www.mynursingtestprep.comANS: 1 Public health nursing focuses on the community at large and the eventual effect of the communitys health status on the health of individuals, families, and groups. The goal of public health is to prevent individual disease and disability, in addition to promoting and protecting the health of the community as a whole, such as tracking the prevalence of disease. Activities, such as scoliosis screening, home care, and vaccination program, are examples of community health nursing. PTS:1DIF:ModerateREF:p. 1501 KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Application 10. A community health nurse planning a new program for teen pregnancy prevention designs a community assessment covering the structure of her target. Which of the following areas would she include? 1) Number of residential and commercial buildings 2) Demographic data of the residents 3) Morbidity and mortality rates of the population 4) Common strategies for conflict resolution ANS: 2 Structure refers to the general characteristics of a community. These include demographic data, such as gender, age, ethnicity, and educational and income levels, as well as data about healthcare services, such as the number of primary care providers or emergency departments in the area. PTS:1DIF:ModerateREF:p. 1500 KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application 11. A patient was involved in a motor vehicle accident that resulted in multiple traumatic injuries. He was hospitalized for 8 days in the intensive care unit and 3 days on the surgical floor. He has been discharged home with home health support. Identify the primary goal of his home care: 1) Provide comprehensive direct care. 2) Promote sleep and rest for healing. 3) Teach the patient and family how to provide care. 4) Explain how home care differs from hospital care. ANS: 3 The primary goal in home healthcare is to promote self-care. Nursing activities are directed at fostering independence or teaching the family or other caregivers to assist the client with ongoing needs. Care continues to be comprehensive; however, rather than providing direct care for all needs, the emphasis shifts toward fostering independence. PTS:1DIF:ModerateREF:p. 1510 KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application 12. Today is the last day of work on the medical-surgical unit for a nurse who has decided to work in home care. A patient asks her why she is going to home care. Select a response that best illustrates the advantages of home care. 1)
www.mynursingtestprep.comCare is much more comprehensive and unhurried in the home; it is more enjoyable for nurses to work in home care. 2) Home care is much more organized than hospital care; you have access to the whole team, and there is less interference from others. 3) A home health nurse has more autonomy and skills than a hospital nurse; Ill get to do more. 4) In home care I can see my patients in their personal environment; this will help me understand them more and allow me to give personalized care. ANS: 4 The home is the clients personal environment: a window into the patients life. The nurse is able to see how the patient lives, interacts, and negotiates the world. Care, in the home and hospital, is comprehensive. In both locations, the nurse has obligations to other patients and will need to watch her schedule. The level of enjoyment a nurse has with her job is dependent on many factors. A disadvantage to home care is the lack of immediate assistance from other members of the health team. Home care nurses may be more autonomous than hospital nurses; however, their scope of practice is identical. PTS:1DIF:ModerateREF:p. 1511 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 13. A 56-year-old man is hospitalized because of poorly controlled diabetes and a leg ulcer that developed as a complication of diabetes. He is awake, alert, and oriented but fatigued and in need of wound care. In the hospital, he was placed on insulin and started on a variety of oral medications. He is learning how to check his blood sugar and administer insulin. He has never given himself insulin, and he does not understand how to interpret his blood sugar readings. The physician has prescribed discharge from the hospital with home health follow-up. Is this an appropriate referral? 1) Yes; the patient is in need of skilled services and, therefore, is eligible for home care services. 2) Yes; the patient has been unable to control his diabetes, is noncompliant, and needs to be monitored. 3) No; the patient should remain hospitalized; he has too many needs for home care services. 4) No; the patient is relatively young and oriented; he should be able to provide his own care. ANS: 1 A client must require skilled services in order to be eligible for home care services. This patient needs wound care, to be taught about diabetes care, and to be monitored. These are all skilled services. All of these needs can be met with home care services. He is alert and oriented, which is important for planning teaching sessions. PTS:1DIFifficultREF:p. 1511 KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Synthesis 14. A home health nurse is working with a physical therapist and home health aides to work out a schedule for their visits that will best address the patients needs.
www.mynursingtestprep.comWhich nursing role does this demonstrate? 1) Direct care provider 2) Client and family educator 3) Client advocate 4) Care coordinator ANS: 4 A care coordinator manages and coordinates the services of members of the healthcare team and develops a plan of care that addresses the clients needs. Direct care involves hands-on tasks, such as dressing wounds and administering medications. The educator role involves communicating with clients and families to help them develop the skills involved to administer self-care. A client advocate supports the clients right to make decisions and protects the client from harm if he is unable to make decisions. PTS:1DIF:EasyREF:p. 1512 KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application 15. A home health nurse has called his patient to arrange an initial home visit and has driven to the home. What is the nurses objective in the first few minutes of the visit? 1) Develop rapport and trust with the patient and family. 2) Gather demographic data and complete the referral form. 3) Assess the patients most important health needs. 4) Determine the patients needs for ongoing care. ANS: 1 All of these objectives are appropriate for the home health visit. However, the first few minutes of the initial visit set the tone for the relationship among client, nurse, family, and agency. In that time, the nurse focuses on developing rapport and trust. Once rapport and trust have been developed, the nurse can gather data, assess the client, and determine the need for ongoing care. PTS: 1 DIF: Moderate REF: p. 1516 KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Synthesis 16. Documentation in home healthcare may take many forms. Some nurses use NANDA-I terminology for diagnoses, whereas others use the Clinical Care Classification (CCC) system. The chief benefit of the CCC system is that it: 1) Contains diagnoses specific to home care, whereas NANDA-I does not. 2) Is simpler to use and more readily understood by other disciplines. 3) Is linked to the OASIS reporting forms required by Medicare. 4) Uses standardized terminology, whereas NANDA-I does not. ANS: 3 Home care nurses more commonly use the CCC because it is linked to the OASIS reporting forms required by Medicare. The CCC was developed for use in home care; however, the diagnoses themselves are not specific to home care. They can be used in any
www.mynursingtestprep.comsetting. NANDA-I, NIC, and NOC all use standardized language that may be used in any setting, including home healthcare. NIC and NOC have some interventions and outcomes that are specific to home care use. PTS:1DIF:ModerateREF:p. 1517 KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level: Analysis 17. A 56-year-old woman provides care to her 91-year-old widowed father. She says she is frequently fatigued and that she no longer socializes with her friends. Im so busy taking care of my dad. Its really hard work because he is bedridden. Sometimes it breaks my heart when I have to feed and bathe him. He always seemed so strong when I was a child. The most appropriate nursing diagnosis for this woman is: 1) Caregiver Role Strain 2) Impaired Home Maintenance 3) Interrupted Family Processes 4) Risk for Caregiver Role Strain ANS: 1 This caregiver is experiencing fatigue, isolation, and difficulty adjusting to role changes. These are signs of Caregiver Role Strain. Because symptoms exist, this is an actual problem as opposed to a potential problem. There is no evidence of Impaired Home Maintenance. Although family processes have been altered, this is not the best nursing diagnosis based on the defining characteristics given. PTS: 1 DIF: Moderate REF: p. 1517 KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level: Application 18. The nurse is visiting a patient who lives in a single-room occupancy hotel. The patient requires wound care and medication management. There is no running water in the room, and the bathroom down the hall is in disrepair and filthy. The patients room is not clean. What supplies would be essential for the nurse to bring with him when visiting this client? 1) All wound care supplies needed for the duration of the care 2) Reclosable plastic bags for disposal of old dressings 3) Small, biohazard sharps container to be left in the room 4) Waterless, antibacterial hand sanitizer solution ANS: 4 The nurse should use a waterless antibacterial hand sanitizer in place of soap and water because there is no sink and conditions are filthy. The nurse should limit the supplies brought into the home if the conditions are not clean. Wound care supplies, for example, would be ordered and kept in the home. Old dressings should be double-bagged to prevent leakage, and discarded in the home. There is no evidence that a sharps disposal container is needed. PTS: 1 DIF: Moderate REF: p. 1520 KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application 19. Which of the following unique aspects of home care do Medicare reimbursement regulations require that the nurse include in documentation?
