Foundations: Unit 1 (Week 1)

As the nurse cares for a patient in an outpatient clinic, the patient states that he recently lost his position as a volunteer coordinator at a local community center. He expresses that he is angry with his former boss and with God. What is the nurse's priority at this time? Assess the patient's spirituality in relation to his vocation. Assess the patient's spirituality in relation to his life satisfaction. Assess the patient's spirituality in relation to his fellowship and community. Assess the patient's spirituality in relation to his connectedness with his family and co-workers.

Assess the patient's spirituality in relation to his vocation. Many people express their spirituality through their vocations, which can include volunteer positions. p. 734

The nurse is recording the results of all the laboratory reports of a patient. Which standard of practice is the nurse performing? Assessment Diagnosis Evaluation Implementation

Assessment In the nursing process, recording data from investigation reports is part of assessment. Nursing diagnosis involves analyzing the assessed data. Evaluation refers to testing the attainment of outcome goals. Implementation is the process of delivering care according to the care plan. p. 2

An Arab woman is admitted to the hospital. A male nurse is assigned to examine this patient. The patient is uncomfortable and expresses displeasure at being assigned a male nurse. What should the nurse manager do? Ask the male nurse to go ahead with the examination. Assign a female nurse to carry out the examination. Remain in the room when the male nurse is examining the patient. Explain to the patient that they are short of staff and that she has to cooperate.

Assign a female nurse to carry out the examination. Arab women are generally reluctant to have males examine them. The head nurse should respect the patient's wish and culture and assign a female nurse to her. The head nurse should not ask the male nurse to proceed, because this would violate the patient's wish. The mere presence of a female nurse during an examination by a male nurse would not make the patient comfortable. Telling the patient the hospital is short-staffed may not be true and should not be used as an excuse to disobey the patient's wishes. Test-Taking Tip: Look for answers that focus on the patient or are directed toward the patient's feelings. p. 103

The nurse is caring for a patient whose daughter wishes to pursue a career in nursing. She wants to enroll in a program that is of short duration and makes her eligible to take the nursing licensure exam. Which educational program should the nurse recommend to this student? Baccalaureate degree program in nursing Associate degree program in nursing Professional doctoral program in nursing Master's degree in nursing

Associate degree program in nursing In the United States, a student can take the NCLEX-RN ® nursing licensure examination after completing either the associate or the baccalaureate degree program in nursing. An associate degree program is a 2-year program, whereas a baccalaureate program is a 4-year program. A master's in nursing degree is an advanced degree. The nurse must complete a master's in nursing program to become eligible for doctoral programs. p. 9

A 50-year-old patient is admitted with acute exacerbation of asthma. The patient is treated with bronchodilators and oxygen therapy. The patient is clinically stable and is planned for discharge. The nurse teaches the patient about deep breathing exercises. The nurse has initiated these exercises to improve the patient's lung capacity. Which professional behavior is the nurse showing? Advocacy Autonomy Accountability Collaboration

Autonomy Deep breathing exercises and chest physiotherapy are performed to prevent respiratory complications. The nurse does not need medical orders to prescribe breathing exercises in this case. The professional behavior shown here by the nurse is autonomy. Autonomy involves the initiation of independent nursing interventions without medical orders. Advocacy refers to protecting the patient's human and legal rights and providing assistance in asserting these rights when needed. Accountability means that the nurse is responsible, professionally and legally, for the type and quality of the nursing care provided. Collaboration refers to nurse interaction with interdisciplinary health professionals to provide the best possible care to the patient. p. 3

The nurse is teaching the proper technique for using an inhaler to a 12-year-old patient who suffers from asthma; the nurse is also teaching exercises to improve the breathing process. What should the nurse focus on to avoid development of an altered self-concept? Awareness of limitations Awareness of strengths Reassessment of life goals Acceptance of changes in physical endurance Providing reinforcement for mastery of a new skill

Awareness of limitations Awareness of strengths Acceptance of changes in physical endurance Providing reinforcement for mastery of a new skill Awareness of the limitations and strengths helps the child to strengthen self-concept. Providing reinforcement for mastering a new skill also helps to strengthen the self-concept that the child has developed. The nurse is helping the patient to accept the changes in physical endurance. Learning alternative techniques to deal with the asthma will help in developing a new self-concept. A 12-year-old is unlikely to have a set of goals in life. Thus, reassessment of goals is not usually required at this age. p. 702

A 50-year-old female patient with breast cancer is admitted to the hospital for surgical management. On the second postoperative day, the nurse finds the patient crying. She tells the nurse that she had agreed to take care of her 8-month-old granddaughter but knows she will be unable to do so. The patient also expresses concern about her looks and that she feels worthless. Which aspects of the patient's self-concept are affected? Body image Self-esteem Concentration Role performance Memory and recall

Body image Self-esteem Role performance Body image is the way a person perceives her body including physical appearance, structure, and function. The patient is unhappy with the way she looks. Self-esteem is the feeling of self-worth. The patient indicates a negative self-esteem. Role performance is the way in which a person perceives the ability to carry out a significant role. The patient doubts she can handle the responsibility of looking after her granddaughter. This shows negative role performance. Concentration, memory, and recall are intellectual aspects and are unaffected in this patient. p. 704, 705

Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system? Client safety Evidence-based practice Client satisfaction Maintenance of competency

Client safety Near-miss events are events that could have caused a problem with patient safety had they not been stopped before patient harm occurred. Nurses who investigate ways to prevent near-miss events work on issues surrounding patient safety. p. 23

A hospital-based nurse has been asked to join a community-based nursing center. In what aspects does the community-based nursing center differ from a hospital setting? Community health care services focus on vulnerable populations. Community health care services result in increased costs for the patient. Community health care services can be directly accessed by patients. Community health care services are provided where the patients live. Community health care services do not incorporate the patient's family into the plan of care.

Community health care services focus on vulnerable populations. Community health care services can be directly accessed by patients. Community health care services are provided where the patients live.

A couple approaches the nurse for advice on contraception. Which method suggested by the nurse does not require a health care provider's prescription? Hormonal injection Subdermal implant Condom Intrauterine device

Condom A condom is a barrier method of contraception. It is a thin rubber sheath worn on the penis to prevent sperm from entering the vagina. Hormonal injections are hormonal preparations to prevent pregnancy and must be prescribed by a health care provider. The subdermal implants are hormonal preparations placed under the skin. They need a health care provider's prescription. An intrauterine device is a plastic or copper device placed inside the uterus through the cervical opening. It is inserted by a health care provider. p. 718

The nurse is counseling a couple on contraceptive methods. Which nonprescription method should the nurse recommend? Condom Diaphragm Vaginal ring Subdermal implant Transdermal skin patch

Condom Condoms are nonprescription methods of contraception. A condom prevents entry of sperm into the vagina. It is made of a thin rubber sheath and fits over the penis. A diaphragm is a barrier with spermicide to be used in females; it must be fitted by a gynecologist and so requires a prescription. Vaginal contraceptive rings, subdermal implants, and transdermal skin patches are hormonal methods of contraception and require a health provider's prescription. p. 718

Which health care services are provided in primary health care facilities? Assisted living Intensive care Family planning Prenatal counseling Nutritional counseling

Family planning Prenatal counseling Nutritional counseling Primary health care services include family planning, prenatal counseling, and nutritional counseling. The aim of these services is to promote health and prevent illness. Assisted living is an example of continuing care. Intensive care is a part of tertiary care, which is more sophisticated care provided at specialized health care centers. p. 17

A patient tells the nurse about receiving green card status in the United States and wishes to learn about the health care system in the country. The nurse is educating this patient about the types of health care services available in the United States. The nurse says that the health care services are divided into categories. What are some examples of primary health care centers? Immunization centers Family planning centers Mental health counseling centers Spinal injury rehabilitation centers Prenatal and well-baby care centers

Family planning centers Prenatal and well-baby care centers A primary health center aims to improve the health and wellness of the entire population; it includes family planning, and prenatal and well-baby care programs. Immunization and mental health counseling are included under preventive care. They aim to reduce and control the risk factors for diseases. Spinal injury rehabilitation is a type of restorative care. It helps individuals with spinal cord injuries to regain maximum functional status and improve the quality of life. p. 17

What are the key aspects of community-based health care? Focus on primary care Emphasis on health promotion Health education about diseases Emphasis on diagnosis and treatment Care is subsidiary to various hospitals.

Focus on primary care Emphasis on health promotion Health education about diseases Community-based health care focuses on providing primary care to individuals and families in the community. It emphasizes health promotion and provides basic knowledge to the community about various health-related problems. Diagnosis and treatment is managed in hospitals rather than community centers. Community-based health care occurs outside traditional health care institutions such as hospitals pp. 31

The nurse works in a community health center. What program might the nurse be responsible for at the community health center? Diagnostics Spiritual health Health education Environmental surveillance

Health education Community health centers are outpatient clinics that cater to the health needs of the community. They are usually associated with a community organization. Services provided in community health centers are health education, physical assessment, health screening, treatment of medical conditions, and counseling. Community health centers do not provide diagnostic services, spiritual health services, or environmental surveillance. p. 18

What is the primary contraceptive action of an intrauterine device (IUD)? It prevents ovulation. It acts as a physical barrier. It prevents fertilization. It kills sperm cells.

It prevents fertilization. The primary action of an intrauterine device (IUD) is to prevent fertilization of the ovum. It has no effect on ovulation, does not act as a physical barrier, and has no effect on the sperm. Hormonal contraception (use of oral contraceptive pills) prevents ovulation. Condoms and diaphragms act as physical barriers to contraception. Spermicidal products, such as spermicidal creams and jellies, kill sperm cells. p. 718

A patient is worried about her 76-year-old grandmother who is in very good health and wants to live at home. The patient's concerns are related to her grandmother's safety. The neighborhood does not have a lot of crime. Using this scenario, which factors are the most relevant to assess for safety? Crime rate, locks, lighting, neighborhood traffic Lighting, locks, clutter, medications Crime rate, medications, support system, clutter Locks, lighting, neighborhood traffic, crime rate

Lighting, locks, clutter, medications The crime statistics note that the grandmother's neighborhood does not have a lot of crime, and therefore crime rates are not a concern. Although you want to ensure that safe, working, effective locks are on the doors, you do not need to assess the crime rate. Being sure that her grandmother can navigate her home with appropriate lighting and ensuring clutter control can reduce her risk for falling and promote physical safety. Finally, knowledge about medication determines if the grandmother is at risk for confusion, dizziness, or falls secondary to medication effects.

What are the familial factors that contribute to the development of high self-esteem? Parental support Social support Authoritarian parenting style Peer relations Positive communication

Parental support Social support Positive communication Parental support and monitoring play a vital role in developing high self-esteem. Social support and acceptance are other important factors. Positive communication in the family helps foster the self-esteem of an individual. An authoritarian parenting style is characterized by strict rules, harsh punishments, and little warmth towards the child. This style of parenting fosters a negative self-concept. Influences of peer relations do not come under the family domain. p. 706

The nurse wants to assess health literacy in a group of patients. Which measure does the nurse use to evaluate word recognition? Calm-Listen, Affirm, Respond, Add (C-LARA) Test of Functional Health Literacy in Adults (TOFHLA) Rapid Estimate of Adult Literacy in Medicine (REALM) Culturally and Linguistically Appropriate Standards (CLAS)

Rapid Estimate of Adult Literacy in Medicine (REALM) Rapid Estimate of Adult Literacy in Medicine (REALM) is one of the health literacy measurements that used to assess word recognition. C-LARA is a communication technique used during cultural assessment. The Test of Functional Health Literacy in Adults (TOFHLA) is used to measure reading skills and numeracy of patients. Culturally and Linguistically Appropriate Standards (CLAS) is an organization that advances health equity, improves quality, and helps eliminate health disparities. p. 100

The nurse has performed a comprehensive assessment of adolescents in a community. What are the main objectives the nurse might attain through this assessment? Reduce incidence of smoking Promote safe sexual practices Prevent congenital anomalies Reduce incidence of inborn metabolic disorders Enhance nutritional status

Reduce incidence of smoking Promote safe sexual practices Enhance nutritional status Comprehensive community assessment among adolescents provides information about the disorders prevalent in the adolescent population. One objective the nurse may identify is to curb the incidence of smoking in the community. Knowledge about the prevalence of smoking in the community can help the nurse to promote health programs that dissuade adolescents from smoking. Adolescents are usually quite sexually active and are prone to sexually transmitted diseases. Therefore, the nurse should promote safe sexual practices among them. The nurse may assess their nutritional status and take the necessary steps to improve their knowledge of good nutrition in this community. A comprehensive community assessment among adolescents will not help prevent congenital anomalies or inborn errors of metabolic disorders. pp. 34

The nurse works in a long-term care unit. Which rules of performance should the nurse keep in mind? Sharing of knowledge Individualization of care Exclusion of the patient from decision-making Transparency with the patient Patient needs are not anticipated but expressed

Sharing of knowledge Individualization of care Transparency with the patient The Institute of Medicine (IOM) has identified 10 important rules of performance for a health care system to follow to better meet patient needs. As per the rules, knowledge is shared with the patient and information flows freely. Patient care is individualized based on needs and values. The patient should be encouraged to actively participate in decision making and take control of his or her own health. Patient needs should be anticipated through planning and met effectively. p. 23

The nurse working in a psychiatric unit teaches a patient about crisis management. What are the various forms of crises? Emotional crises Situational crises Adventitious crises Psychological crises Developmental crises

Situational crises Adventitious crises Developmental crises The three types of crises are situational crises, adventitious crises, and developmental crises. Emotional and psychological crises are not classifications of crises. p. 774

The nurse is educating a couple about sexually transmitted infections caused by bacteria. Which sexual diseases are caused by bacteria? Herpes Syphilis Chlamydia Gonorrhea Genital warts

Syphilis Chlamydia Gonorrhea Sexually transmitted infections caused by bacteria include syphilis, chlamydia, and gonorrhea. Herpes and genital warts are sexually transmitted but are caused by viruses. Herpes is caused by the herpes simplex virus, and genital warts are caused by the human papillomavirus. Study Tip: Notice that the bacterial sexually transmitted infections (STIs) are treatable with antibiotics and curable. Remembering that herpes and genital warts are not curable may help you remember that they are viruses. p. 719

In cases in which a patient is experiencing stress and anxiety, what are the meditation techniques that the nurse needs to teach the patient to help healing? Teach the patient to sit with his or her back straight and breathe slowly. Identify a quiet room in the home that has minimal interruptions. Refer the patient to a teacher who takes personal meditation classes. Instruct the patient to switch off all the fans in the house. Provide a printed teaching guide that explains how to meditate.

Teach the patient to sit with his or her back straight and breathe slowly. Identify a quiet room in the home that has minimal interruptions. Provide a printed teaching guide that explains how to meditate. To teach meditation to the patient, the nurse must teach the techniques of breathing slowly with a straight back position. It should be done in a quiet room away from any interruptions. Teaching guides should be provided for a better understanding. Meditation classes are not always required. Playing peaceful music and turning the fans on may block out distractions. Therefore, it may help to concentrate during meditation. p. 745

A 55-year-old male patient recently underwent a colostomy. Prior to the colostomy, the patient underwent coronary artery bypass graft (CABG) surgery. The nurse finds the patient depressed and weeping. The patient expresses that he is fed up with his poor health. He feels that he has become a burden on his family because he can't work now. Which factors are responsible for lowering the patient's self-esteem? The colostomy Abuse or neglect Dependency on others A change in marital status A physical deficit preventing role assumption

The colostomy Dependency on others A physical deficit preventing role assumption Procedures such as colostomies alter the physical appearance of people, thereby lowering their self-esteem. This patient is dependent on his family due to his physical deficits. This can be a major stressor and further reduce his self-esteem. His self-esteem is also lowered by the fact that he is unable to handle his responsibilities. Abuse or neglect and change in marital status do affect a person's self-esteem, but in this case, these factors are not evident. p. 704-705

A patient tells the nurse that she has just received green card status in the United States and does not have much awareness of the health care system in the country. She asks the nurse whether it is best to have minor surgery in an urban hospital or a stand-alone clinic of an individual health care provider. The nurse answers that physicians perform simple surgeries in office surgical suites. It is preferable to go to them for a minor surgery rather than to a large urban hospital. Why does the nurse give this advice to the patient? Nursing quality is better in private in-office surgical suites as compared to urban hospitals. Surgeries done in office surgical suites use better technology than urban hospitals. The cost of surgeries done in office surgical suites is far less than that in urban hospitals. Surgeries done in office surgical suites have better outcomes than those done in urban hospitals.

The cost of surgeries done in office surgical suites is far less than that in urban hospitals. Costs for surgeries are high in the United States. Health care providers have opened their own small surgical suites for minor procedures. The cost of surgeries in such establishments is less than in urban hospitals. There are no relevant differences in the nursing quality, use of technology, or patient outcomes between in-office surgical suites and urban hospitals. p. 18

A 35-year-old patient approaches the nurse for advice about her children, who are ages 8 and 3 years. The patient informs the nurse that the older son likes drinking milk from his brother's sippy cup. What should the nurse explain to the woman? The elder son is using a regression defense mechanism. The elder son will develop psychiatric disorders in future. The elder son is using a displacement defense mechanism. The elder son will develop intellectual disability in the future. The elder son obtains psychological protection from stress with this behavior.

The elder son is using a regression defense mechanism. The elder son obtains psychological protection from stress with this behavior. Regression is a defense mechanism that happens unconsciously to cope with a stressor. It includes actions and behaviors related to an earlier developmental period in life. Defense mechanisms, as a rule, do not result in psychiatric disorders but are very helpful in coping with the stress. The use of defense mechanisms does not predict the development of a psychiatric disorder in the future. Drinking milk from the younger brother's cup is an example of regression; it is not an example of displacement. The use of defense mechanisms does not predict the development of an intellectual disability in the future. p. 774

In the general adaptation syndrome, what happens in the body because of increased epinephrine? The heart rate increases. Blood glucose levels increase. Oxygen intake increases. Gluconeogenesis increases. Water reabsorption increases.

