Fundamentals of Nursing 11th Edition PDF

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 means that you are responsible, professionally and legally, for the type and quality of nursing care provided. DIF:Apply (application) OBJ:Discuss the roles and career opportunities for nurses. TOP: Implementation MSC: Management of Care 5. A nurse prepares the budget and policies for an intensive care unit. Which role is the nurse implementing? a. Educator b. Manager c. Advocate d. Caregiver ANS: B A manager coordinates the activities of members of the nursing staff in delivering nursing care and has personnel, policy, and budgetary responsibility for a specific nursing unit or facility. As an educator, you explain concepts and facts about health, describe the reason for routine care activities, demonstrate procedures such as self-care activities, reinforce learning or patient behavior, and evaluate the patient’s progress in learning. As a patient advocate, you protect your patient’s human and legal rights and provide assistance in asserting these rights if the need arises. As a caregiver, you help patients maintain and regain health, manage disease and symptoms, and attain a maximal level function and independence through the healing process. DIF:Apply (application) OBJ:Discuss the roles and career opportunities for nurses. TOP: Implementation MSC: Management of Care 6. The nurse has been working in the clinical setting for several years as an advanced practice nurse. However, the nurse has a strong desire to pursue research and theory development. To fulfill this desire, which program should the nurse attend? a. Doctor of Nursing Science degree (DNSc) b. Doctor of Philosophy degree (PhD) c. Doctor of Nursing Practice degree (DNP) d. Doctor in the Science of Nursing degree (DSN) ANS: B Some doctoral programs prepare nurses for more rigorous research and theory development and award the research-oriented Doctor of Philosophy (PhD) in nursing. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. The DNP is a practice doctorate that prepares advanced practice nurses such as nurse practitioners. DIF:Understand (comprehension) OBJ:Compare and contrast the educational programs available for professional registered nurse (RN) education. TOP: Teaching/Learning MSC: Management of Care 7. A nurse attends a workshop on current nursing issues provided by the American Nurses Association. Which type of education did the nurse receive? a. Graduate education b. Inservice education c. Continuing education d. Registered nurse education ANS: C Continuing education involves formal, organized educational programs offered by universities, hospitals, state nurses associations, professional nursing organizations, and educational and health care institutions. After obtaining a baccalaureate degree in nursing, you can pursue graduate education leading to a master’s or doctoral degree in any number of graduate fields, including nursing. Inservice education programs are instruction or training provided by a health care facility or institution. Registered nurse education is the education preparation for an individual intending to be an RN. DIF:Apply (application) OBJ:Compare and contrast the educational programs available for professional registered nurse (RN) education. TOP: Teaching/Learning MSC: Management of Care 8. A nurse identifies gaps between local and best practices. Which Quality and Safety Education for Nurses (QSEN) competency is the nurse demonstrating? a. Safety b. Patient-centered care c. Quality improvement d. Teamwork and collaboration ANS: C Quality improvement identifies gaps between local and best practices. Safety minimizes risk of harm to patients and providers through both system effectiveness and individual performance. Patient-centered care recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. Teamwork and collaboration allows effective functioning within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making. DIF:Understand (comprehension) OBJ:Discuss the roles and career opportunities for nurses. TOP: Evaluation MSC: Management of Care 9. A nurse has compassion fatigue. What is the nurse experiencing? a. Lateral violence and intrapersonal conflict b. Burnout and secondary traumatic stress c. Short-term grief and single stressor d. Physical and mental exhaustion ANS: B Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress. Compassion fatigue may contribute to what is described as lateral violence (nurse-nurse interactions, not intrapersonal). Frequent, intense, or prolonged exposure to grief and loss places nurses at risk for developing compassion fatigue. Stressors, not a single stressor, contribute to compassion fatigue. Physical and mental exhaustion describes burnout only. DIF:Understand (comprehension) 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 Accountability means that the nurse is responsible, professionally and legally, for the type and quality of nursing care provided. Autonomy is an essential element of professional nursing that involves the initiation of independent nursing interventions without medical orders. As a patient advocate, the nurse protects the patient’s human and legal rights and provides assistance in asserting these rights if the need arises. As an educator, the nurse explains concepts and facts about health, describes the reasons for routine care activities, demonstrates procedures such as self-care activities, reinforces learning or patient behavior, and evaluates the patient’s progress in learning. DIF:Remember (knowledge) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Evaluation MSC: Management of Care 18. A nurse is teaching the staff about Benner’s levels of proficiency. In which order should the nurse place the levels from beginning level to ending level? 