www.mynursingtestprep.com1) Patient assessment data and interventions performed 2) Patient response to care and assessment of environment 3) Evidence of homebound status and continued need for skilled care 4) Skilled care delivered and communication with other providers ANS: 3 All of the aspects mentioned should be documented. However, the unique requirements of home care include documentation of homebound status and the continued need for skilled care. PTS:1DIF:ModerateREF:p. 1513 KEY: Nursing process: Evaluation | Client need: SECE | Cognitive level: Application 20. At a home visit, the nurse asks the patient, Have you taken your blood pressure medicine today? The patient replies, I dont remember. Maybe. On the table are several bottles of medication, some open, some not. They have all been prescribed for the patient. The patient cannot say how often to take each one, when asked. A compartmentalized medication organizer is on the table, with a few capsules in it, and some compartments left open. What should the nurse do? 1) Show the patient how to put the medications in the organizer for the next 2 days, and observe while he fills the rest of the organizer. 2) Arrange for a home health aide to come each day to show the patient which pills to take. 3) Administer todays medications and arrange for the pharmacy to put medications in easy- to-open containers in the future. 4) Fill the organizer for each day of the week, explain how to use it, and return in a day or two to evaluate ANS: 4 From the cues given, it seems likely the patient would not be able to accurately load the medication organizerand, in fact, may not be able to use it properly to take the correct medications at the correct time. The nurse would need to return every day or so until he is certain that the patient can actually administer his own meds after someone else loads the organizer. Showing the patient how to load the organizer solves part of the problem; however, this would not allow the nurse to evaluate whether the patient would then know to take the medications each day. Home health aides cannot be responsible for patient medications. There is no indication that the patient is having difficulty opening his medication containers, so there is no need to talk to the pharmacy. PTS:1DIFifficult REF: p. 1519; critical thinking needed to answer question KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 21. A family caregiver is learning to administer insulin injections to her homebound sister. What should the nurse advise her to do with the used needles? 1) Discard the needle and syringe in a thick plastic milk jug with a lid. 2)
www.mynursingtestprep.comSecurely recap them and place them a paper bag in the household trash. 3) Remove the needle and put it in a coffee can with a lid; put the syringe in the trash. 4) Do not recap the needle; break it by bending it on the tabletop. ANS: 1 The caregiver should discard the syringe and needle in a thick plastic milk jug with a lid, a metal coffee can with a lid, or a commercial sharps container. Patients and caregivers should not recap used needles. They should not remove the needle from the syringe or attempt to break it because this increases the risk of needlestick injury. PTS:1DIF:ModerateREF:p. 1520 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. A community health nurse prepares for a new assignment. She has been assigned census tracts 131 and 132. This large area crosses the border of two towns and includes 4,000 people. As a community health nurse, she recognizes that assignments are based on census tracts because census tracts do which of the following? Choose all that apply. 1) Define the geopolitical boundaries of a community. 2) Are made up of persons who share a common heritage and customs. 3) Divide populations into smaller groups that can be assessed more readily. 4) Are natural divisions in communities that are based on voting patterns. ANS: 1, 3 Census tracts are derived from the national census. They typically include 1,500 to 8,000 people. The area of the tract varies based on the density. Census tracts show geopolitical boundaries that are useful to anyone who studies the characteristics and concerns of smaller groups of people. PTS:1DIF:ModerateREF:p. 1499 KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Comprehension 2. A community health nurse is assigned to work in a different area of the city. Which of the following assessment techniques would she likely use to develop an overview of the community? Choose all that apply. 1) Windshield survey 2) Review of demographic data 3) Physical assessment of a sample of the inhabitants 4) Review of the records of area providers ANS: 1, 2 A windshield survey and review of demographic data provide data about the community. She may interview area residents about their experiences or ideas about this community; however, physical examination of a sample of the inhabitants would not give her community-level data. Similarly, she may wish to meet with area providers, but reviewing their records violates HIPAA laws and assumes that the records accurately
www.mynursingtestprep.comreflect the health concerns of the population. PTS:1DIF:ModerateREF:p. 1506 KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Application 3. Which of the following groups represents a vulnerable population? Choose all that apply. 1) Homeless persons with no known illnesses 2) Women who have experienced domestic violence 3) Fifth-grade students at the local elementary school 4) Persons with type 1 diabetes mellitus ANS: 1, 2, 4 Vulnerable populations include those with limited economic or social resources, the very young and the very old, those with chronic disease, and people who have experienced abuse or trauma. PTS:1DIF:ModerateREF:dm 1500-1501 KEY: Nursing process: Assessment | Client need: Physiological Integrity | Cognitive level: Application 4. Which of the following is a primary intervention? Choose all that apply. 1) Immunization for meningitis of college-bound students 2) Safer sex education for high school students 3) Lobbying for health education in the schools 4) Tuberculosis screening via PPD testing ANS: 1, 2, 3 Primary interventions are interventions that occur before disease appears. The goal of primary interventions is to promote health and prevent disease. Secondary interventions aim to reduce the impact of the disease process by early detection and treatment. Tertiary interventions aim to halt disease progression and restore client functioning. PTS:1DIF:ModerateREF:p. 1503 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 5. Identify the nurse who is acting as a community health nurse. Choose all that apply. 1) School nurse who provides screening and direct care in the elementary school 2) Parish nurse who offers health education after services each Sunday 3) Nurse who works for the Red Cross by providing disaster relief 4) A nurse administering vaccines to inmates in a correctional facility ANS: 1, 2, 3, 4 Community health nurses function as client advocates, counselors, case managers, educators, and collaborators for patients and their families in the community setting. All of these nurses are working in community health settings in roles as school nurse, parish nurse, disaster nurse, and prison nurse.
www.mynursingtestprep.comPTS: 1 DIF: Easy REF: dm 1501-1503 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension 6. Which of the following interventions has a public health focus? Choose all that apply. 1) Controlling the blood sugar of a diabetic client with cardiovascular disease 2) Assisting with the launch of an after-school program in a high-crime neighborhood 3) Providing an influenza vaccination program for seniors and persons with chronic illness 4) Offering counseling to the family of a child with severe cognitive deficits ANS: 2, 3 Public health nursing focuses on the community at large and the eventual effect of the communitys health status on the health of individuals and families. Diabetic care is focused on individual health. Family counseling is focused on family health. PTS:1DIF:Moderate REF:p. 1501; question involves critical thinking with synthesis of information acquired from reading this passage KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Application 7. Which of the following clients would most likely require home health services? Choose all that apply. 1) 45-year-old man with an injured rotator cuff that requires surgery 2) 32-year-old terminally ill woman with a supportive family 3) 92-year-old man living independently with multiple medical problems 4) 6-year-old with a fractured hip requiring a leg and pelvic cast ANS: 2, 3 Home care is appropriate for a client with health needs that exceed the abilities of family and friends. Older adults who wish to avoid placement in a skilled nursing facility, those who require ongoing skilled care after discharge from the hospital, the terminally ill, and persons with chronic illness that must be monitored to avoid hospitalization are the most likely home health clients. PTS:1DIF:Moderate REF: p. 1510; critical-thinking item requires synthesis of knowledge acquired from passage KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Application 8. Which of the following services are provided by home health agencies? Choose all that apply. 1) Direct care of clients in the home, performing treatments 2) Indirect care such as provision of medication and supplies 3) Acute care services for clients with complex diseases 4)
www.mynursingtestprep.comRespite care of clients to relieve family caregivers ANS: 1, 2, 4 Home care agencies provide direct, indirect, and respite care in the home. Acute care services are provided in the hospital. PTS:1DIF:ModerateREF:p. 1511 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension 9. Home healthcare and home hospice care are two different types of home health services. What are the differences between these services? Choose all that apply. 1) Home healthcare promotes independence in clients; home hospice care promotes comfort and quality of life. 2) Home healthcare promotes comfort and symptom management; hospice care promotes self-care. 3) Home healthcare is focused on teaching self-care; home hospice care is focused on teaching skilled care to caregivers. 4) Home hospice care is focused on managing symptoms; home healthcare is focused on fostering independence. ANS: 1, 4 The purpose of home healthcare is to promote self-care and foster independence. The purpose of home hospice care is to promote comfort and quality of life by managing symptoms. PTS: 1 DIF: Moderate REF: p. 1512 KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Analysis 10. The nurse has been assigned to a caseload of home health clients. Before making home visits, which two planning activities must she perform first? 1) Order supplies for the home care services. 2) Review the cases to determine the reasons for the visits. 3) Contact the clients to arrange for the visits. 4) Develop a schedule for the day so that all visits can be made. ANS: 2, 3 All of these interventions are appropriate. However, it is essential to determine the nature of the visits and to secure permission for visiting before the nurse can order supplies and plan her day. PTS: 1 DIF: Difficult REF: p. 1514 KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application 11. The nurse is visiting a client who resides in a single-room occupancy hotel. Groups of people are leaning against the building and smoking on the steps. There is obvious drug abuse occurring in the lobby and halls of the building. There is no running water in the room, and the bathroom down the hall is in disrepair and filthy. A primary concern that the nurse must consider when making this visit is safety. Which of the following actions are appropriate safety measures? Choose all that apply.
