RNSG1260 Exam 1 Foundations Latest 2023/2024 Updated Questions with Answers, Exams of Nursing

Download RNSG1260 Exam 1 Foundations Latest 2023/2024 Updated Questions with Answers and more Exams Nursing in PDF only on Docsity! RNSG1260 EXAM 1 FOUNDATIONS LATEST 2023/2024 UPDATED QUESTIONS WITH ANSWERS BEST FOR FINAL EXAM ALREADY GRADED A+ 01: Nursing Today MULTIPLE CHOICE 1. Which nurse most likely kept records on sanitation techniques and the effects on health? 1. Florence Nightingale 2. Mary Nutting 3. Clara Barton 4. 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. 2. The nurse prescribes strategies and alternatives to attain expected outcome. Which standard of nursing practice is the nurse following? 1. Assessment 2. Diagnosis 3. Planning 4. Implementati on 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. 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? graduate fields, including nursing. Inservice education programs are instruction or training provided by a health care facility or institution. 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. 9. A nurse has compassion fatigue. What is the nurse experiencing? 1. Lateral violence and intrapersonal conflict 2. Burnout and secondary traumatic stress 3. Short-term grief and single stressor 4. 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. 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? 1. Manager 2. Patient educator 3. Patient advocate 4. 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. 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? 1. Provide the referral as requested. 2. Offer to provide the newborn care. 3. Refer the patient to the supervising provider. 4. 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. 12. The nurse has a goal of becoming a certified registered nurse anesthetist (CRNA). Which activity is appropriate for a CRNA? 1. Manages gynecological services such as PAP smears 2. Works under the guidance of an anesthesiologist 3. Obtains a PhD degree in anesthesiology 4. Coordinates acute medical conditions 1. Code of ethics 2. Standards of practice 3. Standards of professional performance 4. 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. 16. A graduate of a baccalaureate degree program is ready to start working as an RN in the emergency department. Which action must the nurse take first? 1. Obtain certification for an emergency nurse. 2. Pass the National Council Licensure Examination. 3. Take a course on genomics to provide competent emergency care. 4. 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’s 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. 17. While providing care to a patient, the nurse is responsible, both professionally and legally. Which concept does this describe? 1. Autonomy 2. Accountability 3. Patient advocacy 4. 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. 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 1. 2, 4, 5, 1, 3 2. 2, 5, 4, 3, 1 3. 4, 2, 5, 3, 1 4. 4, 5, 2, 1, 3 ANS: B Benner’s levels of proficiency are as follows: novice, advanced beginner, competent, proficient, and expert. 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.) 1. Human rights 2. Affordable Care Act 3. Demographic changes 4. Medically underserved 5. 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. 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.) 1. Master’s degree 2. Inservice education 3. Doctoral preparation 4. Continuing education 5. 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. 3. A nurse wants to become an advanced practice registered nurse. Which options should the nurse consider? (Select all that apply.) 1. Patient advocate 2. Nurse administrator 3. Certified nurse-midwife 4. Clinical nurse specialist 5. 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. 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 2. A nurse is teaching the staff about managed care. Which information should the nurse include in the teaching session? 1. Managed care insures full coverage of health care costs. 2. Managed care only assumes the financial risk involved. 3. Managed care allows providers to focus on illness care. 4. Managed care causes providers to focus on prevention. ANS: D Managed care describes health care systems in which the provider or the health care system receives a predetermined capitated (fixed amount) payment for each patient enrolled in the program. Therefore, the focus of care shifts from individual illness care to prevention, early intervention, and outpatient care. The actual cost of care is the responsibility of the provider. The managed care organization (provider) assumes financial risk, in addition to providing patient 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? 1. A family can choose whether to have health insurance with no consequences. 2. Primary care physician payments from Medicaid services can equal Medicare. 3. Adult children up to age 26 are allowed coverage on the parent’s plan. 4. Private insurance companies can deny coverage for any reason. ANS: C Adult children up to the age of 26, regardless of student status, are allowed to be covered under their parents’ health insurance plan. 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. 4. A nurse is caring for a patient in the hospital. When should the nurse begin discharge planning? 1. When the patient is ready 2. Close to the time of discharge 3. Upon admission to the hospital 4. 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. 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? 1. Secondary acute 2. Continuing 3. Restorative 4. Tertiar y 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. 6. A nurse provides immunization to children and adults through the public health department. Which type of health care is the nurse providing? 1. Primary care 2. Preventive care 3. Restorative care 4. 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. diseases such as tuberculosis and severe acute respiratory syndrome (SARS) has become more common. In an effort to improve the quality of care, health care institutions are recruiting nurses from around the world to work in the United States, forcing hospitals to better understand and work with nurses from different cultures. Poverty is still deadlier than any disease and is the most frequent reason for death in the world today. The growth of urbanization also is currently affecting the world’s health. Improved communication, easier air travel, and easing of trade restrictions are making it easier for people to engage in “health tourism.” 12. A nurse is using research findings to improve clinical practice. Which technique is the nurse using? 1. Performance improvement 2. Integrated delivery networks 3. Nursing-sensitive outcomes 4. 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. 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. 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. 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? 1. Screening 2. Education 3. Dependence 4. Counseli ng 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. 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? 1. “Technology use has to be combined with nursing judgment.” 2. “The focus of effective nursing care is technology.” 3. “If it’s so easy, why don’t you do it?” 4. “That is true in the 20th 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. 16. A nurse is completing a minimum data set. Which area is the nurse working? 1. Nursing center 2. Psychiatric facility 3. Rehabilitation center 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.) 1. Use informatics. 2. Use transparency. 3. Apply globalization. 4. Apply quality improvement. 5. 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. 3. A nurse is evaluating care based upon the nursing quality indicators. Which areas should the nurse evaluate? (Select all that apply.) 1. Patient satisfaction level 2. Hospital readmission rates 3. Nursing hours per patient day 4. Patient falls/falls with injuries 5. 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. 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.) 1. Empirical quality results 2. Structural empowerment 3. Transformational leadership 4. Exemplary professional practice 5. 