Ex 2

Match the nursing role listed on the left with the appropriate activity listed on the right. Each activity has only one correct answer. 1)Planning the unit's staffing schedule 2)Participating on a committee to develop a program to teach schoolchildren proper handwashing 3)Teaching the client about a scheduled test 4)Discussing new medication at a staff meeting 5)Discussing with the physician the client's reasons for not wanting the recommended surgery. ____ 1. Direct care provider ____ 2. Client advocate ____ 3. Manager ____ 4. Change agent

1.ANS:3PTS:1DIF:Moderate REF:p. 13; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Application 2.ANS:5PTS:1DIF:Moderate REF:p. 13; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Application 3.ANS:1PTS:1DIF:Moderate REF:p. 13; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Application 4.ANS:2PTS:1DIF:Moderate REF:p. 13; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Application

Match the nursing organization with its function in the nursing profession. 1)Responsible for setting and maintaining nursing education standards 2)Developed Code for Nurses and the Standards of Clinical Nursing Practice 3)Responsible for publishing the journal, Image 4)Honor society for nursing 5)Represents nursing and promotes nursing leadership worldwide ____ 11. American Nurses Association (ANA) ____ 12. National Student Nurses Association (NSNA) ____ 13. National League for Nursing (NLN) ____ 14. International Council of Nursing (ICN) ____ 15. Sigma Theta Tau International (STTI)

11. ANS: 2 PTS: 1 DIF: Moderate REF: p. 17 KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 12. ANS: 3 PTS: 1 DIF: Moderate REF: p. 17 KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 13. ANS: 1 PTS: 1 DIF: Moderate REF: p. 17 KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 14. ANS: 5 PTS: 1 DIF: Moderate REF: p. 17 KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 15. ANS: 4 PTS: 1 DIF: Moderate REF: p. 17 KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall

Match the event with the appropriate year. Each item has only one correct answer. 1)Nursing programs become affiliated with religious groups 2)Start of public health nursing with the founding of the Henry Street Settlement 3)First formal nursing education in United States 4)First hospital 5)Establishment of the Army Nursing Service 6)Disassociation of nursing from religious orders 7)Florence Nightingale cared for the soldiers of the Crimean War ____ 5. 1st-century AD ____ 6. 15th to 19th century ____ 7. 1854 ____ 8. 1861 ____ 9. 1873 ____ 10. 1893

5.ANS:4PTS:1DIFgrinifficult REF: pp. 6-11; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 6.ANS:6PTS:1DIFgrinifficult REF: pp. 6-11; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 7.ANS:7PTS:1DIFgrinifficult REF: pp. 6-11; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 8.ANS:5PTS:1DIFgrinifficult REF: pp. 6-11; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 9.ANS:3PTS:1DIFgrinifficult REF: pp. 6-11; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall 10.ANS:2PTS:1DIFgrinifficult REF: pp. 6-11; must recognize examples not provided in content KEY: Nursing process: N/A | Client need: N/A | Cognitive level: Recall

Which of the following nursing activities represent direct care? Choose all that apply. 1)Bathing a patient 2)Administering a medication 3)Documenting an assessment 4)Making work assignments for the shift

ANS: 1 Direct care involves personal interaction between the nurse and clients (e.g., giving medications, dressing a wound, or teaching a client about medicines or care). Nurses deliver indirect care when they work on behalf of an individual, group, family, or community to improve their health status (e.g., restocking the code blue cart [an emergency cart], ordering unit supplies, or arranging unit staffing).

Which of the following factors has the greatest positive effect on sleep quality? 1)Sleeping hours in synchrony with the person's circadian rhythm 2)Sleeping in a quiet environment 3)Spending additional time in stage IV of the sleep cycle 4)Napping frequently during the day hours

ANS: 1 A circadian rhythm is a biorhythm based on the day-night pattern in a 24-hour cycle. Sleep quality is best when the time at which the person goes to sleep and awakens is in synchrony with his circadian rhythm. Not all people require a quiet environment for sleep. Time spent in stage IV of the sleep cycle is affected by the total time spent asleep. Napping on and off throughout the day might disrupt the natural circadian rhythm with uninterrupted periods of sleep that cycle through the various stages of the sleep cycle. PTS:1DIF:ModerateREF:p. 1204

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:1DIFgrinifficultREF:p. 1511

All of the following are aspects of the full-spectrum nursing role. Which one is essential for the nurse to do in order to successfully carry out all the others? 1)Thinking and reasoning about the client's care 2)Providing hands-on client care 3)Carrying out physician orders 4)Delegating to assistive personnel

ANS: 1 A substantial portion of the nursing role involves using clinical judgment, critical thinking, and problem solving, which directly affect the care the client will actually receive. Providing hands-on care is important; however, clinical judgment, critical thinking, and problem solving are essential to do it successfully. Carrying out physician orders is a small part of a nurse's role; it, too, requires nursing assessment, planning, intervention, and evaluation. Many simple nursing tasks are being delegated to nursing assistive personnel; delegation requires careful analysis of patient status and the appropriateness of support personnel to deliver care. Another way to analyze this question is that none of the options of providing hands-on care, carrying out physician orders, and delegating to assistive personnel is required for the nurse to think and reason about a client's care; so the answer must be 1. PTS:1DIFgrinifficultREF: p. 11

The community health nurse has gathered data about the community. She identifies many weaknesses in the community health system that contribute to poor health outcomes. What should be her next step? 1)Prioritize the list of problems. 2)Validate the data. 3)Evaluate the effectiveness of the interventions. 4)Plan the care.

ANS: 1 After a thorough assessment, the nurse compiles a list of community strengths and weaknesses. Once this list is in place, the nurse must prioritize the list considering the client needs, funding, and political feasibility. PTS:1DIF:ModerateREF:p. 1507 KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Analysis

A home health nurse has called his patient to arrange an initial home visit and has driven to the home. What is the nurse's 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 patient's most important health needs. 4)Determine the patient's 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

Which of the following is an example of what traditional medicine and complementary and alternative medicine therapies have in common? 1)Both can produce adverse effects in some patients. 2)Both use prescription medications. 3)Both are usually reimbursed by insurance programs. 4)Both are regulated by the FDA.