www.mynursingtestprep.com1) Notify the police that the nurse plans to visit this site. 2) Carry something that can be used as a weapon if necessary. 3) Inform the home health agency of the nurses route and time of visit. 4) Do not visit if the nurse senses danger when he arrives at the site. ANS: 3, 4 Safety is a primary consideration in home care. The nurse should file a route and planned schedule with the agency. In addition, he should not enter the building if he feels he may be in danger. He should notify the police if he senses danger, but not to tell them of a planned visit. The nurse should always carry a cell phone to alert police when security is threatened. It is not recommended that the nurse carry a weapon. PTS:1DIF:ModerateREF:dm 1514-1515 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 12. The nurse is visiting a patient who lives alone in a two-room house. The patient requires wound care and medication management, but his health is not expected to improve much, even with care. There is no running water in the house, and the bathroom is in disrepair and filthy. At the first home visit, which of the following should the nurse assess? Choose all that apply. 1) Wound status 2) Patient concerns 3) Ability to perform care independently 4) End-of-life planning ANS: 1, 2, 3 The nurse should assess the patients status, condition of the wound, concerns, and ability to perform care independently. End-of-life care is a topic the nurse may wish to explore after a relationship has developed. PTS:1DIF:Easy REF:dm 1516-1517; critical-thinking item requiring synthesis of previously acquired knowledge KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level:Application True/False Indicate whether the statement is true or false. 1. Florence Nightingale is known as the first community health nurse. ANS: F Florence Nightingale was influential in community health because she established the importance of promoting health by manipulating the environment. Lillian Wald is known as the first community health nurse. Chapter 40 Ethics & Values for Nursing Practice Identify the choice that best completes the statement or answers the question. 1. A 77-year-old woman with an inoperable brain tumor has been hospitalized for the past 5 days. Her daughter comes to visit her. The patient has asked that her daughter not be told her diagnosis. After visiting with her mother, the daughter asks to speak to the
www.mynursingtestprep.comnurse. She says, My mother claims she has pneumonia, but I know she is not telling me the truth. The daughter asks the nurse to tell her what is truly wrong with her mother. The nurse should tell her that: 1) Her mother has an inoperable brain tumor, but does not wish anyone to know. 2) She needs to speak to the physician in charge of her mothers care. 3) Her mother has requested that her case not be discussed with anyone, not even family. 4) Her mother is very sick with a serious case of pneumonia that could lead to death. ANS: 3 The nurses first allegiance is to the patient and her desire for confidentiality. Telling the daughter to speak to the physician would place the physician in the same position as the nurse. Telling her that her mother has pneumonia would be a lie. The nurse, of course, should inform the physician of the patients wishes so that he will be prepared if the daughter questions him about her mothers health condition. PTS:1DIF:ModerateREF:p. 1529 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 2. Which of the following terms refers to the ethical questions that arise out of nursing practice? 1) Nursing ethics 2) Bioethics 3) Ethical dilemma 4) Moral distress ANS: 1 Nursing ethics refers to ethical questions that arise out of nursing practice. Bioethics is a broader field that refers to the application of ethics to healthcare. An ethical dilemma occurs when a choice must be made between two equally undesirable actions, and there is no clearly right or wrong option. Moral distress occurs when someone is unable to carry out his or her moral decision. PTS:1DIF:ModerateREF:V1, p. 1526 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 3. A belief about the worth of something that serves as a principle or a standard that influences decision making is called which of the following? 1) Morals 2) Attitudes 3) Beliefs 4) Values ANS: 4 A value is a belief you have about the worth of something that serves as a principle or a
www.mynursingtestprep.comstandard that influences decision making. Morals are private, personal, or group standards of right and wrong. Attitudes are mental dispositions or feelings toward a person, object, or idea. A belief is something that one accepts as true. PTS: 1 DIF: Difficult REF: p. 1530 KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 4. A 45-year-old patient is ventilator dependent after a high cervical neck injury. He is conscious and competent and has decided that he wants to be removed from the ventilator. His family and the multidisciplinary team agree. The nurse believes the patient intends suicide and would prefer he choose differently but says nothing. The nurse remains at the bedside holding the patients hand. In this instance the nurse is displaying which of the following? 1) Value set 2) Value system 3) Value neutrality 4) Value awareness ANS: 3 Value neutrality occurs when we put aside our own values regarding an issue in order to provide nonjudgmental care to clients. A value set is your list of values. A value system is your value set with the values ranked on a continuum from most important to least important. PTS:1DIF:ModerateREF:p. 1532 KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application 5. A 45-year-old patient is ventilator dependent after a high cervical neck injury. He is alert and oriented and, after giving it much thought, has decided that he wants to be removed from the ventilator. The nurse believes the patient intends suicide but supports his final decision. When the ventilator is removed, the nurse remains with the patient to support him. The nurses action demonstrates respect for what moral principle? 1) Nonmaleficence 2) Autonomy 3) Beneficence 4) Fidelity ANS: 2 Autonomy refers to a persons right to choose and his ability to act on that choice. In this case, the nurse respects the patients right to choose to die. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. Fidelity is the obligation to keep promises. PTS:1DIF:ModerateREF:p. 1534 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension 6. Which of the following consequentialist theories takes the position that the value of an action is determined by its usefulness? 1)
www.mynursingtestprep.comEthics of care 2) Utilitarianism 3) Deontology 4) Categorical imperative ANS: 2 Utilitarianism is a consequentialist theory that takes the position that the value of an action is determined by its usefulness. An ethics of care is a nursing philosophy that directs attention to the specific situations of individual patients viewed within the context of their life narrative. Deontology considers an action to be right or wrong independent of its consequences. A categorical imperative is a principle, established by Immanuel Kant, that states that one should act only if the action is based on a principle that is universal. PTS:1DIF:EasyREF:p. 1532 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Comprehension 7. The ability of nurses to base their practice on professional standards of ethical conduct and to participate in ethical decision making is known as which of the following? 1) Ethical agency 2) Attitudes 3) Belief 4) Value neutrality ANS: 1 Ethical agency is the ability of nurses to base their practice on professional standards of ethical conduct and to participate in ethical decision making. Attitudes are mental dispositions or feelings toward a person, object, or idea. A belief is something that one accepts as true. Value neutrality is when we attempt to understand our own values regarding an issue and to know when to put them aside, if necessary, to become nonjudgmental when providing care to clients. PTS: 1 DIF: Moderate REF: p. 1527 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension 8. Identify the third step in the MORAL decision-making model. 1) Reassess the dilemma 2) Resolve the dilemma 3) Review the problem 4) Recall the history of the problem ANS: 2 MORAL is an acronym for the following steps: M, Massage the dilemma; O, Outline the options; R, Resolve the dilemma; A, Act by applying the chosen option; L, Look back and evaluate. PTS: 1 DIF: Easy REF: dm 1540-1541
