theory-based Nursing Care questions

The Kü bler-Ross Stages of Grieving theory reflects a process that progresses through several stages to final acceptance. List these patient statements in order according to the Kü bler-Ross Stages of Grieving. 1. "I am going to get a second opinion." 2. "I find it so hard to think about the fact that I don't have long to live." 3. "I've never smoked in my life. I shouldn't be the one with lung cancer." 4. "I'll have the chemotherapy because I want to see my children grow up." 5. "I don't want a big funeral because I want people to remember me and be happy.

1. "I am going to get a second opinion." 3. "I've never smoked in my life. I shouldn't be the one with lung cancer." 4. "I'll have the chemotherapy because I want to see my children grow up." 2. "I find it so hard to think about the fact that I don't have long to live." 5. "I don't want a big funeral because I want people to remember me and be happy. rationale: 1.This statement reflects "doctor shopping," which is a form of denial, the first stage of the Kübler-Ross Stages of Grieving theory. The patient is experiencing shock and disbelief. 3. This statement reflects the anger stage, the second stage of the Kübler-Ross Stages of Grieving theory. The patient is aware of the reality of the situation and is resentful and angry. 4. This statement characterizes the bargaining stage, the third stage of the Kübler-Ross Stages of Grieving theory. The patient is negotiating for more time. 2. This statement reflects depression, the fourth stage of the Kübler-Ross Stages of Grieving theory. The patient is grieving over what is happening and what will never be. 5. This statement characterizes acceptance, the fifth stage of the Kübler-Ross Stages of Grieving theory. The patient has accepted the inevitable and is looking toward the future.

A nurse is considering the Faith Development Theory by James Fowler while assessing several patients. Which patients does the nurse expect to assume responsibility for their own beliefs about faith? 1. Older adolescents 2. Young adolescents 3. Older school-age children 4. Young school-age children

1. Older adolescents rationale: Older adolescents and young adults assume responsibility for their own commitments, beliefs, and attitudes about faith. This reflects the individuative-reflective stage of faith development.

Freedom from which situation demonstrates a safety and security need in Maslow's Hierarchy of Human Needs? 1. Pain 2. Hunger 3. Ridicule 4. Loneliness

1. Pain rationale: According to Maslow's Hierarchy of Needs, freedom from pain is considered a safety and security need. Confusion sometimes occurs because other theorists, such as R. A. Kalish, believe that pain should be categorized along with adequate air, food, water, rest/sleep, shelter, elimination, and temperature regulation as a first-level physiological need.

A nurse is analyzing information about a patient. Which of the following does Maslow's Hierarchy of Needs theory help the nurse to identify? 1. Patient's problem that has top priority 2. Developmental level of the patient 3. Coping patterns of the patient 4. Patient's health beliefs

1. Patient's problem that has top priority rationale: Patient problems/needs can be ranked in order of ascending importance according to how essential they are for survival using Maslow's Hierarchy of Needs as a framework. Maslow identifies five levels of human needs. A person must meet lower-level needs before addressing higher-level needs. Physiological needs are first-level needs: air, food, water, sleep, shelter, etc.; safety and security needs are second; love and belonging needs are third; self-esteem needs are fourth; and self-actualization is the fifth-level nee

Which concept about health do nurses need to appreciate? 1. Perceptions of health vary among cultures. 2. To be considered healthy a person needs to be productive. 3. There must be an absence of illness for a person to be considered healthy. 4. Underlying consensus exists among theorists about the definition of health.

1. Perceptions of health vary among cultures. rationale: Every individual is influenced by family, ethnic, and cultural beliefs and values. These beliefs and values influence a person's lifestyle through how one perceives, experiences, and copes with health, illness, and disability. The nurse must assess the impact of these influences on the patient's health and health practices.

A nurse gives a resident in a nursing home a choice about which color shirt to wear. Which level need, according to Maslow's Hierarchy of Needs, has the nurse just met? 1. Self-esteem 2. Physiological 3. Safety and Security 4. Love and Belonging

1. Self-esteem rationale: Choosing which color shirt to wear provides a person with the opportunity to make a choice and supports feelings of independence, competence, and self-respect, which all contribute to a positive self-esteem.