1. Expert 2. Novice 3. Proficient 4. Competent 5. Advanced beginner a. 2, 4, 5, 1, 3 b. 2, 5, 4, 3, 1 c. 4, 2, 5, 3, 1 d. 4, 5, 2, 1, 3 ANS: B Benner’s levels of proficiency are as follows: novice, advanced beginner, competent, proficient, and expert. DIF:Understand (comprehension) OBJ:Discuss the development of professional nursing roles. TOP: Teaching/Learning MSC: Management of Care MULTIPLE RESPONSE 1. A nurse is preparing a teaching session about contemporary influences on nursing. Which examples should the nurse include? (Select all that apply.) a. Human rights b. Affordable Care Act c. Demographic changes d. Medically underserved e. Decreasing health care costs ANS: A, B, C, D Multiple external forces affect nursing, including the need for nurses’ self-care, Affordable Care Act (ACA) and rising (not decreasing) health care costs, demographic changes of the population, human rights, and increasing numbers of medically underserved. DIF:Understand (comprehension) OBJ:Discuss the influence of social, historical, political, and economic changes on nursing practices. TOP: Teaching/Learning MSC: Management of Care 2. After licensure, the nurse wants to stay current in knowledge and skills. Which programs are the most common ways nurses can do this? (Select all that apply.) a. Master’s degree b. Inservice education c. Doctoral preparation d. Continuing education e. National Council Licensure Examination retakes ANS: B, D Continuing education programs help nurses maintain current nursing skills, gain new knowledge and theory, and obtain new skills reflecting the changes in the health care delivery system. Inservice education programs are provided by a health care facility to increase the knowledge, skills, and competencies of nurses employed by the institution. Both can help the nurse stay current. Master’s degree programs are valuable for those in the role of nurse educator, nurse administrator, or advanced practice nurse. Professional doctoral programs in nursing (DSN or DNSc) prepare graduates to apply research findings to clinical nursing. National Council Licensure Examination retakes are not to keep current; this test is taken to enter RN practice. DIF:Understand (comprehension) OBJ:Compare and contrast the educational programs available for professional registered nurse (RN) education. TOP: Teaching/Learning MSC: Management of Care 3. A nurse wants to become an advanced practice registered nurse. Which options should the nurse consider? (Select all that apply.) a. Patient advocate b. Nurse administrator c. Certified nurse-midwife d. Clinical nurse specialist e. Certified nurse practitioner ANS: C, D, E Although all nurses should function as patient advocates, ―advanced practice nurse‖ is an umbrella term for an advanced clinical nurse such as a certified nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, or certified nurse-midwife. A nurse administrator is not an example of advanced practice. DIF:Understand (comprehension) OBJ:Discuss the roles and career opportunities for nurses. TOP: Teaching/Learning MSC: Management of Care 4. The nurse manager from the oncology unit has had two callouts; the orthopedic unit has had multiple discharges and probably will have to cancel one or two of its nurses. The orthopedic unit has agreed to ―float‖ two of its nurses to the oncology unit if oncology can ―float‖ a nursing assistant to the orthopedic unit to help with obtaining vital signs. Which concepts does this situation entail? (Select all that apply.) a. Autonomy b. Informatics c. Accountability d. Political activism e. Teamwork and collaboration ANS: A, C, E Staffing is an independent nursing intervention and is an example of autonomy. Along with increased autonomy comes accountability or responsibility for outcomes of an action. When nurses work together, this is teamwork and collaboration. Informatics is the use of information and technology to communicate, manage knowledge, mitigate error, and support decision making. Political activism usually involves more than day-to-day activities such as unit staffing. DIF:Analyze (analysis) 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) OBJ:Explain the concept of ―pay for value,‖ used to reward hospitals financially. TOP: Implementation MSC: Management of Care 8. The nurse is trying to determine risk factors unique to home care patients. What resource should the nurse access? a. Pew Health Professions Commission b. The Outcome and Assessment Information Set (OASIS) c. American Nurses Credentialing Center (ANCC) Magnet Recognition Program d. Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) ANS: B OASIS (the Outcome and Assessment Information Set) includes a group of standardized core assessment items for an adult home care patient. OASIS forms the basis for measuring patient outcomes for the purposes of outcome-based quality. Data items within OASIS include socio-demographic, environmental, support system, health status, functional status, and health service utilization characteristics of a patient. The OASIS assessment tool was designed to gather the data items needed to measure both outcomes and patient risk factors in the home setting. The Pew Health Professions Commission, a national and interdisciplinary group of health care leaders, recommended 21 competencies for health care professionals in the twenty-first century. The Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey developed to measure patient perceptions of their hospital experience. The Magnet Recognition Program recognizes health care organizations that achieve excellence in nursing practice. DIF:Understand (comprehension) OBJ:Discuss the features of an integrated health care system. TOP: Assessment MSC: Management of Care 9. An older-adult patient has extensive wound care needs after discharge from the hospital. Which facility should the nurse discuss with the patient? a. Hospice b. Respite care c. Assisted living d. Skilled nursing ANS: D An intermediate care or skilled nursing facility offers skilled care from a licensed nursing staff. This often includes administration of IV fluids, wound care, long-term ventilator management, and physical rehabilitation. A hospice is a system of family-centered care that allows patients to live with comfort, independence, and dignity while easing the pains of terminal illness. Respite care is a service that provides short-term relief or ―time off‖ for people providing home care to an individual who is ill, disabled, or frail. Assisted living offers an attractive long-term care setting with an environment more like home and greater resident autonomy. DIF:Apply (application) OBJ:Summarize the six levels of health care. TOP: Teaching/Learning MSC: Management of Care 10. A nurse working in a community hospital’s emergency department provides care to a patient having chest pain. Which level of care is the nurse providing? a. Continuing care b. Restorative care c. Preventive care d. Tertiary care ANS: D Hospital emergency departments, urgent care centers, critical care units, and inpatient medical-surgical units provide secondary and tertiary levels of care. Patients recovering from an acute or chronic illness or disability often require additional services (restorative care) to return to their previous level of function or reach a new level of function limited by their illness or disability. Continuing care is available within institutional settings (e.g., nursing centers or nursing homes, group homes, and retirement communities), communities (e.g., adult day care and senior centers), or the home (e.g., home care, home-delivered meals, and hospice). Preventive care is more disease oriented and focused on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs. DIF:Apply (application) OBJ:Summarize the six levels of health care. TOP: Implementation MSC: Management of Care 11. A nurse is teaching about the primary focus of community wellness. Which information should the nurse include in the teaching session? a. Coordination of health care services b. Effective cost containment for services c. Appropriate service delivery to service population d. Identification of services needed to address individual needs ANS: A Wellness care focuses on the health of populations and their communities rather than simply curing an individual’s disease. In wellness care, nurses can help lead communities and health care systems in coordinating resources to better serve their populations. All the remaining options are components of care coordination. DIF:Understand (comprehension) OBJ:Discuss the nursing implications regarding issues facing the health care system. TOP: Teaching/Learning MSC: Management of Care 12. A nurse is using research findings to improve clinical practice and improved care delivery. Which technique is the nurse using? a. Performance scores b. Integrated delivery networks c. Nursing-sensitive outcomes d. Utilization review committees ANS: A Performance improvement activities are typically clinical projects conceived in response to identified clinical problems and designed to use research findings to improve clinical practice by applying earned scores. Larger health care systems have integrated delivery networks (IDNs) that include a network of facilities, providers, and services organized to deliver a continuum of care to a population of patients at a capitated cost in a particular setting. 