ANS: 1 Both traditional and complementary therapies can produce adverse effects in some patients. Many medications are derived from herbs, but the alternative treatments usually use the herbs, not prescription medication. Insurance programs do not necessarily reimburse alternative treatments, because many are not supported by sound scientific research methodology. Alternative medications are not regulated by the FDA. PTS:1DIF:ModerateREF:p. 20

A community health nurse is evaluating the current health programs in the community. Which of these outcomes would indicate a healthy community? 1)Ninety percent of members report adequate access to primary care services. 2)Immunization services are available at hospitals and clinics. 3)Affordable housing in the community is under construction. 4)Mortality rates have been stable over the past 5 years.

ANS: 1 Evidence of health in a community can be judged by examining progress in the focus areas delineated in Healthy People 2020. Access to primary care services is a measurable outcome that provides evidence of effectiveness of health programs. The availability of immunization services at the hospital or at many offices does not provide evidence that these services are being utilized. Similarly, the fact that affordable housing is under construction does not mean that it is being accepted and used or that enough is being built. Mortality rates may be stable but could be quite high and within unacceptable parameters. PTS:1DIFgrinifficultREF:p. 1500

Which of the following contributions of Florence Nightingale had an immediate impact on improving patients' health? 1)Providing a clean environment 2)Improving nursing education 3)Changing the delivery of care in hospitals 4)Establishing nursing as a distinct profession

ANS: 1 Improved sanitation (a clean environment) greatly and immediately reduced the rate of infection and mortality in hospitals. The other responses are all activities of Florence Nightingale that improved healthcare or nursing, but the impact is long range, not immediate. PTS: 1 DIF: Easy REF: V1, p. 3; student must infer from content | V1, p. 10; student must infer from content KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Application

A nurse observes a nursing assistant (NAP) fail to wash her hands before and after placing a patient on a bedpan. When giving negative feedback to the NAP, the nurse should: 1)Be certain to offer constructive criticism about the task and do so in private. 2)Ask the unit manager to be present to document responses of both parties. 3)Call a meeting of all NAPs and stress hand washing to the entire group. 4)Keep a record of the NAP's actions and save them for her annual formal review

ANS: 1 It is important to provide negative feedback in private. It is not necessary for the nurse manager to be present because staff nurses are responsible for delegating to and supervision of NAPs. The nurse should not call a meeting. It would be a waste of time for those who are already washing their hands properly, and it dilutes the effect of the feedback to the NAP who is not washing her hands. She might think, "Oh, everybody does it; no big deal." It is important to allow some time every day for timely feedback. This allows the worker to know what she is doing right and wrong, and allows her to make corrective actions. The nurse should not allow this NAP to continue with her hand washing errors until her annual formal review because this can pose a threat to patient safety and increase the risk of transmitting infectious microbes.

Nurses have the potential to be very influential in shaping healthcare policy. Which of the following factors contributes most to nurses' influence? 1)Nurses are the largest health professional group. 2)Nurses have a long history of serving the public. 3)Nurses have achieved some independence from physicians in recent years. 4)Political involvement has helped refute negative images portrayed in the media.

ANS: 1 Nurses are trusted professionals and the largest health professional group. As such, they have political power to effect changes. If nursing were a small group, there would be little potential for power in shaping policies, even if all the other answers were true. Serving the public, while positive, does not necessarily help nurses to be influential in establishing health policy. Independence from physicians, although positive, does not necessarily make nurses influential in establishing healthcare policy. Refuting negative media, although positive, does not necessarily make nurses influential in establishing healthcare policy. PTS: 1 DIF: Moderate REF: p. 21

Patterns of waking behavior that appear during sleep are known as: 1)Parasomnias. 2)Dyssomnias. 3)Insomnia. 4)Hypersomnia.

ANS: 1 Parasomnias are patterns of waking behavior that appear during sleep. Sleepwalking, sleep talking, and bruxism are parasomnias. PTS: 1 DIF: Easy REF: p. 1208

A nurse serving the community in a public health role would likely perform which of the following functions within a particular community? 1)Tracking the prevalence of gonorrhea between January and June 2)Screening for scoliosis among 12- to 14-year-old girls in middle school 3)Weighing premature infants receiving phototherapy at home 4)Giving the H1N1 vaccine to fire and police personnel

ANS: 1 Public health nursing focuses on the community at large and the eventual effect of the community's 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

The primary focus of your interventions for a 6-year-old child who sleepwalks would be to: 1)Maintain patient safety during episodes of somnambulation. 2)Administer and teach about medications to suppress stage IV sleep. 3)Encourage the child to verbalize feelings regarding sleep pattern. 4)Provide a quiet environment for nighttime sleep.

ANS: 1 Sleepwalking places the patient at Risk for Injury because of his lack of awareness of the surroundings. The nurse's primary intervention would be to protect the patient from injury (e.g., falls) while sleepwalking, also called somnambulation. Because the child is only 6 years old, administering and teaching about medications and having him verbalize feelings would not be useful. Providing a quiet environment would likely be ineffective and certainly not the focus of interventions. PTS:1DIF:ModerateREF:p. 1211

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)Securely 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

The surgical unit is experiencing difficulty recruiting new RNs, although the hospital has an excellent reputation in the community and has no difficulty recruiting nurses for other units. A task force has been formed, consisting of one nurse from each shift on the unit, the unit manager, and the hospital nurse recruiter. The group has gathered data and identified the problem. What is the next step in this process? 1)Generate possible solutions. 2)Evaluate whether the problem has been resolved. 3)Implement the solution changes. 4)Evaluate suggested solutions.

ANS: 1 The next step in the process is to generate possible solutions. Once several possibilities have been identified, each of the suggested solutions should be evaluated. From among that list, the best solution is chosen and then implemented. Finally, the task force critiques the process by evaluating whether the problem has been resolved.

