every behavior, and you have the responsibility to learn the reason before reacting. Response A is uncaring and insulting to the patient. Response B is responding with anger and does not allow you to determine the cause of the outburst. If the patient becomes unruly, you should ask for assistance, but you should first try to determine the reason for the outburst and provide comfort if you can.

PTS:1

KEY: Nursing Process Step: Implementation | Patient Care Area: Mental health, psychology

11.ANS:B

You were speaking to Mrs. Brewster as if she were a child, a form of paternalism. Elderly people should be addressed with respect, usually by Mr. or Mrs., unless they specifically ask you to use their first name. Responses A and D are ethical principles in nursing—beneficence to be aimed for, malfeasance to be avoided. Response C is also incorrect: your supervisor would not reprimand you for that. More importantly, caring includes respect, and paternalism is not respectful to an older adult.

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

12.ANS:A

A cardinal rule is “A patient’s pain is what the patient tells you it is.” If he reports a pain level of 9 and you think it might be 5, you should act on the basis of the reported level of 9. You cannot determine how he feels (response B). Most physicians leave standing orders for postoperative pain, so response C is incorrect. His pain is not being controlled, so response D would be belittling.

PTS: 1 KEY: Nursing Process Step: Implementation | Patient Care Area: Pain management

13.ANS:B

The increased numbers of elderly people in the United States has resulted in new definitions. The term “young old” is used for people 65 to 74 years old; “middle-old,” for people 75 to 84 years old; “old-old,” for people 85 to 100 years old; and “elite old,” for people older than 100 years.

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

14.ANS:D

Key concepts in holistic nursing include following physician instructions and communicating with the physician; using your own clinical experience; respecting the ideas the elderly patient has about his or her own body and how to make it well and incorporating those ideas into the nursing plan, if possible; and involving family members in the care of the elderly patient.

PTS: 1 KEY: Nursing Process Step: Not applicable | Patient Care Area: Not applicable

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