Which words describe the concept of adaptive capacity? Select all that apply. 1. _____Adjust 2. _____Modify 3. _____Change 4. _____Etiology 5. _____Remission 6. _____Compliance

1. _____Adjust 2. _____Modify 3. _____Change rationale: 1. Adaptive capacity refers to the quality and quantity of resources one can draw on to regain balance after one is threatened. This process requires an individual to adjust consciously or unconsciously in the physical, emotional, mental, or spiritual dimension in an effort to achieve balance or homeostasis. 2. Adaptive capacity refers to the quality and quantity of resources one can draw on to regain balance after one is threatened. This process requires an individual to modify consciously or unconsciously in the physical, emotional, mental, or spiritual dimension in an effort to achieve balance or homeostasis. 3. Adaptive capacity refers to the quality and quantity of resources one can draw on to regain balance after one is threatened. This process requires an individual to change consciously or unconsciously in the physical, emotional, mental, or spiritual dimension in an effort to achieve balance or homeostasis.

A nurse is assessing patients in the postanesthesia care unit. For which physiological responses to stress should the nurse monitor this patient? Select all that apply. 1. _____Dilated pupils 2. _____Slow, bounding pulse 3. _____Delayed response time 4. _____Inability to concentrate 5. _____Rapid, shallow breathing 6. _____Increased muscle tension

1. _____Dilated pupils 5. _____Rapid, shallow breathing 6. _____Increased muscle tension rationale: 1.Dilated pupils increase visual perception in reaction to a perceived threat. 5. Rapid, shallow breathing is a physiological response associated with the fight-or-flight response of the autonomic nervous system when large amounts of cortisone and epinephrine are released into the body as a person perceives a threat. 6. Increased muscle tension prepares the body for fight or flight.

A nurse is differentiating between primary and secondary stressors. Which stressors are examples of secondary stressors? Select all that apply. 1. _____Pain 2. _____Cold weather 3. _____Death of a spouse 4. _____Shortness of breath 5. _____Ingested microorganisms 6. _____Increased blood pressure

1. _____Pain 4. _____Shortness of breath 6. _____Increased blood pressure rationale: 1. Pain initially is a response to some previous primary stressor, threat, or stimuli. However, when pain stimulates additional responses in an effort to manage the pain, the pain becomes a secondary stressor. 4. Shortness of breath is a response to a primary stressor such as cancer of the lung or a respiratory tract infection. Shortness of breath then becomes a secondary stressor precipitating further adaptations in the individual. 6. Increased blood pressure is a secondary stressor. It is in response to a primary stressor such as a systemic infection or fear of the unknown.

A nurse educator is conducting a class about child development for nurses. The nurse reviews the Stages of Moral Development Theory by Lawrence Kohlberg. Place the following patient statements about what motivates them to behave that reflects the reasoning typical of progression through Kohlberg's stages of moral development. 1. "I was following the rules." 2. "I did not want to get punished." 3. "I expected to receive a reward." 4. "I thought it was the right thing to do." 5. "I wanted others to see me as a good person." 6. "I was doing what is acceptable in our community.

2. "I did not want to get punished." 3. "I expected to receive a reward." 5. "I wanted others to see me as a good person." 1. "I was following the rules." 6. "I was doing what is acceptable in our community. 4. "I thought it was the right thing to do." rationale: 2. The first stage of moral development is Obedience and Punishment. The motivation for behavior is fear of negative consequences (e.g., punishment, disapproval). 3. The second stage of moral development is Individualism and Exchange. The motivation for behavior is the desire for a positive consequence (e.g., reward, good result). 5. The third stage of moral development is Interpersonal Relationships. The motivation for behavior is based on pleasing others because it is what others expect. 1. The fourth stage of moral development is Maintaining Social Order. The motivation for behavior is based on following the rules to uphold the law. 6. The fifth stage of moral development is Social Contract and Individual Rights. The motivation for behavior is based on differing beliefs and values but adheres to standards agreed upon by society. 4. The sixth stage of moral development is Universal Principles. Motivation for behavior is based on abstract reasoning, universal ethical principles, and principles of justice.

Of the patients presented, which patient's level of wellness does the nurse determine best represents the placement of the X on Dunn's Health Grid? Very favorable environment Death Health-Axis Peak wellness Very unfavorable environment 1. A healthy, active older adult who has an apartment in an independent living facility that provides daily meals, weekly housekeeping, and services such as activities, medical and dental care on site, and banking available 2 days a week 2. A person with a diagnosis of diabetes with a stable blood glucose who receives weekly visits from a public health nurse and has a home health aide who visits three mornings a week 3. A person with a diagnosis of stage II-A lung cancer who lives in a men's shelter and who consistently misses clinic appointments 4. A relatively healthy homeless person with a diagnosis of pneumonia and who is responding to medication

2. A person with a diagnosis of diabetes with a stable blood glucose who receives weekly visits from a public health nurse and has a home health aide who visits three mornings a week rationale: 2. This person is in poor health but receives routine care from health team members. This person reflects protected poor health and should be plotted on the upper left side of Dunn's Health Grid.