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. MATCHING A nurse is teaching about the different types of health care plans. Match the correct information to the type of health care plans the nurse should include in the teaching session. 1. Insurance for low-income families 2. Federal insurance for people aged 65 and older 3. Health maintenance focus to specific group of voluntarily enrolled people 4. Services at a discount for companies under contract 1. Preferred provider organizatDion 2. Managed care organization C 3. Medicaid A 4. Medicare B 1.ANS:D DIF:Understand (comprehension)REF:15-16 2.ANS:C DIF:Understand (comprehension)REF:15-16 3.ANS:A DIF:Understand (comprehension)REF:15-16 4.ANS:B DIF:Understand (comprehension)REF:15-16 Chapter 04: Theoretical Foundations of Nursing Practice 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? 1. “You are correct, but we have to learn it anyway.” 2. “This keeps the focus of nursing narrow.” 3. “Theories help explain why nurses do what they do.” 4. “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. 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 “noncompliance.” What is the rationale for the nurse’s behavior? 1. Orem’s theory is useful in designing interventions to promote self-care. 2. Orem’s theory focuses on cultural issues that may affect compliance. 3. Orem’s theory allows for reduction of anxiety with communication. 4. Orem’s theory helps nurses manipulate the patient’s environment. ANS: A 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. 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? 1. Nursing theory can direct how a nurse uses the nursing process. 2. Nursing theory requires the nursing process to develop knowledge. 3. Nursing theory with the nursing process has a minor role in professional nursing. 4. 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. 6. The nurse views the patient as an open system that needs help in coping with stressors. Which theorist is the nurse using? 1. King 2. Levine 3. Neuman 4. Johnso n 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. 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? 1. Input 2. Output 3. Content 4. Feedbac k 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. 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? 1. First level 2. Second level 3. Third level 4. 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. 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? 1. Humans have an orderly, predictive process of growth and development. 2. Humans respond to threats by adapting with growth and development. 3. Humans respond with cognitive principles for growth and development. 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. 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? 1. Peplau’s theory 2. Henderson’s theory 3. Nightingale’s theory 4. 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. 13. The nurse is caring for a patient who is actively bleeding. The health care provider prescribes blood transfusions. The patient is a Jehovah’s Witness and does not want blood products. The nurse contacts the health care provider to request alternative treatment. Which theory is the nurse using? 1. Roy’s theory 2. Leininger’s theory 3. Watson’s theory 4. 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. 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? 1. Roy’s theory 2. Watson’s theory 3. Henderson’s theory 4. 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. 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? 1. Watson’s theory 2. Orem’s theory 3. Roger’s theory 4. 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. 2. A nurse wants to incorporate psychosocial theories into nursing practice. Which elements will the nurse include? (Select all that apply.) 1. Physiological needs of the patient 2. Psychological needs of the patient 3. Sociocultural needs of the patient 4. Cognitive needs of the patient 5. 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)REF:46 OBJ: Review selected shared theories from other disciplines. TOP: Caring MSC: Psychosocial Integrity Chapter 05: Evidence-Based Practice MULTIPLE CHOICE 1. A nurse uses evidence-based practice (EBP) to provide nursing care. What is the best rationale for the nurse’s behavior? 1. EBP is a guide for nurses in making clinical decisions. 2. EBP is based on the latest textbook information. 3. EBP is easily attained at the bedside. 4. 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. 2. In caring for patients, what must the nurse remember about evidence-based practice (EBP)? 1. EBP is the only valid source of knowledge that should be used. 2. EBP is secondary to traditional or convenient care knowledge. 3. EBP is dependent on patient values and expectations. 4. EBP is not shown to provide better patient outcomes. ANS: C Even when the best evidence available is used, application and outcomes will differ based on patient values, preferences, concerns, and/or expectations. Nurses often care for patients on the basis of tradition or convenience. Although these sources have value, it is important to learn to rely more on research evidence than on nonresearch evidence. Evidence- based care improves quality, safety, patient outcomes, and nurse satisfaction while reducing costs. 3. A nurse wants to change a patient procedure. Which action will the nurse take to easily find research evidence to support this change? 1. Read all the articles found on the Internet. 2. Make a general search of the Internet. 3. Use a PICOT format for the search. 4. 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. 4. A nurse has collected several research findings for evidence- based practice. Which article will be the best for the nurse to use? 1. An article that uses randomized controlled trials (RCT) 2. An article that is an opinion of expert committees 3. An article that uses qualitative research 4. 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 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. 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”? 1. After surgery 2. Who listen to music 3. Who receive standard nursing care 4. 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)? 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? 1. Conduct a pilot study to investigate findings. 2. Drop the idea of making the change at this time. 3. Insist that management hire the needed staff to facilitate the change. 4. 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. 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? 1. Nonexperimental research 2. Experimental research 3. Qualitative research 4. Evaluation research ANS: C Qualitative research involves using inductive reasoning to develop generalizations or theories from specific observations or interviews. Evaluation and experimental research are forms of quantitative research. Nonexperimental descriptive studies describe, explain, or predict phenomena such as factors that lead to an adolescent’s decision to smoke cigarettes. 13. In conducting a research study, the nurse researcher guarantees the subject no information will be reported in any manner that will identify the subject and only the research team will have access to the information. Which concept is the nurse researcher fulfilling? 1. Bias 2. Confidentiality 3. Informed consent 4. The research process ANS: B Confidentiality guarantees that any information the subject provides will not be reported in any manner that identifies the subject and will not be accessible to people outside the research team. Biases are opinions that may influence the results of research. Informed consent means that research subjects (1) are given full and complete information about the purpose of the study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research; (3) have the power to voluntarily consent or decline participation; and (4) understand how confidentiality or anonymity is maintained. The research process is a broader concept that provides an orderly series of steps that allow the researcher to move from asking a question to finding the answer. 