www.mynursingtestprep.comKEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 9. A patient has asked the nurse to explain her laboratory results. The nurse informs the patient that he must first assist another patient to the bathroom and then he will explain the results. The nurse assists the other patient to the bathroom and then returns to explain the results to the patient. What moral principle has the nurse displayed? 1) Nonmaleficence 2) Autonomy 3) Beneficence 4) Fidelity ANS: 4 Fidelity is the obligation to keep promises. Autonomy refers to a persons right to choose and his ability to act on that choice. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. PTS:1DIF:ModerateREF:p. 1535 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 10. The nurse is a member of the ethics committee. An alert, oriented, and competent 87-year-old man has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and requests the ethics committee to intervene on their behalf. The ethics committee would most likely use which model in this patients case? 1) Social justice 2) Patient benefit 3) Autonomy 4) DNAR determination ANS: 3 The autonomy model is useful when the patient is competent to decide. This model emphasizes patient autonomy and choice as the highest values. The patient benefit model assists in decision making for the incompetent patient by using substituted judgment. The social justice model focuses more on broad social issues involving the entire institution rather than on a single patient issue. There is no DNAR determination model. PTS:1DIF:ModerateREF:p. 1542 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Synthesis 11. A 60-year-old patient with a treatable form of breast cancer has decided not to pursue radiation or chemotherapy. The nurse believes that the patient should be treated. She coerces her into receiving treatment by continuing to remind the patient about her responsibilities for raising her children. What type of behavior has the nurse displayed? 1) Nonmaleficence 2) Autonomy 3) Paternalism
www.mynursingtestprep.com4) Beneficence ANS: 3 Paternalistic behavior occurs when the nurse thinks she knows what is best for a competent patient and coerces the patient to act as she wishes rather than to act as the patient originally desired. Autonomy refers to a persons right to choose and his ability to act on that choice. Nonmaleficence is the twofold principle of doing no harm and preventing harm. Beneficence is the duty to do or promote good. PTS:1DIF:ModerateREF:p. 1535 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 12. Nursing codes are: 1) Legally binding. 2) Not legally binding. 3) Legally binding in some circumstances. 4) Not admissible in court. ANS: 2 Codes of ethics are open to public scrutiny. The ethical aspects of nursing work, just like the technical aspects, are subject to review by professional groups and licensure boards, which may use sanctions to punish code violations. However, nursing codes are not legally binding. PTS:1DIFifficultREF:p. 1536 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 13. An alert, oriented, and competent frail older adult man has been told that he is dying and has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and asks the healthcare team to ignore the request. After a great deal of discussion among the physician, nurse, and family, they are no closer to resolution of the conflict. The nurse asks the hospital chaplain to come and help the family and the team understand each others opposing views. Which step of the MORAL model does this illustrate? 1) MMassage the dilemma 2) OOutline the options 3) RResolve the dilemma 4) LLook back and evaluate ANS: 2 This illustrates the Outlining-options step. In Massaging the dilemma, the team would already have identified and defined the issues in the dilemma, and considered the values and options of all the major players. At the Outlining the options step, someone should delineate all of the options to all parties, including those that are less realistic and conflicting. In that step, someone often asks a member of the ethics committee or the hospital chaplain to help the parties understand the opposing viewpoints. Resolving the dilemma is the step in which all the options are reviewed and basic moral principles and frameworks are applied to arrive at a decision. Looking back to evaluate is done after a
www.mynursingtestprep.comdecision has been made and acted on. At that time, the entire process, including the consequences, is evaluated to determine how well it worked. PTS: 1 DIF: Difficult REF: dm 1540-1541 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application 14. An alert, oriented, and competent frail older adult man has been told that he is dying, and has asked to have a DNAR order put on his chart. The patients family does not agree with his decision and asks the healthcare team to ignore the request. The healthcare team does not comply with the familys wishes, and after several days the family takes the matter to court. The court sides with the family and orders the healthcare team to remove the DNAR order. This is an example of which of the following? 1) An integrity-producing (good) compromise 2) An ethically sound compromise 3) Settlement of an issue by force 4) An effort to keep peace on the unit ANS: 3 This is clearly an example of settling an issue by force, bringing in a more powerful entity (the court) to force the healthcare team to do what the family wants. It is not a compromiseof any sortbecause neither party backed away from its original position, and the action that was taken was not agreed on by both parties. This was not an effort to keep peace. The familys effort was to settle the disagreement in their favor. If the healthcare teams goal had been to keep peace on the unit, they would have acceded to the familys wishes without the need for court order. PTS:1DIFifficultREF:p. 1542 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. Which of the following is an example of whistle-blowing? Choose all that apply. 1) Reporting fraudulent billing practices 2) Reporting patients health status against the patients wishes 3) Reporting unsafe work practices 4) Reporting a coworker for working under the influence of drugs ANS: 1, 3, 4 Reporting a patients health status against the patients wishes is a breach of patient confidentiality. Whistle-blowing is identifying incompetent, unethical, or illegal situations or actions of others in the workplace and reporting to someone who may be in a position to rectify the situation. Fraudulent billing practices are illegal and unethical; unsafe work practices are unethical and illegal; and a coworker under the influence of drugs is a risk to patients, as well acting in an illegal and unethical manner. PTS: 1 DIF: Moderate REF: p. 1528; requires critical thinking KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Analysis 2. The nurses obligations in ethical decisions include which of the following? Choose all that apply.
