Fundamentals Chapter 4

5. A nurse is using nursing theory and the nursing process simultaneously to plan nursing care. How will the nurse use nursing theory and the nursing process in practice? a. Nursing theory can direct how a nurse uses the nursing process. b. Nursing theory requires the nursing process to develop knowledge. c. Nursing theory with the nursing process has a minor role in professional nursing. d. Nursing theory combined with the nursing process is specific to certain ill patients.

ANS: A Nursing theory can direct how a nurse uses the nursing process. Integration of theory into practice (nursing process) serves as the basis for professional nursing. The nursing process provides a systematic process for the delivery of care, not the knowledge component of the discipline. Useful theories are adaptable to different patients and to all care settings.

16. A nurse is conducting research about the needs of depressed patients. The nurse writes the following: Depression is a patient reporting a score above 7 on the Hamilton Depression Rating Scale. What did the nurse write? a. Operational definition b. Conceptual definition c. Paradigm d. Concept

ANS: A Operational definitions state how concepts are measured (Hamilton Depression Rating Scale). Theoretical or conceptual definitions simply define a particular concept, much like what can be found in a dictionary, based on the theorist's perspective (a mood disorder causing severe sadness and apathy). A paradigm is a pattern of beliefs used to describe a discipline's domain. Think of concepts as ideas and mental images, like depression is a concept.

12. The home health nurse listens to the patient's concerns about having "open-heart" surgery. The nurse explains the different surgical procedures and other options, like cardiac rehabilitation. After several visits, the patient wants cardiac rehabilitation. The nurse notifies the health care provider and sets up a referral. Which theory is the nurse using? a. Peplau's theory b. Henderson's theory c. Nightingale's theory d. Orem's self-care deficit theory

ANS: A Peplau's theory focuses on the individual, the nurse, and the interactive process or nurse-patient relationship. The nurse serves as a resource person, counselor, and surrogate. Henderson's theory focuses on helping the patient with activities that the patient would perform unaided if he or she were able. Nightingale viewed nursing not as limited to the administration of medications and treatments but rather as oriented toward providing fresh air, light, warmth, cleanliness, quiet, and adequate nutrition. The goal of Orem's theory is to help the patient perform self-care.

18. A nurse is using theoretical knowledge in nursing practice to provide patient care. Which nursing behavior is an example of theoretical knowledge? a. Reads about different concepts b. Reflects on clinical experiences c. Combines the art and science of nursing d. Creates a narrow understanding of nursing practice

ANS: A Theoretical knowledge is acquired through "reading, observing, or discussing" concepts. The goals of theoretical knowledge are to stimulate thinking and create a broad understanding of nursing science and practices. Experiential, or clinical, knowledge is formed from nurses' clinical experiences. Both types of knowledge are needed in order to provide safe, comprehensive nursing care.

2. The nurse is caring for a patient who does not follow the prescribed regimen for diabetes management. As a prescriber to Orem's theory, the nurse interviews the patient in an attempt to identify the cause of the patient's "noncompliance." What is the rationale for the nurse's behavior? a. Orem's theory is useful in designing interventions to promote self-care. b. Orem's theory focuses on cultural issues that may affect compliance. c. Orem's theory allows for reduction of anxiety with communication. d. Orem's theory helps nurses manipulate the patient's environment.

ANS: A When applying Orem's theory, a nurse continually assesses a patient's ability to perform self-care and intervenes as needed to ensure that the patients meet physical, psychological, sociological, and developmental needs. According to Orem, people who participate in self-care activities are more likely to improve their health outcomes. Leiniger's culture care theory focuses on culture diversity and provides culturally specific nursing care. According to Peplau, nurses help patients reduce anxiety by converting it into constructive actions, using therapeutic communication. Nightingale's grand theory is a patient's environment can be manipulated by nurses to restore a patient to health.

9. A nurse is caring for pediatric patients and using the developmental theory to plan nursing care. What is the focus of this nurse's care? a. Humans have an orderly, predictive process of growth and development. b. Humans respond to threats by adapting with growth and development. c. Humans respond with cognitive principles for growth and development. d. Humans have psychosocial domains to growth and development.

ANS: A With development theory, human growth and development is an orderly predictive process that begins with conception and continues through death. Stress/adaptation theories describe how humans respond to threats by adapting in order to maintain function and life. Educational theories explain the teaching-learning process by examining behavioral, cognitive, and adult-learning principles. Psychosocial theories explain human responses within the physiological, psychological, sociocultural, developmental, and spiritual domains.