The heart rate increases. Blood glucose levels increase. Oxygen intake increases. When a stressor occurs, the pituitary gland, adrenal medulla, and sympathetic nervous system are activated. These in turn produce hormones that bring about changes in the body. Epinephrine is one of the hormones produced because of the arousal of the sympathetic nervous system and adrenal medulla. Increased epinephrine results in increased heart rate, blood glucose levels, and oxygen intake. Increased epinephrine does not affect gluconeogenesis or water reabsorption. Gluconeogenesis increases because of increased cortisol, and increased water reabsorption occurs due to increased aldosterone. p. 772

The nurse is assessing a 47-year-old, female patient who has been recently diagnosed with carcinoma of the right breast. Her left breast was removed 2 years ago for the same reason. What symptoms in the patient may indicate ineffective coping? The patient appears poorly groomed. The patient complains of weight gain. The patient laughs inappropriately. The patient is able to meet her basic needs. The patient responds accurately to questions.

The patient appears poorly groomed. The patient complains of weight gain. The patient laughs inappropriately. The nurse should be aware of the characteristics that define ineffective coping. These include poor grooming, weight gain, and inappropriate laughing or crying. A patient who is able to meet basic needs and responds accurately to the questions asked demonstrates effective coping skills. p. 777

The nurse is trying to assess if a patient is free from identity stressors. What would suggest that the patient has a strong identity? The patient has been happily married for 10 years. The patient exercises daily. The patient does not abuse substances. The patient is involved in church activities.

The patient has been happily married for 10 years. Identity achievement is reflected by a patient's intimate relationships. The patient who has been happily married for 10 years probably has a strong identity. Positive behaviors such as exercising daily, not abusing substances, and being involved in church activities do not indicate that the patient is free of identity stressors. p. 703

A patient survived a motor vehicle accident; the driver of the other car did not. The patient feels extremely guilty and says, "I am never going to touch the wheel again in my life." If the nurse intervened to improve the patient's self-esteem, what would be the most likely immediate outcome? The patient would talk to the victim's family. The patient would drive back to work in a month. The patient would drive his or her kids to school in a month.

The patient would at least sit in the driver's seat in 3 days. The patient survived a major motor vehicle accident and suffers from situational low self-esteem. The nursing interventions should be directed towards improving the self-esteem of the patient. The most likely immediate outcome of these interventions would be that the patient thinks about being able to drive again and would sit in the driver's seat within 3 days. It would take more time for the patient to drive back to work, drive his or her kids, or talk to the victim's family. p. 712

The nurse is teaching a group of nursing students about improvements in health care systems through managed care. Which statements are true about managed care? The provider receives a predetermined capitated payment for each patient. The provider assumes financial risk in addition to providing patient care. The focus of care shifts to individual illness care. The services focus on improving the functional status of individuals. The services focus on reducing patient costs and improving patient satisfaction.

The provider receives a predetermined capitated payment for each patient. The provider assumes financial risk in addition to providing patient care. The services focus on improving the functional status of individuals. The services focus on reducing patient costs and improving patient satisfaction. Managed care is a health care system in which the health care provider receives a predetermined capitated payment for each patient enrolled in the specific program. Therefore, the provider takes the risk of financial management in addition to providing health care services. The health care services focus on keeping patients healthy and functional. Health costs can be reduced by keeping patients healthy and satisfied with the health care provided. The focus of care is not individual illness but the prevention of illness, prompt detection and timely treatment, and outpatient care. p. 15

A couple is diagnosed as positive for the human immunodeficiency virus (HIV). Which information should the nurse include when educating this couple about HIV? They should not engage in sexual intercourse. Their children will also be HIV positive. Their duration of survival would increase with treatment. They can be cured by highly active antiretroviral therapy (HAART).

Their duration of survival would increase with treatment. Individuals infected with human immunodeficiency virus (HIV) can survive for about 10 years if left untreated. Because they are already infected, they may have sexual intercourse with each other. Their children are at risk, but not all children born to HIV mothers test positive for HIV. Highly active antiretroviral therapy (HAART) greatly increases the longevity of infected individuals but does not cure the disease. p. 719

Which statements apply to theory generation? Theory generation builds a scientific knowledge base of nursing. Theory generation discovers relationships of phenomena to practice. Theory generation tests specific phenomena. Theory generation identifies observations about a phenomenon. Theory generation proves hypotheses.

Theory generation builds a scientific knowledge base of nursing. Theory generation discovers relationships of phenomena to practice. Theory generation identifies observations about a phenomenon. Theory-generating research identifies observations or describes phenomena. It contributes to the scientific knowledge base of nursing. Relationships of the phenomena to practice and testing specific phenomena are part of the theory-testing research activities. pp. 41-42, 49

The nurse understands that some people believe that there is no known ultimate reality. These people are referred to as agnostics. What are the beliefs of an agnostic person? They discover meaning in what they do or how they live. They do not believe in the existence of God. They do not find ultimate meaning for the way things are. They believe that people bring meaning to what they do. They search for meaning in life through their work and their relationships with others.

They discover meaning in what they do or how they live. They do not find ultimate meaning for the way things are. They believe that people bring meaning to what they do. Agnostics believe that there is no ultimate reality; they tend to discover meaning in what they do and how they live. They are unable to find the ultimate meaning for the way things are. They believe that people bring meaning to what they do. An atheist does not believe in the existence of God and searches for the meaning of life through work and relationships with others. p. 734

What is the goal of transcultural nursing? To provide care to fit with a patient's own values, beliefs, and traditions To help with recognizing biases, prejudices, and assumptions about other people To assess social, cultural, and biophysical factors that influence patient treatment and care To motivate the nurse to learn from the others, accept the role as a learner, and be open to and accepting of cultural differences

To provide care to fit with a patient's own values, beliefs, and traditions The goal of transcultural nursing is to provide care to fit with the patient's own values, beliefs, and traditions. Cultural awareness is required to recognize biases, prejudices, and assumptions about other people. Cultural skill helps to assess social, cultural, and biophysical factors that influence patient treatment and care. Cultural desire involves the motivation to learn from others, accept the role as a learner, and be open to and accepting of cultural differences. p. 103

What is the primary goal of patient-centered care? To provide care that fits a patient's own values, beliefs, and traditions To help in recognizing biases, prejudices, and assumptions about other people To provide individualized care and restore an emphasis on personal relationships To assess social, cultural, and biophysical factors that influence patient treatment and care

To provide individualized care and restore an emphasis on personal relationships The primary goal of patient-centeredness is to provide care and restore an emphasis on personal relationships. The goal of transcultural nursing is to provide care that fits with the patient's own values, beliefs, and traditions. Cultural awareness would help in recognizing biases, prejudices, and assumptions about other people. Cultural skills help to assess social, cultural, and biophysical factors that influence patient treatment and care. p. 105

To control rising health care costs, the federal government created professional standard review organizations (PSRO). What are the functions of PSROs? To review the quality of hospital care To review the quantity of hospital care required To review admissions To review the cost of hospital care To identify and eliminate overuse of diagnostic and treatment services

To review the quality of hospital care To review the quantity of hospital care required To review the cost of hospital care The functions of a professional standard review organization (PSRO) are to review the quality of hospital care provided, the quantity of hospital care required, and the overall cost of hospital care. Reviewing admissions, and identifying and eliminating overuse of diagnostic and treatment services are functions of utilization review (UR) committees. p. 15

The nurse is teaching a group of young adults about the normal changes in role performance associated with maturation. What are the common stressors related to role performance in this stage of life? Societal attitudes Dependency on others Transition from school to work setting Physical, emotional, or cognitive deficits preventing role assumption Death of a loved one

Transition from school to work setting Physical, emotional, or cognitive deficits preventing role assumption Death of a loved one Role performance is the way in which individuals perceive their abilities to carry out significant roles (e.g., parent, supervisor, or close friend). Normal changes associated with maturation result in changes in role performance. The common stressors include transition from school to work setting, and the physical, emotional, or cognitive deficits preventing role assumption. The death of a loved one creates an emotional deficit that may prevent a person from assuming his or her roles. Societal attitudes and dependency on others are related to identity. p. 705

What can cause an adventitious crisis in a person? Tsunami Earthquake Childbirth Death of a pet Leg amputation

Tsunami Earthquake An adventitious crisis can be triggered by a major natural disaster, a man-made disaster, or a crime of violence. Therefore, a tsunami or earthquake can result in an adventitious crisis. Childbirth, the death of a pet, or a leg amputation can cause a situational crisis. p. 774

The nurse is conducting a sexual assessment of an adolescent. Which should the nurse keep in mind when interacting with this age group? Use simple language. Check for signs of physical injuries. Keep the findings private and confidential. Use a closed and positive approach. Inform patients that answering questions is normal.

Use simple language. Check for signs of physical injuries. Inform patients that answering questions is normal. When interacting with an adolescent about sexuality, use simple and understandable language. The physical examination should involve checking for any signs of injuries to assess for abuse. The patient may be hesitant to interact and hence should be informed that answering such questions is normal. The findings should be shared with the parent or guardian when dealing with a minor. The nurse's approach should be open and positive, because a closed approach may make the patient uncomfortable while responding. pp. 716, 717

A couple does not desire to have any more children. Which contraceptive method should the nurse suggest to the couple? Skin patch Abstinence Intrauterine device Vasectomy

Vasectomy As the couple does not wish to have any more children, it is advisable for the couple to opt for permanent contraception. Vasectomy is usually a permanent sterilization procedure for men and involves tying and cutting of the vas deferens. Skin patches and intrauterine devices are not as effective and do not offer permanent contraception. Abstinence from sex is difficult to maintain for most couples. Study Tip: The contraceptive methods that are permanent are also referred to as sterilization. These include vasectomy for the man and tubal ligation for the woman. Both can rarely be surgically reversed, so vasectomy and tubal ligation are usually permanent. Be sure you are ready for questions on sterilization as well as contraception. pp. 718

Which population does Medicaid cover? Very poor children All pregnant women All children under age 10 Low-income individuals with disabilities Low-income pregnant women

Very poor children Low-income individuals with disabilities Low-income pregnant women Medicaid is a federally funded program that covers health care for low-income individuals. This program finances care for very poor children, low-income people with disabilities, and low-income pregnant women. Pregnant women and children who do not belong to low-income groups do not benefit from this program. p. 16

Which questions would best assess a patient's level of connectedness? What gives your life meaning? Which aspects of your spirituality would you like to discuss right now? Whom do you consider to be the most important person in your life at this time? How do you feel about the accomplishments you've made in your life so far?

Whom do you consider to be the most important person in your life at this time? Connectedness refers to feelings about relationships with the self, others, and God; this question asks about connectedness with others. p. 738

Which is an example of a contrast question? "Do you have siblings?" "What area hurts most often?" "How long have you been alone?" "How severe is your headache compared to the last one?"

"How severe is your headache compared to the last one?" The questions pertaining to comparison of two events are called contrast questions. The question, "How severe is your headache compared to the last one?" compares pain occurring at two different times. "Do you have siblings?", "Where does it hurt more often?", and "How long have you been alone?" are examples of open-ended questions. p. 107

During the assessment interview of an older woman experiencing a developmental crisis, what does the nurse say? "How is this flood affecting your life?" "Since your husband has died, what have you been doing in the evening when you feel lonely?" "How is having diabetes affecting your life?" "I know this must be hard for you. Let me tell you what might help."

"Since your husband has died, what have you been doing in the evening when you feel lonely?" A developmental crisis occurs as a person moves through life's stages, including widowhood. p. 774

Which question should the nurse ask a patient with low self-esteem in order to assess the nature of the problem? "What do you like about your appearance?" "Can you remember a time when you felt good about yourself?" "What impact does your self-esteem have on your relationships?" "When did you start thinking or feeling differently about yourself?"

"What do you like about your appearance?" During the assessment process, the nurse asks open-ended, focused, and specific questions in order to determine accurate data. The nurse asks the patient about the perception of his or her own appearance to understand the nature of the problem. The nurse asks about the times the patient has felt good about himself or herself in order to determine which area is important for patient care. To determine the effects of low self-esteem on a patient, the nurse asks about the impact of relationships on the patient's self-esteem. To assess the onset and duration of symptoms, the nurse asks when the patient began to feel differently. p. 708

What is the approximate duration (in weeks) required by a person to resolve a crisis? Record your answer using a whole number.

6 weeks Crisis occurs when a person is under stress and is unable to cope up with it. The event that has caused the crisis usually occurs 1 to 2 weeks before the patient seeks help. A person generally resolves a crisis in some way within approximately 6 weeks. p. 772

The nurse is caring for a patient with end-stage lung disease. The patient wants to go home on oxygen and be comfortable. The family wants the patient to have a new surgical procedure. The nurse explains the risk and benefits of the surgery to the family and discusses the patient's wishes with the family. Which role is the nurse playing for the patient? Educator Advocate Caregiver Case manager

Advocate An advocate protects the patient's human and legal right to make choices about care. An advocate may also provide additional information to help a patient decide whether or not to accept a treatment or find an interpreter to help family members communicate their concerns. p. 3

A 34-year-old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. What is your best response? "Are you thinking of suicide?" "You've been doing a good job raising your children. You can do it!" "Is there someone who can help you?" "You have so much to live for."

"Are you thinking of suicide?" Although this sounds abrupt, the patient usually is relieved that you've broached this issue. For safety reasons it is very important to discuss the patient's suicidal thoughts. Test-Taking Tip: The correct answer may have surprised you because the other three choices share a milder approach. This is an answer that places safety as the highest priority. Think "Safety first!" when answering a question. p. 777

Which statements made by an older adult whose husband recently died most indicates the need for follow-up by the nurse? "I planted a tree in my husband's honor at my church." "I have been unable to talk with my children lately." "My friends think that I need to go to a grief support group." "I believe that someday I'll meet my husband in heaven."

"I have been unable to talk with my children lately." Feelings of connectedness are important for the older adult; this statement indicates that this woman is having difficulty staying connected with her children, who are potentially an important resource for the woman. p. 734, 738

The nurse is providing education about condom use at a community clinic for older adults. Which statements demonstrate that the adults understand correct use of condoms? "I can use any kind of lubricant such as lotions or baby oil." "Before using the condom, I should check the package for damage or expiration." "I need to use a condom to help reduce the risk of sexually transmitted infections." "A good place to store condoms is in the bathroom so they don't dry out." "I should not use a condom because I have a latex allergy."

"Before using the condom, I should check the package for damage or expiration." "I need to use a condom to help reduce the risk of sexually transmitted infections." Older adults sometimes are not familiar with condom use and storage. Teach them to use water-based lubricants because oil-based products contribute to breakage of latex condoms. Condoms should be stored in a cool, dry location away from sunlight. Condoms are available in non-latex varieties. p. 728

The registered nurse is evaluating the statements of a student nurse after teaching about cultural assessment models. Which statement by the student nurse needs correction? "Cultural assessment models are used to stereotype a particular group of patients." "Cultural assessment models help to focus on the information relevant to patient's problem." "Cultural assessment models can be used to understand a patient's religious beliefs." "Cultural assessment models help one to understand the complex factors that influence a patient's cultural world view."

"Cultural assessment models are used to stereotype a particular group of patients." Stereotyping is generalizing a patient based on his or her cultural group. Cultural assessment models are used to understand the cultural beliefs of a patient and are not used to generalize (stereotype) the patient. Cultural assessment models help to focus on the information relevant to patient's problem by providing a worldview. Cultural assessment models are used to understand patient's religious beliefs and the complex factors that influence a patient's cultural worldview. p. 107

The registered nurse is admitting a patient of French heritage to the hospital. Which question asked by the nurse indicates that the nurse is stereotyping the patient? "What are your dietary preferences?" "What time do you typically go to bed?" "Do you bathe and use deodorant more than one time a week?" "Do you have any health issues that we should know about?"

"Do you bathe and use deodorant more than one time a week?" Nurses need to avoid stereotypes or unwarranted generalizations about any particular group that prevents further assessment of the individual's unique characteristics. p. 106

The nurse is caring for a patient suffering from a severe illness. What are the questions that the nurse should ask to assess the spiritual strength of the patient? "Do you use prayer or meditation?" "Are you an atheist?" "Do you believe in God?" "How do you feel after praying?" "What gives you energy during difficult times?"

"Do you use prayer or meditation?" "How do you feel after praying?" "What gives you energy during difficult times?" If the nurse wants to assess the spiritual strength of the patient, the nurse will ask whether the patient prays or not. This will help the nurse determine if the patient is spiritual and has religious beliefs. Asking about the feeling after prayers will help to analyze the patient's faith and hope in their spiritual beliefs. Asking the patient about the source of his or her strength during difficult times helps to determine the patient's spirituality and religious beliefs. The nurse should never ask directly whether the patient is an atheist or does not believe in God. p. 738

The nurse is caring for a 16-year-old patient who is under immense stress. He is depressed because his mother had a stroke and he is the only caregiver. The nurse previously prepared a care plan and asked the patient to follow the same at home. The patient came back for reevaluation after 1 month of the initial appointment. Which questions should the nurse ask in order to find out the effectiveness of the interventions? "How is your mother?" "Has your fatigue level decreased?" "Which music do you prefer listening to?" "What changes have you brought about in your day-to-day life?" "How will you perform the progressive relaxation technique?"

"Has your fatigue level decreased?" "What changes have you brought about in your day-to-day life?" During reevaluation, the nurse should ask questions that would reflect upon the effectiveness of the patient's care plan. The nurse should ask whether the stress and fatigue levels have reduced and what changes the interventions have brought to his daily life. Asking about his mother's recovery is irrelevant to assessing the effectiveness of the plan. Asking about the type of music the patient prefers listening to should be done during the initial assessment, because listening to music could be an effective intervention to induce relaxation. Understanding of the progressive relaxation technique should be assessed during evaluation in the first session. p. 779

The nurse is assessing a patient who is demonstrating symptoms of severe stress. The nurse interviews the patient to learn whether the patient is using any maladaptive coping skills to reduce stress. Which questions should the nurse ask? "What do you think of when you are awake?" "Have you started sleeping excessively?" "Do you have high blood pressure?" "Do you live alone or with family?" "Have you started smoking or drinking?"