14. The nurse researcher is preparing to publish the findings and is preparing to add the limitations to the manuscript. Which area of the manuscript will the nurse researcher add this information? 1. Abstract 2. Conclusion 3. Study design 4. Clinical implications ANS: B During results or conclusions, the researcher interprets the findings of the study, including limitations. An abstract summarizes the purpose of the article with major findings. Study design involves selection of research methods and type of study conducted. The researcher explains how to apply findings in a practice setting for the type of subjects studied in the clinical implications section. 15. A nurse is trying to decrease the rate of falls on the unit. After reviewing the literature, a strategy is implemented on the unit. After 3 months, the nurse finds that the falls have decreased. Which process did the nurse institute? 1. Performance improvement 2. Peer-reviewed project 3. Generalizability study 4. Qualitative research ANS: A Performance improvement focuses on performance issues like falls or pressure ulcer incidence. A peer-reviewed article is reviewed for accuracy, validity, and rigor and approved for publication by experts before it is published. Generalizability is not a study/research; it is if the results of a study can be compared to other patients with similar experiences. This is a quantitative study, not a qualitative study. 16. A nurse identifies a clinical problem with pressure ulcers. Which step should the nurse take next in the research process? 1. Analyze results. 2. Conduct the study. 3. Determine method. 4. Develop a hypothesis. ANS: D After identifying an area of interest or clinical problem, the steps of the research process are as follows: Develop research question(s)/hypotheses; determine how the study will be conducted; conduct the study; and analyze results of the study. measurement. Phenomenology and grounded theory are forms of qualitative research. 2. Before conducting any study with human subjects, the nurse researcher must obtain informed consent. What must the nurse researcher ensure to obtain informed consent? (Select all that apply.) 1. Gives complete information about the purpose 2. Allows free choice to participate or withdraw 3. Understands how confidentiality is maintained 4. Identifies risks and benefits of participation 5. Ensures that subjects complete the study ANS: A, B, C, D Informed consent means that research subjects (1) are given full and complete information about the purpose of a study, procedures, data collection, potential harm and benefits, and alternative methods of treatment; (2) are capable of fully understanding the research and the implications of participation; (3) have the power of free choice to voluntarily consent or decline participation in the research; and (4) understand how the researcher maintains confidentiality or anonymity. 3. The nurse is reviewing nursing research literature related to a potential practice problem on the nursing unit. What is the rationale for the nurse’s action? (Select all that apply.) a) Nursing research ensures the nurse’s promotion. b) Nursing research identifies new knowledge. c) Nursing research improves professional practice. d) Nursing research enhances effective use of resources. e) Nursing research leads to decreases in budget expenditures. ANS: B, C, D Nursing research is a way to identify new knowledge, improve professional education and practice, and use resources effectively. Nursing research itself does not lead to a decrease in budget expenditures; however it does lead to using health care resources effectively.. Chapter 06: Health and Wellness MULTIPLE CHOICE 1. A nurse is teaching about the goals of Healthy People 2020. Which information should the nurse include in the teaching session? 1. Eliminate health disparities in America. 2. Eliminate health behaviors in America. 3. Eliminate quality of life in America. 4. Eliminate healthy life in America. ANS: A The nurse should include eliminating health disparities in America. Healthy People 2020 promotes a society in which all people live long, healthy lives. There are four overarching goals: (1) attain high- quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, healthy development, and healthy behaviors across all life stages. 2. A nurse is following the goals of Healthy People 2020 to provide care. Which action should the nurse take? 1. Allow people to continue current behaviors to reduce the stress of change. 2. Focus only on health changes that will lead to better local communities. 3. Create social and physical environments that promote good health. 4. Focus on illness treatment to provide fast recuperation. ANS: C Healthy People 2020 includes four goals, one of which is to create social and physical environments that promote good health for all. 3. A nurse is using the World Health Organization definition of health to provide care. Which area will the nurse focus on while providing care? 1. Making sure the patients are disease free 2. Making sure to involve the whole person 3. Making sure care is strictly personal in nature 4. Making sure to focus only on the pathological state ANS: B The World Health Organization (WHO) defines health as a “state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.” Therefore, nurses’ attitudes toward health and illness should consider the total person, as well as the environment in which the person lives. All people free of disease are not necessarily healthy. 4. The nurse is preparing a smoking cessation class for family members of patients with lung cancer. The nurse believes that the class will convert many smokers to nonsmokers once they realize the benefits of not smoking. Which health care model is the nurse following? 1. Health belief model 2. Holistic health model 3. Health promotion model 4. Maslow’s hierarchy of needs ANS: A The health belief model addresses the relationship between a person’s beliefs and behaviors. The holistic health model recognizes the natural healing abilities of the body and incorporates complementary and alternative interventions such as music therapy. The health promotion model focuses on the following three areas: (1) individual characteristics and experiences, (2) behavior- specific knowledge and affect, and (3) behavioral outcomes, in which the patient commits to or changes a behavior. Maslow’s’ hierarchy of needs is based on the theory that all people share basic human needs, and the extent to which basic needs are met is a major factor in determining a person’s level of health. 5. A nurse is using Maslow’s hierarchy to prioritize care for an anxious patient that is not eating and will not see family members. Which area should the nurse address first? 1. Anxiety 2. Not eating 3. Mental health 4. Not seeing family members ANS: B According to Maslow, in all cases an emergent physiological need takes precedence over a higher- level need. Nutrition is a physiological need and should be addressed first. Anxiety, mental health, and not seeing family members are all higher-level needs. 1. External variables have little effect on compliance. 2. A person’s compliance is affected by economic status. 3. Employment status is an internal variable that impacts compliance. 4. Noncompliant patients thrive on the disapproval of authority figures. ANS: B A person’s compliance with treatment is affected by economic status. A person tends to give a higher priority to food and shelter than to costly drugs or treatments. External variables can have a major impact on compliance. Employment status is an external variable, not an internal variable. A person generally seeks approval and support from social networks, and this desire for approval affects health beliefs and practices; noncompliance does not occur from thriving on disapproval of authority figures. 9. The nurse is working on a committee to evaluate the need for increasing the levels of fluoride in the drinking water of the community. Which concept is the nurse fostering? 