www.mynursingtestprep.com1) Be a patient advocate. 2) Involve institutional ethics committees. 3) Improve ones own ethical decision making. 4) Respect patient confidentiality. ANS: 1, 2, 3, 4 The nurses obligations in ethical decisions include being a patient advocate, using and participating in institutional ethics committees, and improving ethical decision making. Confidentiality is a basic patient right. The nurses role is to uphold that right. Chapter 41 Legal Accountability Identify the choice that best completes the statement or answers the question. 1. A pregnant 15-year-old girl presents to the emergency department (ED) of the local private hospital. She has been transported by her mother and appears to be in active labor. The girl is crying uncontrollably and says she is scared and experiencing painful contractions. Her mother states, We dont have any money or insurance, but this hospital is closer than the public hospital, and she needs help now. What is the first step that the ED staff should take? 1) Arrange for an ambulance to transport her to the nearest public hospital. 2) Explain to the girl and her mother that the hospital only accepts patients who can pay the hospital bill. 3) Examine her to determine if her condition is stable or if she requires immediate medical attention. 4) Inform her mother that she will need to transport her daughter to the nearest public hospital. ANS: 3 When a client comes to the ED requesting examination or treatment for an emergency medical condition (including labor), the hospital must provide stabilizing treatment; the client cannot be transferred until she is stable. PTS:1DIF:ModerateREF:p. 1550 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 2. For the patient with no healthcare coverage who is seeking medical care, the emergency department staff members decide whether to provide care or transport to a public facility based on which law, enacted by Congress in 1986 and updated in 2003? 1) Health Care Quality Improvement Act (HCQIA) 2) Patient Self-Determination Act (PSDA) 3) Newborns and Mothers Health Protection Act (NMHPA) 4) Emergency Medical Treatment and Active Labor Act (EMTALA)
www.mynursingtestprep.comANS: 4 The intent of the Emergency Medical Treatment and Active Labor Act (EMTALA) is to ensure public access to emergency services regardless of ability to pay. The EMTALA prohibits patient dumping, which is transferring indigent or uninsured patients from a private hospital to a public hospital without appropriate screening and stabilization. An exception is made if a hospital does not have the capability to stabilize a patient or if the patient requests a transfer. PTS:1DIFifficultREF:p. 1550 KEY:Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension 3. A patient tells you that chart entries made by the nurse from the previous day indicate he was uncooperative when asked to ambulate. He says this is not true and asks his record be corrected. You understand that, if what he says is accurate, he has the right to have the documentation error corrected based on which of the following regulations? 1) Americans with Disabilities Act (ADA) 2) Patient Self-Determination Act (PSDA) 3) Health Insurance Portability and Accountability Act (HIPAA) 4) Health Care Quality Improvement Act (HCQIA) ANS: 3 The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule of 2004 provides comprehensive protection for the privacy of protected health information (confidentiality of patient records). In addition, patients have the right to see and copy their medical records and to reconcile incorrect information. PTS:1DIF:ModerateREF:p. 1550 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension 4. Upon initial assessment of a 75-year-old patient, you identify bruises and scratches on the patients arms, legs, and trunk in various stages of healing. You notify your supervisor when you suspect the patient may be a victim of physical abuse. You are complying with which of the following state laws? 1) Good Samaritan Law 2) Mandatory Reporting Law 3) Nurse Practice Act 4) Nursing Standards of Practice ANS: 2 Under state mandatory reporting laws, nurses must report to designated authorities (e.g., Adult Protective Services) suspected physical, sexual, emotional, or verbal abuse or neglect by healthcare workers or family members. In general, nurses who fail to report suspected abuse or neglect may be held criminally or civilly liable. PTS:1DIF:ModerateREF:p. 1552 KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Application 5. Nursing codes of ethics support which of the
www.mynursingtestprep.comfollowing? 1) Patients can receive emergency treatment regardless of their ability to pay. 2) Nurses will educate patients about advance directives. 3) Nurses with HIV must disclose their condition to their employer. 4) Patients have the right to dignity, privacy, and safety. ANS: 4 In the Patient Bill of Rights, patients have the right to dignity, privacy, and safety. Although they are not laws, nursing codes of ethics specify ethical duties of the nurse to the patient as related to corresponding patient rights. Although patients do have a right to receive emergency medical care regardless of their ability to pay, this is not part of the nursing code of ethics. Likewise, a nurses role is to educate patients about advance directives; this is a goal supported by nursing organizations but is not part of the code of ethics. PTS:1DIF:ModerateREF:p. 1553 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis 6. The charge nurse in a progressive care unit assigns the care of a patient receiving hemodialysis to a newly hired licensed practical nurse (LPN) without checking to see that the nurse has been determined competent to care for hemodialysis patients. The LPN is in orientation and fails to inform the charge nurse that she does not have experience with this type of patient. The actions of the charge nurse would be considered to be which of the following? 1) Malpractice 2) Incompetence 3) Negligence 4) Abandonment ANS: 3 Negligence is the failure to use ordinary or reasonable care or the failure to act in a reasonable and prudent (careful) manner. It is negligent to assign a nurse to care for a patient without verifying the nurse has training, experience, and clinical competence in caring for such patients. PTS:1DIF:ModerateREF:p. 1557 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 7. In which of the following circumstances might the nurse defer obtaining informed consent for care and treatment of a patient? 1) The patient is confused and cannot understand or sign the consent form. 2) The patient is brought to the emergency department in cardiac arrest; no family is present. 3) The surgeon requests that the patient be sent to the surgical suite before you get the consent form signed.
www.mynursingtestprep.com4) An unconscious patient is admitted to your unit; he is alone. ANS: 2 Informed consent is the necessary authorization by the patient for any and all types of care and must be written and signed by the patient or the person legally responsible for the patient for hospital admission and for invasive or specialized treatments or diagnostic procedures. Written consent is not necessary in an emergency if experts agree that there was an immediate threat to life or health. The physician responsible for the care of the patient has the duty to obtain informed consent from the patient. PTS:1DIF:ModerateREF:p. 1563 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis 8. A 4-year-old child is brought to the emergency department by his mother. He has a large bruise in his left chest and multiple contusions on his face. His mother tells you her boyfriend intentionally pushed the child down the stairs in anger. The child appears to be in a great deal of pain. Which of the following four items should the nurse do first? 1) Notify the nursing supervisor of the suspected physical abuse. 2) Complete a physical assessment of the child. 3) Obtain an order for pain medication. 4) Notify Child Protective Services of the suspected abuse. ANS: 2 Although the nurse must report to designated authorities (Child Protective Services) suspected physical abuse, the primary responsibility of the nurse in this situation is to evaluate the patients physical condition and extent of his injuries in order for appropriate medical treatment to be provided. Pain medication should not be administered prior to a thorough physical assessment. The nurse should always notify the nursing supervisor if any outside agencies may need to be contacted. PTS:1DIF:Moderate REF: p. 1552; critical-thinking item requires synthesis of previously acquired knowledge KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Analysis 9. You are caring for an alert, oriented 47-year-old patient who is recovering from abdominal surgery. The patient becomes angry and upset and says, Im leaving this hospital. Remove my IV and surgical drains or I will do it myself. In order to keep him from removing his lines and leaving the hospital, you apply bilateral wrist restraints until you can contact the physician for an order for patient restraint. This is an example of which of the following? 1) Assault and battery 2) Felony 3) False imprisonment 4) Quasi-intentional tort ANS: 3 False imprisonment involves an intentional or willful detention of a patient without consent or authority to do so. Restraining a patient without consent is another form of civil
www.mynursingtestprep.comfalse imprisonment. Competent patients have a right to leave an institution, even if it is harmful to their health. Whenever possible, have the person sign a form stating that he is aware that he is leaving against medical advice. PTS:1DIF:ModerateREF:p. 1557 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 10. A registered nurse forgot to put the side rails up for a confused patient. The patient fell out of bed and fractured his hip. The patient sues and wins a judgment (award) for $2 million. The nurse has an occurrence policy with double limit coverage of $3 million/$10 million that covered the time period when the incident occurred. The statement that best describes the nurses situation is that her insurance policy will: 1) Not cover her. 2) Pay $4 million. 3) Pay $2 million. 4) Pay 75% of the $2 million ANS: 3 An occurrence policy will cover those claims that occurred during the time the policy was in effect. However, the policy will pay up to $3 million per claim; because the amount awarded does not exceed this, the nurse is covered. PTS:1DIFifficultREF:dm 1566-1567 KEY: Nursing process: Evaluation | Client need: SECE | Cognitive level: Analysis 11. A registered nurse administers the wrong medication to a patient. She does not notify anyone of the error and documents that the correct medication was administered. The nurse was reported to the state board of nursing. Which of the following actions can the state board of nursing take against the nurse in this situation? 1) Disciplinary action against the nurses license to practice 2) Criminal misdemeanor charges against the nurse 3) Medical malpractice lawsuit against the nurse 4) Employment release from the institution ANS: 1 The state board of nursing is empowered to initiate disciplinary action against the nurses license for professional misconduct. The board does not bring criminal charges or sentence the nurse to jail; that is the parameter of the state prosecutor and judge. A patient or the person harmed can bring medical malpractice lawsuits against the nurse. PTS: 1 DIF: Moderate REF:dm 1553, 1555 KEY: Nursing process: Intervention | Client need: SECE | Cognitive level: Application Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. Which of the following are examples of invasion of privacy by nurses? Choose all that apply. 1) Searching a patients belongings without permission
www.mynursingtestprep.com2) Reviewing the plan for patient care in the lunchroom 3) Discussing healthcare issues for an unconscious patient with his power of attorney 4) Releasing patient health information to local newspaper reporters ANS: 1, 2, 4 Invasion of privacy violates a persons right to be free from unwanted interference in her private affairs, such as occurs in discussing patient matters in a public setting; searching patients private items without their permission; and releasing private information to the public. A durable power of attorney is a document empowering a person selected by the patient to make healthcare decisions in the event that the patient is unable to do so. It is permissible to discuss pertinent issues related to the welfare of the patient with the person holding a power of attorney. PTS:1DIF:EasyREF:p. 1557 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis 2. While you are admitting an adult patient, he asks you whether he should create an advance directive. To provide him adequate information to make an informed decision, you should tell the patient which of the following? Choose all that apply. 1) If he is unable to communicate, his family may make changes to his advance directive. 2) Once he signs an advance directive, no further care will be provided to him. 3) He may change his advance directive by telling his physician or by making changes in writing. 4) An advance directive will ensure he gets as much or as little care as he wishes. ANS: 3, 4 Advance directives include living wills and durable powers of attorney. A living will establishes the patients wishes regarding future healthcare should he become unable to give instructions. A patient may specify actions in a living will that are not supported by family members, such as a desire for a do not resuscitate order, or for as much or as little care as he wishes. A person may change or revoke an advance directive at any time. Changes and written revocation should be signed and dated and shared with the patients physician. Even without an official written change, orally expressed direction to the physician generally has priority over any statement made in an advance directive as long as the patient is able to decide for himself and can communicate his wishes. PTS:1DIF:ModerateREF:dm 1550-1551 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application 3. What do negligence and malpractice have in common? Choose all that apply. 1) Negligence and malpractice are non-intentional torts. 2) Negligence and malpractice are felonies. 3) Malpractice is the professional form of negligence. 4) Negligence and malpractice involve the intent to do harm to a patient.