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 is not a nursing quality indicator. Value stream analysis is a method that focuses on improvement of processes in a health care institution. DIF:Apply (application) OBJ:Discuss the role of nurses in various health care settings. TOP: Evaluation MSC: Management of Care 4. A nurse is working in a health care organization that has achieved Magnet status. Which components are indicators of this status? (Select all that apply.) a. Empirical quality results b. Structural empowerment c. Transformational leadership d. Exemplary professional practice e. Willingness to recommend the agency ANS: A, B, C, D The American Nurses Credentialing Center (ANCC) established the Magnet Recognition Program to recognize health care organizations that achieve excellence in nursing practice. The five components are transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation, and improvements; and empirical quality results. Willingness to recommend the hospital/agency is a component of the Hospital Consumer of Assessment of Healthcare Providers and Systems survey. DIF:Understand (comprehension) OBJ:Discuss the nursing implications regarding issues facing the health care system. TOP: Assessment MSC: Management of Care MATCHING A nurse is teaching about the different types of health care model. Match the correct information to the type of health care model the nurse should include in the teaching session. a. Insurance for low-income families b. Federal insurance for people aged 65 and older c. Ties payment to organizations offering Medicare Advantage plans to the quality ratings of the coverage they offer d. Uses diagnosis-related group model 1. Prospective payment system (IPPS) 2. Affordable Care Act 3. Medicaid 4. Medicare 1. ANS: D DIF:Understand (comprehension) OBJ:Discuss the factors that affect a person’s access to health care. TOP: Teaching/Learning MSC: Management of Care 2. ANS: C DIF:Understand (comprehension) OBJ:Discuss the factors that affect a person’s access to health care. TOP: Teaching/Learning MSC: Management of Care 3. ANS: A DIF:Understand (comprehension) OBJ:Discuss the factors that affect a person’s access to health care. TOP: Teaching/Learning MSC: Management of Care 4. ANS: B DIF:Understand (comprehension) OBJ:Discuss the factors that affect a person’s access to health care. TOP: Teaching/Learning MSC: Management of Care Chapter 03: Community-Based Nursing Practice Potter: Fundamentals of Nursing, 11th Edition MULTIPLE CHOICE 1. A nurse is working as a public health nurse. What will be the nurse’s primary focus? a. The individual as one member of a group b. Individuals and families c. Needs of a population d. Health promotion ANS: C Public health nursing primary focus is understanding the needs of a population. Community-based care focuses on health promotion. Community health nursing focuses on health care of individuals, families, and groups within the community. DIF:Understand (comprehension) OBJ:Explain the relationship between public health and community health nursing. TOP: Caring MSC: Management of Care 2. A nurse wants to become a specialist in public health nursing. Which educational requirement will the nurse have to obtain? a. A baccalaureate degree in nursing b. Preparation at the basic entry level c. The same level of education as the community health nurse d. A graduate level education with a focus in public health science ANS: D A specialist in public health has a graduate level education with a focus in public health science. Public health nursing requires preparation at the basic entry level and sometimes requires a baccalaureate degree in nursing. A community health nurse is not the same thing as a public health nursing specialist. DIF:Understand (comprehension) OBJ:Explain the relationship between public health and community health nursing. TOP: Teaching/Learning MSC: Management of Care 3. A nurse is working as a community health nurse. Which action is a priority for this nurse? a. Provide direct care to subpopulations. b. Focus on the needs of the ill individual. c. Provide first level of contact to health care systems. 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 Members of vulnerable groups frequently have many risks or a combination of risk factors that make them more sensitive to the negative effects of individual risk factors. Individual risk factors are not always overwhelming, depending on the patient’s beliefs and values and sources of social support. DIF:Apply (application) OBJ:Identify characteristics of patients from vulnerable populations that influence the community-based nurse’s approach to care. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 12. The nurse is making a home visit to a Korean mother after the birth of girl. The spouse is pressing different parts of the patient’s hand and lower arm to relieve a headache. What is the nurse’s next action? a. Tell the spouse to stop and give the mother acetaminophen. b. Let the spouse finish and then give the mother medication. c. Ask the mother and/or spouse to explain the procedure. d. Explain to the spouse that it will not work. ANS: C The nurse should not judge the patient’s/family’s beliefs and values about health. The nurse needs to understand cultural beliefs, values, and practices to determine their specific needs. Acetaminophen may not be an acceptable alternative for this family. Criticizing the family’s beliefs and practices or saying they will not work may only create a barrier to care. 