1. Illness prevention 2. Wellness education 3. Active health promotion 4. Passive health promotion ANS: D Fluoridation of municipal drinking water and fortification of homogenized milk with vitamin D are examples of passive health promotion strategies. With active strategies of health promotion, individuals are motivated to adopt specific health programs such as weight reduction and smoking cessation programs. Illness prevention activities such as immunization programs protect patients from actual or potential threats to health. Wellness education teaches people how to care for themselves in a healthy way. 10. The nurse is working in a clinic that is designed to provide health education and immunizations. Which type of preventive care is the nurse providing? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Risk factor prevention ANS: A Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Primary prevention includes health education programs, immunizations, and physical and nutritional fitness activities. Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration. While risk factor modification is an integral component of health promotion, it is not a type of preventive care. 11. The patient is admitted to the emergency department of the local hospital from home with reports of chest discomfort and shortness of breath. The patient is placed on oxygen, has labs and blood gases drawn, and is given an electrocardiogram and breathing treatments. Which level of preventive care is this patient receiving? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Health promotion ANS: B Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. Activities are directed at diagnosis and prompt intervention. Primary prevention precedes disease or dysfunction and is applied to people considered physically and emotionally healthy. Health promotion includes health education programs, immunizations, and physical and nutritional fitness activities for healthy people. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease or disability through interventions directed at preventing complications and deterioration. 12. A patient is admitted to a rehabilitation facility following a stroke. The patient has right-sided paralysis and is unable to speak. The patient will be receiving physical therapy and speech therapy. Which level of preventive care is the patient receiving? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Health promotion cannot pick up the attempt where left off. It is believed that change involves movement through a series of stages (precontemplation, contemplation, preparation, action, and maintenance). Anticipating that the patient does not want to and will never quit is premature. While the patient will need to adopt a new lifestyle for change to be effective, it does not correlate to this scenario since the patient relapsed. 15. The nurse is working in a drug rehabilitation clinic and is in the process of admitting a patient for “detox.” What should the nurse do next? 1. Identify the patient’s stage of change. 2. Realize that the patient is ready to change. 3. Teach the patient that choices will have to change. 4. Instruct the patient that relapses will not be tolerated. ANS: A The nurse should identify the stage of change and assess where the patient is currently in this situation. To be most effective, nursing interventions should match the stage of change. The nurse cannot realize the patient is ready for change because only a minority of people are actually in the action stage of changing. While teaching that choices will have to change, it will follow later after the nurse has determined which stage the person is in. As individuals attempt a change in behavior, relapse followed by recycling through the stages occurs frequently. 16. A female patient has been overweight for most of her life. She has tried dieting in the past and has lost weight, only to regain it when she stopped dieting. The patient is visiting the weight loss clinic/health club because she has decided to do it. She states that she will join right after the holidays, in 3 months. Which stage is the patient displaying? 1. Precontemplation 2. Contemplation 3. Preparation 4. Actio n ANS: B This patient is planning to make the change within the next 6 months and is in the contemplation stage. These stages range from no intention to change (precontemplation), to considering a change within the next 6 months (contemplation), to making small changes (preparation), to actively engaging in strategies to change behavior (action), to maintaining a changed behavior (maintenance). 17. Upon completion of the assessment, the nurse finds that the patient has quit drinking and has been alcohol free for the past 2 years. Which stage best describes the nurse’s assessment finding? 1. Contemplation 2. Maintenance 3. Preparation 4. Actio n ANS: B Because the patient has been alcohol free for 2 years, the patient is in the maintenance stage. These stages range from no intention to change (precontemplation), to considering a change within the next 6 months (contemplation), to making small changes (preparation), to actively engaging in strategies to change behavior (action), to maintaining a changed behavior (maintenance). 18. The patient had a colostomy placed 1 week ago. When approached by the nurse, the patient and spouse refuse to talk about it and refuse to be taught about how to care for it. How will the nurse evaluate this couple’s stage of adjustment? 1. Shock 2. Withdrawal 3. Acceptance 4. Rehabilitatio n ANS: B As the patient and family recognize the reality of a change, they become anxious and may withdraw, refusing to discuss it. This is an adaptive coping mechanism that assists the patient in making the adjustment. Initially, the patient may be shocked by the change. This is followed by withdrawal, acknowledgment, acceptance, and rehabilitation (ready to adapt to the change through use of colostomy bag). 19. A patient has had emphysema (lung disease) for many years. When approached by the nurse, the patient states “I would be better off dead.” The patient supports the family, and now because of oxygen dependency the patient must quit work. The patient’s spouse will have to go to work. Which action should the nurse take? 1. Develop a plan of care for the family. 2. Contact psychiatric services for a referral. 3. Assure the patient that things will work out. 4. Focus the plan of care solely on maximizing patient function. ANS: A Because of the effects of chronic illness, family dynamics often change. The nurse must view the whole family as a patient under stress, planning care to help the family regain its maximal level of functioning and well-being. Psychiatric services may be a part of that plan but do not represent the entire plan. Offering false assurance is never acceptable. Focusing only on the patient will not help the family adjust. 20. A nurse is teaching about the transtheoretical model of change. In which order will the nurse place the progression of the stages from beginning to end? 1. Action 2. Preparation 3. Maintenance 4. Contemplation 5. Precontemplation 1. 5, 4, 2, 1, 3 2. 2, 5, 4, 3, 1 3. 4, 5, 3, 1, 2 4. 1, 5, 2, 3, 4 ANS: A The stages of change in the transtheoretical model of change include five stages. These stages range from no intention to change (precontemplation), considering a change within the next 6 months (contemplation), making small changes (preparation), and actively engaging in strategies to change behavior (action), to maintaining a changed behavior (maintenance stage). MULTIPLE RESPONSE 1. Which areas should the nurse assess to determine the effects of external variables on a patient’s illness? (Select all that apply.) 1. Patient’s perception of the illness 4. Non-Hispanic African- Americans ANS: B While Asian Americans generally have lower cancer rates than the non- Hispanic Caucasian population, they also have the highest incidence rates of liver cancer for both sexes compared with Hispanic, non-Hispanic Caucasians, or non-Hispanic African- Americans. 2. A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this patient? 1. There is a decreased frequency of morbidity. 2. There is an increased incidence of disease. 3. There is an increased level of health. 4. There is a decreased mortality rate. ANS: B Populations with health disparities (immigrant with low income) have a significantly increased incidence of disease or increased morbidity and mortality when compared with the general population. Although Americans’ health overall has improved during the past few decades, the health of members of marginalized groups has actually declined. 