Which healthcare worker should the nurse consult to counsel a patient about financial and family stressors affecting healthcare? 1)Social worker 2)Occupational therapist 3)Physician's assistant 4)Technologist

ANS: 1 The social worker coordinates services and counsels patients about financial, housing, marital, and family issues affecting healthcare. The occupational therapist helps patients regain function and independence for activities of daily living. Physician's assistants work under the physician's direction to diagnose certain diseases and injuries. Technologists provide a variety of specific functions in hospitals, diagnostic centers, and emergency care. For example, laboratory technologists aid in the diagnosis and treatment of patients by examining blood, urine, tissue, and body fluids. Radiology technologists perform x-rays and other diagnostic testing. PTS:1DIF:ModerateREF:ESG, Chapter 1, "Healthcare Delivery Systems—Expanded Discussion," "What Healthcare Providers Will You Work With?"

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. "I'm so busy taking care of my dad. It's 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

A nurse with 2 years' experience frequently appears stressed and has difficulty completing his work. He is clocking out 30 to 45 minutes late every day, even when his assignment load is light. The charge nurse describes his problem as "running from one duty to the next and having no organization or daily routine." Which situation most likely describes this nurse? 1)Has time management problems 2)Has a heavy patient load 3)Works at a hospital that is understaffed 4)Is in a management position

ANS: 1 This nurse most likely has trouble managing his time. Time management entails setting your own goals and organizing your work. Although there will be difficult days, the nurse who consistently finishes late and has no organization to his daily schedule has a problem managing time. Time management includes efficiently meeting clients' care needs during a nursing shift and organizing one's workload.

A patient who underwent a total abdominal hysterectomy is assisted out of bed as soon as her vital signs are stable. This intervention is most likely being directed by a 1)Critical pathway 2)Nursing care plan 3)Case manager 4)Traditional care model

ANS: 1 This patient's care is most likely being directed by a critical pathway. A critical pathway is a multidisciplinary approach to care that sequences interventions over a length of stay for a given case type, such as total abdominal hysterectomy. Using this model, the patient can be assisted out of bed as soon as her vital signs are stable. Using the traditional model, the nurse would have to obtain a physician's order to assist the patient out of bed after surgery. The nursing care plan guides nursing care but cannot specify when the patient can get out of bed postoperatively without a physician's order. When case management is used, care is coordinated by the case manager across the healthcare setting, but the case manager does not direct each care intervention. PTS:1DIF:ModerateREF:ESG, Chapter 1, "Healthcare Delivery Systems—Expanded Discussion," "Issues Related to Healthcare Reform"

During which of the following developmental stages does a person tend to need the most hours of sleep? 1)Toddler 2)Adolescence 3)Middle adulthood 4)Older adulthood

ANS: 1 Toddlers (ages 1 to 3 years) require 12 to 14 hours of sleep in a 24-hour period. Adolescents (ages 12 to 18 years) usually need 8 to 9 hours in a 24-hour period. Middle-aged adults (ages 40 to 65 years) typically require 7 hours in a 24-hour period. Older adults (age 65 years and older) often need 5 to 7 hours of sleep in a 24-hour period. PTS:1DIF:EasyREF:p. 1204

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 reflect the health concerns of the population. PTS:1DIF:ModerateREF:p. 1506

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

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 patient's 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

Select the factors known to affect sleep. Choose all that apply. 1)Age 2)Environment 3)Lifestyle 4)State of health 5)Ethnicity

ANS: 1, 2, 3, 4 Age, environment, lifestyle, and state of health are factors affecting sleep. Many older adults sleep less but require more rest. Alcohol, caffeine, nicotine use, and diet are examples of lifestyle factors that affect sleep. When a person is ill, she may sleep more or find that she cannot sleep because of pain or other factors associated with illness. Changes in environment also affect sleep. PTS:1DIF:EasyREF:pp. 1207-1208

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. PTS: 1 DIF: Easy REF: pp. 1501-1503

Which of the following activities is/are involved when delegating tasks to other members of the nursing team? Choose all that apply. 1)Supervising patient care that is given 2)Determining the skill mix of unit personnel 3)Assessing the needs of the clients involved 4)Deciding which tasks to assign to a team member

ANS: 1, 2, 3, 4 Delegation of patient care tasks to other healthcare workers is one of the most important responsibilities of the registered nurse. When delegating tasks, the nurse must take into consideration the skills and competency of the team members as well as the condition and needs of the clients receiving care. The nurse is also responsible for supervising patient care to ensure that it is competently delivered.

Which of the following are characteristics of an effective nurse manager? Choose all that apply. 1)Clinical expertise 2)Business sense 3)Master's degree 4)Leadership skills

ANS: 1, 2, 4 An effective nurse manager possesses a combination of qualities: leadership skills, clinical expertise, and business sense. It is the combination of all these that prepares a person for the complex task of managing a group or team of healthcare providers. The extent of education that a person has does not determine her effectiveness as a manager.

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)Respite 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

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:pp. 1500-1501 KEY: Nursing process: Assessment | Client need: Physiological Integrity | Cognitive level: Application

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

An experienced nurse serves as a mentor to a new graduate. Which of the following are responsibilities of the person being mentored? Choose all that apply. 1)Demonstrates an ability to move toward independence 2)Has the ability to encourage excellence in others 3)Seeks feedback and uses it to modify behaviors 4)Demonstrates flexibility and an ability to change

ANS: 1, 3, 4 The ability to encourage excellence in others is a responsibility of the mentor. Responsibilities of the person being mentored are the following: demonstrates an ability to move toward independence; seeks feedback and uses it to modify behaviors; and demonstrates flexibility and an ability to change.