Which statement does the nurse understand is related to adaptations associated with the General Adaptation Syndrome? 1. Adaptations depend on the nature of the stressor. 2. Adaptations can be conscious or unconscious. 3. Adaptations become secondary stressors. 4. Adaptations are maladaptive responses.

2. Adaptations can be conscious or unconscious. rationale: Reactions to stress are both conscious and unconscious. In the General and Local Adaptation Syndromes, automatic physiological responses are not under conscious control. Adaptations, such as behavioral responses, are often under conscious control

Which person is considered healthy when referring to the Role-Performance Model of Health? 1. Coal miner who retires after acquiring black lung disease 2. Coach who continues to coach after becoming a paraplegic 3. Brick layer who takes a leave of absence while recovering from hernia surgery 4. Police officer who sells alarm systems after leaving the force because of being shot while on duty

2. Coach who continues to coach after becoming a paraplegic rationale: According to the Role-Performance Model of Health, as long as a person can perform work associated with societal roles, even if a person is limited physically, the person is considered healthy. A coach who continues coaching even though ill or disabled is considered healthy in light of the Role-Performance Model of Health.

The Health Belief Model attempts to explain and predict health behaviors and focuses on which of the following? 1. One's ability to fulfill one's assigned roles 2. Constructs associated with perceived threat and net benefit 3. Locus of control being important in one making choices about health behaviors 4. People moving along a continuum from health on one end to illness on the other end

2. Constructs associated with perceived threat and net benefit rationale: The Health Belief Model focuses on perceived threats, severity, benefits, barriers, cues to action, and self- efficacy, which all influence a person's "readiness to act" in response to a health threat; Rosenstock first proposed this model during the 1950s

A nurse is assessing a patient who is experiencing prolonged stress. For which most serious complication should the nurse monitor the patient? 1. Altered sleeping 2. Impaired immunity 3. Increased muscle tension 4. Decreased intestinal peristalsis

2. Impaired immunity rationale:Impaired immunity is a serious threat caused by prolonged periods of stress. Stressors elevate blood cortisone levels, which decrease anti-inflammatory responses, deplete energy stores, lead to a state of exhaustion, and decrease resistance to diseas

A prospective nurse is being interviewed for a job by the nurse manager in an urgent care center. The nurse manager states that the facility adheres to a clinical model of health/illness. Which should the nurse anticipate will be expected of the nurses within this facility? 1. Consider patients as holistic human beings. 2. Make assessment of patients in the physiological domain. 3. Identify the relationship between patients' beliefs and actions. 4. Recognize if patients are able to perform their role within the family.

2. Make assessment of patients in the physiological domain. rationale: The clinical model, also known as the medical model, is concerned with the presence or absence of signs and symptoms of illness, disease, or injury. It is a narrow interpretation of health/ illness because the focus is on the identification and treatment of a defect or dysfunction. Urgent care centers are concerned with meeting acute health- care needs.

A nurse identifies that love and belonging needs associated with Maslow's Hierarchy of Needs are related to which of Gordon's Functional Health Patterns? 1. Values-belief pattern 2. Role-relationship pattern 3. Cognitive-perceptual pattern 4. Sexuality-reproductive pattern

2. Role-relationship pattern rationale: Love and belonging needs identified in Maslow's Hierarchy of Needs are associated with Gordon's Role- Relationship Pattern category. Gordon's Role-Relationship Pattern category addresses topics such as social issues, loneliness, and relationships among family members and others.

A nurse is assessing a child in relation to the stages of Jean Piaget's Theory of Cognitive Development. Which behavior indicates that the child has reached the Formal Operations stage of cognitive development according to Piaget? 1. Employs logical thought to organize collected information 2. Utilizes deductive reasoning to examine alternatives 3. Explores objects by placing them in the mouth 4. Uses language to communicate with others

2. Utilizes deductive reasoning to examine alternatives rationale: Using deductive reasoning to examine alternatives reflects the Formal Operations stage of cognitive development. These individuals use symbols related to abstract concepts and are capable of hypothetical and deductive reasoning.

A nurse is assessing a patient who experienced an emotional stress. Which most common response should the nurse anticipate the patient will exhibit? 1. Anger 2. Denial 3. Anxiety 4. Depression

3. Anxiety rationale: tress. Anxiety is the most common response to all new experiences that serve as an emotional threat.