3. A nurse is assessing the health care disparities among population groups. Which area is the nurse monitoring? 1. Accessibility of health care services 2. Outcomes of health conditions 3. Prevalence of complications 4. Incidence of diseases ANS: A While health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases and related complications, health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. 4. A nurse is providing care to a patient from a different culture. Which action by the nurse indicates cultural competence? 1. Communicates effectively in a multicultural context 2. Functions effectively in a multicultural context 3. Visits a foreign country 4. Speaks a different language ANS: B Cultural competence refers to a developmental process that evolves over time that impacts ability to effectively function in the multicultural context. Communicates effectively and speaking a different language indicates linguistic competence. Visiting a foreign country does not indicate cultural competence. 5. The nurse learns about cultural issues involved in the patient’s health care belief system and enables patients and families to achieve meaningful and supportive care. Which concept is the nurse demonstrating? 1. Marginalized groups 2. Health care disparity 3. Transcultural nursing 4. Culturally congruent care ANS: D The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a person’s life patterns, values, and system of meaning, provides meaningful and beneficial nursing care. Marginalized groups are populations left out or excluded. Health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. 6. A nurse is beginning to use patient-centered care and cultural competence to improve nursing care. Which step should the nurse take first? 1. Assessing own biases and attitude 2. Learning about the world view of others 3. Understanding organizational forces 4. Developing cultural skills ANS: A Becoming more aware of your biases and attitudes about human behavior is the first step in providing patient-centered care, leading to culturally competent care. It is helpful to think about cultural competence as a lifelong process of learning about others and also about yourself. Learning about the world view, developing cultural skills, and understanding organizational forces are not the first steps. 7. A nurse is performing a cultural assessment using the ETHNIC mnemonic for communication. Which area will the nurse assess for the “H”? 1. Health 2. Healers 3. History 4. Homelan d ANS: B The “H” in ETHNIC stands for healers: Has the patient sought advice from alternative health practitioners? While health, history, and homeland are important, they are not components of “H.” 8. The nurse is caring for a patient of Hispanic descent who speaks no English. The nurse is working with an interpreter. Which action should the nurse take? 1. Use long sentences when talking. 2. Look at the patient when talking. 3. Use breaks in sentences when talking. 4. Look at only nonverbal behaviors when talking. ANS: B Direct your questions to the patient. Look at the patient, instead of looking at the interpreter. Pace your speech by using short sentences, but do not break your sentences. Observe the patient’s nonverbal and verbal behaviors. 9. Which action indicates the nurse is meeting a primary goal of cultural competent care for patients? 1. Provides care to transgender patients 2. Provides care to restore relationships 3. Provides care to patients that is individualized 4. Provides care to surgical patients An ethnohistory question is the following: How different is your life here from back home? Caring beliefs and practice questions include the following: Which caregivers do you seek when you are sick and How different is what we do from what your family does when you are sick? The language and communication is the following: What language do you speak at home? 15. A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy? 1. A patient 35 years old 2. A patient 68 years old 3. A patient with a college degree 4. A patient with a high-school diploma ANS: B About 9 out of 10 people in the United States experience challenges in using health care information. Patients who are especially vulnerable are the elderly (age 65+), immigrants, persons with low incomes, persons who do not have a high-school diploma or GED, and persons with chronic mental and/or physical health conditions. 16. A nurse works at a hospital that uses equity- focused quality improvement. Which strategy is the hospital using? 1. Document staff satisfaction. 2. Focus on the family. 3. Implement change on a grand scale. 4. Reduce disparities. ANS: D Organizations can implement equity-focused quality improvement by recognizing disparities and committing to reducing them. Staff diversity is a priority for equity-focused quality improvement, not staff satisfaction. While the family is important, the focus is on the patients. Organizations should start by implementing a change on a small scale (pilot testing), learning from each test, and refining the intervention through performance improvement cycles (e.g., plan, do, study, and act). 17. A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of providing culturally congruent care? 1. Provides care that fits the patient’s valued life patterns and set of meanings 2. Provides care that is based on meanings generated by predetermined criteria 3. Provides care that makes the nurse the leader in determining what is needed 4. Provides care that is the same as the values of the professional health care system ANS: A The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person’s life patterns, values, and system of meaning. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Discovering patients’ cultural values, beliefs, and practices as they relate to nursing and health care requires you to assume the role of learner (not become the leader) and to partner with your patients and their families to determine what is needed to provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different from the values and meanings of the professional health care system. 18. A nurse is assessing the patient’s meaning of illness. Which area of focus by the nurse is priority? 1. On the way a patient reacts to disease 2. On the malfunctioning of biological processes 3. On the malfunctioning of psychological processes 4. On the way a patient reacts to family/social interactions ANS: A To provide culturally congruent care, you need to understand the difference between disease and illness. Illness is the way that individuals and families react to disease, whereas disease is a malfunctioning of biological or psychological processes. The way a patient interacts to family/social interactions is communication processes and family dynamics. MULTIPLE RESPONSE 1. A nurse is using Campinha-Bacote’s model of cultural competency. Which areas will the nurse focus on to become competent? (Select all that apply.) 1. Cultural skills 2. Cultural desire 3. Cultural transition Chapter 15: Critical Thinking in Nursing Practice MULTIPLE CHOICE 1. Which action should the nurse take when using critical thinking to make clinical decisions? 1. Make decisions based on intuition. 2. Accept one established way to provide care. 3. Consider what is important in a given situation. 4. Read and follow the heath care provider’s orders. ANS: C A critical thinker considers what is important in each clinical situation, imagines and explores alternatives, considers ethical principles, and makes informed decisions about the care of patients. Patient care can be provided in many ways. The use of evidence- based knowledge, or knowledge based on research or clinical expertise, makes you an informed critical thinker. Following health care provider’s orders is not considered a critical thinking skill. If your knowledge causes you to question a health care provider’s order, do so. 2. Which patient scenario of a surgical patient in pain is most indicative of critical thinking? 