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 13. A nurse is assessing the social system of a community. Which area should the nurse assess? a. Housing b. Economic status c. Volunteer programs d. Predominant ethnic groups ANS: C Social systems include volunteer programs, education system, government, and health systems. Housing and economic status are included in the structure assessment. Predominant ethnic groups are a component of the population assessment. DIF:Understand (comprehension) OBJ:Identify elements of a community assessment. TOP: Assessment MSC: Psychosocial Integrity 14. The nurse is working with a 16-year-old pregnant female who tells the nurse that she needs an abortion. The nurse, acting as a counselor, provides the patient with information on alternatives to abortion. After discussing the options, the patient still expresses an interest in an abortion. What should the nurse, in the counselor role, do next? a. Encourage the patient to speak with a ―Right-to-Life‖ advocate. b. Refuse to provide a referral to an abortion service. c. Provide referral to an abortion service. d. Delay referral to an abortion service. ANS: C As a counselor, the nurse is responsible for providing information, listening objectively, and being supportive, caring, and trustworthy and providing a referral to an abortion service. The role of counselor should not be influenced by personal biases or values. The nurse does not make decisions, like going to a ―Right-to-Life‖ advocate, but rather helps the patient reach decisions that are best for him or her. To refuse to provide a referral or to delay referral would not be supportive of the patient’s decision. DIF:Apply (application) OBJ:Explain the competencies important for success in community-based nursing practice. TOP: Implementation MSC: Psychosocial Integrity 15. Before a patient diagnosed in the beginning stage of Alzheimer’s disease is discharged, the community-based nurse is making a visit to the patient’s home. The patient’s daughter and family live in the home with the patient. What is the major focus of this visit? a. Teaching the family how to monitor blood pressure. b. Demonstrating techniques for providing care. c. Stressing to the family how difficult it will be to provide care at home. d. Encouraging the family to send the patient to an extended care facility. ANS: B The role of the community health nurse, when dealing with patients with Alzheimer’s disease, is to maintain the best possible functioning, protection, and safety for the patient. The nurse should demonstrate to the primary family caregiver techniques for dressing, feeding, and toileting the patient while providing encouragement and emotional support to the caregiver. Monitoring blood pressure is not necessary for an Alzheimer’s patient; blood pressure would be for a patient with hypertension. The nurse should protect the patient’s rights and maintain family stability, not encourage placement in an extended care facility. DIF:Analyze (analysis) OBJ:Explain the competencies important for success in community-based nursing practice. TOP: Implementation MSC: Management of Care 16. While conducting a community assessment, the nurse seeks data on the average household income and the number of residents on public assistance. In doing so, the nurse is evaluating which component of a community assessment? a. Structure b. Population c. Social system d. Welfare system ANS: A Economic status is part of the community structure. Population would involve age and gender distribution, growth trends, density, education level, and ethnic or religious groups. The welfare system is part of the social system that also includes the education, government, communication, and health systems. DIF:Understand (comprehension) 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. DIF:Understand (comprehension) OBJ:Explain how theory is used in nursing practice. TOP: Evaluation MSC: Management of Care 3. A nurse is testing meditation for migraine headaches and the expected outcome of care when performing this intervention. Which type of theory is the nurse using? a. Grand b. Prescriptive c. Descriptive d. Middle-range ANS: B A prescriptive theory details nursing interventions (meditation) for a specific phenomenon (migraine headaches) and the expected outcome of the care. Grand theories are broad in scope and complex and require further specification through research; it does not provide guidance for specific nursing interventions. Descriptive theories do not direct specific nursing activities but help to explain patient assessment. A middle-range theory tends to focus on a concept found in a specific field of nursing, such as uncertainty, incontinence, social support, quality of life, and caring, rather than reflect on a wide variety of nursing care situations. DIF:Understand (comprehension) OBJ:Discuss types of nursing theories. TOP: Implementation MSC: Management of Care 4. The nurse researcher is evaluating whether holding pressure at an injection site after injecting the anticoagulant enoxaparin will reduce bruising at the injection site. This study involves a prescriptive theory. What is the nurse’s rationale for involving a prescriptive theory? a. It explains why bruising occurs. b. It is broad in scope and complex. c. It tests a specific nursing intervention. d. It reflects a wide variety of nursing care situations. ANS: C Prescriptive theories detail nursing interventions for a specific phenomenon and the expected outcome of the care but it does not explain why. Grand theories are broad in scope and complex and focus on a wide variety of nursing care situations. DIF:Understand (comprehension) OBJ:Discuss