"Have you started sleeping excessively?" "Do you live alone or with family?" "Have you started smoking or drinking?" Use of maladaptive coping skills can be assessed by finding out whether the patient has started sleeping, eating, or drinking excessively, or has started staying alone. These behaviors indicate that the patient is not coping well. Asking what the patient is thinking when awake could be helpful to find out the patient's appraisal of stress. Asking questions about high blood pressure or the patient's medications gives the nurse an idea about the patient's adherence to healthy practices. p. 777

A patient suffers from situational low self-esteem following the death of her pet dog. What are the appropriate questions for the nurse to ask during assessment of her self-esteem? "What recreational activities do you like?" "What is your favorite food?" "What are the three activities that you used to do with your dog?" "How do you feel about yourself?"

"How do you feel about yourself?" The nurse's assessment should focus on individual components, and asking the patient how she feels about herself helps the nurse to identify any identity crises the patient might have. Asking about recreational activities, favorite foods, and activities with the pet would not be useful in assessing the problems related to the patient's identity, role performance, or body image. p. 708

During a spiritual assessment, which question asked by the nurse assesses connectedness? "How do you feel after you've prayed?" "What gives you energy during difficult times?" "How happy or satisfied are you with your life?" "How do these changes affect what you need to do?"

"How do you feel after you've prayed?" The nurse asks the patient direct questions during a spiritual assessment in order to make clinical decisions required for effective nursing care. Connectedness is described as connection within oneself, with others, and with the environment. To assess the connectedness of the patient, the nurse asks the patient about his or her feelings after prayer. To assess the concept of spirituality and spiritual health, the nurse asks the patient about the patient's source of energy during difficult times. The nurse asks the patient about his or her satisfaction with life, which is an aspect of spiritual assessment. The nurse asks the patient about role changes and the effects of these changes on the patient's life in order to assess the patient's own life and self-responsibility. p. 734

After the birth of a baby, a divorced mother is finding it difficult to take care of the baby and work at the same time. The patient seeks advice from the nurse to handle this stress effectively. What question does the nurse ask the patient during the crisis assessment? "Do you know that you are in a situational crisis? "What does your husband do?" "How is your work and responsibility as a mother affecting your life?" "Where is your husband now? Why didn't you bring him along?"

"How is your work and responsibility as a mother affecting your life?" When a person is experiencing a crisis, the nurse should ask the patient about the impact of the stress on his or her life. The nurse should use lay terms rather than medical jargon such as "situational crisis" when talking to a patient. It is not appropriate at this stage to ask about her husband. p. 777

The nurse is evaluating the sexual assessment data of a patient. The nurse finds that the patient has various self-concept issues that are affecting sexual health. Which statements by the patient would indicate such self-concept issues? "I am not attractive." "I am a chain smoker." "I can't accomplish my sexual desires." "The disease has made me very weak." "Overwork leaves me sleepless at nights."

"I am not attractive." "I can't accomplish my sexual desires." "The disease has made me very weak." A patient's sexuality is affected by various factors, including self-concept issues related to identity, body image, and self-esteem. A sense of looking ugly may cause a person to feel undesirable. Disease conditions may lead to poor body image and weakness, which may cause dejection and the feeling that one cannot accomplish sexual desires. Being a chain smoker or getting insufficient sleep are lifestyle factors that may affect sexuality but are not self-concept issues. p. 723

Which statement made by a patient with cancer reflects positive thoughts about personal health? "I will not get better soon." "I am a burden to my family." "I have the ability to get well quickly." "I can't stand to look at myself anymore."

"I have the ability to get well quickly." A person's belief about personal health helps the nurse to understand the patient's self-concept. The patient who feels he or she has the ability to get well reflects positive thoughts about personal health. A verbalization such as, "I will not get better soon," indicates that the patient is suffering from chronic illnesses. If the patient states that he or she is a burden to his or her family, it indicates negative perceptions about personal health. The patient who states, "I can't stand to look at myself anymore" is indicating that he or she does not have positive thoughts about personal health. pp. 703-704

What statements made by the patient indicate that the patient's self-concept is improving following treatment? "I am pretty comfortable with my crutches." "It is easier to administer insulin than I had imagined." "The prosthesis hurts; I cannot endure it." "Physical therapy is going well. I'm going to be on my feet soon." "I don't find the social gathering very interesting."

"I am pretty comfortable with my crutches." "It is easier to administer insulin than I had imagined." "Physical therapy is going well. I'm going to be on my feet soon." Acceptance of the use of assistive devices and understanding teaching, such as how to administer insulin, suggest good progress. Positive attitudes toward returning to previous levels of functioning also indicate good progress. Not wanting to put additional efforts into rehabilitation and not wanting to socialize indicate negative self-concept. Test-Taking Tip: Narrow the choices by first eliminating answers you know are incorrect. For this question, the statements "The prosthesis hurts; I cannot endure it" and "I don't find the social gathering very interesting" are examples of a patient displaying negative responses. Those responses do not correlate with what the question is asking about (improved self-concept), so you know to eliminate them as possibilities. p. 713

The nurse is caring for an elderly patient who has diarrhea, and the nurse suspects that the patient has a biomedical perspective of illness. Which statement by the patient helped the nurse to reach this conclusion? "I will recover if I drink hot beverages." "I will feel better after meeting with a mambo." "I am sick because of unhygienic surroundings." "I am sick because of supernatural forces surrounding me."

"I am sick because of unhygienic surroundings." Biomedical theory postulates that microorganisms are responsible for specific disease conditions. Therefore, the patient's statement that unhygienic surroundings are responsible for the illness supports the nurse's conclusion. Patients who believe in the yin/yang or hot/cold theory believe in a naturalistic approach to healing. Therefore, the statement that the patient will be better after drinking hot beverages indicates that the patient believes in the naturalistic perspective. People who believe in a magico-religious perspective believe that illness is a result of supernatural powers. A mambo is a female voodoo priest who treats illness with faith healing. Therefore, the statement that the patient will be better after meeting a mambo would indicate belief in a magico-religious perspective. Many Southeast Asian patients believe that illness is caused by supernatural forces. p. 108

After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. What is the nurse's first response? "Don't be sad. People live with cancer every day." "Have you thought about how you are going to tell your family?" "I can sit with you for a while, if you would like to talk." "I know another patient whose colon cancer was cured by surgery."

"I can sit with you for a while, if you would like to talk." Ask the patient if he would like you to sit down for a few minutes so he can talk. Asking an open-ended question and providing an opportunity for the patient to talk allow the nurse to assess the patient's perception of the situation, which is of utmost importance. Test-Taking Tip: Look for answers that allow the patient to express feelings. p. 776

A patient comes to a rheumatology clinic for pain in her knees due to osteoarthritis. The orthopedic surgeon advises her to undergo knee replacement surgery. The patient practices Buddhism. Which patient statement reflects her religious beliefs? "Will a female surgeon do the surgery?" "Aren't there any alternative techniques for treating this?" "I don't want to be admitted to the hospital." "Please change the date of my surgery since it is a holy day." "Some evil spirit has invaded my body and caused illness."

"I don't want to be admitted to the hospital." "Please change the date of my surgery since it is a holy day." "Some evil spirit has invaded my body and caused illness." Buddhists accept modern medical science and believe that health is an integral part of life. Buddhists prefer not to visit hospitals and may refuse treatments on holy days. They believe that nonhuman spirits invade the body and cause illness. There is no indication that Buddhists would refuse conventional treatments in favor of alternative treatments. Muslims, rather than Buddhists, are likely to request female practitioners if they are female. p. 739

The nurse is assessing the coping skills of a patient who lost his mother and is depressed. Which response by the patient will show that the patient is coping well? "I always feel better when I paint. I think it might help me to relieve depression." "My friend said that she drinks a good red wine when she is depressed. I will try that at home." "My grief will be resolved only when I go to a different world altogether." "I have been going to a support group that I find is very good and I am resuming my studies."

"I have been going to a support group that I find is very good and I am resuming my studies." A patient who is coping well would feel better than before and would try to resume the activities of daily life. Therefore, the statement that the patient feels good and is resuming studies indicates that the patient is coping well with the loss. The statement that the patient feels better when painting indicates that the patient has been speculating about various strategies that might help. Drinking alcohol is not a healthy sign of coping and should be discouraged. The statement that the patient wants to go to another world indicates that the patient has suicidal ideations. p. 774

The nurse is providing education on sexually transmitted infections (STIs) to a group of adolescents. Which statement by an adolescent indicates the need for further teaching? "A vaccine is available to reduce infection from certain types of human papillomavirus." "I should be screened for an STI after I am with a new partner." "I know I'm not infected if I don't have any symptoms such as discharge or sores." "A viral infection such as herpes or human papillomavirus cannot be treated with antibiotics."

"I know I'm not infected if I don't have any symptoms such as discharge or sores." Many sexually transmitted infections (STIs) have few symptoms and are often detected during routine screening. The risk of infection is higher in people who are under the age of 25 and who have multiple sex partners. Viral infections cannot be cured with antibiotics, but medication is available to suppress outbreaks. Bacterial infections can be treated with antibiotics, but the infection can recur with new exposure. p. 719

While measuring the vital signs of a Muslim patient, the nurse observes that the patient is anxious. Which statement by the nurse indicates a good understanding of transcultural nursing? "I know modesty is very important for you, but you'll have to adjust this time." "I know modesty is very important for you, but it should not interrupt the assessment." "I know modesty is very important for you. However, we have to adhere to hospital rules." "I know modesty is very important for you. Is there any way I can make you comfortable?"

"I know modesty is very important for you. Is there any way I can make you comfortable?" Muslim patients often highly value modesty and may be uncomfortable with certain procedures, particularly if the health care worker is of the opposite sex. Therefore, the nurse should make the patient comfortable by showing an attitude of helpfulness and asking what can be done to make the patient more comfortable. The nurse should demonstrate flexibility and should not instruct the patient to adjust, because it may violate the patient's core values. The nurse should provide culturally congruent assessment to the patient. The nurse should not force the patient to adhere to the hospital rules; instead, the nurse should provide patient-centered care. p. 103

After teaching a group of young adults about contraception, the nurse concludes that there is a need for further teaching. Which statement made by a young adult supports the nurse's conclusion? "A vasectomy is a contraceptive method that is permanent." "A condom is the most effective barrier method for contraception." "I consult a health care provider before starting hormonal contraceptive therapy." "I prefer to use a combined method of birth control to reduce the risk of sexually transmitted infections (STIs)."

"I prefer to use a combined method of birth control to reduce the risk of sexually transmitted infections (STIs)." Contraception, also known as birth control, is the method or device used to prevent pregnancy. The nurse teaches about contraception to people who are sexually active in order to provide higher protection against a number of diseases. However, methods that are effective for contraception do not always reduce the risk of sexually transmitted infection (STIs). Therefore, the nurse should correct the statement about using a combined method of contraception to reduce the risk of STIs. A vasectomy or male sterilization is a permanent contraceptive surgical method. A condom is the most effective barrier method. A condom is a thin rubber sheath that fits over the penis to prevent the entrance of sperm into the vagina. The use of hormonal contraception requires a primary health care provider's prescription. Therefore, the young adult will consult a health care provider before beginning a suitable therapy. p. 718, 719

Following a bilateral mastectomy, a 50-year-old patient refuses to eat, discourages visitors, and pays little attention to her appearance. One morning the nurse enters the room to see the patient with her hair combed and makeup applied. Which statement is the best response from the nurse? "What's the special occasion?" "You must be feeling better today." "This is the first time I have seen you look this good." "I see that you've combed your hair and put on makeup."

"I see that you've combed your hair and put on makeup." When the nurse uses a matter-of-fact approach and acknowledges a change in the patient's behavior or appearance, it allows the patient to establish its meaning. p. 706

The registered nurse is evaluating the student nurse for the Teach-Back technique. Which statements made by the student nurse indicate the need for further teaching? "I should avoid using models during the teaching process." "I should use charts to facilitate patient understanding." "I should ask the patient whether he or she understood the teaching." "I should let the patient ask questions during the course of teaching." "I should teach the patient again after finishing the first round of teaching."

"I should avoid using models during the teaching process." "I should ask the patient whether he or she understood the teaching." The nurses can use different methods to explain a concept or procedure to a patient until he or she feels confident that the patient has understood. The use of models is one such method the nurse can employ. The nurse should not ask whether the patient has understood but should instead check the patient's extent of learning or verify understanding by asking the patient specific questions about the teaching. The nurse can use charts/pictures to facilitate better understanding. The Teach-Back technique is an ongoing process of asking patients for feedback through explanation. Therefore, patients can be permitted to ask questions during the course of teaching. In case the patient doesn't understand completely, the nurse should explain it to the patient again after the first round of teaching. p. 100

The nurse is evaluating the coping success of a patient experiencing stress from after being diagnosed with multiple sclerosis and psychomotor impairment. Which statement indicates that the patient is coping successfully? "I'm going to learn to drive a car so I can be more independent." "My sister says she feels better when she goes shopping, so I'll go shopping." "I've always felt better when I go for a long walk. I'll do that when I get home." "I'm going to attend a support group to learn more about multiple sclerosis."

"I'm going to attend a support group to learn more about multiple sclerosis." Support groups often benefit people experiencing stress. pp. 778, 781

The nurse is performing a cultural assessment of a patient. Which question of the nurse reflects a focused question? "Who lives with you?" "What do you do to keep yourself well?" "What do you think caused your illness?" "Is there someone with whom you want us to talk about your care?"

"Is there someone with whom you want us to talk about your care?" Asking the patient if there is someone with whom he or she would like the health care team to discuss his or her care is an example of a focused question. Asking the patient what he or she does to keep him- or herself well assesses the patient's beliefs and practices. Asking the patient with whom he or she lives assesses the patient's social organization. Asking the patient what he or she thinks the reason is for an illness is an open-ended question. p. 107

The nurse at a community health center is teaching a group of menopausal women about normal changes in the female sexual response that occur with aging. Which statement by one of the women indicates that the information is understood? "It's normal for me to take longer to reach an orgasm." "I might experience chest pain or shortness of breath during intercourse." "It's normal for me to lose interest in sexual relationships." "I won't need to be concerned about contraception or sexually transmitted infections because of my age."

"It's normal for me to take longer to reach an orgasm." Normal changes in the female sexual response include a decrease in sex hormone levels, decrease in vaginal lubrication, longer time to reach orgasm, and longer refractory times. Many factors such as chronic illness, medications, stress, or loss of partner can influence the older adult's sexual activity. Older adults may not be comfortable using barrier methods such as condoms and therefore are at increased risk for sexually transmitted infections. pp. 717-718

Which statement made by the nurse is an example of applying the principle of patient-centered care while focusing on alleviating the patient's fear and anxiety? "Let's talk about the concerns that you have about going home." "I'll get the medication prescriptions for you before discharge." "I'll be back in 30 minutes to help you get cleaned up." "I'll make a referral to the home health nurse for you."

"Let's talk about the concerns that you have about going home." Interventions that focus on the alleviation of fear and anxiety are related to allowing the patient and family time to express fears and concerns, understand the impact that illness will have on the patient's ability to care for himself or herself, and express worries about their ability to pay for medical care. Identifying staff that can help with payment plans alleviates fear and anxiety. p. 23

The nurse is teaching stress management techniques to a patient. Which instructions should the nurse give the patient to manage stress? "Eat whatever you feel like." "Listen to music that you enjoy." "Sleep more." "Exercise for 15 to 30 minutes every day." "Engage yourself in pleasurable activities."

"Listen to music that you enjoy." "Exercise for 15 to 30 minutes every day." "Engage yourself in pleasurable activities." When teaching about stress management, the nurse should encourage the patient to listen to good music because it relaxes the mind. Exercise induces a sense of well-being. Engaging in pleasurable activities will help to offer a break from monotonous life. Giving instructions such as eating whatever the patient feels like and sleeping more are inappropriate. Eating and sleeping more are ineffective coping strategies. p. 781

The nurse is using the "Teach Back" technique to evaluate a patient after teaching about medication adherence. Which question by the nurse is appropriate to verify the patient's understanding? "Did you understand?" "Do you have any questions?" "Please let me know whether this information was useful to you." "Please review what we talked about. How will you make it work at home?"

"Please review what we talked about. How will you make it work at home?" The "Teach Back" technique helps the nurse confirm whether the patient has understood the teaching or not. When using the teach-back technique, the nurse should ask open-ended questions such as asking the patient to review the information and explain how he or she will make it work at home. This question will help the nurse to verify the patient's understanding. The nurse should not ask the patient whether he or she understood the teaching, whether he or she has any questions, or about the usefulness of the provided information, because these are unlikely to elicit detailed answers that reflect the patient's understanding. pp. 100, 111

The registered nurse is teaching a patient of a different cultural background the procedure to self-administer insulin. After teaching, the nurse asks the patient to self-administer insulin. Which type of technique does the nurse use in this situation? "Teach Back" Health literacy Cultural encounter Linguistic competence

"Teach Back" The "Teach Back" technique is an ongoing process of asking patients for feedback by demonstration. In this instance, the registered nurse is asking the patient to self-administer insulin in front of the nurse. Health literacy is the ability to obtain and understand health information. Cultural encounter is an intervention that involves a nurse directly interacting with patients from culturally diverse backgrounds. Linguistic competence is the ability of the nurse to communicate effectively and convey information in a manner that is easily understood by the patient. p. 100

A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress, what does the nurse say? "Tell me who I can call to help you." "Tell me what bothers you the most about this experience." "I'll contact someone who can help get you temporary housing." "I'll sit with you until other family members can come help you get settled."

"Tell me what bothers you the most about this experience." A patient's appraisal of the crisis is the most important area to address first. p. 777

The nurse educator is delivering a lecture on nursing as a profession to a group of nursing students who have recently joined the baccalaureate nursing degree course. Which statements are true? "The nurse is responsible to provide specific health care to patients." "The nurse is responsible and accountable to the patients." "Nurses have to follow a specific code of ethics while delivering care." "Care delivery by nurses is only based on orders given by the health care provider." "Nursing education involves learning the caregiving techniques without any theoretical body of knowledge."