1. Administering pain-relief medication according to what was given last shift 2. Offering pain-relief medication based on the health care provider’s orders 3. Asking the patient what pain-relief methods, pharmacological and nonpharmacological, have worked in th 4. Explaining to the patient that self-reporting of severe pain is not consistent with the minor procedure that d. performed ANS: C Asking the patient what pain-relief methods have worked in the past is an example of exploring many options for pain relief. Nonpharmacological pain- relief methods are available, as are medications for pain. Administering medication based on a previous assessment is not practicing according to standards of care. The nurse is to conduct an assessment each shift on assigned patients and intervene accordingly. Pain is subjective. The nurse should offer pain-relief methods based on the patient’s reports without being judgmental. 3. Which action indicates a registered nurse is being responsible for making clinical decisions? 1. Applies clear textbook solutions to patients’ problems 2. Takes immediate action when a patient’s condition worsens 3. Uses only traditional methods of providing care to patients 4. Formulates standardized care plans solely for groups of patients ANS: B Registered nurses are responsible for making clinical decisions to take immediate action when a patient’s condition worsens. Patient care should be based on evidence-based practice, not on tradition. Most patients have health care problems for which there are no clear textbook solutions. Care plans should be individualized for each patient, not just for groups. 4. A charge nurse is supervising the care of a new nurse. Which action by a new nurse indicates the charge nurse needs to intervene? 1. Making an ethical clinical decision 2. Making an informed clinical decision 3. Making a clinical decision in the patient’s best interest 4. Making a clinical decision based on previous shift assessments ANS: D The charge nurse must intervene when the nurse is using previous shift assessments to make a decision; this is inappropriate. Nurses are responsible for assessing their own patients to make decisions. Making informed, ethical decisions in the patient’s best interest is practicing responsibly and does not need follow-up from the charge nurse. 5. Which action demonstrates a nurse utilizing reflection to improve clinical decision making? 1. Obtains data in an orderly fashion 2. Uses an objective approach in patient situations 3. Improves a plan of care while thinking back on interventions effectiveness 4. Provides evidence-based explanations and research for care of assigned patients ANS: C Reflection utilizes critical thinking when thinking back on the effectiveness of interventions and how they were performed. It involves purposeful thinking back or recalling a situation to discover its purpose or meaning. The other options are not examples of reflection but do represent good nursing practice. Using an objective approach and obtaining data in an orderly fashion do not involve purposefully thinking back to discover the meaning or purpose of a situation. Providing evidence- based explanations for nursing interventions does not always involve thinking back to discover the meaning of a situation. 6. A nursing instructor needs to evaluate students’ abilities to synthesize data and identify relationships between nursing diagnoses. Which learning assignment is best suited for this instructor’s needs? 1. Concept mapping 2. Reflective journaling 3. Lecture and discussion 4. Reading assignment with a written summary ANS: A Concept mapping challenges the student to synthesize data and identify relationships between nursing diagnoses. The primary purpose of concept mapping is to better synthesize relevant data about a patient, including assessment data, nursing diagnoses, health needs, nursing interventions, and evaluation measures. Reflective journaling involves thinking back to clarify concepts. Reading assignments and lecture do not best provide an instructor the ability to evaluate students’ abilities to synthesize data. 7. A nurse is using a critical thinking model to provide care. Which component is first that helps a nurse make clinical decisions? 1. Attitude 2. Experience 3. Nursing process 4. Specific knowledge base ANS: D The first component of the critical thinking model is a nurse’s specific knowledge base. After acquiring a sound knowledge base, the nurse 1. Evaluation 2. Explanation 3. Interpretation 4. Self- regulation ANS: C Interpretation involves being orderly in data collection, looking for patterns to categorize data, and clarifying uncertain data. This nurse is clarifying the data in this situation. Evaluation involves determining the effectiveness of interventions or care provided. The nurse in this scenario is assessing the patient, not evaluating interventions. Self- regulation is reflecting on experiences. Explanation is supporting findings and conclusions. The nurse in this question is clarifying uncertain data (determining cause of the low pulse), not supporting the finding of a low pulse. 11. A patient continues to report postsurgical incision pain at a level of 9 out of 10 after pain medicine is given. The next dose of pain medicine is not due for another hour. What should the critically thinking nurse do first? 1. Explore other options for pain relief. 2. Discuss the surgical procedure and reason for the pain. 3. Explain to the patient that nothing else has been ordered. 4. Offer to notify the health care provider after morning rounds are completed. ANS: A The critically thinking nurse should explore all options for pain relief first. The nurse should use critical thinking to determine the cause of the pain and determine various options for pain, not just ordered pain medications. The nurse can act independently to determine all options for pain relief and does not have to wait until after the health care provider rounds are completed. Explaining the cause of the pain does not address options for pain relief. 12. Which action should the nurse take to best develop critical thinking skills? 1. Study 3 hours more each night. 2. Attend all inservice opportunities. 3. Actively participate in clinical experiences. 4. Interview staff nurses about their nursing experiences. ANS: C Nursing is a practice discipline. Clinical learning experiences are necessary to acquire clinical decision-making skills. Studying for longer hours, interviewing nurses, and attending inservices do not provide opportunities for clinical decision making, as do actual clinical experiences. 13. While caring for a hospitalized older-adult female post hip surgery, the nurse is faced with the task of inserting an indwelling urinary catheter, which involves rotating the hip into a contraindicated position. Which action should the nurse take? 1. Postpone catheter insertion until the next shift. 2. Adapt the positioning technique to the situation. 3. Notify the health care provider for a urologist consult. 4. Follow textbook procedure with contraindicated position. ANS: B The nurse must use critical thinking skills in this situation to adapt positioning technique. In practice, patient procedures are not always presented as in a textbook, but they are individualized. A urologist consult is not warranted for positioning problems. 14. The nurse enters a room to find the patient sitting up in bed crying. How will the nurse display a critical thinking attitude in this situation? 1. Provide privacy and check on the patient 30 minutes later. 2. Set a box of tissues at the patient’s bedside before leaving the room. 3. Limit visitors while the patient is upset. 4. Ask the patient about the crying. ANS: D A clinical sign or symptom (crying) often indicates a variety of problems. Explore and learn more about the patient so as to make appropriate clinical judgments. This is demonstrating curiosity, which is an attitude of critical thinking. Checking on the patient 30 minutes later, providing tissues, and limiting visitors may be appropriate actions but these actions do not address critical thinking. 