Which of the following are examples of a health-promotion activity? Select all that apply. 1)Helping a client develop a plan for a low-fat, low-cholesterol diet 2)Disinfecting an abraded knee after a child falls off a bicycle 3)Administering a tetanus vaccination after an injury from a car accident 4)Distributing educational brochures about the benefits of exercise

ANS: 1, 4 Health promotion includes strategies that promote positive lifestyle changes. Disinfecting an abraded knee is a treatment/intervention for an injury. Administering a vaccination is a disease-prevention and treatment activity. PTS: 1 DIF: Moderate REF: p. 18; high-level question, not directly stated in text KEY: Nursing process: N/A | Client need: HPM | Cognitive level: Application

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

An 80-year-old patient fell and fractured her hip and is in the hospital. Before the fall, she lived at home with her husband and managed their activities of daily living very well. The goal is for the patient to recover from the injury and return to her home. The hospital is ready to discharge her because she has exceeded the recommended length of stay in a hospital. However, she cannot walk or care for herself yet, and she will require lengthy physical therapy and further monitoring of her medications and her physical and mental status. To which type of facility should she be transferred? 1)Nursing home 2)Rehabilitation center 3)Outpatient therapy center 4)None of these; she should receive home healthcare

ANS: 2 A skilled nursing facility primarily provides skilled nursing care for patients who can be expected to improve with treatment. For example, a patient who no longer needs hospitalization may transfer to a skilled nursing facility to get skilled care until she is able to return home. A nursing home provides custodial care for people, like this patient, who cannot live on their own but who are not sick enough to require hospitalization. It provides a room, custodial care, and opportunity for recreation. This patient cannot ambulate or perform activities of daily living, so outpatient therapy and home care would not be appropriate. PTS:1DIF:ModerateREF:p. 18 KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Application

What is the purpose of using a sleep diary? 1)Identify sleep-rest patterns over a 1-year period. 2)Note the trend in sleep-wakefulness patterns over a 2-week period. 3)Note typical sleep habits and most common daily routines. 4)Examine the patterns of sleep during the night and naps during the day.

ANS: 2 A sleep diary provides specific information about the patient's sleep-wakefulness patterns over a certain period of time. It allows identification of trends in sleep-wakefulness patterns and associates specific behaviors interfering with sleep. The diary is typically kept for 14 days. PTS: 1 DIF: Moderate REF: p. 1212

Of the following, the biggest disadvantage of having nursing assistive personnel (NAP) help nurses is that the nurse 1)Must know what aspects of care can legally and safely be delegated to the NAP 2)May rely too heavily on information gathered by the NAP when making patient care decisions 3)Is removed from many components of direct patient care that have been delegated to the NAP 4)Still maintains responsibility for the patient care given by the NAP

ANS: 2 All of the options may be disadvantages to using NAPs, but making decisions based on another's information is the greatest drawback because of the potential for negatively affecting patient care. Treatment decisions based on incorrect information may cause harm to the patient. PTS:1DIFgrinifficultREF:p. 20-21; students must conclude from content

A patient tells you that she has trouble falling asleep at night, even though she is very tired. A review of symptoms reveals no physical problems and she takes no medication. She has recently quit smoking, is trying to eat healthier foods, and has started a moderate-intensity exercise program. Her sleep history reveals no changes in bedtime routine, stress level, or environment. Based on this information, the most appropriate nursing diagnosis would be Disturbed Sleep Pattern related to: 1)Increased exercise. 2)Nicotine withdrawal. 3)Caffeine intake. 4)Environmental changes.

ANS: 2 Based on the information given, the patient is not experiencing significant stress or change in sleep routine or environment, which commonly lead to insomnia. People who use nicotine tend to have more difficulty falling asleep and are more easily aroused than those who are nicotine free. People who stop smoking often experience temporary sleep disturbances during the withdrawal period. PTS:1DIF:ModerateREF:p. 1208

Theories that focus on what the leader does are called: 1)Trait theories. 2)Behavioral theories. 3)Situational theories. 4)Transformational theories.

ANS: 2 Behavioral theories are concerned with what a leader does, whereas trait theories are concerned with what a leader is. Situational theories recognize that each situation is different and that leaders must consider a number of factors when deciding how to take action. Transformational theories focus on the ability of the leader to communicate her vision in such a way that it inspires commitment among workers.

The American Red Cross was established by 1)Louisa May Alcott 2)Clara Barton 3)Dorothea Dix 4)Harriet Tubman

ANS: 2 Clara Barton was an American teacher, nurse, and humanitarian who organized the American Red Cross after the Civil War. Louisa May Alcott was an American novelist who wrote Little Women in 1868. Dorothea Dix was an American activist who acted on behalf of the indigent population with mental illness. She was credited for establishing the first psychiatric institution. Harriet Tubman was an African American abolitionist and Union spy during the Civil War. After escaping captivity, she set up a network of antislavery activists, known as the Underground Railroad. PTS:1DIF:EasyREF:p. 10

Which statement pertaining to Benner's practice model for clinical competence is true? 1)Progression through the stages is constant, with most nurses reaching the proficient stage. 2)Progression through the stages involves continual development of thinking and technical skills. 3)The nurse must have experience in many areas before being considered an expert. 4)The nurse's progress through the stages is determined by years of experience and skills.

ANS: 2 Movement through the stages is not constant. Benner's model is based on integration of knowledge, technical skill, and intuition in the development of clinical wisdom. The model does not mention experience in many areas. The model does not mention years of experience. PTS:1DIF:ModerateREF:p. 15

The similarities between the Omaha System and the NANDA-I taxonomy are that both contain which of the following? 1)Evaluation tools expressed in standardized language 2)Nursing diagnoses expressed in standardized language 3)Diagnoses, outcomes, and interventions 4)Labels that are intended for use in any healthcare setting

ANS: 2 NANDA-I and the Omaha System both contain nursing diagnoses expressed in standardized language. The Omaha System also contains outcomes and interventions. The Omaha System was developed for use in community settings, whereas NANDA-I may be used in all settings. PTS:1DIF:ModerateREF:p. 1507 KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level: Analysis

Which of the following is considered a primary care service? 1)Providing wound care 2)Administering childhood immunizations 3)Providing drug rehabilitation 4)Outpatient hernia repair

ANS: 2 Primary care services focus on health promotion and disease prevention; administering childhood immunizations is one such service. Providing wound care and drug rehabilitation are examples of tertiary care services. Outpatient hernia repair surgery is an example of a secondary care service. PTS:1DIF:ModerateREF:ESG, Chapter 1, "Healthcare Delivery Systems—Expanded Discussion," "Categories of Healthcare?"