A patient with terminal cancer is willing to try new therapies. Which stage of Kü bler-Ross Stages of Grieving does the nurse identify that the patient is experiencing? 1. Denial 2. Depression 3. Bargaining 4. Acceptance

3. Bargaining rationale; A patient in the bargaining stage of grieving seeks to avoid the loss and will try new therapies to gain more time

A nurse is teaching a course about death and dying to a community group. Which is most important for the nurse to teach parents about preparing a child for the death of a grandparent? 1. Wait until the child asks a question about the situation. 2. Encourage the child to participate in mourning rituals. 3. Begin at the child's level of understanding. 4. Praise the child for being strong.

3. Begin at the child's level of understanding. rationale: Beginning at the child's level of understanding is essential when preparing a child for the death of a grandparent. Because there is such a difference regarding how children of different ages view the concept of death, it is important first to assess the child's level of understanding.

A nurse is caring for a group of patients. A patient experiencing which of the following situations does the nurse anticipate will have the hardest time coping? 1. Scheduled for a biopsy 2. Unable to control the course of illness 3. Challenged by a multiplicity of stressors 4. Having to relocate to an assisted-living facility

3. Challenged by a multiplicity of stressors rationale: As the multiplicity of stressors increases, it becomes harder for a person to cope. As each stress is added, the accumulated impact is greater than just the sum of each individual stresso

A nurse is facilitating a support group for people who are coping with the death of a significant other. Which patient behavior reflects complicated grieving? 1. Remarrying within 6 months after the death of a wife 2. Being continuously angry 3 months after the death of a parent 3. Keeping a child's room unchanged for 4 years after the death of the child 4. Displaying clinical symptoms of depression 9 months after the death of a husband

3. Keeping a child's room unchanged for 4 years after the death of the child rationale: Keeping a deceased child's room unchanged for years is outside the usual limits of grieving. Often a person can get stuck in a stage of grieving and is unable to progress to the next stage. Keeping a room unchanged for years reflects an inability to face the reality of the loss or to deal with the feelings associated with the loss.

Which statement best reflects a principle common to all theories of health, wellness, and illness? 1. Health is synonymous with a sense of well-being. 2. People are able to control factors that affect health. 3. Many variables influence a person's perception of health. 4. Being able to meet the demands of one's role is necessary for health.

3. Many variables influence a person's perception of health. rationale: There is little consensus about any one definition of health, wellness, and illness. However, all definitions of health, wellness, and illness address the fact that there are a number of factors that influence health.

A nurse is caring for a newly admitted patient. The nurse collects data and reviews the patient's clinical record. Which level need is the priority for this patient according to Maslow's Hierarchy of Needs? 1. Physiologic 2. Self-esteem 3. Safety and security 4. Love and belonging

3. Safety and security rationale: 3. Pain is a safety and security level need based on Maslow's Hierarchy of Needs. Pain relief is the patient's priority need.

A nurse is caring for a patient recently diagnosed with advanced cancer. Which patient statements reflect the Kü bler-Ross stage of denial in the grief process? Select all that apply. 1. _____" Why did this have to happen to me now?" 2. _____"How could this happen when I quit smoking cigarettes?" 3. _____"Maybe they mixed up my records with someone else's records." 4. _____"I probably will not live long enough to see my children married." 5. _____"I don't want to talk about the fact that they tell me I have advanced cancer."

3. _____"Maybe they mixed up my records with someone else's records." 5. _____"I don't want to talk about the fact that they tell me I have advanced cancer." rationale: 3. This statement characterizes the denial stage of the grieving process. When in denial a patient may identify reasons why the diagnosis is not possible. 5. This statement characterizes the denial stage of the grieving process. The patient is using the defense mechanism of suppression. During denial the person is not ready to address or believe that the loss is happening.

Which are examples of a health belief? Select all that apply. 1. _____Eating foods that are low in fat 2. _____Accepting grim results of diagnostic tests 3. _____Concluding that illness is the result of being bad 4. _____Recognizing that smoking can cause lung cancer 5. _____Respecting a patient's decision regarding therapeutic treatment

3. _____Concluding that illness is the result of being bad 4. _____Recognizing that smoking can cause lung cancer rationale: 3. This is an example of a health belief. A health belief is a conviction or opinion that influences health-care practices or decisions. If a person believes that illness is the result of being bad, the person may feel the need to suffer in silence as a form of penance. 4. This is an example of a health belief. If a person believes that smoking cigarettes can cause lung cancer, then the person may refrain from smoking.