"The nurse is responsible to provide specific health care to patients." "The nurse is responsible and accountable to the patients." "Nurses have to follow a specific code of ethics while delivering care." Nursing is a profession that involves administering quality patient-centered care in a safe and knowledgeable manner. The nurse provides a specific kind of health care to patients. The nurse is responsible for the care delivered to the patient and is accountable to the patients. Ethical health care delivery is a very important characteristic of the nursing profession. Nurses have the right to participate in the decision-making process for the patient, so they need not always rely on the prescription given by the health care provider for delivering care. Nursing education includes a theoretical body of knowledge leading to defined skills, abilities, and norms. pp. 1-2

When conducting a comprehensive sexual history assessment, which questions should the nurse include? "To how many babies have you given birth?" "Do you know about contraception?" "Have you had a urinary tract infection?" "How many sexual partners have you ever had?" "Have you undergone a surgical removal of a kidney?"

"To how many babies have you given birth?" "Do you know about contraception?" "How many sexual partners have you ever had?" While assessing a patient's sexual history, the nurse should ask about the number of children and the means of contraception. A comprehensive sexual assessment also gathers information about the number of sexual partners the patient has had in the past. Questions regarding urinary tract infection or surgical removal of a kidney do not provide information about the sexual history and hence are not included in the assessment. p. 723

A registered nurse is teaching a group of student nurses about various guidelines for assessing members of vulnerable population groups in a community. Which statement made by a student nurse indicates the need for further teaching? "We should look for indications of mental and physical abuse." "We should ask about the patient's cooking and laundry facilities." "We should see if there is adequate ventilation in patient's home." "We should avoid examining a patient's clothes if substance abuse is suspected."

"We should avoid examining a patient's clothes if substance abuse is suspected." Inadequate clothing may indicate substance abuse. Therefore, the student nurse should examine the patient's clothing when substance abuse is suspected. The nurse should be alert for indications of mental and physical abuse, which may help the nurse determine the source of the patient's problem. The student nurse should observe the patient's living environment, such as cooking and laundry facilities and ventilation, as a part of the home assessment. pp. 34-35

While assessing a patient of a different culture, the nurse wants to know the patient's perception of the etiology of the disease. Which is the most appropriate question asked by the nurse using a patient's explanatory model? "What do you call your problem?" "Why do you think it started when it did? "What do you think your sickness does to you?" "What are the chief problems your sickness has caused you?

"What do you call your problem?" A patient's explanatory model is an effective approach to assess the disease condition in a patient belonging to different culture by asking questions. Asking the patient about what he or she calls his or her problem can help identify the cause of the disease. Questioning the patient about why he or she thinks the disease started will help identify the time and onset of the disease. Asking the patient about what he or she thinks the disease does to him or her will help the nurse understand the pathophysiology of the disease. Questioning the patient about the chief problems the disease caused him or her will help the nurse understand the course of illness of the disease. p. 108

Which question does the nurse ask a patient to assess the beliefs and practices of the patient? "What caused your problem?" "What is your main source of income?" "What do you do to keep yourself well?" "How should we address you or what should we call you?"

"What do you do to keep yourself well?" Asking the patient about what he or she does to keep well indicates that the nurse is assessing the beliefs and practices of the patient. Asking the patient what caused the problem indicates assessment of bicultural ecology. Questioning the patient about the main source of income indicates assessment of socioeconomic status. Asking the patient how to address him or her indicates that the nurse is assessing language and communication. p. 107

The nurse is conducting a health interview for a patient. Which assessment question is an example of an open-ended question? "Did you have this problem before?" "What do you think caused your illness?" "How do you want us to help you with your problem?" "How different is this problem from the one you had previously?" "Is there someone with whom you want us to talk about your care?"

"What do you think caused your illness?" "How do you want us to help you with your problem?" An open-ended question is asked to encourage the patient to provide expansive responses. Asking what the patient thinks caused the illness and how the patient wants the health care team to help him or her are examples of open-ended questions. Asking whether the patient has had the problem before is an example of a focus question. Inquiring about the difference between the present and the previous problem is a contrast question. Asking whether the patient would like the nurse to discuss the required care with a guardian indicates caring beliefs and practices but is not an example of an open-ended question. p. 107

The nurse is carrying out an assessment of a Chinese patient with pain in the abdomen. Which question by the nurse is open-ended? "Is the pain here?" "Is the pain very severe or mild?" "What do you think of your problem?" "How many days have you had this pain?"

"What do you think of your problem?" Open-ended questions allow the patient to express feelings or to elaborate more on the situation. Open-ended questions do not limit the patient's response to either "yes" or "no" or a short answer. In this scenario, asking what the patient thinks about the problem is an open-ended question. Asking about the location, severity, or duration of the pain are closed-ended questions. p. 107

While interviewing a patient who is experiencing a developmental crisis, the nurse is assessing the patient's perception of stressors. Which question should the nurse ask during the assessment? "Do you live alone or with others?" "Do you have high blood pressure?" "Have you started drinking or smoking?" "What is bothering you most right now?"

"What is bothering you most right now?" Stressors are tension-producing stimuli. The nurse assesses the patient's perception of the stressor when there is a problem that the patient cannot solve. Therefore, the nurse asks the patient about what aspects, if any, are bothering him or her. To determine the patient's coping style and method, the nurse asks the patient about living conditions in order to assess situational support. The nurse asks the patient about blood pressure control to determine the patient's adherence to health care practices. The nurse also asks the patient about habits such as drinking and smoking to determine the coping strategies used during stress. p. 777

A patient is diagnosed with breast cancer. She is upset about the diagnosis. What questions should the nurse ask to assess the coping skills of the patient? "What is bothering you most right now?" "Have you started drinking and smoking?" "Has your caffeine intake increased?" "What is your monthly income?" "How far is the health care clinic from your house?"

"What is bothering you most right now?" "Have you started drinking and smoking?" "Has your caffeine intake increased?" Asking the patient about the issues bothering her helps the nurse understand the patient's concerns. Asking whether the patient has started drinking and smoking or has increased her caffeine intake checks the patient's maladaptive skills. Information about monthly income and the distance of the clinic from the patient's home does not help assess coping skills. p. 777

The nurse evaluates a patient for achievement of goals related to spiritual well-being and finds that the patient does not display positive outcomes. What questions should the nurse ask to develop an appropriate modification to the care plan for such a patient? "What is the problem with you? Why aren't you coping well with the situation?" "What is holding you back, and what can I do to help restore hope?" "Why hasn't your family shown up? Are you not yet talking to them?" "Do you want me to ask your wife to talk to you? "Do you want me to put you on antidepressants?"

"What is holding you back, and what can I do to help restore hope?" "Do you want me to ask your wife to talk to you? When appropriate outcomes are not met, the nurse should ask the patient about strategies to reach positive outcomes. Asking about what is holding the patient back and if the patient wants his wife to talk to him may help the nurse determine appropriate continued care. Asking blunt questions, such as "What is the problem with you?" and "Why hasn't your family shown up?" may prompt the patient to stop talking. Opting for medication use when dealing with health-related stress is not recommended. p. 746

Which questions should the nurse ask a patient to assess bicultural ecology and health risks while performing cultural assessment? "What do you do for a living?" "What is the cause your illness?" "Have you had this illness before?" "What other illnesses do you have?" "What do you do to keep yourself well?" "How do you treat this illness at home?"

"What is the cause your illness?" "What other illnesses do you have?" "How do you treat this illness at home?" The nurse performs a cultural assessment to gather significant information from the patient to help provide culturally congruent and safe patient care. The nurse asks about the cause of the illness and the presence of other illnesses to identify associated health risks. To determine bicultural risks, the nurse asks about emotional responses of the patient and the patient's family to the health problem. The nurse would ask about the patient's employment to assess socioeconomic status. The nurse would ask the patient about any previous episodes of the illness to provide focused care. The nurse would ask about the health promotion activities that help to maintain the patient's wellness. This also helps the nurse to determine the patient's caring beliefs and practices. p. 107

The nurse is assessing a couple who have been unable to conceive a child for some time. Which questions should the nurse ask the couple to determine whether they should be diagnosed as infertile? "What is the duration of having unprotected sex?" "Do you experience a sense of failure?" "Do you feel that your body is defective?" "Do you enjoy having sexual intercourse?" "Do you live in a city or suburban area?"

"What is the duration of having unprotected sex?" "Do you experience a sense of failure?" "Do you feel that your body is defective?" Patients are diagnosed as infertile if they are unable to conceive after having 1 year of unprotected sexual intercourse. The patients may experience a feeling of failure and may even think that their bodies are defective. Infertility does not depend on seeking pleasure from sexual intercourse and enjoying the activity. The location of a residence does not affect fertility. p. 721

The nurse is caring for an older patient in the community who has hypertension. Which instructions are beneficial to the patient? "You should add high-fat fruit to your diet." "You should rest rather than exercise." "You should consume a sodium-rich diet." "You should measure your weight regularly." "You should perform stress-management techniques daily."

"You should measure your weight regularly." "You should perform stress-management techniques daily." An increase in body weight increases the risk of hypertension in patients. Therefore, patients should monitor their weight frequently. Stress-management techniques such as meditation, yoga, and laughter therapy can reduce the risk of hypertension in patients. An avocado is a fat-rich fruit. Therefore, patients with hypertension should avoid eating some fruits. Patients with hypertension should maintain a balance between rest and physical activity. Sodium-rich foods can increase blood pressure. Therefore, patients with hypertension should eat a low-salt diet. p. 36

The nurse educator is explaining different career opportunities in nursing. Which statements are true about a Certified Registered Nurse Anesthetist (CRNA)? CRNAs manage medical care for healthy individuals as well as those with chronic illnesses. A CRNA is an advanced practice registered nurse (APRN). CRNAs can provide surgical anesthesia under supervision. CRNAs provide routine gynecological care. CRNAs provide care for patients with complex problems using a more holistic approach.

A CRNA is an advanced practice registered nurse (APRN). CRNAs can provide surgical anesthesia under supervision. A Certified Registered Nurse Anesthetist (CRNA) is an advanced practice registered nurse (APRN) and provides surgical anesthesia under supervision of the anesthesiologist. A CRNA does not manage medical care for healthy and chronically ill patients; these activities are performed by the Certified Nurse Practitioner (CNP). The Clinical Nurse Specialist (CNS) has a specialty area identified by a population as well as a disease. The Certified Nurse Midwife (CNM) provides routine gynaecological care. The CNP provides care for patients with complex problems using a more holistic approach. p. 4

Which event in the patient's life would be considered stress occurring due to a maturational factor? Adjusting to an acute illness Transferring to a job in a new location A changing family structure because of divorce The uncertainty associated with treatment methods

A changing family structure because of divorce There are numerous factors affecting the individual's life span. Maturational factors affect the mood of an individual and vary according to the life stage. Therefore, the changing of family structure because of divorce is a maturational factor producing stress in an individual. Situational stress arises from personal or family health changes or job relocation. These factors include adjusting to illness, transferring a job to a new location, and uncertainty associated with treatment methods. p. 775

The spouse of a patient who is terminally ill is in spiritual distress. What other situations adversely affect the spirituality of an individual? A diagnosis of diabetes A major motor vehicle accident A successful surgery The birth of twins A near-death experience

A diagnosis of diabetes A major motor vehicle accident A near-death experience Spirituality is significantly influenced by chronic illness, acute illness, and near-death experiences. The diagnosis of diabetes, a chronic illness, creates stress and anxiety in a person because that person will have to modify his or her lifestyle and diet. A person who experiences a major motor vehicle accident may be in distress and confused, possibly leading to spiritual distress. A patient who had a near-death experience may feel that no one will believe his or her experiences. A successful surgery and the birth of twins likely would elevate the spirits of an individual. pp. 735-736

In a case in which a patient suffers from spiritual distress, of what patient feelings should the nurse be aware? A feeling of doubt A feeling of being cheated A feeling of loneliness A feeling of loss of faith The desire to kill others

A feeling of doubt A feeling of loneliness A feeling of loss of faith One of the common symptoms observed in a patient experiencing spiritual distress is having doubts about the self and others. The patient also feels lonely or abandoned and suffers from a loss of faith. The feeling of being cheated and the desire to kill others are not found commonly. Thus, when caring for such a patient, the nurse needs to be cautious. Spiritual distress also occurs when there is conflict between a person's beliefs and the treatment prescribed for health. Some treatment regimens may not be acceptable to patients from certain cultures or religions. p. 741

The nurse is explaining Medicare to a patient. Which statement about Medicare is true? All medical expenses are funded by the hospital. All medical expenses are funded by the government. A monthly deduction is taken from the payroll of all working people. The medical expenses are funded by the government and hospital jointly.

A monthly deduction is taken from the payroll of all working people. Medicare is a federally administered health care funded program. The program is funded by a payroll deduction. In Medicare, medical expenses are not funded by the hospital, the government, or a joint effort of the government and the hospital. p. 16

The nurse plans care for a 16-year-old male taking into consideration the stressors experienced most commonly by adolescents. What should the nurse consider? A loss of autonomy caused by health problems Physical appearance, family, friends, and school Self-esteem issues, changing family structure A search for identity with peer groups and separation from family

A search for identity with peer groups and separation from family During adolescence, the teenager is searching for his or her identity and usually identifies more with peers and less with the family group. The loss of autonomy caused by health problems applies to the older adult. Stressors related to physical appearance, family, friends, and school apply to children. Self-esteem issues and a changing family structure apply to preadolescents. p. 775

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, what does one of the first assessments include? The amount of family support A 3-day diet recall A thorough physical assessment Threats to safety in the home

A thorough physical assessment Physical causes for problems need to be discovered before treatment for psychosocial problems can be initiated. Test-Taking Tip: Safety cannot be overemphasized in nursing practice. Thus, your awareness of practices that support safety should guide you in responding to test questions. A thorough physical assessment and examination of medications is essential in such a case. p. 776

The American Nursing Association (ANA) strives to improve the quality of nursing care. Which statements are true about ANA? ANA is a part of the International Council of Nurses (ICN). ANA employs registered nurses as lobbyists at the federal level. ANA sets standards for excellence and innovation in nursing education. ANA sponsored the Quality and Safety Education for Nurses (QSEN) initiative. ANA lobbied state legislatures to restrict the length of overtime for individual nurses.

ANA is a part of the International Council of Nurses (ICN). ANA employs registered nurses as lobbyists at the federal level. ANA lobbied state legislatures to restrict the length of overtime for individual nurses. The objective of the American Nurses Association (ANA) is to promote national associations of nurses, improve standards of nursing practice, seek a higher status for nurses, and provide an international power base for nurses. ANA is a part of International Council of Nurses (ICN). It lobbies at the federal level about practice-related issues. ANA successfully lobbied state legislatures to restrict the length of overtime for individual nurses. ANA is not involved in nursing education; the National League for Nursing (NLN) handles education. The Robert Wood Johnson Foundation sponsored the Quality and Safety Education for Nurses (QSEN) initiative to respond to reports about safety and quality patient care. pp. 9, 13

An elderly patient in a long-term care facility complains of abdominal pain. The patient has been on calcium supplements for the past 3 years. The patient worked as a flight attendant for an airline several years before, and she traveled to Egypt many times in her youth. She also has had liposuction. Which components of this information should the nurse include in the minimum data set (MDS)? Abdominal pain Vacation to Egypt Calcium supplements History of liposuction Occupation-flight attendant

Abdominal pain Calcium supplements History of liposuction Occupation-flight attendant The MDS serves as an information source for nurses to help determine the best intervention for the patient. In this scenario, the patient's physical complaint, medication history, and history of liposuction are relevant for the MDS. The patient's occupation gives an idea of her lifestyle and possible cause of the trouble. The trips to Egypt were taken long ago and are not relevant for the MDS. p. 21

A couple approaches the nurse for advice about nonprescription contraceptive methods. Which methods should the nurse mention to the couple? Abstinence Skin patches Vaginal rings Condoms and spermicides Timing of coitus

Abstinence Condoms and spermicides Timing of coitus Nonprescription contraceptive options for couples include abstinence from sexual intercourse, condoms and spermicidal jellies, and timing intercourse with the woman's ovulation cycle. Skin patches and vaginal rings contain hormonal substances that require a health care provider's prescription for use. Test-Taking Tip: Not all barrier methods are nonprescription. The diaphragm must be fitted by a health care practitioner and thus needs a prescription. Be sure you know which method of contraception is being discussed before you respond to a question. p. 718

What are the common responses associated with general adaptation syndrome (GAS)? Alarm Resistance Exhaustion Helplessness Intrusive recollection

Alarm Resistance Exhaustion The alarm stage is the stage of GAS that is characterized by the responses of fight or flight due to adrenal hormones. Resistance is a stage of GAS where the patient will show a response due to activation of the parasympathetic nervous system. Exhaustion is a stage of GAS that may lead to stress-induced illness or death. Helplessness and intrusive recollections are responses that occur in a person due to posttraumatic stress disorder. p. 772

Nurses are responsible for the quality of care provided to patients. Which will help nurses practice safe nursing? Acquiring knowledge Minimizing documentation Improving competencies Acquiring technical skills Exhibiting complete dependence

Acquiring knowledge Improving competencies Acquiring technical skills The nursing profession is accountable for the type and quality of care delivered to patients, so nurses should prepare by acquiring and updating knowledge, improving competencies, and acquiring technical skills. Avoiding documentation may generate more complications, such as legal issues. Nurses are given autonomy for various nursing practices, so they should be dependent only in aspects of care beyond their scope of practice. pp. 1-2

Which is required in the delivery of culturally congruent care? Learning about vast cultures Being motivated and committed to caring Influencing treatment and care of patients Acquiring specific knowledge, skills, and attitudes

Acquiring specific knowledge, skills, and attitudes Specific knowledge, skills, and attitudes are required in the delivery of culturally congruent care. pp. 103, 107

A patient who was cured of cancer is diagnosed with relapse of the disease. The primary health care provider recommends that the patient consume foods rich in antioxidants and drink plenty of water. Which step of the C-LARA mnemonic is the primary health care provider performing? Add Affirm Respond Calm down