When making rounds on the night shift, the nurse observes her patient to be in deep sleep. His muscles are very relaxed. When he arouses as the nurse changes the IV tubing, he is confused. What stage of sleep was the patient most likely experiencing? 1)Stage V 2)Stage IV 3)Stage III 4)REM

ANS: 2 Stage IV is the deepest sleep. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. It is difficult to awaken someone in stage IV sleep; if awakened, the person may appear confused and react slowly. During this stage, the body releases human growth hormone, which is essential for repair and renewal of brain and other cells. PTS:1DIF:EasyREF:p. 1206

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

Which of the following best explains why it is difficult for the profession to develop a definition of nursing? 1)There are too many different and conflicting images of nurses. 2)There are constant changes in healthcare and the activities of nurses. 3)There is disagreement among the different nursing organizations. 4)There are different education pathways and levels of practice.

ANS: 2 The conflicting images of nursing make it more important to develop a definition; they may also make it more difficult, but not to the extent that constant change does. Healthcare is constantly changing and with it come changes in where, how, and what nursing care is delivered. Constant changes make it difficult to develop a definition. Although different nursing organizations have different definitions, they are similar in most ways. The different education pathways affect entry into practice, not the definition of nursing. PTS: 1 DIF: Moderate REF: p. 11; "How Is Nursing Defined?"

What is the first stage of the complex process of change? 1)Recognizing resistance 2)Unfreezing 3)Forming a comfort zone 4)Actively resisting

ANS: 2 The first stage in the change process is unfreezing. In this stage, the person leaves the stable comfort zone that has existed and begins to make changes. Recognizing resistance and actively resisting are activities associated with change, but they are not the first stage of the process.

The manager is conducting an informal negotiation between two staff members who have had ongoing difficulty working together peacefully. Most recently there was an argument about who would be scheduled for first lunch each day. At this stage of the informal negotiation, the manager is focusing on managing the emotions and setting the ground rules. Which stage does this demonstrate? 1)Setting the stage 2)Conducting the negotiation 3)Making offers and counteroffers 4)Agreeing on resolution of the conflict

ANS: 2 The manager has begun conducting informal negotiation. This includes managing the emotions, setting ground rules, and clarifying the problem. The first step of conflict resolution is introspective and is similar to data gathering. The negotiator thinks, "What am I trying to achieve? What problems am I likely to encounter?" The next step, setting the stage, may involve confronting the two parties with their behavior toward one another and making direct statements designed to open communication and challenge them to seek resolution of the situation. After conducting the negotiation, the parties move to making offers and counteroffers, and then to agreeing on the resolution of the conflict.

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. What components of the community must the community health nurse assess prior to beginning her new assignment? 1)Income levels, health status, and relationships among groups 2)Structure of the tracts, effectiveness of the community, and current status 3)Number of clients with health problems compared to the number of healthcare providers 4)Community organizations and beliefs about their role in the community

ANS: 2 To understand a community and its needs, the nurse must assess the community's structure, status (the biological, social, and emotional outcome components of the community), and process (overall effectiveness of the community). Income level and demographic data, such as community organizations and healthcare providers, are included in the assessment of the community structure. The number of clients with health problems is only a part of the assessment of the community status. PTS:1DIFgrinifficultREF:p. 1500

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

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

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 community's 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

A mother expresses concern that her 7-year-old has episodes of nocturnal enuresis approximately 3 to 4 times per week. The nurse's best response would be which of the following? Choose all that apply. 1)"Your daughter's bladder is still developing at this point in her life." 2)"Be patient; most children outgrow enuresis." 3)"Wake your daughter every 4 hours to use the bathroom." 4)"You might consider purchasing protective pads for the bed." 5)"Try a bed alarm to wake her when she starts wetting the bed at night."

ANS: 2, 4 Enuresis is nighttime incontinence past the stage at which toilet training has been well established. Most incidents occur during NREM sleep when the child is difficult to arouse. As the great majority of children outgrow enuresis, the best strategy is patience. In the meantime, protecting the mattress from moisture and odor will help reduce frustration and embarrassment. A bed alarm can be used for older children (typically older than age 10 or 12) who are resistant to other behavioral strategies. PTS:1DIF:ModerateREF:p. 1211

A person who is deprived of REM sleep for several nights in succession will usually experience: 1)Extended NREM sleep. 2)Paradoxical sleep. 3)REM rebound. 4)Insomnia.

ANS: 3 A person who is deprived of REM sleep for several nights will usually experience REM rebound. The person will spend a greater amount of time in REM sleep on successive nights, generally keeping the total amount of REM sleep constant over time. PTS:1DIF:ModerateREF:p. 1205

The inhabitants of Yulupa, California, form which of the following? 1)Aggregate 2)Community 3)Population 4)Vulnerable population

ANS: 3 A population is all of the people inhabiting a specified area. In contrast, a community is a group of like-minded individuals or one whose members have a common purpose, and an aggregate has shared characteristics. A vulnerable population is an aggregate with increased risk for poor health outcomes. PTS: 1 DIF: Moderate REF: p. 1499

A graduate nurse completed her nursing education 3 weeks ago and has just begun work at the local hospital. She is orienting to her new position with an experienced nurse, one who has been an RN for 15 years and an employee at the hospital for 7 years. She will provide guidance and practical teaching to the new graduate as she assumes a new position in the nursing unit. What role is the experienced RN assuming? 1)Mentor 2)Manager 3)Preceptor 4)Leader

ANS: 3 A preceptor is someone with more experience who provides practical teaching and guidance for a student or new employee. In contrast, a mentor is someone more experienced who provides career development information and serves as a role model. A manager is an employee of an organization who has the power, authority, and responsibility for planning, organizing, coordinating, and directing the work of others. A leader is someone who has the ability to influence others and commit them to action.