2. A nurse wants to incorporate psychosocial theories into nursing practice. Which elements will the nurse include? (Select all that apply.) a. Physiological needs of the patient b. Psychological needs of the patient c. Sociocultural needs of the patient d. Cognitive needs of the patient e. Spiritual needs of the patient

ANS: A, B, C, E When nursing incorporates psychosocial theories into nursing practice, the nurse strives to meet the physiological, psychological, sociocultural, developmental, and spiritual needs of patients. Cognitive needs of the patient are included in educational theories.

1. A nurse is using a nursing metaparadigm to define nursing. Which concepts will the nurse include? (Select all that apply.) a. Person b. Disease c. Health d. Nursing e. Environment

ANS: A, C, D, E Nursing's metaparadigm includes four concepts: person, health, environment/situation, and nursing. Disease is not part of nursing's metaparadigm.

8. A patient is admitted with possible methicillin-resistant Staphylococcus aureus (MRSA) and is placed in isolation until cultures can be obtained and declared noninfectious. During the isolation process, the nurse encourages family visits. Which level of Maslow's hierarchy of needs is the nurse promoting when the family is encouraged to visit? a. First level b. Second level c. Third level d. Fourth level

ANS: C The third level contains love and belonging needs, including family and friends. The first level includes physiological needs. The second level includes safety and security needs. The fourth level encompasses esteem and self-esteem needs. The fifth and final level is the need for self-actualization.

3. A nurse is testing meditation for migraine headaches and the expected outcome of care when performing this intervention. Which type of theory is the nurse using? a. Grand b. Prescriptive c. Descriptive d. Middle-range

ANS: B A prescriptive theory details nursing interventions (meditation) for a specific phenomenon (migraine headaches) and the expected outcome of the care. Grand theories are broad in scope and complex and require further specification through research; it does not provide guidance for specific nursing interventions. Descriptive theories do not direct specific nursing activities but help to explain patient assessment. A middle-range theory tends to focus on a concept found in a specific field of nursing, such as uncertainty, incontinence, social support, quality of life, and caring, rather than reflect on a wide variety of nursing care situations.

10. Upon assessment, the nurse notices that the patient's respirations have increased, and the tip of the nose and earlobes are becoming cyanotic. The nurse finds that the patient's pulse rate is over 100 beats per minute. According to Maslow's hierarchy of needs, which patient need should the nurse address first? a. Self-esteem b. Physiological c. Self-actualization d. Love and belonging

ANS: B Maslow's hierarchy is useful in setting patient priorities. Basic physiological and safety needs are usually the first priority. After the physiological and safety needs are met, the nurse can move to love and belonging, self-esteem, and self-actualization.

7. The nurse is caring for a patient diagnosed with essential hypertension. The health care provider prescribes blood pressure medication that the nurse administers. The nurse then monitors the patient's blood pressure for several days to help determine effectiveness. Which system component is the nurse evaluating? a. Input b. Output c. Content d. Feedback

ANS: B Output is the end product of a system and, in the case of the nursing process, it is defined as whether the patient's health status improves or remains stable as a result of nursing care. Input consists of the data that come from a patient's assessment. Feedback serves to inform a system about how it functions. Content is the product and information obtained from the system.

13. The nurse is caring for a patient who is actively bleeding. The health care provider prescribes blood transfusions. The patient is a Jehovah's Witness and does not want blood products. The nurse contacts the health care provider to request alternative treatment. Which theory is the nurse using? a. Roy's theory b. Leininger's theory c. Watson's theory d. Orem's theory

ANS: B The goal of Leininger's theory is to provide the patient with culturally specific nursing care that integrates the patient's cultural traditions, values, and beliefs into the plan of care. The goal of Roy's model is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependence domains. Watson's theory believes that the purpose of nursing action is to understand the interrelationship between health, illness, and human behavior. The goal of Orem's theory is to help the patient perform self-care.

15. The patient is newly diagnosed with diabetes and will be discharged in the next day or so. The nurse is teaching the patient how to draw up and self-administer insulin. Which nursing theory is the nurse utilizing? a. Watson's theory b. Orem's theory c. Roger's theory d. Henderson's theory

ANS: B The goal of Orem's theory is to help the patient perform self-care. In Watson's theory, the nurse is concerned with promoting and restoring health and preventing illness. Roger's theory considers caring as a fundamental component of professional nursing practice and is based upon 10 curative factors. Henderson defines nursing as assisting patients with 14 activities until patients can meet these needs for themselves.