Add The step "add" in the C-LARA mnemonic refers to providing the patient and/or the caregivers with additional information that may help them. It may also include educating the patient. The primary health care provider is educating the patient regarding the inclusion of antioxidants and plenty of water in his or her diet. The step "affirm" in the mnemonic means expression of a feeling or a perspective that strengthens the patient's concern. If the primary health care provider responds to a question posed by the patient, then he or she is performing the "respond" step. The "calm down" step is used to relax the patient, wherein the patient is encouraged to stay calm and the pulse rate is determined. p. 109

The nurse is attending to a patient with violent behavior. The patient is diagnosed with posttraumatic stress disorder (PTSD), paranoia, and psychosis. What factors can contribute to situational stress for this patient? Adjusting to chronic illness Accepting physical aging Limited access to health care providers Living in a disintegrated neighborhood Paying for medical bills and expenses

Adjusting to chronic illness Limited access to health care providers Paying for medical bills and expenses Situational stress may arise from any deviation from the normal situation of the patient. Being hospitalized, unable to work, adjusting to chronic illness, having limited access to health care providers, and paying medical bills and other expenses may be causes of situational stress. Accepting physical aging (which relates to maturational stress) and living in a disintegrated neighborhood are sociocultural factors. p. 755

The nurse is caring for an 80-year-old patient. What factors influence this particular patient's current self-concept? The living conditions Adjustment to a role change Adjustment to the loss of a spouse Assurance of sexual intimacy Behaviors of relatives providing care

Adjustment to a role change Adjustment to the loss of a spouse An 80-year-old patient's self-concept is likely to be altered by changes in the role in the family and by the loss of the spouse. Living conditions do not influence self-concept at this age. Sexual intimacy is generally not desired at this age, because the production of sexual hormones lowers. The behavior of relatives providing care is not a significant factor for altering self-concept at this age. pp. 705-706

The nurse is caring for an 87-year-old patient. What factor most directly influences this patient's current self-concept? Attitude and behaviors of relatives providing care Caring behaviors of the nurse and health care team Level of education, economic status, and living conditions Adjustment to role change, loss of loved ones, and physical energy

Adjustment to role change, loss of loved ones, and physical energy Older adults experience significant challenges to self-concept, including mental and physical changes associated with aging and changes in identity and roles following retirement and/or loss of significant others. The adjustment to stressors is most important. The other influences are important but to a lesser degree. p. 703

A patient has been advised to have a total knee replacement because of osteoarthritis. The patient is not willing to undergo the surgery, but family members want to get the surgery done to relieve the disability. The nurse explains the details of the surgery and the risks associated with it, and also discuss the patient's wishes with the family. Which nursing role is the nurse playing here? Educator Caregiver Case manager Advocate

Advocate As a patient advocate, the nurse's duty is to provide information to help a patient and family members decide whether or not to accept a treatment. As a caregiver, the nurse's role is to help patients maintain and regain health, manage symptoms, and attain maximum functional independence. As nurse educator, the nurse is expected to teach a patient or group of patients about health and self-care activities. As a case manager, the nurse develops a care plan based on the assessment and coordinates other health care resources and services that could help the patient attain the outcome goals. p. 3

A patient with psychiatric illness is prescribed antipsychotic medications. The nurse helps the patient decide whether to accept the treatment. Which role does the nurse play in this situation? Educator Advocate Caregiver Communicator

Advocate The nurse provides additional information and helps the patient decide whether to accept the treatment. Here, the nurse is acting as the patient's advocate, protecting human and legal rights and providing assistance in asserting these rights when needed. If the nurse explains concepts and facts about health, describes the reason for routine care activities, and demonstrates procedures such as self-care activities, the nurse is playing the role of an educator. As a caregiver, the nurse helps the patient and family set goals and assists them with meeting these goals using minimal financial cost, time, and energy. As a communicator, the nurse directly communicates strengths or weaknesses to the patient and the patient's family to give comfort and emotional support. p. 3

A crisis intervention nurse is working with a mother whose Down syndrome child has been hospitalized with pneumonia. During this hospitalization, the mother lost her entitlement check. When should the nurse expect the mother to regain stability? After 2 weeks when the child's pneumonia begins to improve After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks After 1 month when the child goes home and the mother gets help from a food pantry After 6 months when the child is back in school

After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks Generally, a person resolves the crisis and reaches psychological equilibrium in about 6 weeks. STUDY TIP: Memory aids can take many forms. They do not have to be serious. If you can exaggerate the s's in the following sentence, the silliness of the exaggeration will help anchor the information in your mind: "It takes approximately six weeks to resolve a crisis" will sound like "It takesss approxsssimately sssixsss weeksss to resssolve the crissssisss." p. 782

A Muslim patient is scheduled for transplant surgery. The patient asks the nurse to postpone the operation for an hour so that the evening prayers can be completed before the operation. How should the nurse respond to such a request? Ask the patient to finish his prayers early. Offer to pray on his behalf so the operation is on time. Ask the family to persuade the patient to be on time for surgery. Agree to the patient's request and postpone surgery.

Agree to the patient's request and postpone surgery. The nurse should allow time for the patient's religious rituals, prayers, spiritual visitations, and attendance in religious services. These are integral parts of the patient's spiritual well-being. Followers of Islam have specific timing for prayers and should not be asked to pray early. The nurse may offer to pray with the patient but not on his behalf, because the nurse may not know the prayer ceremonies the patient prefers. The nurse should not ask the family to persuade the patient to be on time for the operation if that means he misses his prayer time. Test-Taking Tip: Look for patient-centered choices that support the patient's cultural and spiritual well-being. With that in mind, the answer to this question is clear. p. 739

What are the different stages of the general adaptation syndrome (GAS)? Alarm reaction Resistance Appraisal Crisis Exhaustion

Alarm reaction Resistance Exhaustion The general adaptation syndrome (GAS) is a reaction to stress. It can be triggered directly by physical stress such as an injury or indirectly by psychological stress. It has three stages that describe how the body reacts to different stressors. These stages include the alarm reaction, resistance stage, and exhaustion stage. The alarm stage is characterized by rising hormone levels. The resistance stage is characterized by body reactions in opposition to the alarm reactions. The exhaustion stage occurs when the body has depleted its resources. Appraisal is the continuous process of being aware of the stressors and the coping mechanisms. Crisis occurs in response to the body's stressors. Test-Taking Tip: Consider the mnemonic, " ARE you so stressed that you have reacted with GAS?" The A is for Alarm reaction, R is Resistance, and E is Exhaustion. You can also create your own mnemonic to remember the stages of the general adaptation syndrome. p. 772

The nurse has to examine a patient and administer an intravenous medication that is not a life-saving drug. The patient is a devout Muslim. When the nurse goes to administer the medication the nurse finds that patient is getting ready for namaz (prayers). The nurse understands that the patient prays at certain times, as specified in his culture. What should the nurse do in this scenario? Administer the drug while the patient prays. Ask the patient to pray after the medication is administered. Allow the patient to pray and come back later to administer the medication. Tell the patient that the nurse has other patients to look after and cannot come later.

Allow the patient to pray and come back later to administer the medication. The nurse should respect the patient's religious beliefs. Muslims offer namaz, or prayers, at specific times of the day. The nurse should let the patient complete the prayers and then administer the medication. It would be inappropriate to administer the drugs while the patient is praying because that would show disrespect to the patient. It would be inappropriate for the nurse to ask the patient to delay prayer, because his culture dictates that he pray at specific times. The nurse should not refer to responsibilities with other patients. Test-Taking Tip: Choose answers that reflect culturally competent care. p. 104

A patient who is diagnosed with terminal colon cancer says, "It's just a stomach infection; I don't have any cancer, and it's a wrong diagnosis." What does the nurse do? Refer the patient to a psychiatrist immediately. Show the laboratory reports to the patient. Explain the similarity between stomach infections and colon cancer. Allow the patient to use denial as a coping mechanism.

Allow the patient to use denial as a coping mechanism. The patient is using denial as a coping mechanism to deal with the stress. Therefore, the nurse should allow some time for the patient to cope with the stress before giving more information about the cancer or further process. The patient is overwhelmed by the diagnosis of cancer and does not need a consultation with a psychiatrist. The nurse should not offend the patient by showing the laboratory reports. Telling the patient that a stomach infection and colon cancer manifest with similar symptoms indicates giving false assurance. p. 774

The nurse wants to include spiritual care when planning care for a sick patient. What actions should the nurse perform? Allow time for religious readings. Allow the patient to play slow, religious music. Allow family members to plan a prayer session. Allow the patient to read religious books all the time. Allow the patient to fast and miss medication occasionally.

Allow time for religious readings. Allow the patient to play slow, religious music. Allow family members to plan a prayer session. To support spiritual activities, the nurse must allow the patient to read religious books, and listen to slow religious music or classical music. These activities help to build a healthy environment. Family members can also plan a prayer session without disturbing the patient's normal activities. Reading religious books continuously can disturb the patient's schedule of rest. Fasting or missing medication cannot be allowed even occasionally. p. 744

Which body image stressors would likely damage the self-concept of an individual? A new haircut Alopecia due to chemotherapy Amputation of the foot Knee replacement surgery Plastic surgery

Alopecia due to chemotherapy Amputation of the foot Body image involves an individual's attitude toward his or her physical appearance, structure, and bodily functions. Various stressors influence body image. The loss of hair due to chemotherapy and the loss of a foot due to amputation influence a person's body image. A new haircut would not act as a stressor because it is transient and may improve physical appearance. Knee replacement surgery and plastic surgery would enhance the physical appearance or functioning of the body and thus would not be stressors. p. 705

When teaching the patient progressive muscle relaxation techniques, the nurse asks the patient to take deep breaths. What would be the next instruction after breathing deeply? Sit in a comfortable position. Close your eyes and try to relax. Relax all the muscle groups at one time. Alternately tighten and relax specific muscle groups.

Alternately tighten and relax specific muscle groups. Anxiety causes muscle tension and progressive muscle relaxation is a technique used to relax the muscle groups. A person usually achieves a relaxed state after deep chest breathing. Once this is done, the patient is then asked to alternately tighten and relax specific muscle groups. The instructions, "sit in a comfortable position" and "close your eyes," are given before asking the patient to do deep breathing. This helps to relax the body. Not all the muscle groups should be worked on at the same time. p. 781

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. What is this is an example of? A situational crisis A maturational crisis An adventitious crisis A developmental crisis

An adventitious crisis An adventitious crisis is a type of crisis resulting from a natural disaster such as a tsunami. STUDY TIP: To remember the meaning of adventitious, think of accidental or alien when you see the word. Even though an adventitious crisis may be a natural disaster, it is not caused by an expected event in life. p. 774

Which type of crisis is an earthquake that has killed more than 7000 people? A situational crisis A maturational crisis An adventitious crisis A developmental crisis

An adventitious crisis An adventitious crisis is also known as a disaster crisis. It occurs due to a major natural disaster or man-made disaster. A situational crisis occurs due to external sources such as a job change, a motor vehicle crash, or severe illness. A maturational crisis is also known as a developmental crisis. Developmental stages such as marriage, pregnancy, and the birth of a child require new coping styles. Failure to cope with the exposure to stressors during these stages leads to developmental crises. p. 774

Self-esteem stressors vary with developmental stages. In children, what are the stressors that affect self-esteem and self-worth? Unsuccessful relationships An inability to meet parents' expectations Sibling rivalry Late onset of education Loss of companionship

An inability to meet parents' expectations Sibling rivalry In children, the inability to meet the expectations of parents and sibling rivalry issues can decrease the level of self-esteem and self-worth. An unsuccessful relationship is a stressor that affects the self-esteem of an adult. The late onset of education has a limited, if any, effect on a child's self-esteem. The loss of a companion or a spouse can affect self-concept in an older adult. p. 705

The nurse is teaching a 10-year-old patient about personal hygiene. What observation would indicate that the child has not reached an age-appropriate developmental stage? An inability to understand and master brushing technique An inability to accept age-related body changes An inability to assess life goals An inability to decide on a future career

An inability to understand and master brushing technique As per Erikson's developmental stages, a 10-year-old child should be able to understand and reinforce information provided and master new skills, such as the basic hygiene tasks the nurse discusses. A person starts to accept age-related body changes and begins to establish goals in adolescence, but may not do so as young as 10 years of age. The assessment of life goals is not expected until adulthood. Setting goals for the future, such as deciding which school to attend or what career to pursue, is a developmental behavior for children 12 to 20 years old. p. 702

A 54-year-old male patient who is being seen for an annual physical tells the nurse that he is having difficulty sustaining an erection. The nurse reviews his health history and notes no current health problems except medical treatment for depression. What should the nurse understand about this? A personal issue such as this is best addressed by a male physician during the examination. Erectile dysfunction affects most men over the age of 50. The patient needs to be screened for sexually transmitted infections (STIs). Antidepressant medication may be affecting the patient's sexual functioning.

Antidepressant medication may be affecting the patient's sexual functioning. Many drugs can affect sexual function. Antidepressants can alter sexual functioning by blocking neurotransmitters. The decision to screen a patient should be based on health history, assessment, and sexual practices. p. 722

An elderly patient is suffering from a chronic illness with multiple medical conditions and has a poor prognosis for recovery. What nursing actions are appropriate during the last hours of life before death? Avoid further spiritual interventions. Arrange a visit from a cleric. Ask if the patient wants to meet loved ones. Help the patient with guided imagery to attain peace. Withdraw all life-supporting modalities.

Arrange a visit from a cleric. Ask if the patient wants to meet loved ones. Help the patient with guided imagery to attain peace. A patient in the last stages of life may greatly benefit from a visit from a member of the clergy. A meeting with a cleric might help the patient attain peace and tranquility. If the patient desires to meet someone in particular, the nurse should arrange for such a meeting. The nurse can help the patient get relief from pain and be comforted and relaxed with the help of guided imagery and other relaxation techniques. Spiritual interventions should be continued until the end of life. They prepare the patient to leave the world in peace. Withdrawal of life support should be a decision made by family or the patient and is definitely not the nurse's call. p. 744

The nurse is caring for a patient who is an atheist. The nurse identifies a need for spiritual intervention. What action would not be appropriate for the nurse to perform to meet the spiritual needs of this patient? Talking to the patient about enrolling in a nonreligious group meeting Asking the family about what is important in the patient's life Arranging for a clergy person to visit the patient Teaching the patient meditation and relaxation techniques

Arranging for a clergy person to visit the patient The nurse should be sensitive to a patient's personal beliefs and should not impose her personal beliefs and assumptions on patients. When the nurse arranges a visit by a clergy person for an atheist patient, he or she may offend the patient's personal beliefs and principles. This would negatively affect the therapeutic relationship and could lead to undesired outcomes. When planning interventions such as group meetings, the nurse should include the patient and should respect the patient's beliefs. The family and those closest to the patients should also be included and consulted. Learning and practicing meditation and relaxation techniques may help the patient reduce stress and achieve inner peace and tranquility. p. 734

The nurse is attending to a patient with posttraumatic stress disorder (PTSD) following a motor vehicle accident. The patient lost his left leg in the accident. When completing an assessment of this patient, what are the things that the nurse should take care of? Ask open-ended questions. Ask questions that the patient can answer with a yes or no. Take the patient's medical history and observe the patient's nonverbal behavior. In order to make the assessment, consult with the patient's partner regarding the patient's medical history. Learn about the patient by asking questions as well as by observing his or her nonverbal behavior.

Ask open-ended questions. Take the patient's medical history and observe the patient's nonverbal behavior. Learn about the patient by asking questions as well as by observing his or her nonverbal behavior. Always ask the patient open-ended questions because they encourage the patient to express his or her feelings and give more information. It is essential that the nurse assess the patient by asking questions as well as by observing his or her nonverbal behavior. Do not ask the patient questions that can be answered with just yes or no. In order to make the most accurate assessment, the nurse should consult with the patient directly rather than with the patient's partner. p. 776

The nurse at an outpatient clinic asks a Chinese American patient with newly diagnosed hypertension if he is limiting sodium intake as directed. The patient nods his head but does not make eye contact with the nurse. What should the nurse do next? Ask the patient how much salt he is consuming each day. Discuss the health implications of sodium and hypertension. Remind the patient that many foods such as soy sauce contain hidden sodium. Suggest some low-sodium dietary alternatives.

Ask the patient how much salt he is consuming each day. In Asian cultures spoken messages often have little to do with their meanings. The nurse should clarify how much salt the patient is consuming in his diet. p. 107

In a community setting, which nursing practice is potentially harmful for a patient with a chronic leg ulcer? Including chronic wound support groups in a care plan Explaining the stages and time needed for wound healing Understanding that patients with chronic leg ulcers may have depression Asking the patient to visit the hospital to reduce the work of nursing wound care specialists

Asking the patient to visit the hospital to reduce the work of nursing wound care specialists Nursing wound care specialists make home visits to patients in their community setting. These visits help track the healing process, and the specialists provide suggestions for quicker healing. Support groups will increase the patient's social interaction with other individuals in the community. Patients may develop depression due to slow wound healing and thus, the nurse should explain the stages and time needed for wound healing to the patient. Because of the home visits provided by nursing wound specialists, the nurse should not ask the patients to visit the hospital just to reduce the work of the wound specialist. If a complication arises, the patient may be asked to make an appointment with the wound clinic in a hospital environment. p. 32

Which activities performed by the nurse are focused on the patient-centered care principle of physical comfort? Asking the patient what a tolerable level of pain is for him or her following surgery Providing a back rub at bedtime Offering the patient a warm washcloth for his or her hands before eating Teaching the patient about the new antihypertensive medication ordered Scheduling the patient's follow-up appointments on discharge Changing the bed linens for a patient who is experiencing diaphoresis

Asking the patient what a tolerable level of pain is for him or her following surgery Providing a back rub at bedtime Offering the patient a warm washcloth for his or her hands before eating Changing the bed linens for a patient who is experiencing diaphoresis Interventions for the patient-centered care principle of physical comfort are focused on care that increases the comfort of the patient. Responding to patient's need for pain medications and using nursing interventions that increase comfort are important. Teaching is focused on the principle of continuity and transition; scheduling appointments is an intervention for access to care. p. 25

The nurse is using an interpreter to communicate with a patient who does not speak English. Which action by the nurse may hamper the communication between the nurse and the patient? Introducing the interpreter to the patient Determining the interpreter's qualifications Looking at the patient instead of the interpreter Asking the patient's family members to serve as interpreters

Asking the patient's family members to serve as interpreters Interpreters are used to communicate effectively with a patient of a different culture. The family members of the patient should not be asked to serve as interpreters, because the patient may not be comfortable sharing certain information with them. The interpreter should be introduced to the patient for better understanding. The interpreter's qualifications should be determined for effective outcomes. While communicating with the patient, the nurse should look at the patient and not the interpreter to encourage the patient and to gain his or her trust and confidence. p. 100

A patient presents with decreased libido, depression, and ineffective coping. Which nursing interventions would be helpful for the patient? Assess for influence of cultural beliefs. Assess the causes of ineffective coping. Help the patient to set realistic goals. Encourage the patient to express feelings. Explain to the patient about the use of condoms.