www.mynursingtestprep.comANS: 1, 3 Negligence and malpractice are non-intentional tortsnurses can be negligent without intending to do harm. Negligence is simply the failure to use ordinary or reasonable care as dictated by the standards of practice and/or by what a reasonable and prudent nurse would do in the same or similar circumstances. Intent is not an element of negligence. When a nurse or other licensed professional healthcare provider is negligent and fails to exercise ordinary care, it is called malpractice. Malpractice is the professional form of negligence. PTS: 1 DIF: Moderate REF: p. 1557 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis 4. You are caring for a patient with renal failure. His morning laboratory results reveal an abnormal potassium level of 6.8. This value is more elevated than on the previous day, when the level was within normal limits. You page the patients physician, but he does not return your call right away. You become busy with another patient and forget to notify the physician again and fail to mention the critical laboratory value to the oncoming nurse during shift report. Which of the following does this scenario illustrate? Choose all that apply. 1) Failure to implement a plan of care 2) Failure to evaluate 3) Malpractice 4) Failure to assess and diagnose ANS: 1, 2, 4 Failure to implement a plan of care and failure to evaluate are two of the most common causes of nursing malpractice claims. The above scenario represents a failure to follow standards of care, failure to communicate, and failure to document, which are in the category of failure to implement a plan of care. It also represents a failure to assess and report a significant change in the patients condition, which is part of the category of failure to evaluate. The nurse did assess the potassium level and recognize that it was too high. PTS: 1 DIF: Difficult REF: dm 1559-1560 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application Completion Complete each statement. 1.The American Nurses Association (ANA) believes nurses should not participate in active euthanasia (and assisted suicide) because such acts violate . • the Patient Self-Determination Act • civil laws • the Good Samaritan laws • the Code of Ethics for Nurses ANS: 4 The ANA defines assisted suicide, a form of active euthanasia, as providing a patient the means to end his life, with full knowledge of the patients intentions to do so. The ANA believes that participation in active euthanasia violates the Code of Ethics for Nurses and
www.mynursingtestprep.comthe ethical traditions of the profession. PTS: 1 DIF: Moderate KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Recall 2.Prioritize the following guidelines for nursing practice in order of specificity (14, with 4 being the most specific). • State laws • Institutional policies and procedures • Federal laws • State nurse practice acts ANS: 3, 1, 4, 2 Institutional policies and procedures are usually more specific and detailed than standards set by professional organizations. State nurse practice acts identify the minimum level of nursing care for a specific patient in specific situations. Standards in nurse practice acts are set forth in statutes and enforced by authority granted by the state. Federal laws, both constitutional and statutory, affect nursing practice in the most general terms. Chapter 38 Informatics Identify the choice that best completes the statement or answers the question. 1. In informatics, raw, unprocessed numbers, symbols, or words that have no meaning by themselves are called which of the following? 1) Information 2) Data 3) Knowledge 4) Wisdom ANS: 2 Data are raw, unprocessed numbers, symbols, or words that have no meaning by themselves. Information consists of groupings of data processed into a meaningful, structured form. Knowledge is formed when data are grouped, creating meaningful information and relationships, which are then added to other structured information. Wisdom is the appropriate use of knowledge in managing or solving human problems. PTS:1DIF:EasyREF: p. 1572 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 2. Which informatics concept concerns the appropriate use of knowledge in managing or solving human problems? 1) Wisdom 2) Data 3) Knowledge 4) Information ANS: 1 Wisdom is the appropriate use of knowledge in managing or solving human problems.