15. A patient is having trouble reaching the water fountain while holding on to crutches. The nurse suggests that the patient place the crutches against the wall while stabilizing him or herself with two hands on the water fountain. Which critical thinking attitude did the nurse use in this situation? 1. Humility 2. Creativity 3. Risk taking 4. Confidenc e ANS: B The nurse uses creativity in this situation to figure out how the patient can safely get a drink of water. Humility is recognizing when more information is needed to make a decision. Confidence is being well prepared to perform nursing care safely. This question best illustrates the attitude of creativity. 16. A nurse is pulled from the surgical unit to work on the oncology unit. Which action by the nurse displays humility and responsibility? 1. Refusing the assignment 2. Asking for an orientation to the unit 3. Admitting lack of knowledge and going home 4. Assuming that patient care will be the same as on the other units ANS: B Humility and responsibility are displayed when the nurse realizes lack of knowledge and requests an orientation to the unit. The other answer choices represent inappropriate actions in this situation and are not examples of humility and responsibility. The nurse should explore all options before refusing an assignment. The nurse should not make assumptions. Assuming is not an example of critical thinking. 17. A nurse is using professional standards to influence clinical decisions. What is the rationale for the nurse’s actions? 1. Establishes minimal passing standards for testing 2. Utilizes evidence-based practice based on nurses’ needs 3. Bypasses the patient’s feelings to promote ethical standards 4. Uses critical thinking for the highest level of quality nursing care ANS: D Professional standards promote the highest level of quality nursing care. Application of professional standards requires you to use critical thinking for the good of individuals or groups. Bypassing the patient’s feelings is not practicing according to professional standards. The primary purpose of professional standards is not to establish minimal passing standards for testing 4. Those who maintain perceptual biases ANS: B Nurses who develop critical thinking skills make the best communicators. Just liking people does not make an effective communicator because it is important to apply critical thinking standards to ensure sound effective communication. Just learning psychomotor skills does not ensure that the nurse will use those techniques, and communication involves more than psychomotor skills. Critical thinking helps the nurse overcome perceptual biases or human tendencies that interfere with accurately perceiving and interpreting messages from others. 2. A nurse believes that the nurse-patient relationship is a partnership and that both are equal participants. Which term should the nurse use to describe this belief? 1. Critical thinking 2. Authentic 3. Mutuality 4. Atten d ANS: C Effective interpersonal communication requires a sense of mutuality, a belief that the nurse-patient relationship is a partnership and that both are equal participants. Critical thinking in nursing, based on established standards of nursing care and ethical standards, promotes effective communication and uses standards such as humility, self-confidence, independent attitude, and fairness. To be authentic (one’s self) and to respond appropriately to the other person are important for interpersonal relationships but do not mean mutuality. Attending is giving all of your attention to the patient. 3. A nurse wants to present information about flu immunizations to the older adults in the community. Which type of communication should the nurse use? 1. Public 2. Small group 3. Interpersonal 4. Intraperson al ANS: A Public communication is interaction with an audience. Nurses have opportunities to speak with groups of consumers about health- related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students. When nurses work on committees or participate in patient care conferences, they use a small group communication process. Interpersonal communication is one-on-one interaction between a nurse and another person that often occurs face to face. Intrapersonal communication is a powerful form of communication that you use as a professional nurse. This level of communication is also called self-talk. 4. A nurse is using therapeutic communication with a patient. Which technique will the nurse use to ensure effective communication? 1. Interpersonal communication to change negative self-talk to positive self-talk 2. Small group communication to present information to an audience 3. Electronic communication to assess a patient in another city 4. Intrapersonal communication to build strong teams ANS: C Electronic communication is the use of technology to create ongoing relationships with patients and their health care team. Intrapersonal communication is self-talk. Interpersonal communication is one- on- one interaction between a nurse and another person that often occurs face to face. Public communication is used to present information to an audience. Small group communication is interaction that occurs when a small number of persons meet. When nurses work on committees or participate in patient care conferences, they use a small group communication process. 5. A nurse is standing beside the patient’s bed. Nurse: How are you doing? Patient: I don’t feel good. Which element will the nurse identify as feedback? 1. Nurse 2. Patient 3. How are you doing? 4. I don’t feel good. ANS: D “I don’t feel good” is the feedback because the feedback is the message the receiver returns. The sender is the person who encodes and delivers the message, and the receiver is the person who receives and decodes the message. The nurse is the sender. The patient is the receiver. “How are you doing?” is the message. 6. A nurse is sitting at the patient’s bedside taking a nursing history. Which zone of personal space is the nurse using? 1. Socio-consultative 2. Personal 3. Intimate 4. Publi c ANS: B Personal space is 18 inches to 4 feet and involves things such as sitting at a patient’s bedside, taking a patient’s nursing history, or teaching an individual patient. Intimate space is 0 to 18 inches and involves things such as performing a physical assessment, bathing, grooming, dressing, feeding, and toileting a patient. The socio- consultative zone is 9 to 12 feet and involves things such as giving directions to visitors in the hallway and giving verbal report to a group of nurses. The public zone is 12 feet and greater and involves things such as speaking at a community forum, testifying at a legislative hearing, or lecturing. 7. A smiling patient angrily states, “I will not cough and deep breathe.” How will the nurse interpret this finding? 1. The patient’s denotative meaning is wrong. 2. The patient’s personal space was violated. 3. The patient’s affect is inappropriate. 4. The patient’s vocabulary is poor. ANS: C An inappropriate affect is a facial expression that does not match the content of a verbal message (e.g., smiling when describing a sad situation). The patient is smiling but is angry, which indicates an inappropriate affect. The patient’s personal space was not violated. The patient’s vocabulary is not poor. Individuals who use a common language share denotative meaning: baseball has the same meaning for everyone who speaks English, but code denotes cardiac arrest primarily to health care providers. The patient’s denotative meaning is correct for cough and deep breathe. 8. The nurse asks a patient where the pain is, and the patient responds by pointing to the area of pain. Which form of communication did the patient use? 1. Verbal 2. Nonverbal ANS: A The time before the nurse meets the patient is called the preinteraction phase. This phase can involve things such as reviewing available data, including the medical and nursing history, talking to other caregivers who have information about the patient, or anticipating health concerns or issues that can arise. The orientation phase occurs when the nurse and the patient meet and get to know one another. This phase can involve things such as setting the tone for the relationship by adopting a warm, empathetic, caring manner. The working phase occurs when the nurse and the patient work together to solve problems and accomplish goals. The termination phase occurs during the ending of the relationship. This phase can involve things such as reminding the patient that termination is near. 11. During the initial home visit, a home health nurse lets the patient know that the visits are expected to end in about a month. Which phase of the helping relationship is the nurse in with this patient? 