Assess the causes of ineffective coping. Help the patient to set realistic goals. Encourage the patient to express feelings. Assessment of the cause of ineffective coping will help the nurse to understand the patient's problems and plan the treatment accordingly. Helping the patient to set realistic goals would help increase the patient's confidence and prevent frustration. Encouraging the patient to express feelings will provide greater insight into the problem. Assessing the influence of cultural beliefs is helpful regarding social isolation. Explaining to the patient about the use of condoms would not help increase libido or enhance coping. Test-Taking Tip: Look for answers that focus on the patient or are directed toward feelings. p. 723

A 35-year-old woman comes to the clinic for her general health checkup. She is the mother of a 6-year-old girl. The patient expresses that she and her husband are exhausted because of their work schedules and this has affected their sexual relationship. What advice can the nurse provide to improve the couple's sexual relationship? Avoid alcohol and tobacco. Do not have sexual intercourse until your workload lightens. Have well-balanced meals and follow a regular sleep pattern. Plan sexual activities in the morning or another time when you are well rested. Communicate your concerns with your partner.

Avoid alcohol and tobacco. Have well-balanced meals and follow a regular sleep pattern. Plan sexual activities in the morning or another time when you are well rested. Communicate your concerns with your partner. Modern working couples become exhausted due to hectic work schedules. This can affect their health as well. The couple should avoid alcohol, tobacco, and caffeine, as these have detrimental effects on their health. A well-balanced diet and regular sleep patterns help maintain good health and energy levels. Planning sexual activity in the mornings or another time when the couple is well rested solves the problem of tiredness. The partners should communicate to each other about their concerns so that they can deal with the problem together. It is incorrect to advise the couple to abstain from sexual activity until their workload lightens, because this does not solve the problem. p. 728

The senior nurse is explaining to the nurse who holds an associate degree about immediate future options in advanced nursing education. Which educational options should be included? Doctor of Nursing Practice (DNP) A master's degree in nursing Doctor of Philosophy (PhD) in Nursing Bachelor of Science in Nursing (BScN) Bachelor in Nursing (BN)

Bachelor of Science in Nursing (BScN) Bachelor in Nursing (BN) The higher education opportunities available for the nurse with an associate degree include baccalaureate programs in nursing, such as Bachelor of Science in Nursing (BScN) and Bachelor in Nursing (BN). A Doctor of Nursing Practice (DNP) degree can be pursued only after a master's degree. A Doctor of Philosophy (PhD) in Nursing also requires a master's degree. The nurse must hold a baccalaureate degree before enrolling in a master's degree program. p. 9

To enhance cultural awareness, which should the nursing students include in their self-examination? Motivation, culture, and commitment to caring Social, cultural, and biophysical factors Engagement in cross-cultural interactions Background, personal biases, and prejudices

Background, personal biases, and prejudices Cultural awareness involves an in-depth self-examination of one's own background, recognizing biases and prejudices and assumptions about other people. p. 104

A patient is on Medicare, a national health insurance program of the United States. What care costs are covered by part A of Medicare? Basic medical care costs Basic surgical care costs Basic outpatient care costs Basic psychiatric care costs Premium prescription drug costs

Basic medical care costs Basic surgical care costs Basic psychiatric care costs Medicare is a national health insurance program in the United States for people aged 65 and older. Part A of Medicare provides basic protection for medical, surgical, and psychiatric care based on diagnosis-related groups. Part B of Medicare covers outpatient care costs and provides voluntary medical insurance for additional benefits. Part D of Medicare is the voluntary plan that provides improved drug coverage. p. 16

A 26-year-old married woman recently discovered that she is pregnant and is at her first prenatal visit. While assessing the patient, the nurse practitioner discovers that the patient has purulent vaginal discharge. The patient states, "It burns when I urinate, and I seem to have to go to the bathroom frequently." Based on these symptoms, what follow-up would the nurse practitioner likely advise for this patient? Be tested for human immunodeficiency virus (HIV). Be tested for a sexually transmitted infection (STI) such as Chlamydia. There is no need for follow-up as this is a normal sign of pregnancy. Obtain education on proper perineal hygiene

Be tested for a sexually transmitted infection (STI) such as Chlamydia. Chlamydia does not cause symptoms in about 75% of women; thus they are often unaware that they have a sexually transmitted infection (STI). It often causes genitourinary tract infections in men and women. Serious complications can result from untreated STIs in pregnancy such as preterm labor and rupture of membranes and premature delivery of the newborn. Purulent discharge indicates infection and is not an expected finding in pregnancy or from poor hygiene practices. p. 719

After assessing a patient's immediate complaint, the nurse asks a patient, "What other problems do you have?" What is the nurse trying to assess by posing this question to the patient? Socioeconomic status Caring beliefs and practices Bicultural ecology and health risks Sexual orientation and gender identity

Bicultural ecology and health risks Asking the patient about the other problems helps to assess bicultural ecology and health risks. Asking the patient about employment status and sources of income helps to assess the patient's socioeconomic status. Asking the patient about home care management helps to assess caring beliefs and practices. Asking the patient about gender, current relationship status, and current sexual partner helps to assess the patient's sexual orientation and gender identity. p. 107

The nurse is assessing a patient by asking, "How does this problem affect you and how has it affected your life and your family"? Which type of nursing assessment question is the nurse asking? Ethnohistory Socio economic status Caring beliefs and practices Bicultural ecology and health risks

Bicultural ecology and health risks Bicultural ecology and health risk questions involve inquiring about a problem and its effect on life and the family. Ethnohistory questions refer to ethnic background and history. Socioeconomic status questions deal with income and means of living. Caring beliefs and practices questions deal with self care and care provided to and by family members. p. 107

Which term best describes the type of elements that people in Western cultures believe cause illness? Supernatural Biomedical Medicoreligious Imbalance between humans and nature

Biomedical Western cultures believe that illnesses have biomedical causes. Beliefs that illnesses are caused by supernatural or medicoreligious causes, or by an imbalance between humans and nature, are more common in non-Western cultures. p. 106

Which external forces influence current nursing practices? Bioterrorism Affordable Care Act Health insurance policies Static demographic factors Medically underserved people

Bioterrorism Affordable Care Act Medically underserved people Multiple external forces affect nursing. Bioterrorism could be a reality in the near future, and nurses should have the adequate knowledge and education to handle a disaster associated with bioterrorism. The Affordable Care Act is an external influence on health care. Medically underserved people also influence nursing practice. In order to serve this population, nurses may need to promote health and disease prevention to the homeless, mentally ill, and other people who do not have adequate access to health care services. Health insurance policies do not influence nursing practices, nor do static demographics. p. 6

The caregiver of a patient with terminal illness is receiving respite care. Which type of primary and preventive care service offers this kind of care? Physicians' offices Nurse-managed clinics Block and parish nursing Community health centers

Block and parish nursing Block and parish nursing is a preventive and primary care service that provides services for respite care, homemaker aides, spiritual health, help with errands, and transportation. Respite care provides short-term relief or time off for people providing home care to an ill, disabled, or frail older adult. Physicians' offices offer services such as routine physical examinations and treatment of acute and chronic illnesses. Nurse-managed clinics help in wellness counseling and acute and chronic care management. Community health centers offer services such as health screenings, disease management, counseling, and physical assessments. p. 18

A patient underwent six cycles of chemotherapy for her cancer. She lost all of her hair due to drug effects. She is very worried and says, "My children may find me ugly. I will not be able to tolerate that." What stressor is most affecting her self-concept? Chemotherapy Body Image Role performance Identity

Body Image The patient is very concerned about her physical appearance and is worried that her children will be shocked on seeing her with no hair. She has low self-concept related to body image. Chemotherapy does not affect the patient's self-concept as much as body image. The patient does not doubt herself in the role of a mother and is not facing any identity issues. p. 705

The nurse is providing a sex education session to a group of grade-school students. Which aspect of sexual education should the nurse include in the teaching? Body changes Menstruation Sexually transmitted infections Contraception Sexual relationships

Body changes Menstruation Menstruation is the periodic discharge of blood from the uterus through the vagina. Due to lack of information about menstruation, grade-school children may view it as a dreadful disease. Therefore, the nurse should teach or encourage parents or teachers to educate children about menstruation. School-age children have questions about changes in their bodies and emotions, and they need accurate information about these changes. Body changes are more evident in adolescents due to hormonal changes that influence their health. Adolescents who are sexually active may also have several sexual partners. They may seek sexual relationships to achieve the goals of intimacy and pleasure. Therefore, the nurse should teach adolescents (not grade-school children) about contraception, sexually transmitted infections, and sexual relationships.

An elderly patient complains of severe pain in both lower extremities. The patient becomes tearful when describing the pain and states that it is intolerable. How should the nurse develop a healing relationship with the patient? By inquiring how the pain is affecting the patient's daily routine By telling the patient about various pain-relieving interventions By encouraging the patient to be strong and deal with the pain positively By asking the family to help the patient cope with pain and anxiety By administering pain medications and encouraging the patient to exercise

By inquiring how the pain is affecting the patient's daily routine By telling the patient about various pain-relieving interventions By asking the family to help the patient cope with pain and anxiety To establish a healing relationship and a helping role, the nurse should not just look at the patient's leg pain as a medical problem. The nurse should also try to understand how it affects the patient's daily life and spirituality, and work to improve the patient's overall well-being. By informing the patient about various methods to alleviate pain, the nurse mobilizes hope in the patient. The nurse should also help the patient use social resources, such as friends and family, who can help the patient deal with his or her health condition. Asking the patient to be strong and deal with the pain may decrease spirituality and increase stress and anxiety. The nurse should focus on more than just prescribing medications and exercise to develop a healing relationship. p. 744

Which roles and responsibilities should every nurse be expected to fill? Caregiver Autonomy and accountability Patient advocate Health promotion Lobbyist

Caregiver Autonomy and accountability Patient advocate Health promotion Each of these roles includes activities for the professional nurse. Each is used in direct care or is part of the professionalism that guides nursing practice. Some nurses are lobbyists, but being a lobbyist is not expected of all professional nurses. p. 3

A community health nurse visits a patient with chronic diabetic ulcers. The nurse cleans the ulcer and applies a dressing. The next day, the nurse takes the patient to a diabetologist for expert care. What are the roles that the nurse played here? Caregiver Educator Change agent Epidemiologist Client advocate

Caregiver Client advocate The role of a caregiver in the community setting is to manage and care for the health of the community. A caregiver also ensures that appropriate, individualized nursing care is given to specific patients and their families. Here, the nurse is giving specific care by managing diabetic ulcers for patients and is thus playing the role of a caregiver. As a patient advocate, the nurse needs to help patients with identifying resources and guide the community people members in reaching the appropriate authority. The nurse should also advise patients on service requests, and the process to follow through with the information the patients receive. As an educator, the nurse should arrange for health education programs. A change agent identifies and implements new approaches to a current problem, which is not true in this case. As an epidemiologist, the nurse may be involved in case finding, health teaching, and tracking incident rates of an illness. pp. 35-36

A registered nurse has recently started her nursing career by joining a cardiac care unit. The mentor explains the duties of the nurse. The mentor states that the nurse does not require any permission or orders to give routine hygiene care measures. The nurse's duty is to provide holistic care to the patient. Which aspects of nursing do these duties illustrate? Caregiving Autonomy Educating Accountability Patient advocating

Caregiving Autonomy Accountability Providing all-around care is an example of the nurse's caregiver role. Nursing interventions such as performing hygiene procedures for a patient do not require medical orders. This is an example of autonomy in nursing care. Accepting responsibility for the nursing care provided to a patient is an example of accountability in nursing care. The nurse educator teaches a patient or group of patients about health and self-care activities. The patient advocate provides information to help the patient and family members decide whether to accept a treatment and otherwise make health care-related decisions. p. 3

A woman has been diagnosed with infertility. The nurse finds that the patient has multiple sexual partners and suspects a correlation between the patient's infertility and her promiscuous lifestyle. Which could have caused infertility in this patient? Human immunodeficiency virus (HIV) Chlamydia Herpes simplex Human papillomavirus

Chlamydia Chlamydia trachomatis infection, if left untreated, may cause infertility, pelvic inflammatory disease, and ectopic pregnancy. Most chlamydia infections are not treated because they do not cause any symptoms in women. Human immunodeficiency virus (HIV) usually does not cause infertility. Herpes causes painful genital lesions but does not cause infertility. Human papillomavirus causes warts and cervical and anogenital malignancies. p. 719

Which is the most commonly reported bacterial sexually transmitted infection (STI) in the United States? Syphilis Gonorrhea Genital herpes Chlamydia

Chlamydia Syphilis, gonorrhea, genital herpes, and chlamydial infections are all commonly reported; however, infection with Chlamydia organisms is the most common bacterial sexually transmitted infection (STI) in the United States. Other STIs include syphilis, gonorrhea, and genital herpes. Syphilis is caused by Treponema pallidum. Gonorrhea is caused by Neisseria gonorrhoeae. Genital herpes is caused by herpes simplex virus. p. 719

The nurse observes that a patient whose home life is chaotic including intermittent homelessness, a child with spina bifida, and an abusive spouse who appears to be experiencing an allostatic load. As a result, what does the nurse expect to detect while assessing the patient? Posttraumatic stress disorder Rising hormone levels Chronic illness Return of vital signs to normal

Chronic illness An increased allostatic load can result in long-term physiological problems and chronic illness. Posttraumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage. Vital signs return to normal in the resistance stage. STUDY TIP: Be sure you have committed to memory the stages of stress response and their physiologic correlates. p. 775

30-year-old patient suffering from osteoarthritis is unable to move without using a splint and lives with her mother. The patient no longer has a job. The patient refuses to meet anyone and feels worthless. What factors are responsible for this change in self-concept? Chronic illness Dependency on others Physical impairment Loss of job identity Self-absorption

Chronic illness Dependency on others Physical impairment Loss of job identity The factors that influence the self-concept of a person are chronic illness, dependency on others, and physical impairments. Loss of job identity also leads to alteration of self-concept and role performance. Self-absorption is the seventh stage of Erickson's psychosocial theory of development. Self-absorption may be a result of an inability to accept the changes in appearance and physical endurance. Accepting the changes due to the aging process leads to generativity. p. 704, 705

Which nursing action takes priority when working with a patient who opts for an abortion? Explain that abortion means killing a life. Clarify the nurse's own personal values. Convince the patient that abortion is a crime. Criticize the patient for the decision.