types of nursing theories. TOP: Planning MSC: Management of Care 5. A nurse is using nursing theory and the nursing process simultaneously to plan nursing care. How will the nurse use nursing theory and the nursing process in practice? a. Nursing theory can direct how a nurse uses the nursing process. b. Nursing theory requires the nursing process to develop knowledge. c. Nursing theory with the nursing process has a minor role in professional nursing. d. Nursing theory combined with the nursing process is specific to certain ill patients. ANS: A Nursing theory can direct how a nurse uses the nursing process. Integration of theory into practice (nursing process) serves as the basis for professional nursing. The nursing process provides a systematic process for the delivery of care, not the knowledge component of the discipline. Useful theories are adaptable to different patients and to all care settings. DIF:Understand (comprehension) OBJ:Explain how theory is used in nursing practice. TOP: Implementation MSC: Management of Care 6. The nurse views the patient as an open system that needs help in coping with stressors. Which theorist is the nurse using? a. King b. Levine c. Neuman d. Johnson ANS: C Neuman views a patient as being an open system that is in constant energy exchange with the environment that the nurse must help cope with stressors. King views a patient as a unique personal system that is constantly interacting/transacting with other systems that the nurse helps with goal attainment. Levine believes nurses promote balance between nursing interventions and patient participation to assist in conserving energy needed for healing. Johnson perceives patients as a collection of subsystems that forms an overall behavioral system focusing on balance. DIF:Understand (comprehension) OBJ:Determine how to apply different nursing theories in different patient situations. TOP: Evaluation MSC: Management of Care 7. The nurse is caring for a patient diagnosed with essential hypertension. The health care provider prescribes blood pressure medication that the nurse administers. The nurse then monitors the patient’s blood pressure for several days to help determine effectiveness. Which system component is the nurse evaluating? a. Input b. Output c. Content d. Feedback ANS: B Output is the end product of a system and, in the case of the nursing process, it is defined as whether the patient’s health status improves or remains stable as a result of nursing care. Input consists of the data that come from a patient’s assessment. Feedback serves to inform a system about how it functions. Content is the product and information obtained from the system. DIF:Understand (comprehension) OBJ:Review selected shared theories from other disciplines. TOP: Evaluation MSC: Management of Care 8. A patient is admitted with possible methicillin-resistant Staphylococcus aureus (MRSA) and is placed in isolation until cultures can be obtained and declared noninfectious. During the isolation process, the nurse encourages family visits. Which level of Maslow’s hierarchy of needs is the nurse promoting when the family is encouraged to visit? a. First level b. Second level 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 16. A nurse is conducting research about the needs of depressed patients. The nurse writes the following: Depression is a patient reporting a score above 7 on the Hamilton Depression Rating Scale. What did the nurse write? a. Operational definition b. Conceptual definition c. Paradigm d. Concept ANS: A Operational definitions state how concepts are measured (Hamilton Depression Rating Scale). Theoretical or conceptual definitions simply define a particular concept, much like what can be found in a dictionary, based on the theorist’s perspective (a mood disorder causing severe sadness and apathy). A paradigm is a pattern of beliefs used to describe a discipline’s domain. Think of concepts as ideas and mental images, like depression is a concept. DIF:Analyze (analysis) OBJ:Describe theory-based nursing practice. TOP: Evaluation MSC: Management of Care 17. Which action indicates the nurse is using the nursing process in patient care? a. Generates nursing knowledge for use in nursing practice. b. Conceptualizes an aspect of nursing to predict nursing care. c. Develops nursing care as a specific, distinct phenomenon. d. Delivers nursing care using a systematic approach. ANS: D The nursing process provides a systematic approach for the delivery of nursing care. Theory generates nursing knowledge for use in practice; the nursing process is not a theory. A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care. An interdisciplinary theory explains a phenomenon specific to the discipline that developed the theory. DIF:Understand (comprehension) OBJ:Describe theory-based nursing practice. TOP: Evaluation MSC: Management of Care 18. A nurse is using theoretical knowledge in nursing practice to provide patient care. Which nursing behavior is an example of theoretical knowledge? a. Reads about different concepts. b. Reflects on clinical experiences. c. Combines the art and science of nursing. d. Creates a narrow understanding of nursing practice. ANS: A Theoretical knowledge is acquired through ―reading, observing, or discussing‖ concepts. The goals of theoretical knowledge are to stimulate thinking and create a broad understanding of nursing science and practices. Experiential, or clinical, knowledge is formed from nurses’ clinical experiences. Both types of knowledge are needed in order to provide safe, comprehensive nursing care. DIF:Understand (comprehension) OBJ:Describe theory-based nursing practice. TOP: Teaching/Learning MSC: Management of Care 19. A nurse is using Maslow’s hierarchy of needs to prioritize care. Place the levels in order of basic priority to highest priority that the nurse will follow. 