www.mynursingtestprep.comData are raw, unprocessed numbers, symbols, or words that have no meaning by themselves. Information consists of groupings of data processed into a meaningful, structured form. Knowledge is formed when data are grouped, creating meaningful information and relationships, which are then added to other structured information. PTS:1DIF:EasyREF:p. 1573 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 3. Computers are important for evidence-based practice because: 1) They are available in all healthcare institutions. 2) Extra training is not required for information retrieval. 3) Information can be accessed and managed more efficiently. 4) All of the best evidence is located on a computer. ANS: 3 To incorporate the current, best evidence in your nursing practice, you must be able to locate the evidence, evaluate its quality and relevance to the problem, and apply the solution to clinical care. Computers are useful for data access, management, storage, and retrieval when conducting research or reviewing research findings. Specialized software aids in statistical analysis of research data. Computers are not available to all personnel in all healthcare institutions nor can the entirety of best evidence be found electronically. Training and experience are required to learn how to use a computer as well as how to conduct a literature search. PTS:1DIF:ModerateREF:p. 1582 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application 4. You are a preceptor for a new nursing employee at the local hospital. She needs to access a patients electronic health record (EHR) to retrieve laboratory results; however, the newly hired nurse has not yet received a computer password. What action should you take? 1) Give her your password to use until she obtains her own password. 2) Log on and remain with her while she views the record. 3) Notify your supervisor that the new employee needs a password. 4) Inform her that she will not receive a password until her orientation is complete. ANS: 3 Never share your password with another person or log on to a computer to allow another access to information. Instead, notify your supervisor that the new employee needs a password. In most hospitals, nurses are given a password during their orientation. PTS:1DIF:ModerateREF:p. 1581 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application 5. Review the following: 38 years old; growth in height to 52; female gender; weight gain of 15 pounds. This list can be referred to as which of the following? 1) Information 2)
www.mynursingtestprep.comKnowledge 3) Data 4) Patient record ANS: 1 The segments are grouped into a meaningful, structured form and are considered together as information. However, 38, 52, female, 15 standing alone would be examples of raw, unprocessed numbers, symbols, or words that have no meaning by themselves and therefore would be data. PTS:1DIF:ModerateREF:p. 1572 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Analysis 6. CINAHL is a(n): 1) Popular periodical. 2) Internet site. 3) Scholarly journal. 4) Literature database ANS: 4 CINAHL, The Cumulative Index of Nursing and Allied Health Literature, is a literature database covering nursing, allied health, biomedical, and consumer health journal articles. CINAHL may be accessed by the Internet or in hard copy in most libraries. PTS: 1 DIF: Easy REF: p. 1583 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Comprehension 7. A nurse is entering a pharmacy request for patient medication in the patients electronic health record (EHR) while seated at a computer in the nursing station. A physician approaches her and asks her to access another patients EHR so that he can look at the patients laboratory report. Which of the following is the best action for the nurse to take? 1) Access the lab report for the physician. 2) Log off the computer before proceeding. 3) Quickly finish the pharmacy requisition before the physician logs on. 4) Allow the physician to access the laboratory report without logging out. ANS: 2 The nurse should log off the computer and then allow the physician to log on under his own password. Accessing information that is not relevant to the care that the nurse is providing is a HIPAA violation. Rushing to complete a pharmacy request for patient medication is a situation of risk for medication error. The nurse should never hurriedly order or administer medication because that is when errors are more likely to occur. The nurse should never allow anyone to use her password to access information. PTS:1DIFifficult REF: p. 1581; critical thinking item requiring synthesis of knowledge acquired from text KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application
www.mynursingtestprep.com8. What is (are) the primary benefit(s) of computer physician order entry (CPOE)? 1) Increased privacy 2) Improved access to patient data 3) Cost savings 4) Reduced medication errors ANS: 4 Computer physician order entry (CPOE) is technology that allows healthcare providers to enter orders into a computerized prescribing system instead of handwriting them. Orders are integrated with patient information, including allergy history and laboratory and other prescription data. The new order is then automatically checked for potential errors or problems. This reduces prescription errors resulting from illegible penmanship. It can detect dosing errors by flagging medication dilution or dosages that fall outside normal dosing standards. The system warns about the possibility of a drug interaction, allergy, or incorrect dose. As some drug names sound like other drugs, CPOE can alert prescribers and potentially avoid a drug error that could be serious or fatal. Although the efficiencies of the CPOE reduce costs, it is not the primary benefit of the system. Likewise, orders entered into the computer are more conveniently accessed by nurses and pharmacists, but the most important benefit of CPOE is to reduce errors. PTS:1DIFifficultREF:p. 1578 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. Which of the following are main functions of a computer? Choose all that apply. 1) Process 2) Storage 3) Memory 4) Output ANS: 1, 2, 4 Memory refers to the amount of space available for storage of digital information on a computer. The four main functions of a computer are input, process, output, and storage. PTS: 1 DIF: Moderate REF: p. 1573 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 2. Which of the following aspects of a computer determine its power? Choose all that apply. 1) User friendliness 2) Speed of operations 3) Accessibility for the user 4) Data storage capacity ANS: 2, 4
www.mynursingtestprep.comThe power of a computer is determined by its speed, accuracy, reliability, and data storage and processing capabilities. Although ease of use and accessibility are important features for users, these factors do not determine the power of a computer. PTS:1DIFifficultREF:p. 1573 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 3. Which of the following health information is protected in the electronic health record? Choose all that apply. 1) Social Security number 2) Insurance information 3) Physicians name 4) Laboratory results ANS: 1, 2, 4 A patients protected health information includes any individually identifiable health information; current, past, or potential physical or mental conditions; and any payment information, such as Social Security numbers or insurance. PTS: 1 DIF: Moderate REF: p. 1574 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 4. The nurse is preparing to pass the 0900 medications prescribed for her patients. She removes the medications from the automated dispensing unit. When scanning the medication, an alert notifies the nurse that the patient is allergic to this medication. What action should the nurse take? Choose all that apply. 1) Override the alert and administer the medication. 2) Confirm the patients allergies and type of reaction. 3) Notify the prescriber of the patient medication allergy. 4) Be sure an antidote is available at the patients bedside. ANS: 2, 3 Alerts are configured to notify the nurse of potential adverse effects before the patient receives the medication. Sometimes patients state they are allergic to a medication when, in reality, they may only have experienced a side effect. The physician or pharmacist can be instrumental in discerning if the patients reaction was a true allergy. The physician should always be notified before administering medications when an allergy error has been received. Although an antidote to a medication could be useful in the event of a harmful effect, the medication in the situation should not be given, and therefore, the antidote would not be necessary. PTS:1DIFifficult REF: p. 1580; critical thinking is necessary to answer question KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application Completion Complete each statement. • is the managing and processing of information necessary to make decisions. ANS: Informatics
PTS: 1 DIF: Moderate REF: p. 1572 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall • is the use of telecommunication to send healthcare information between patients and professionals at different locations. ANS: Telehealth PTS:1DIF:ModerateREF:p. 1575 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 3.Facebook, MySpace, and LinkedIn are examples of tools. ANS: social networking PTS:1DIF:EasyREF:dm 1574-1575 www.mynursingtestprep.com KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Comprehension 4. such as NIC, NOC, NANDA-I, and PNDS can be used to describe the unique nursing contributions to patient care. ANS: Standardized nursing languages Standardized nursing languages communicate health information, promote evidence- based practice using health records, decrease medical error, and protect patient privacy and confidentiality. However, no single nursing language currently describes all of the aspects of nursings contribution to care. Use of standardized terminology helps to match like terms within the electronic medical record. Chapter 12 Spirituality Identify the choice that best completes the statement or answers the question. 1. The concept of holism focuses on which of the following? 1) Relationship between nurse and patient 2) Practice of spiritualism 3) Relationships among all living things 4) Totality of the body ANS: 3 The concept of holism focuses on the relationships among all living things. PTS:1DIFifficultREF:p. 2 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Comprehension 2. A patient is receiving healthcare focused on his illness and counteracting his symptoms. What type of healthcare is he receiving? 1) Holistic 2) Integrative 3) Complementary 4) Allopathic ANS: 4 Allopathic care is conventional medical care focused on counteracting symptoms. Holistic healthcare uses the concept of holism to focus on the relationships among all