Clarify the nurse's own personal values. Before nurses can be helpful to patients opting for an abortion, they must be aware of and comfortable with their own feelings and values. The nurse should not provide wrong and biased information to the patient to influence the decision. As a corollary, nurses must be comfortable with the idea that patients have a right to their own values. Nurses must also avoid criticism and censure. p. 721

A new graduate nurse is working in a rehabilitation center that specializes in the care of patients with spinal cord injuries (SCIs). The new graduate knows that sexual issues are common among patients with SCIs. Which actions can enhance the nurse's comfort in discussing sexual issues with patients? Clarifying personal values related to sexuality Role playing discussion of sexual concerns with another nurse Attending a conference to enhance knowledge about sexuality Avoiding a discussion of sexual concerns until after completing new nurse orientation Asking a nurse who is experienced in caring for patients with SCIs about common sexual concerns

Clarifying personal values related to sexuality Role playing discussion of sexual concerns with another nurse Attending a conference to enhance knowledge about sexuality Asking a nurse who is experienced in caring for patients with SCIs about common sexual concerns Nurses often avoid discussing sexual issues with patients because they are uncomfortable, lack knowledge, or have personal values in conflict with the patients' values. Nurses who have difficulty addressing sexual issues need to seek education and experiences to increase knowledge and explore their personal values. p. 722

A new graduate nurse is working in a rehabilitation center that specializes in the care of patients with spinal cord injuries (SCIs). The new graduate knows that sexual issues are common among patients with SCIs. Which actions can enhance the nurse's comfort in discussing sexual issues with patients? Clarifying personal values related to sexuality Role playing discussion of sexual concerns with another nurse Attending a conference to enhance knowledge about sexuality Avoiding a discussion of sexual concerns until after completing new nurse orientation Asking a nurse who is experienced in caring for patients with SCIs about common sexual concerns

Clarifying personal values related to sexuality Role playing discussion of sexual concerns with another nurse Attending a conference to enhance knowledge about sexuality Asking a nurse who is experienced in caring for patients with SCIs about common sexual concerns Nurses often avoid discussing sexual issues with patients because they are uncomfortable, lack knowledge, or have personal values in conflict with the patients' values. Nurses who have difficulty addressing sexual issues need to seek education and experiences to increase knowledge and explore their personal values. p. 722

The nurse is interviewing a 15-year-old female patient and finds that the patient has an altered body image. Which factors can affect body image in this patient? Cognitive and physical growth Cultural and societal attitudes Role performance Fulfillment of role expectations Achievement of identity

Cognitive and physical growth Cultural and societal attitudes An altered body image can lead to a negative self-concept. Cognitive and physical growth during adolescence and aging can affect the body image. The hormonal changes during adolescence and puberty affect the way one perceives oneself. The cultural and societal attitudes and values may also affect body image. Some cultures consider aging to be a normal growth process, whereas other cultures are more youth oriented. Role performance and fulfillment of role expectations do not affect body image but have an impact on self-concept. Achievement of identity does not affect body image. p. 703, 705

While teaching a group of student nurses about nursing roles, a registered nurse states, "The nurse in this role has to develop mutual trust and respect for other professionals' abilities and contributions." To which nursing role is the registered nurse referring? Counselor Collaborator Change agent Case manager

Collaborator The nurse as a collaborator will be competent in working not only with patients and their families but also with other related health care disciplines. For collaboration to be effective, the nurse should develop a mutual trust and respect for other professionals' abilities and contributions. The nurse acts as a counselor by helping the patients in identifying and clarifying health issues and in choosing appropriate measures to solve those issues. The nurse as a change agent identifies and implements new approaches to solve problems. The nurse as a case manager coordinates resources and services for the patient's well-being across a continuum of care. pp. 36-37

After assessing a 2-year-old child, the nurse observes that the child is in the psychosocial development stage of autonomy versus shame and doubt, according to Erikson's theory of self-concept. Which developmental tasks does the nurse observe in the child? Communication of likes and dislikes Appreciation of body appearance and function Increased independence in thoughts and actions Incorporation of feedback from peers and teachers Increased language skills, including identification of feelings

Communication of likes and dislikes Appreciation of body appearance and function Increased independence in thoughts and actions Children between the ages of 1 and 3 years of age are in the psychosocial development stage of autonomy versus shame and doubt. During this stage, children begin to communicate likes and dislikes that promote the development of self-concept. The positive appreciation of body appearance and function increases the self-esteem and self-concept. Children from 1 to 3 years of age gain independence in actions and thoughts due to self-exploration. This also promotes development of self-concept due to increased autonomy. Children between 1 and 3 years of age cannot understand feedback given by peers and teachers. Children from 3 to 6 years of age have increased language skills, including the identification of feelings. p. 702

Using Healthy People 2020 as a guide, which action would improve delivery of care to a community? Community assessment Implementing public health policies Increasing access to care Determining rates of specific illnesses Reducing the number of fast food restaurants in the community

Community assessment Implementing public health policies Increasing access to care Determining rates of specific illnesses Improved delivery of health care occurs through the assessment of health care needs of individuals, families, and communities; development and implementation of public health policies; and improved access to care. For example, assessment includes systematic data collection on the population, monitoring the health status of the population, and accessing available information about the health of the community. pp. 32

A patient in labor has been brought to the certified nurse midwife (CNM). Which interventions should the CNM undertake in this situation? Conduct the labor. Provide care for the newborn. Administer uterine relaxants and refer the patient to a tertiary center. Perform C-section surgery. Provide a physical presence until the patient has been transferred to tertiary care.

Conduct the labor. Provide care for the newborn. Certified nurse midwives (CNM) are nurses trained in providing care in pregnancy, conducting labor, and providing care to the newborn. The CNM does not have the authority to administer uterine relaxants. Performing a C-section exceeds the scope of practice for a CNM. p. 4

The nurse asks a patient, "How is this health problem different from the previous one you had?" Which type of nursing assessment question has the nurse asked? Contrast Focused Open-ended Bicultural ecology and health risks

Contrast Asking the patient about the difference between the present problem and the previous one is a contrast nursing assessment question. Asking the patient whether he or she had the problem earlier is a focused nursing assessment question. An open-ended question may be asked to obtain information from the patient about what he or she thinks the cause of a problem is. A bicultural ecology and health risks nursing assessment question might ask about how a problem affects the patient and those close to the patient. p. 107

A patient lost a job recently due to poor performance at work and has no alternative source of financial support. The patient reports difficulty sleeping and loss of appetite. On medical examination, there is no organic cause found for the patient's symptoms. Which defense mechanism is the patient using? Conversion Dissociation Identification Displacement

Conversion There are different types of ego-defense mechanisms used to cope with stressors. In conversion, anxiety is repressed unconsciously, which is then transformed into nonorganic symptoms such as difficulty sleeping or loss of appetite. In dissociation, the patient may experience a subjective sense of numbness and reduced awareness of his or her surroundings. In identification, a person assumes the qualities, characteristics, and actions of another person. In displacement, a person transfers his or her emotions from a stressful situation to a less anxiety-producing substitute. Test-Taking Tip: In conversion, a patient converts stress into symptoms. p. 772

An elderly couple visits the hospital for regular health checkups. The woman, who is 67 years old, has been diagnosed with dementia. She lives with her husband, who is 75 years old. He has hypertension and is on antihypertensive drugs. He is looking for information on health care providers and services to take appropriate care of his wife. What role is the nurse playing when giving information about the community resources to the patient? Counselor Caregiver Educator Change agent

Counselor A community health nurse may have many roles. As a counselor, the nurse provides information about community resources. As an educator, the nurse conducts health education programs on prenatal care, infant care, cancer screenings and child safety. As a change agent, the nurse identifies and implements new approaches to maintain health. The nurse is not acting as a caregiver in this setting. pp. 37

While caring for a patient in a community-based hospital, the nurse helps the patient identify and clarify health issues, and choose appropriate measures to solve those issues. Which nursing role is the nurse performing in this scenario? Counselor Collaborator Case manager Epidemiologist

Counselor The nurse acts as a counselor by helping patients identify and clarify health issues, and choose appropriate measures to solve those issues. The nurse as a case manager coordinates the resources and services needed for a patient's well-being across a continuum of care. The nurse as a collaborator will be competent in working not only with patients and their families but also with other related health care disciplines. The nurse as an epidemiologist is involved in case finding, health teaching, and tracking incident rates of an illness. pp. 36-37

Nurses have an important role in patient care that is different from other health care providers. Patients seek out nurses to help them cope up with difficult situations during the course of an illness. What skills would help the nurse understand a patient's spiritual needs? Politeness and kindness Critical thinking skills Knowledge of spirituality Therapeutic communication Physical and psychological fitness

Critical thinking skills Knowledge of spirituality Therapeutic communication A skilled nurse who applies concepts of critical thinking, integrates knowledge from past experiences, and is skilled in techniques of therapeutic communication can effectively assess the patient's spiritual needs and help the patient. Politeness and physical and psychological fitness may help in developing a therapeutic relationship with the patient but are not helpful in understanding a patient's spiritual needs. p. 744

Which type of cultural competency recognizes biases, prejudices, and assumptions about other people? Cultural skills Cultural desire Cultural awareness Cultural knowledge

Cultural awareness Cultural awareness refers to recognizing biases, prejudices, and assumptions about other people. Cultural skills assess social, cultural, and biophysical factors that influence patient treatment and care. Cultural desire describes the motivation to learn from the others, accept the learner, be open to and accepting of cultural differences. Cultural knowledge includes sufficient comparative knowledge of diverse groups, including the values, health beliefs, care practices, and worldview. p. 104

The nurse is explaining the concept of being culturally competent to another nurse. Which are components of cultural competence? Cultural awareness Cultural knowledge Cultural skills Cultural encounters Cultural desire Cultural difference

Cultural awareness Cultural knowledge Cultural skills Cultural encounters Cultural desire Cultural competence consists of five components: cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desires. Cultural awareness refers to an in-depth self-examination of one's beliefs to help recognize biases, prejudices, and assumptions. Cultural knowledge involves obtaining adequate information about cultural groups. Cultural skills allow a person to assess social, cultural, and biophysical factors that affect treatment and care of patients. Cultural encounters involve engaging in cross-cultural interactions that provide information about other cultures. Cultural desire refers to the motivation and commitment to build on cultural similarities. Cultural difference is not a component of cultural competence. STUDY TIP: When recalling the components of cultural competence, use the mnemonic "ASK ED." Each letter represents one of the five components of cultural competence: A= awareness; S = skills; K = knowledge; E = encounters; and D = desires. pp. 104-105

The nurse, while caring for a patient of a different cultural background, learns about their cultural practices that affect health. The nurse uses these facts to plan the patient's care for better acceptance. Which component of Campinha-Bacote's model of cultural competency is reflected in this scenario? Cultural skill Cultural desire Cultural encounter Cultural knowledge

Cultural encounter Campinha-Bacote's model of cultural competency includes interrelated components. Cultural encounter involves the cross-cultural interactions between the nurse and the patient that provide opportunities to learn about other cultures and develop effective intercultural communication. Cultural skill is the ability to assess the social, cultural, and biophysical factors that influence patient treatment and care. Cultural desire is the motivation and commitment to care for a patient. Cultural knowledge is the knowledge of diverse groups, including the values, health beliefs, care practices, worldview, and bicultural ecology commonly found within each group. pp. 104, 105

Which statement is true regarding culturally congruent care? Culturally congruent care has predetermined criteria from which patterns of life and the system of meaning are generated. Culturally congruent care bridges gaps to provide supportive care for patients from certain cultures. In culturally congruent care, transcultural nursing enables primary health care providers to deliver uniform services irrespective of health beliefs. Culturally congruent care sometimes diverges from the values of the professional health care system.

Culturally congruent care sometimes diverges from the values of the professional health care system. Culturally congruent care sometimes diverges from the values and meanings of the professional health care system. Patterns of life and systems of meaning are generated by people themselves. Culturally congruent care bridges gaps to provide supportive care for all patients, not only patients from certain cultures. Transcultural nursing provides culturally congruent care, or care that fits a person's life patterns, values, and the system of meaning. p. 103

During their clinical postconference meeting, several nursing students were discussing their patients with their instructor. One student from a middle-class family shared that a patient was homeless. Which difference is being described? Ethnicity Culture Heritage Religion

Culture Culture is the context in which groups of people interpret and define their experiences relevant to life transitions. These include events such as birth, illness, and dying. Culture refers to the system of meanings by which people make sense of their experiences. po. 103, 107

The nurse finds that a 12-year-old girl displays physical aggression, excessive masturbation, poor school performance, and poor peer relationships. Which other findings observed in the girl indicate a history of being sexually abused? Difficulty eating Difficulty walking or sitting Unusual odor in the genital area Vomiting or abdominal tenderness Fractures of the face, nose, and arms

Difficulty walking or sitting Unusual odor in the genital area Physical aggression, excessive masturbation, poor school performance, and poor peer relationships are behavioral symptoms of sexual abuse. Symptoms such as difficulty walking or sitting and an unusual odor in the genital area often indicate sexual abuse. Therefore, the nurse should confirm the history of sexual abuse during assessment. Difficulty eating occurs due to anorexia, which is a common finding in adults. Vomiting or abdominal tenderness and fractures of the face, nose, and arms are physical signs that often indicate sexual abuse in adults. p. 724

A registered nurse is reviewing community assessment data collected by a student health nurse in the chart below. Which datum charted indicates the need for further teaching? Datum 1 Datum 2 Datum 3 Datum 4

Datum 4 Information about housing is not included under the Population component of Community Assessment. Therefore, datum 4 needs correction. Housing information should be included under the Structure component. Emergency services (datum 1) are included in the Structure component. Sex distribution (datum 2) is included in the Population component. Information about local government (datum 3) is included in the Social System component. p. 38

The nurse educator is preparing to teach a group of nursing students about nursing interventions for managing bioterrorism. Which topics should the nurse include in the teaching plan? Defibrillator usage Decontamination methods Stress-management techniques Anatomy of the human body Evidence-based research on vaccines

Decontamination methods Evidence-based research on vaccines Preparing for community disasters is an important part of the nurse education curriculum. While teaching about nursing management interventions regarding bioterrorism, the nurse educator should speak on decontamination methods and vaccine research. Teaching the use of the defibrillator, stress management techniques, and anatomy of the human body is not pertinent to this situation. p. 6

A nursing student in the last semester of the baccalaureate nursing program is beginning the community health practicum and will be working in a community-based clinic with a focus on asthma. What is the focus of the community health nurse in this clinic setting? Decreasing the incidence of asthma attacks in the community Increasing healthy food choices for school lunches Assessing the factors that contribute to asthmatic attacks in the community Providing asthma education programs for the teachers in the local schools Increasing the educational programs for overweight children in the local schools

Decreasing the incidence of asthma attacks in the community Assessing the factors that contribute to asthmatic attacks in the community Providing asthma education programs for the teachers in the local schools All of the correct options improve the level of health and quality of life for patients in this community. Controlling and managing symptoms of any disease improve the patient's quality of life. Assessing the factors that contribute to asthmatic attacks and making educational programs available improve the level of health within a community. The example here was asthma, but managing chronic diseases in the community improves the overall level of health of that community. Community-based nursing care takes place in community settings such as the home or a clinic in which the focus is on the needs of the individual or family. It involves the safety needs and acute and chronic care of individuals and families, and enhancement of their capacity for self-care. pp. 33

A 50-year-old woman complains of dyspareunia. Which is a possible cause of dyspareunia in the patient? Diminished sexual desire Diabetes and hypertension Diminished vaginal lubrication Increased vaginal elasticity

Diminished vaginal lubrication Dyspareunia is painful sexual intercourse. In perimenopausal women, estrogen secretion decreases and leads to diminished vaginal lubrication and elasticity. These changes may cause dyspareunia. Diminished sexual desire could be due to low estrogen but does not lead to dyspareunia. Diabetes and hypertension do not cause dyspareunia. p. 717

The nurse is participating in a clinical care coordination conference for a patient with terminal cancer. The nurse talks with colleagues about using the nursing code of ethics for professional registered nurses to guide care decisions. A nonnursing colleague asks about this code. What does this code do? Improves self-health care Protects the patient's confidentiality Ensures identical care to all patients Defines the principles of right and wrong when providing patient care

Defines the principles of right and wrong when providing patient care The code of ethics identifies the philosophical ideals of right and wrong that define the principles that nurses follow when providing care for patients. The code serves as a guide for carrying out nursing responsibilities to provide quality nursing care and describes the ethical obligations of the profession. The code of ethics does not include methods to improve self-health care. Protecting the patient's confidentiality is a standard of care and is covered in the language of the Health Insurance Portability and Accountability Act (HIPAA). Care must be provided based on differing patient needs. When giving care, it is essential to provide a specified service according to standards of practice and to follow a code of ethics. p. 3

ich factors contribute to major health problems of older adults in the community? Poverty Dementia Polypharmacy Chronic physical illness Communicable diseases

Dementia Polypharmacy Chronic physical illness Dementia and medication abuse are the major health problems affecting older adults in a community. Chronic physical illness, which includes arthritis, is also a major health problem affecting older adults. Poverty and communicable diseases are not major health problems for older adults in a community. pp. 35-36

An elderly couple visits the hospital for regular health checkups. The woman, 67 years old, has been diagnosed with advanced dementia. She lives with her husband, her sole caregiver, who is 75 years old. He is a hypertensive patient and is on antihypertensive drugs. What interventions should the nurse perform to promote well-being of the patient's wife? Demonstrate the techniques of dressing, feeding, and bathing his wife. Provide encouragement and emotional support. Advise the patient to seek help from respite care and support groups. Encourage the patient to perform all daily activities for his wife. Recommend financial services if needed.

Demonstrate the techniques of dressing, feeding, and bathing his wife. Provide encouragement and emotional support. Advise the patient to seek help from respite care and support groups. Recommend financial services if needed. The patient's wife is suffering from dementia and is dependent on the patient. The community health nurse should demonstrate the correct techniques of bathing, feeding, and dressing the wife. The patient is the only caregiver for his wife; therefore, he needs encouragement and emotional support. The nurse should advise the patient to check out respite care and support groups if he needs help. Community resources can be approached for seeking financial help if needed. The patient should not make his wife completely dependent on him. Her functional ability should be preserved as much as possible. pp. 36

A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1c, a measure of blood sugar control over the past 90 days, has increased by saying, "The hemoglobin A1c is wrong. My blood sugar levels have been excellent for the last 6 months." Which defense mechanism is the patient using? Denial Conversion Dissociation Displacement

Denial Denial is avoiding emotional stress by refusing to consciously acknowledge anything that causes intolerable anxiety. This patient's statements reflect denial about poorly controlled blood sugars. p. 774

The nurse could not get through her licensing exam. After seeing the results, the nurse said, "No! I do not believe this. I prepared for the exam for 2 years. I should have made it through the test. There must be some error in this." What is this kind of response called? Denial Illusion Primary appraisal Posttraumatic stress disorder

Denial Denial is one of the types of ego-defense mechanisms used to cope with stressors. In such a case, a person consciously refuses to acknowledge anything that causes intolerable emotional pain. Illusion is a false belief. Evaluating a situation for its personal meaning is called primary appraisal. Posttraumatic stress disorder does not present in this way. Posttraumatic stress disorder occurs when a person experiences a traumatic incident and continues to respond to stressful situations with intense fear and helplessness. The stress in this patient is not due to a traumatic incident. p. 774

A Hindu patient is admitted to the hospital. The nurse prepares a diet plan for the patient. What should the nurse do to appropriately plan the patient's diet? Determine whether the patient consumes nonvegetarian food. Ask if the patient is observing a fast. Ask if the patient has any particular food preferences. Ask the patient to talk to the dietitian about preferences. Make sure the patient consumes only food provided by the health care facility.

Determine whether the patient consumes nonvegetarian food. Ask if the patient is observing a fast. Ask if the patient has any particular food preferences. Ask the patient to talk to the dietitian about preferences. Food is an important aspect of a patient's health and an important component of religious beliefs and observances. People following Hinduism are often vegetarians. They may fast on sacred days and only consume specific food items while fasting. Some sects avoid consuming certain foods, such as onion and garlic. The nurse should determine these preferences before outlining a diet plan. The patient should talk to the dietitian to explain food preferences and suggest changes if necessary. If the patient is not comfortable with the food and food preparation at the health care facility, the nurse should allow the patient to eat food made at home, assuming that food meets the patient's dietary restrictions. p. 745

A patient is being discharged from the hospital following a surgical procedure. What is the role of the nurse in discharge planning? Develop a plan for further care. Ensure a smooth transition from the hospital to another health care level. Exclude referrals to other disciplines. Anticipate and identify patient needs. Begin planning immediately once the discharge instruction is given.