Which of the following is an example of an illness prevention activity? Select all that apply. 1)Encouraging the use of a food diary 2)Joining a cancer support group 3)Administering immunization for HPV 4)Teaching a diabetic patient about his diet

ANS: 3 Administering immunization for HPV is an example of illness prevention. Although cancer is a disease, it is assumed that a person joining a support group would already have the disease; therefore, this is not disease prevention but treatment. Illness-prevention activities focus on avoiding a specific disease. A food diary is a health-promotion activity. Teaching a diabetic patient about diet is a treatment for diabetes; the patient already has diabetes, so it cannot prevent diabetes. PTS: 1 DIF: Moderate REF: p. 18; high-level question, not directly stated in text KEY: Nursing process: N/A | Client need: HPM | Cognitive level: Application

Which of the following unique aspects of home care do Medicare reimbursement regulations require that the nurse include in documentation? 1)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

The community health nurse is working with the residents of government-subsidized senior housing. She meets with them regularly to discuss concerns and evaluate whether they receive healthcare that meets their needs. Which of the following nursing roles best describes these actions? 1)Case manager 2)Client advocate 3)Collaborator 4)Counselor 5)Educator

ANS: 3 As a collaborator, the nurse forges partnerships and coalitions that can effectively address common concerns among different communities. In this role, the nurse facilitates discussion to work toward problem resolution. As a case manager, the nurse makes referrals to or collaborates with other health and social agencies. In the client advocate role, the nurse supports the identified or voiced concerns of the client or community. As an educator, the nurse focuses on wellness and disease prevention through patient teaching. A counselor offers practical solutions to resolve problems. PTS:1DIF:ModerateREF:p. 1502

From what stage of sleep are people typically most difficult to arouse? 1)NREM, alpha waves 2)NREM, sleep spindles 3)NREM, delta waves 4)REM

ANS: 3 Contrary to previous beliefs, stages III and IV of NREM (delta wave) are the deepest stages of sleep—not REM. It is difficult to awaken someone in stage IV slow wave NREM sleep, and if she is awakened, the person may appear confused and react slowly. Stage I NREM is a light sleep from which the sleeper can easily be awakened. Stage II (sleep spindles) is also light sleep; the sleeper in this stage is easily roused. REM sleep is the stage at which most dream activity occurs, as well as more spontaneous awakenings. PTS:1DIF:ModerateREF:p. 1205

Which of the following is the main difference between sleep and rest? 1)In sleep, the body may respond to external stimuli. 2)Short periods of sleep do not restore the body as much as do short periods of rest. 3)Sleep is characterized by an altered level of consciousness. 4)The metabolism slows less during sleep than during rest.

ANS: 3 During rest, the mind remains active and conscious; sleep is characterized by altered consciousness. Sleep is a cyclic state of decreased motor activity and perception. A sleeping person is unaware of the environment and does respond selectively to certain external stimuli. However, at rest, the body is disturbed by all external stimuli; sleep restores the body more than does rest. The metabolism decreases more during sleep than during rest. PTS:1DIF:EasyREF:p. 1202

An expert nurse feels confident in her role as a clinician on the unit. The nurse enjoys her work and feels in charge of her career. Which leadership state is she experiencing? 1)Power-based authority 2)Effective management skills 3)Empowerment in her role 4)Followership skills

ANS: 3 Empowerment is a psychological state, a feeling of competence, control, and entitlement that a person experiences. Empowerment refers to feelings, whereas power refers to action. The person who feels empowered has feelings of self-determination, meaning, competence, and impact. This nurse may have power on the unit because of her expertise, but there is no evidence that she is an authority figure. Empowerment is not always associated with management. Managers have authority by virtue of their position but do not always thrive in that role. There is not enough information in the scenario to judge the nurse's followership skills.

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 setting. 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

A patient states that many of his friends told him to ask for Valium or Ativan to help him sleep while hospitalized. The nurse knows that nonbenzodiazepines (such as Ambien) are often preferred over benzodiazepines (Ativan or Valium). Why is this? 1)Benzodiazepines are eliminated from the body faster than are nonbenzodiazepines, so they do not provide a full night of sleep. 2)Nonbenzodiazepines cause daytime sleepiness, allowing people to rest throughout the day. 3)Benzodiazepines produce daytime sleepiness and alter the sleep cycle. 4)Nonbenzodiazepines remain in the body longer than do benzodiazepines.

ANS: 3 Nonbenzodiazepines (such as Ambien) have a short half-life, which means that they are eliminated from the body quickly and do not cause daytime sleepiness. Ativan is a long-acting benzodiazepine and remains in the body longer than Ambien, often causing daytime sleepiness. PTS: 1 DIF: Moderate REF: p. 1215

Within the past month, there has been a change in the nursing documentation requirements at the hospital. The nurses have been trained in the new requirements and are documenting as requested, with the exception of one nurse. This nurse has been unable to attend any of the documentation in-service meetings and has been too busy to attend a private training session with the nurse manager. Meanwhile, she continues to use the old documentation process. What do the nurse's actions illustrate? 1)Unfreezing 2)Active resistance 3)Passive resistance 4)Comfort zone

ANS: 3 Passive resistance behaviors include avoidance; canceling appointments to discuss implementing change; being "too busy" to make the change; agreeing to the change but doing nothing to change; and simply ignoring the entire process as much as possible. In the above situation, the nurse is not actively refusing to comply with the new documentation requirements; however, her actions are a passive approach to resisting change. When a person knows what to expect and how to deal with whatever problems arise in the course of a day, that person is operating within her "comfort zone." The first stage in the change process is when the person begins moving out of the comfort zone, unfreezing. This nurse is resisting, not unfreezing.

Which type of managed care allows patients the greatest choice of providers, medications, and medical devices? 1)Health maintenance organization 2)Integrated delivery network 3)Preferred provider organization 4)Employment-based private insurance

ANS: 3 Preferred provider organizations are a form of managed care that allows the patient a greater choice of providers, medications, and medical devices within the designated list. Health maintenance organizations allow the patient to choose a primary care provider within the organization to coordinate his care. This type of program will only reimburse medical care when the patient has first obtained a referral from the primary provider. Integrated delivery networks combine providers, healthcare facilities, pharmaceuticals, and services into one system, and the patient must remain within the system to receive care. Employment-based private insurance is not a managed care organization. PTS:1DIF:EasyREF:ESG, Chapter 1, "Healthcare Delivery Systems, Expanded Discussion," "How Do Healthcare Policy and Reform Efforts Affect Care?"