14. The patient is terminally ill and is receiving hospice care. The nurse cares for the patient by bathing, shaving, and repositioning him. The patient would like a Catholic priest called to provide the Sacrament of the Sick. The nurse places a call and arranges for the priest's visit. Which theory does this nurse's care represent? a. Roy's theory b. Watson's theory c. Henderson's theory d. Orem's self-care deficit theory

ANS: C Henderson defines nursing as assisting the patient with 14 activities (hygiene, positioning) until patients can meet these needs for themselves—or assist patients to have a peaceful death. Roy's model is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependence domains. Watson's theory believes that the purpose of nursing is to understand the interrelationship between health, illness, and human behavior. The goal of Orem's theory is to help the patient perform self-care.

6. The nurse views the patient as an open system that needs help in coping with stressors. Which theorist is the nurse using? a. King b. Levine c. Neuman d. Johnson

ANS: C Neuman views a patient as being an open system that is in constant energy exchange with the environment that the nurse must help cope with stressors. King views a patient as a unique personal system that is constantly interacting/transacting with other systems that the nurse helps with goal attainment. Levine believes nurses promote balance between nursing interventions and patient participation to assist in conserving energy needed for healing. Johnson perceives patients as a collection of subsystems that forms an overall behavioral system focusing on balance.

11. Which behavior from a nurse indicates the nurse is using Nightingale's theory to plan nursing care? a. Knows all about the disease processes affecting patients b. Focuses on medication administration and treatments c. Thinks about the patients and patients' environments d. Considers nursing knowledge and medicine the same

ANS: C Nightingale's theory provides nurses with a way to think about patients and their environment. Nightingale's concept of the environment was the focus of nursing care, and her firm conviction was that nursing knowledge is distinct from medical knowledge. Nightingale did not view nursing as limited to the administration of medications and treatments.

4. The nurse researcher is evaluating whether holding pressure at an injection site after injecting the anticoagulant enoxaparin will reduce bruising at the injection site. This study involves a prescriptive theory. What is the nurse's rationale for involving a prescriptive theory? a. It explains why bruising occurs. b. It is broad in scope and complex. c. It tests a specific nursing intervention. d. It reflects a wide variety of nursing care situations.

ANS: C Prescriptive theories detail nursing interventions for a specific phenomenon and the expected outcome of the care but it does not explain why. Grand theories are broad in scope and complex and focus on a wide variety of nursing care situations.

1. The nursing instructor is teaching a class on nursing theory. One of the students asks, "Why do we need to know this stuff? It doesn't really affect patients." What is the instructor's best response? a. "You are correct, but we have to learn it anyway." b. "This keeps the focus of nursing narrow." c. "Theories help explain why nurses do what they do." d. "Exposure to theories will help you later in graduate school."

ANS: C Theories offer well-grounded rationales for how and why nurses perform specific interventions and for predicting and/or prescribing nursing care measures. Although nursing theory will help the nurse in graduate school, it is also an important basis for the nurse's approach to daily patient care, and it expands scientific knowledge of the profession.

19. A nurse is using Maslow's hierarchy of needs to prioritize care. Place the levels in order of basic priority to highest priority that the nurse will follow. 1. Physiological 2. Self-esteem 3. Self-actualization 4. Safety and security 5. Love and belonging a. 4, 1, 2, 3, 5 b. 1, 4, 5, 3, 2 c. 4, 5, 3, 2, 1 d. 1, 4, 5, 2, 3

ANS: D Maslow's hierarchy is as follows: physiological, safety and security, love and belonging, self-esteem, and self-actualization.

17. Which action indicates the nurse is using the nursing process in patient care? a. Generates nursing knowledge for use in nursing practice. b. Conceptualizes an aspect of nursing to predict nursing care. c. Develops nursing care as a specific, distinct phenomenon. d. Delivers nursing care using a systematic approach

ANS: D The nursing process provides a systematic approach for the delivery of nursing care. Theory generates nursing knowledge for use in practice; the nursing process is not a theory. A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, or prescribe nursing care. An interdisciplinary theory explains a phenomenon specific to the discipline that developed the theory.