Which are examples of a response to a physiological stressor? Select all that apply. 1. _____A sunburn after being outside all day 2. _____Diarrhea after eating contaminated food 3. _____Shortness of breath when walking up a hill 4. _____A rapid heart rate during a final examination 5. _____Fluid volume excess as a result of renal disease

3. _____Shortness of breath when walking up a hill 5. _____Fluid volume excess as a result of renal disease rationale: 3. Shortness of breath is a response to the physiological stress of walking up a hill. The body is reacting via physiological mechanisms to take in more oxygen to meet the oxygen demand of cells when walking. 5. Fluid volume excess is a response to the physiological stress of kidney impairment. Because of impaired kidney function the body is unable to secrete urine and fluid, volume excess occur

A nurse is caring for patients who have experienced a variety of stressful life events. Which event has the greatest potential to contribute to stress-related illness? 1. Retirement 2. Pregnancy 3. Adoption 4. Divorce

4. Divorce rationale: According to the Social Readjustment Rating Scale by Holmes and Rahe, divorce is ranked second on the list of life events likely to cause stress-related illness with a life-change unit score of 73 of 100. Only death of a spouse, ranked first on the scale with a score of 100, is considered more stressful than divorce.

According to Maslow, which characteristic is least associated with a person who is self-actualized? 1. Is autonomous 2. Is able to see the good in others 3. Has the ability to problem-solve 4. Has an external locus of control

4. Has an external locus of control rationale: 4. An external locus of control least describes self-actualized people. People with an external locus of control respond to a reward or recognition that comes from outside the self. People who are self-actualized strive to develop their maximum potential based on motivation from withi

Which statement identifies a basic principle associated with Sigmund Freud and his work? 1. The reality principle reflects man's need for immediate gratification. 2. Defense mechanisms are a common means of conscious coping. 3. The id controls the personality. 4. No behavior is accidental.

4. No behavior is accidental. rationale: Freud believed that all behavior has meaning and called this theory psychic determinism. He believed that every psychic event is determined by prior events. Behavior, mental phenomena, and even dreams are not accidental but rather an expression of thoughts, feelings, or needs that have a relationship to the rest of a person's life.

A nurse is caring for an immobilized patient who was admitted to the hospital with a pressure ulcer. Which type of stressor precipitated the pressure ulcer? 1. Microbiological 2. Physiological 3. Chemical 4. Physical

4. Physical rationale: The force of pressure is a physical stressor. Pressure is the continuous force of a body part on a surface as a result of gravity; compression of tissue occurs between a bony prominence and the surface on which the body part is resting. This force is external to the body. The pressure ulcer, which is the response, becomes a secondary stressor that is then physiological in nature.

A nurse inadvertently commits a medication error without the knowledge of other nursing team members. According to Freud, which part of the personality guides the nurse to initiate an Incident Report? 1. Id 2. Ego 3. Libido 4. Superego

4. Superego rationale: The superego monitors the ego. The superego is concerned with social standards, ethics, self-criticism, moral standards, and conscience. If the nurse initiates an Incident Report, it is the uperego that directs the achievement of ego-ideal behavior. If the nurse does not initiate an Incident Report, it is the superego that criticizes, punishes, and causes a sense of guilt.

Which concept identified by the nurse is basic to the health-illness continuum model? 1. People can be both healthy and ill at the same time on the continuum. 2. Actualization must be achieved to be on the healthy end of the continuum. 3. When variables are balanced people are in the exact center of the continuum. 4. There is no distinct boundary between health and illness along the continuum.

4. There is no distinct boundary between health and illness along the continuum. rationale: Health and illness are on opposite ends of the health-illness continuum and there is no distinct boundary between health and illness. Only a person can place herself or himself somewhere along the health-illness continuum based on his or her own perceptions about what constitutes health and illness.

Which nursing interventions support a problem in the Role-Relationship Pattern category of Gordon's Functional Health Patterns? Select all that apply. 1. _____Seeking the assistance of a spiritual advisor 2. _____Teaching the patient self-care in preparation for going home 3. _____Referring a patient to a self-help group to learn colostomy care 4. _____Assessing a family member's readiness to provide care in the home 5. _____Protecting a patient from family members who disagree with the patient's medical choices

4. _____Assessing a family member's readiness to provide care in the home 5. _____Protecting a patient from family members who disagree with the patient's medical choices rationale: 4. This action supports achievement of a goal in the Role-Relationship category. 5. This action supports achievement of a goal in the Role-Relationship category. Patients have a right to make medical decisions for themselves.