1. Physiological 2. Self-esteem 3. Self-actualization 4. Safety and security 5. Love and belonging a. 4, 1, 2, 3, 5 b. 1, 4, 5, 3, 2 c. 4, 5, 3, 2, 1 d. 1, 4, 5, 2, 3 ANS: D Maslow’s hierarchy is as follows: physiological, safety and security, love and belonging, self-esteem, and self-actualization. DIF:Understand (comprehension) OBJ:Review selected shared theories from other disciplines. TOP: Caring MSC: Management of Care MULTIPLE RESPONSE 1. A nurse is using a nursing metaparadigm to define nursing. Which concepts will the nurse include? (Select all that apply.) a. Person b. Disease c. Health d. Nursing e. Environment ANS: A, C, D, E Nursing’s metaparadigm includes four concepts: person, health, environment/situation, and nursing. Disease is not part of nursing’s metaparadigm. DIF:Understand (comprehension) OBJ:Propose examples of the four concepts included in the nursing metaparadigm. TOP: Planning MSC: Management of Care 2. A nurse wants to incorporate psychosocial theories into nursing practice. Which elements will the nurse include? (Select all that apply.) a. Physiological needs of the patient b. Psychological needs of the patient c. Sociocultural needs of the patient d. Cognitive needs of the patient e. Spiritual needs of the patient ANS: A, B, C, E When nursing incorporates psychosocial theories into nursing practice, the nurse strives to meet the physiological, psychological, sociocultural, developmental, and spiritual needs of patients. Cognitive needs of the patient are included in educational theories. 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. TOP: Planning MSC: Management of Care 9. A nurse is reviewing research studies for evidence-based practice. Which article should the nurse use for qualitative nursing research? a. An article about the number of falls after use of no side rails b. An article about infection rates after use of a new wound dressing c. An article about the percentage of new admissions on a new floor d. An article about emotional needs of dying patients and their families ANS: D Studying emotional needs is a qualitative study. Qualitative nursing research is the study of phenomena that are difficult to quantify or categorize, such as patients’ perceptions of illness. The number of falls, infection rates, and percentages of new admissions are all examples of quantitative research. DIF:Analyze (analysis) OBJ:Elaborate on how nursing research improves nursing practice. TOP: Assessment MSC: Management of Care 10. A nurse develops the following PICOT question: Do patients who listen to music achieve better control of their anxiety and pain after surgery when compared with patients who receive standard nursing care following surgery? Which information will the nurse use as the ―C‖? a. After surgery. b. Who listen to music? c. Who receive standard nursing care? d. Achieve better control of their anxiety and pain. ANS: C Do patients (P) who listen to music (I) achieve better control of their anxiety and pain (O) after surgery (T) when compared with patients who receive standard nursing care following surgery (C)? DIF:Understand (comprehension) OBJ:Develop a PICOT question. TOP: Implementation MSC: Management of Care 11. The nurse uses a PICOT question to develop an evidence-based change in protocol for a certain nursing procedure. However, to make these changes throughout the entire institution would require more evidence than is available at this time. What is the nurse’s best option? a. Conduct a pilot study to investigate findings. b. Drop the idea of making the change at this time. c. Insist that management hire the needed staff to facilitate the change. d. Seek employment in another institution that may have the staff needed. ANS: A When evidence is not strong enough to apply in practice, the next option is to conduct a pilot study to investigate the PICOT question. Dropping the idea would be counterproductive; insisting that management hire staff could be seen as a mandate and could produce negative results. Seeking employment at another institution most likely would not be the answer because most institutions operate under similar established guidelines. DIF:Apply (application) OBJ:Discuss how nurses apply evidence in practice. TOP: Implementation MSC: Management of Care 12. The nurse is trying to identify common general themes relative to the effectiveness of cardiac rehabilitation from patients who have had heart attacks and have gone through cardiac rehabilitation programs. The nurse conducts interviews and focus groups. Which type of research is the nurse conducting? a. Nonexperimental research b. Experimental resear

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