Which of the following provides evidence-based support for the contribution that advanced practice nurses (APNs) make within healthcare? 1)Reduced usage of diagnostics using advanced technology 2)Decreased number of unnecessary visits to the emergency department 3)Improved patient compliance with prescribed treatments 4)Increased usage of complementary alternative therapies

ANS: 3 Studies demonstrate that APNs have improved patient outcomes over those of physicians, including increased patient understanding and cooperation with treatments and decreased need for hospitalizations. No well-known, scientific studies support APNs' effect on the use of advanced technology. No well-known, scientific studies support APNs' effect on the frequency of emergency department visits. No well-known, scientific studies support APNs' effect on the use of alternative therapies. PTS:1DIF:ModerateREF:p. 20

Nursing was described as a distinct occupation in the sacred books of which faith? 1)Buddhism 2)Christianity 3)Hinduism 4)Judaism

ANS: 3 The Vedas, the sacred books of the Hindu faith, described Indian healthcare practices and were the earliest writings of a distinct nursing occupation. PTS:1DIF:EasyREF:p. 7

The nurse in the intensive care unit is providing care for only one patient, who was admitted in septic shock. Based on this information, which care delivery model can you infer that this nurse is following? 1)Functional 2)Primary 3)Case method 4)Team

ANS: 3 The nurse is following the case method model of nursing care. In this model, one nurse cares for one patient during a single shift. When the functional nursing model is employed, care is compartmentalized, and each task is assigned to a staff member with the appropriate knowledge and skills. In primary nursing, one nurse plans the care for a group of patients round-the-clock. The primary nurse assesses the patient and develops the plan of care. When he or she is working, he or she provides care for those patients that he or she is responsible for. In his or her absence, the associate nurses deliver care. Although the nurse in this case could possibly be a primary nurse, there are not enough data to confidently infer that. If the team nursing approach is utilized, a licensed nurse (RN or LVN) is paired with a nursing assistant. The pair is then assigned to a group of patients. PTS:1DIF:ModerateREF:ESG, Chapter 1, "Healthcare Delivery Systems—Expanded Discussion," "What Models of Care Are Used to Provide Nursing Care?"

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

What is the most influential factor that has shaped the nursing profession? 1)Physicians' need for handmaidens 2)Societal need for healthcare outside the home 3)Military demand for nurses in the field 4)Germ theory influence on sanitation

ANS: 3 Throughout the centuries, stability of the government has been related to the success of the military to protect or extend its domain. As the survival and well-being of soldiers is critical, nurses provided healthcare to the sick and injured at the battle site. The physician's handmaiden was/is a nursing stereotype rather than an influence on nursing. Although there has been need for healthcare outside the home throughout history, this has more influence on the development of hospitals than on nursing; this need provided one more setting for nursing work. Germ theory and sanitation helped to improve healthcare but did not shape nursing. PTS: 1 DIF: Moderate REF: pp. 9-10 KEY: Nursing process: N/A Client need: N/A | Cognitive level: Recall

A community health nurse gathers information about how individuals in a low-income neighborhood perceive the community and its state of health. Which of the following assessment strategies would be appropriate? 1)Conducting a windshield survey while driving 2)Reviewing a multitude of community databases 3)Interviewing residents living on every fifth block 4)Analyzing demographic data on the community

ANS: 3 To assess community perceptions, the nurse will need to interact with a cross-section of the community. Interviewing residents is one way to find out about community concerns and opinions. The other methods are assessment strategies that will provide data about the community but do not offer information on how community members view the community. PTS:1DIF:ModerateREF:pp. 1506-1507

The patient is diagnosed with obstructive sleep apnea. Identify the symptoms you would expect the client to exhibit. Choose all that apply. 1)Bruxism 2)Enuresis 3)Daytime fatigue 4)Snoring 5)Drooling

ANS: 3, 4 Obstructive sleep apnea is caused by partial airway occlusion (usually by the tongue or palate) during sleep. The patient experiences interrupted sleep as he arouses frequently to clear the airway. As a result, the patient has episodes of snoring and daytime fatigue. PTS:1DIF:ModerateREF:p. 1210

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. 1)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 nurse's 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:pp. 1514-1515

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 patient's needs. Which 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 client's 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 client's 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

An older adult has type 1 diabetes. He can perform self-care activities but needs help with shopping and meal preparation as well as with blood glucose monitoring and insulin administration. Which type of healthcare facility would be most appropriate for him? 1)Acute care facility 2)Ambulatory care facility 3)Extended care facility 4)Assisted living facility

ANS: 4 Assisted living facilities are intended for those who are able to perform self-care activities but who require assistance with meals, housekeeping, or medications. Acute care facilities focus on preventing illnesses and treating acute problems. These facilities include physicians' offices, clinics, and diagnostic centers. Ambulatory care facilities provide outpatient care. Clients live at home or in nonhospital settings and come to the site for care. Ambulatory care facilities include private health and medical offices, clinics, surgery centers, and outpatient therapy centers. Extended care facilities typically provide long-term care, rehabilitation, wound care, and ongoing monitoring of patient conditions. PTS:1DIF:EasyREF:p. 18; ESG, Chapter 1, "Healthcare Delivery Systems—Expanded Discussion," "Where is Healthcare Provided?"

At a home visit, the nurse asks the patient, "Have you taken your blood pressure medicine today?" The patient replies, "I don't 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 today's 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 organizer—and, 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:1DIFgrinifficult

Which patient teaching would be most therapeutic for someone with sleep disturbance? 1)Give yourself at least 60 minutes to fall asleep. 2)Avoid eating carbohydrates before going to sleep. 3)Catch up on sleep by napping or sleeping in when possible. 4)Do not go to bed feeling upset about a conflict.