www.mynursingtestprep.comliving things. Integrative healthcare encompasses all traditional and alternative health practices used by a patient. Complementary healthcare is alternative care used in conjunction with traditional medical care. PTS: 1 DIF: Moderate REF: p. 3 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 3. A client has a diagnosis of chronic pain. The physician has prescribed tramadol hydrochloride (Ultram) for the pain. The patient also receives therapeutic touch (TT) from a practitioner three times a week. In this situation, TT is considered to be which of the following? 1) A complementary modality 2) An alternative modality 3) A placebo response 4) Holistic healthcare ANS: 1 A complementary modality is one that is used alongside traditional medical care. The patient receives prescription medication from a physician as well as receiving TT. An alternative modality is one that is used instead of traditional medical care. A placebo response is the clients expectation that a treatment will be effective. Holistic healthcare uses the concept of holism to focus on the relationships among all living things. PTS: 1 DIF: Moderate REF: p. 3 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application 4. A client tells the nurse that he is having difficulty sleeping. He says, I dont want to use sleeping pills, but Im thinking about getting some melatonin. Which of the following is most important for the nurse to include in a response to the client? 1) Melatonin is an effective treatment for certain sleep disorders. 2) Melatonin appears to be a relatively safe sleep aid for most people. 3) You may experience some side effects, such as elevated blood pressure. 4) Before taking melatonin, you should consult your primary care provider. ANS: 4 All of the statements are true about melatonin; however, side effects are rare. It is most important to consult the primary care provider because melatonin is known to interact with other medications, including prescription medications. Therefore, the client should talk with the provider about this possibility. PTS:1DIFifficultREF:p. 14 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application 5. A woman is receiving physical therapy after surgery to repair a hip fracture. She tells the therapist before therapy begins that she expects therapy to be very painful. She rates her pain as 1 on a scale of 1 to 10 before therapy. Three minutes into the treatment session, the patient complains of excruciating pain rated as 10 and says she cannot tolerate exercise any longer. The therapist is concerned with the amount of pain, because severe pain is not expected during that form of exercise. The therapist considers the patient could be experiencing:
www.mynursingtestprep.com1) Phantom limb pain. 2) Ineffective pain medication. 3) A nocebo effect. 4) A complication from the surgery. ANS: 3 The nocebo effect is a demonstration of the power of the mind to create bodily distress. The patient was expecting the treatment to be very painful, and this tends to increase the treatment discomfort. Phantom limb pain is sometimes experienced after an amputation but has nothing to do with surgery to repair a hip fracture. There is no evidence that the patients pain medication is ineffective or that she is experiencing a complication from surgery. PTS:1DIF:ModerateREF:p. 3 KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Analysis 6. Identify the holistic nursing theorist who describes disease as disequilibrium, which stimulates the person toward growth and regaining wholeness. 1) Jean Watson 2) Margaret Newman 3) Martha Rogers 4) Charles Darwin ANS: 2 Margaret Newman identifies disease as disequilibrium, which stimulates the person toward growth and regaining wholeness. Jean Watson identifies caring as the primary focus of nursing. Martha Rogers states that the environmental energy field is in constant and meaningful interaction with the human energy field. Charles Darwin created the theory of natural selection. He is not a nursing theorist. PTS:1DIFifficultREF:p. 5 KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall 7. A client wishes to avoid taking blood pressure medications. He is eating a healthy diet and exercising regularly. In addition, a CAM therapist has recommended an alternative therapy that will allow him to learn voluntary control over his blood pressure. What type of therapy is the therapist probably recommending? 1) Homeopathy 2) Naturopathy 3) Biofeedback 4) Hypnosis ANS: 3 Biofeedback is a technique by which people learn voluntary control over typically involuntary activities. Homeopathy is based on an understanding of how the body heals itself and an acceptance that all symptoms represent the bodys attempt to restore itself to health. Naturopathy is the belief that nature and each living being have the innate ability to establish, maintain, and restore health. Hypnosis is a trancelike state characterized by relaxed brain waves, hypersuggestibility, and heightened imagination. Hypnosis has been
www.mynursingtestprep.comused to promote relaxation, weight loss, and smoking cessation and to suppress various symptoms. PTS:1DIF:ModerateREF:dm 9-10 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension 8. What is the best rationale to gather data about patients use of herbal products? 1) The nurse practice act requires RNs to monitor all drug dosages. 2) Herbal products need to be evaluated for research purposes. 3) Patients medication records must be kept accurate. 4) Many herbs are known to interact with medications. ANS: 4 Many herbs are known to interact with medications and to affect some disease processes adversely. Nurse practice acts do require RNs to assess patients but do not specifically require monitoring of drug dosages. Herbal products do need to be evaluated in research, and medication records must be accurate, but they do not provide the rationale for patient data collection. PTS:1DIF:ModerateREF:p. 11 KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Application 9. A patient at the Integrative Health Clinic is scheduled for a massage technique that promotes unblocking of a terminal nerve in order to improve function along that nerve pathway. What type of therapy is he receiving? 1) Myofascial release 2) Shiatsu massage 3) Swedish massage 4) Reflexology ANS: 4 Reflexology is a massage technique that promotes unblocking of a terminal nerve in order to improve function along that nerve pathway. Myofascial release restores balance, alignment, and mobility to the body by releasing tension in the soft connective fasciae. Shiatsu massage is a finger pressure method that balances the energy force in the body. Swedish massage is used to induce relaxation and restore flexibility. PTS:1DIF:ModerateREF:p. 15 KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension 10. Therapeutic touch, Reiki, and Qigong are examples of: 1) Energy therapies. 2) Manipulative therapies. 3) Biologically based therapies. 4)
www.mynursingtestprep.comMindbody interventions. ANS: 1 Therapeutic touch, Reiki, and Qigong involve manipulation of energy fields and are classified as energy therapies. Manipulative therapies focus on body manipulation and movement to improve health. Biologically based therapies use substances found in nature, such as food, herbs, vitamins, and aromatherapy. Mindbody therapies are based on awareness of the unity of the mind and body and on the ability of social, familial, and economic factors to affect all aspects of health and illness. PTS: 1 DIF: Moderate REF: dm 15-17 KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. Which of the following beliefs is an essential component of holistic healthcare? Choose all that apply. 1) Illness occurs when there is a shift in an individuals balance. 2) Regardless of the type of care received, ultimately all healing is self-healing. 3) More healthcare resources should be focused on alternative healers. 4) Illness can create an opportunity for personal and spiritual growth. ANS: 1, 2, 4 Foundational beliefs of holistic care include the following: illness reflects a shift in balance, all healing is self-healing, and illness creates an opportunity for growth. Although holistic healthcare includes the use of alternative modalities, it does not emphasize the use of healthcare resources (money, time, etc.) for alternative healers. PTS: 1 DIF: Moderate REF: p. 3 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Synthesis 2. Which of the following complementary and alternative modalities may be considered alternative medical systems? Choose all that apply. 1) Acupuncture 2) Prayer 3) Ayurveda 4) Aromatherapy ANS: 1, 3 Acupuncture and Ayurveda are considered alternative medical systems. Prayer is a mindbody intervention, and aromatherapy is a biologically based therapy. PTS:1DIF:EasyREF:dm 5-7 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Comprehension 3. Which of the following are reasons for the popularity of biologically based therapies, such as dietary supplements and herbal products? Choose all that apply. 1) They are almost all readily available to consumers.
www.mynursingtestprep.com2) They can be practiced as self-care measures. 3) It is easy to know what dosage you are obtaining from a product. 4) Products on the market have been proven to be safe to use. ANS: 1, 2 Biologically based therapies use substances found in nature, such as food, herbs, vitamins, and aromatherapy. These therapies are readily available and are often practiced as self-care measures, so people who do not wish to see a practitioner may not need to do so. The U.S. Food and Drug Administration (FDA) regulates biologically based therapies and is developing guidelines for good manufacturing practices (GMPs). However, dosage and manufacturing processes are not standardized. The Federal Trade Commission monitors dietary supplements for truth in advertising. At present, it is difficult to know what dosage you are obtaining from a product, and safety cannot always be guaranteed. PTS:1DIF:ModerateREF:p. 10 KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Analysis 4. An elderly client with a history of COPD is having difficulty sleeping and does not wish to see a medical practitioner. Which of the following strategies should the nurse discourage the client from using, or urge him to see a physician before beginning the therapy? The client has not used any of these therapies in the past. Choose all that apply. 1) Aromatherapy 2) Tai chi 3) Yoga 4) Melatonin ANS: 3, 4 Aromatherapy is known to be safe, and may be effective. Tai chi is safe for older adults and may be effective for sleep. Yoga is possibly effective for sleep, but it is physically rigorous, so it has the potential to be harmful for older adults, who may have a variety of chronic conditions. The client should see a physician before beginning yoga. Melatonin is effective for certain sleep disorders, but it does interact with several prescription drugs. Therefore, the client should not take melatonin without consulting a physician. PTS:1DIFifficult REF: dm 9, 11, 14, 15; not stated directly in text: critical thinking required KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application Completion Complete each statement. • is the vital process of discovering meaning, purpose, fulfillment, and values in life. ANS: Spirituality PTS:1DIFifficultREF:p. 4 KEY:Nursing process: N/A | Client need: PSI | Cognitive level: Recall • , specifically for health reasons, is probably the most commonly used CAM therapy. ANS: Prayer
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