1. Preinteraction 2. Orientation 3. Working 4. Terminatio n ANS: B Letting the patient know when to expect the relationship to be terminated occurs in the orientation phase. Preinteraction occurs before the nurse meets the patient. Working occurs when the nurse and the patient work together to solve problems and accomplish goals. Termination occurs during the ending of the relationship. 12. A nurse and a patient work on strategies to reduce weight. Which phase of the helping relationship is the nurse in with this patient? 1. Preinteraction 2. Orientation 3. Working 4. Terminatio n ANS: C The working phase occurs when the nurse and the patient work together to solve problems and accomplish goals. Preinteraction occurs before the nurse meets the patient. Orientation occurs when the nurse and the patient meet and get to know each other. Termination occurs during the ending of the relationship. 13. A nurse uses SBAR when providing a hands-off report to the oncoming shift. What is the rationale for the nurse’s action? 1. To promote autonomy 2. To use common courtesy 3. To establish trustworthiness 4. To standardize communication ANS: D SBAR is a popular communication tool that helps standardize communication among health care providers. Common courtesy is part of professional communication but is not the purpose of SBAR. Being trustworthy means helping others without hesitation. Autonomy is being self-directed and independent in accomplishing goals and advocating for others. 14. A patient was admitted 2 days ago with pneumonia and a history of angina. The patient is now having chest pain with a pulse rate of 108. Which piece of data will the nurse use for “B” when using SBAR? 1. Having chest pain 2. Pulse rate of 108 3. History of angina 4. Oxygen is needed ANS: C The B in SBAR stands for background information. The background information in this situation is the history of angina. Having chest pain is the Situation (S). Pulse rate of 108 is the Assessment (A). Oxygen is needed is the Recommendation (R). 15. A patient just received a diagnosis of cancer. Which statement by the nurse demonstrates empathy? 1. “Tomorrow will be better.” 2. “This must be hard news to hear.” 3. “What’s your biggest fear about this diagnosis?” 4. “I believe you can overcome this because I’ve seen how strong you are.” ANS: B “This must be hard” is an example of empathy. Empathy is the ability to understand and accept another person’s reality, accurately perceive feelings, and communicate this understanding to the other. An example of false reassurance is “Tomorrow will be better.” “I believe you can overcome this” is an example of sharing hope. “What is your biggest fear?” is an open-ended question that allows patients to take the conversational lead and introduces pertinent information about a topic. 16. A nurse is taking a history on a patient who cannot speak English. Which action will the nurse take? 1. Obtain an interpreter. 2. Refer to a speech therapist. 3. Let a close family member talk. 4. Find a mental health nurse specialist. ANS: A Interpreters are often necessary for patients who speak a foreign language. Using a family member can lead to legal issues, speech therapists help patients with aphasia, and mental health nurse specialists help angry or highly anxious patients to communicate more effectively. 17. A nurse is using SOLER to facilitate active listening. Which technique should the nurse use for R? 1. Relax 2. Respect 3. Reminisce 4. Reassu re ANS: A In SOLER, the R stands for relax. It is important to communicate a sense of being relaxed and comfortable with the patient. Active listening enhances trust because the nurse communicates acceptance and respect for the patient, but it is not the R in SOLER. Reminisce is a therapeutic communication technique, especially when used with the elderly. Reassuring can be therapeutic if the nurse reassures patients that there are many kinds of hope and that meaning and personal growth can come from illness experiences. 18. An older-adult patient is wearing a hearing aid. Which technique should the nurse use to facilitate communication? The nurse needs to intervene to correct the use of “honey.” Avoid terms of endearment such as “honey,” “dear,” “grandma,” or “sweetheart.” Communicate with older adults on an adult level, and avoid patronizing or speaking in a condescending manner. Facing an older-adult patient, making sure the older adult has clean glasses, and allowing time to respond facilitate communication with older- adult patients and should be encouraged, not stopped. 21. A confused older-adult patient is wearing thick glasses and a hearing aid. Which intervention is the priority to facilitate communication? 1. Focus on tasks to be completed. 2. Allow time for the patient to respond. 3. Limit conversations with the patient. 4. Use gestures and other nonverbal cues. ANS: B Allowing time for patients to respond will facilitate communication, especially for a confused, older patient. Focusing on tasks to be completed and limiting conversations do not facilitate communication; in fact, they block communication. Using gestures and other nonverbal cues is not effective for visually impaired (thick glasses) patients or for patients who are confused. 22. The staff is having a hard time getting an older- adult patient to communicate. Which technique should the nurse suggest the staff use? 1. Try changing topics often. 2. Allow the patient to reminisce. 3. Ask the patient for explanations. 4. Involve only the patient in conversations. ANS: B Encouraging older adults to share life stories and reminisce about the past has a therapeutic effect and increases their sense of well- being. Avoid sudden shifts from subject to subject. It is helpful to include the patient’s family and friends and to become familiar with the patient’s favorite topics for conversation. Asking for explanations is a nontherapeutic technique. 23. A nurse is implementing nursing care measures for patients’ special communication needs. Which patient will need the most nursing care measures? 1. The patient who is oriented, pain free, and blind 2. The patient who is alert, hungry, and has strong self-esteem 3. The patient who is cooperative, depressed, and hard of hearing 4. The patient who is dyspneic, anxious, and has a tracheostomy ANS: D Facial trauma, laryngeal cancer, or endotracheal intubation often prevents movement of air past vocal cords or mobility of the tongue, resulting in inability to articulate words. An extremely breathless person needs to use oxygen to breathe rather than speak. Persons with high anxiety are sometimes unable to perceive environmental stimuli or hear explanations. People who are alert, have strong self- esteem, and are cooperative and pain free do not cause communication concerns. Although hunger,blindness, and difficulty hearing can cause communication concerns, dyspnea, tracheostomy, and anxiety all contribute to communication concerns. 24. A patient is aphasic, and the nurse notices that the patient’s hands shake intermittently. Which nursing action is most appropriate to facilitate communication? 1. Use a picture board. 2. Use pen and paper. 3. Use an interpreter. 4. Use a hearing aid. ANS: A Using a pen and paper can be frustrating for a nonverbal (aphasic) patient whose handwriting is shaky; the nurse can revise the care plan to include use of a picture board instead. An interpreter is used for a patient who speaks a foreign language. A hearing aid is used for the hard of hearing, not for an aphasic patient. 25. Which behavior indicates the nurse is using a process recording correctly to enhance communication with patients? 1. Shows sympathy appropriately 2. Uses automatic responses fluently