ANS: 4 Intense emotion before bedtime can interfere with rest and sleep. Lying awake longer than 30 minutes is counterproductive. Eating a small amount of a complex carbohydrate can aid in falling asleep. Avoid simple sugars because sucrose can lead to a short-term energy boost instead of relaxation. Taking naps during the day and sleeping late on some mornings can actually exacerbate a sleep disturbance. It's better to establish a consistent routine for wake and sleep. The extra sleep during the day can interfere with the body's readiness for sleep at night. PTS:1DIF:EasyREF:pp. 1207-1208

Which of the following is the most important reason to develop a definition of nursing? 1)Recruit more informed people into the nursing profession 2)Evaluate the degree of role satisfaction 3)Dispel the stereotypical images of nurses and nursing 4)Differentiate nursing activities from those of other health professionals

ANS: 4 Nursing organization leaders think it is important to develop a definition of nursing to bring value and understanding to the profession, differentiate nursing activities from those of other health professionals, and help student nurses understand what is expected of them. A definition of nursing would not be likely to increase the number of informed people recruited into nursing. A definition of nursing would do little to improve the nurse's role satisfaction. Although a definition of nursing might contribute to fighting stereotypes of nursing, other, more powerful influences (e.g., media portrayals) exist to counteract it. PTS:1DIF:EasyREF:V1, pp. 11-13; students must infer from content

The physical therapy department and the nursing department at a local rehabilitation hospital are in conflict over which department is responsible for transporting patients to and from therapy appointments. The members of the therapy department state they do not have sufficient time to come to the nursing unit to pick up the patients and that patients often are not ready to be transported. Nursing staff members state that they do not have the time to transport the patients from the unit and this leaves a shortage of nursing personnel on the floor. Managers from both departments have attempted to resolve the conflict with input from nursing and therapy staff members. All attempts at conflict resolution have failed. What is the next step the managers should take? 1)Inform the nurses that they must take the patients to and from therapy. 2) Inform the therapists that they must take the patients to and from therapy. 3)Ask the hospital administrator to make an unbiased decision. 4)Begin informal negotiation between the two departments.

ANS: 4 One of a manager's responsibilities is to function as an informal negotiator when a resolution to conflict cannot be reached.

What is the type of nursing with a focus on the community as a whole and the health status of individuals as an aggregate? 1)School nursing 2)Community health nursing 3)Community-oriented nursing 4)Public health nursing

ANS: 4 Public health nursing focuses on the community at large and the eventual effect of the community's health status on the health of individuals, families, and groups. Community health nursing focuses on the health of individuals, families, and groups and on how their health affects the health of the community. Community-oriented care combines elements of community health nursing and public health. School nursing focuses on optimizing health for a community of students in a school setting. PTS: 1 DIF: Moderate REF: p. 1501

A 6-year-old boy is admitted to the hospital for a surgical procedure associated with a hospital stay. When the nurse asks his mother about the boy's sleep patterns, she says, "Sometimes he will get out of bed, walk into the kitchen, and get the cereal out of the cabinet. Then he just turns around and goes back to bed." The nurse explains that he is sleepwalking. The best nursing diagnosis for Tad would be: 1)Risk for Insomnia related to sleepwalking. 2)Risk for Fatigue related to sleepwalking. 3)Disturbed Sleep Pattern related to dyssomnia. 4Risk for Injury related to sleepwalking.

ANS: 4 Sleepwalking occurs during stages III and IV of NREM sleep. The sleeper leaves the bed and walks about with little awareness of surroundings. He may perform what appear to be conscious motor activities but does not wake up and has no memory of the event on awakening. The boy is at high risk for injury when sleepwalking because of his lack of awareness of his surroundings. Insomnia is a medical diagnosis rather than a nursing diagnosis. Certainly his sleep pattern is disturbed; however, there is little in the way of independent actions that the nurse could take for either the problem or etiology of this diagnosis, so it would not be useful. The boy does not awaken while sleepwalking and is not likely to experience fatigue from the event. PTS:1DIF:ModerateREF:p. 1213

At a recent nurse staff meeting, the chief nursing officer (CNO) announced that all nursing staff would work 12-hour shifts on a day-night rotation schedule that would alternate every 6 weeks. The CNO announced that she made this decision as a means to solve discord between the day- and night-shift nurses. She explained that this plan will allow the staff to experience the work on each shift and to appreciate the various job responsibilities on each shift. What type of leadership is the CNO displaying? 1)Management 2)Laissez-faire 3)Democratic 4)Authoritarian

ANS: 4 The authoritarian leader makes decisions for the group as a whole, gives orders, and bears most of the responsibility for the outcomes. A laissez-faire leader postpones making decisions or may never make a decision at all. Thus, laissez-faire leadership is really a lack of leadership. A democratic leader shares the planning, decision making, and responsibility for outcomes with other members of the group. This type of leader tends to provide guidance rather than control. There is no leadership style called "management."

Which is a major factor regulating sleep? 1)Electrical impulses transmitted to the cerebellum 2)Level of sympathetic nervous system stimulation 3)Amount of sleep a person has become accustomed to 4)Amount of light received through the eyes

ANS: 4 The circadian rhythm is a biorhythm based on the day-night pattern in a 24-hour cycle. A person's circadian rhythm is regulated by a cluster of cells in the hypothalamus of the brainstem that respond to changing levels of light. A major factor in regulating sleep is the amount of light received through the eyes—not the typical amount of sleep the person has within a 24-hour period. The autonomic nervous system (rather than central nervous system) controls the involuntary processes of the body, such as sleep, digestion, immune function, and so on. PTS:1DIF:ModerateREF:p. 1204

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)"Care 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; I'll 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 client's personal environment: a window into the patient's 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

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 patient's 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

The expected outcome (goal) for a patient with Disturbed Sleep Pattern is that she will: 1)Limit exercise to 1 hour per day early in the day. 2)Consume only one caffeinated beverage per day. 3)Demonstrate effective guided imagery to aid relaxation. 4)Verbalize that she is sleeping better and feels less fatigued.

ANS: 4 The patient would verbalize that she is sleeping better and feels less fatigued. The expected outcome (goal) is based on the nursing diagnosis, and its achievement should reflect resolution of the problem. The other options are outcomes that demonstrate only that the patient took certain actions. They would not, if achieved, demonstrate that the problem of Disturbed Sleep Pattern had been resolved. PTS:1DIF:ModerateREF:p. 1213

Which member of the healthcare team typically serves as the case manager? 1)Occupational therapist 2)Physician 3)Physician's assistant 4)Registered nurse

ANS: 4 Typically, registered nurses serve as case managers for patients with specific diagnoses. Their role is coordinator of care across the healthcare system. The occupational therapist, physician, and physician's assistant all serve on the healthcare team and take direction from the case manager. PTS: 1 DIF: Easy REF: ESG, Chapter 1, "Healthcare Delivery Systems—Expanded Discussion," "What Healthcare Providers Will You Work With?"