Develop a plan for further care. Ensure a smooth transition from the hospital to another health care level. Anticipate and identify patient needs. Discharge planning is an important nursing activity that requires critical thinking. When planning a discharge, the nurse develops a plan for further care of the patient ensuring that there is a smooth transition from the hospital to another level of health care such as a nursing home. The nurse anticipates and identifies the patient's needs so that the plan includes the care needed once the patient leaves the hospital setting. Referrals are important in ensuring that all the patient's needs are met. Discharge planning starts as soon as the patient is admitted. p. 19

The nurse is assessing a recently married patient who is stressed due to responsibilities towards family and work. The patient tells the nurse that being single was better than being married. What kind of situation or crisis does the patient have? Situational crisis Developmental crisis Posttraumatic stress disorder General adaptation syndrome

Developmental crisis Crisis occurs when the intensity of stress is beyond the patient's ability to cope. There are three different types of crisis: developmental, situational, and adventitious. A developmental crisis occurs when a new developmental stage occurs in a person's life such as a marriage, the birth of a child, or retirement. A situational crisis occurs when external sources such as a job change or motor vehicle crash provoke stress. Posttraumatic stress disorder occurs when a person experiences a traumatic incident and responds with intense fear and helplessness. The stress in this patient is not due to a traumatic incident. General adaptation syndrome is not a type of crisis. It refers to the process of reaction to stress. p. 774

A middle-aged patient is diagnosed with erectile dysfunction. Which associated conditions might the nurse find in the patient? Diabetes Hypertension Anorexia Hyperlipidemia Hyperthyroidism

Diabetes Hypertension Hyperlipidemia Diabetes mellitus, hypertension, and hyperlipidemia are risk factors associated with erectile dysfunction. Obesity, not anorexia, is a risk factor for erectile dysfunction. Hypothyroidism, not hyperthyroidism, is associated with erectile dysfunction. p. 722

The nurse is presenting information to a management class of nursing students on the topic of groups of in-patient hospital services that have a fixed reimbursement amount, with adjustments made based on case severity and regional costs. The nurse is presenting information to the class on which topic? Utilization review committee Resource utilization group Capitation payment system Diagnosis-related groups

Diagnosis-related groups Diagnosis-related groups (DRGs) are grouped in-patient hospital services for Medicare patients. Each group has a fixed reimbursement amount, with adjustments based on case severity, rural/urban/regional costs, and teaching costs. Hospitals receive a set amount for each patient based on the assigned DRG regardless of the patient's length of stay or use of services. DRGs are part of the prospective payment system. p. 15

A patient who was severely injured in a motorcycle accident underwent surgery 3 days ago for multiple bone fractures. The nurse teaches the patient interventions that will help the patient recover while instilling hope and support. What are the interventions that the nurse should mention? Dietary therapies Meditation Avoiding home-cooked food Offering prayers in a group or with family Physiotherapy

Dietary therapies Meditation Offering prayers in a group or with family Food and nutrition are the most important parts of patient care. Dietary therapies help maintain the proper nutrition needed by the patient after surgery. Meditation helps reduce the patient's stress and relax the patient. This helps the patient regain peace of mind. Offering prayers in a group or with family enhances connectedness and hope for a better life. It also helps the patient cope with the physical and psychological symptoms of the injury. Home-cooked food that does not violate the dietary restrictions of the patient should be allowed. Physiotherapy is not recommended for a patient who has undergone a major surgery until the pain reduces and the stitches heal to some extent. pp. 744-745

During a stress response, what does a secondary appraisal focus on? Factors triggering stress in a person Factors hindering coping for a person with stress Effects of stress for a person with stress Different coping strategies available to a person with stress

Different coping strategies available to a person with stress Appraisal is the process of evaluating the stressors in a patient's life and how the person can deal with them. There are two types of appraisals: primary and secondary. Secondary appraisal focuses on the coping strategies available to the person. Primary appraisal includes identifying factors that trigger stress or factors that interfere with coping with stress. It also includes the patient's own evaluation of the meaning of stress. p. 773

A patient presents with ineffective sexual functioning. Which strategies should the nurse suggest to enhance sexual functioning in the patient? Discourage the use of pain medications. Discourage the use of alcohol and tobacco. Encourage touching and kissing. Discourage the use of pillows during sex. Communicate concerns and fears with the partner.

Discourage the use of alcohol and tobacco. Encourage touching and kissing. Communicate concerns and fears with the partner. Alcohol and tobacco may decrease sexual functioning and should be discouraged. Touching, kissing, and tactile stimulation are forms of intimacy and should be encouraged. Communicating concerns and fears with the partner and health care provider help in better understanding the problem. Pain medication may be promoted before intercourse in the patient who has chronic pain that could affect intercourse. p. 728

When the nurse has a prejudice against a particular culture, which type of behavior is likely to result? Discrimination Culturally congruent care Effective intercultural communication Sufficient knowledge of diverse groups

Discrimination Prejudices associate negative characteristics with people who are different from the valued group. When a person acts on these prejudices, discrimination occurs. Prejudices are not compatible with culturally congruent care, effective intercultural communication, or sufficient knowledge of diverse groups. p. 104

Which ego defense mechanism does the nurse suspect in the patient who breaks objects when he experiences high levels of stress? Denial Regression Identification Displacement

Displacement Displacement is the defense mechanism that occurs when the emotions are transferred from one target to another target that is considered less stressful or neutral. Therefore, the patient is exhibiting the displacement defense mechanism. Denial is the refusal to acknowledge the existence of a real situation or the feelings associated with it. Regression is retreating to an earlier level of development and the comforting measures associated with that level of functioning. Identification is an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual whom one admires. p. 774

The nurse is assessing a patient to identify spiritual needs. What questions would help the nurse assess the patient's spirituality? Do you attend a religious service on a regular basis? What is do you want to achieve in your life? Whom do you feel is the closest to you? Have you assigned a power of attorney? Do you wish to change your profession?

Do you attend a religious service on a regular basis? What is do you want to achieve in your life? Whom do you feel is the closest to you? When assessing a patient's spirituality, the nurse should inquire about the patient's feelings and views on life, the level of connectedness with the self and others, and the practice of religion. Asking if the patient attends church (religious practice), the one person the patient is closest to (connectedness), and the patient's goal in life (view of life) would help the nurse identify the patient's spiritual needs. The assignment of a power of attorney and the desire to change professions would not shed light on the patient's spirituality. p. 735

Which question represents a nonjudgmental approach when gathering a sexual health history? "How do you and your wife/husband feel about intimacy?" "Do you have sex with men, women, or both?" "Are you heterosexual or homosexual?" "What is your sexual orientation?"

Do you have sex with men, women, or both?" A nonjudgmental attitude facilitates trust and open communication between the nurse and patient. Using terms such as partner versus wife or husband allows patients to identify their sexual preference. The terms gay, lesbian, bisexual, or transgender are preferred over the terms heterosexual or homosexual and are more specific in reference to sexual practices. pp. 723-724

A female Islamic patient died of leukemia. What nursing interventions and medical practices are against the beliefs of the Islamic religion? Donating eyes Cleaning the body Informing the family members Postmortem examination Praying in groups

Donating eyes Postmortem examination Organ donation and postmortem examination are against the Islamic religion. Cleaning the body, informing the family members, and praying in groups are allowed by most religions. p. 739

he nurse is reviewing the sexual and physical examination data of a patient diagnosed with sexual dysfunction. Which signs and symptoms might the nurse anticipate finding in the assessment data? Dyspareunia Erectile dysfunction Uncontrolled hypertension Depression and guilt Foul-smelling genitals

Dyspareunia Erectile dysfunction Uncontrolled hypertension Depression and guilt Sexual dysfunction is the inability to accomplish sexual desires. It can be due to many reasons. Dyspareunia is pain occurring with sexual intercourse that may lead to decreased sexual desire. Erectile dysfunction that prevents erection required for satisfactory copulation may also lead to decreased desire. Sexual dysfunction may also be related to various psychological factors, including anxiety, depression, and guilt. Uncontrolled hypertension is a risk factor for sexual dysfunction. Foul-smelling genitals call into question cleanliness or suggest the presence of infection. pp. 717, 721, 722, 724

An indigenous population of a tribal area has a high incidence of heart attacks. The community-based nurse learns that the population suffers from high blood pressure. What nursing interventions are helpful in preventing heart attacks in this population? Educating about nutrition Monitoring blood pressure Administering antianxiety or stress-relieving medication Educating about prescribed hypertensive medications Performing mass administration of hypertensive medications

Educating about nutrition Monitoring blood pressure Educating about prescribed hypertensive medications The community-based nurse should take measures to ensure early detection and early intervention of high blood pressure; this would help prevent heart disease and problems related to high blood pressure. Teaching the community about good nutrition healthy eating habits can help reduce high blood pressure. The nurse should take a patient's blood pressure at every visit to ensure that it is within a normal range. The nurse should also discuss which medications might help to reduce blood pressure. Stress management techniques are preferred over medication at the community level. The nurse should not administer antistress medications on his or her own. Mass administration is not justifiable because not everyone will need medication. pp. 35

The nurse is learning about the standards of nursing practice. Which activities are part of the practice of implementation? Developing strategies for patient care Educating patients for health awareness Analyzing assessment data for diagnosis Using therapeutic procedures for patient care Providing consultation to enhance patient care

Educating patients for health awareness Using therapeutic procedures for patient care Providing consultation to enhance patient care Implementation is when the nurse actually uses and performs particular actions or puts a strategy into use. Educating patients, using therapeutic knowledge, and providing consultation all provide opportunities for the nurse to implement skills. Developing strategies for patient care is a part of planning in nursing practice. Analyzing the assessment data is part of diagnosis in nursing practice. p. 2

The nurse plans her nursing care with the knowledge that old age is primarily focused on which of Erikson's stages of growth and development? Intimacy versus isolation Autonomy versus shame and doubt Generativity versus self-absorption Ego integrity versus despair

Ego integrity versus despair The developmental stage of ego integrity versus despair (late 60s to death) is focused on feeling positive about life and its meaning and providing a legacy for the next generation. p. 702

Which priority nursing intervention should be included in the plan of care based on the fact that the majority of sexually transmitted infections (STIs) have few if any symptoms? Encourage regular screenings in all sexually active individuals. Provide information about contraception options. Administer prescribed antibiotics for human papillomavirus (HPV) or genital herpes outbreaks. Ask all patients if they are experiencing any symptoms.

Encourage regular screenings in all sexually active individuals. One of the challenges in reducing the incidence of sexually transmitted infections (STIs) is that most STIs have few symptoms in males or females. Asymptomatic STIs can be diagnosed during a physical examination with appropriate laboratory tests. Screening after each new sex partner is the most effective method to detect and manage STIs. Human papillomavirus (HPV) and herpes are viral infections and cannot be treated with antibiotics. p. 719

The nurse is explaining to a nursing student about discharge planning. Which objectives are included in the discharge planning? Encourage the patient to seek medical help if complications arise. Identify appropriate resources to ensure continuity of care. Help the patient learn safe and effective use of medication. Teach the patient self-administration of intravenous fluids. Teach rehabilitation techniques to support adaptation.

Encourage the patient to seek medical help if complications arise. Identify appropriate resources to ensure continuity of care. Help the patient learn safe and effective use of medication. Teach rehabilitation techniques to support adaptation. Discharge planning is based on anticipating the patient's needs once he or she leaves the health care establishment. The patient should be encouraged to identify complications and seek timely help. The patient should be referred to appropriate resources to maintain continuity of care. The patient should be taught about safe use of medications. Teaching rehabilitation techniques is important to help the patient adapt to a new lifestyle or resume daily activities. Intravenous fluids should be administered only by a professional. The patient should not be encouraged to self-administer IV fluids. p. 19

The nurse is planning care and treatment of a patient with a below-the-knee amputation who currently has very low self-esteem. What interventions should the nurse include to improve the self-concept of the patient when outlining the care plan? Enroll the patient in a class that will teach ambulation with assistive devices. Limit the number of visitors to minimize stressors. Involve the patient in planning the schedule and extent of physical therapy. Convince the patient to enroll in group therapy. Schedule a prosthetic expert to talk to the patient.

Enroll the patient in a class that will teach ambulation with assistive devices. Involve the patient in planning the schedule and extent of physical therapy. Schedule a prosthetic expert to talk to the patient. When planning care for improving the self-concept of a patient, the nurse should try to minimize self-concept stressors. Enrolling the patient in a class with other patients with the same condition increases self-concept. The patient should be involved in planning his or her physical therapy so that the plan is realistic and goal-directed. A visit from a prosthetic expert would allow the patient to build hope and motivate him or her to attain the required levels of physical strength. Limiting the number of visitors would not help because the patient may need to verbalize and express feelings. Therapies should not be forced upon the patient, as this could lead to breakdown of the therapeutic relationship between the patient and the nurse. p. 709

A patient who is suffering from chronic stress reports sleep deprivation, chronic fatigue, and depression. On examination, the patient's blood pressure is 160/98 mm Hg and the heart rate is 78 beats/minute. What could be the most probable reason for this presentation? The inability to sleep Polymyalgia rheumatica Increased venous return to the heart Excessive wear and tear by hormones

Excessive wear and tear by hormones The symptoms indicate that the patient is in a state of allostatic load. A chronic stress response and excessive wear and tear by hormones results in this state. The persistence of the allostatic load can cause problems such as chronic hypertension, depression, insomnia, and autoimmune disorders. Insomnia is one of the symptoms and not the cause. Polymyalgia rheumatica does not present in this way. Increased venous return to the heart does not lead to all these symptoms. p. 772

A 50-year-old male patient comes for a follow-up visit a few months after a myocardial infarction. The nurse plans to interview the patient to assess his sexual health. What precautions should the nurse take when assessing the patient's sexuality? Ensure that the patient is comfortable discussing the issue. Ensure that the patient has privacy. Close the door or curtains of the room. Avoid talking to the patient. Hand him a questionnaire and ask him to complete it. Ask open-ended questions, such as how the patient's health problem has affected his sexual activity. Include the family members in the discussion to get more information.

Ensure that the patient is comfortable discussing the issue. Ensure that the patient has privacy. Close the door or curtains of the room. Ask open-ended questions, such as how the patient's health problem has affected his sexual activity. When assessing a patient's sexuality, it is extremely important that the patient is comfortable discussing it. The nurse should maintain privacy by closing the doors and curtains of the room. Asking open-ended question gives the patient the opportunity to explore his situation completely. It is an incorrect nursing practice to avoid discussion with the patient and just handing him a questionnaire. Family members should not be included in the discussion, because that may be an invasion of the patient's privacy. p. 723

What did Mary Adelaide Nutting contribute to the development of nursing as a profession? Established the Frontier Nursing Service Founded public health nursing in New York City Ensured affiliation of nursing education with universities Was the first professor of nursing at Columbia University Teachers College Developed the American Red Cross while she was a Civil War nurse

Ensured affiliation of nursing education with universities Was the first professor of nursing at Columbia University Teachers College Mary Adelaide Nutting was instrumental in the affiliation of nursing education with universities and became the first professor of nursing at Columbia University Teachers College in 1906. Maitland Stewart founded the Frontier Nursing Service, which provided the first organized midwifery service in the United States. Lillian Wald founded the Henry Street Settlement in New York City and is considered the founder of community, or public health, nursing. Clara Barton was a Civil War nurse who used her experience on the battlefield to found the American Red Cross. p. 6

A 50-year-old male reports he is experiencing issues related to his sexual performance. His blood levels are normal except for a high glucose level. His semen analysis is within normal limits. Which disorder is likely responsible for his condition? Hypoactive sexual desire Erectile dysfunction Dyspareunia Infertility

Erectile dysfunction High blood sugar often leads to sexual dysfunction. Erectile dysfunction is a type of sexual dysfunction in which the person cannot have or sustain an erection. Hypoactive sexual desire disorder is a disorder in which the person has no or very low sexual desire. Dyspareunia is the occurrence of pain during intercourse, which can be the result of decreased levels of estrogen in perimenopausal women. Infertility is the inability to conceive after 1 year of unprotected intercourse. p. 721

A patient experiencing a stomach ache was diagnosed with stomach cancer. What are the health promoting measures that the nurse may adopt? Establish a presence Mobilize hope for the patient Solve the patient's problems with quick remedies Help the patient to use social and spiritual resources Misinterpret the illness to make it acceptable to the patient

Establish a presence Mobilize hope for the patient Help the patient to use social and spiritual resources Establishing a physical presence helps the patient physically, psychologically, and spiritually. The nurse can establish presence by sitting with a patient to attentively listen to his or her feelings and situation, talking with the patient, crying with the patient, and simply offering time are powerful spiritual care approaches (Bowers and Rieg, 2014). Mobilizing hope in the patient is central to a healing relationship. Social and spiritual interventions are health promoting measures for the patient. Using quick remedies for solving problems may not be effective in curing the disease. Instead, measures should be taken to promote long-term changes in the patient's lifestyle. Illness should not be misinterpreted; rather it should be interpreted in a way that is acceptable to the patient. p. 744

The nurse is assessing patients from different cultural backgrounds. Which actions should the nurse perform to obtain a systematic cultural assessment? Overlook the patient's beliefs about health care. Establish trusting relations with the patient. Obtain information by asking open-ended questions. Gather area demographic information from census data. Obtain information about economic backgrounds.

Establish trusting relations with the patient. Obtain information by asking open-ended questions. Gather area demographic information from census data. Cultural assessment is time-consuming and establishing trusting relations with the patient is helpful. Using open-ended and focused questions can encourage patients to provide information about their cultural values. Gathering background demographic knowledge of the patient's culture can help in cultural assessment. Understanding patients' beliefs about health care is an important part of cultural assessment. Obtaining information about economic backgrounds is not relevant to cultural assessment. p. 107

Decreased levels of which hormone may result in painful sexual intercourse? Estrogen Testosterone Growth hormone Follicle-stimulating hormone (FSH)

Estrogen Decreased estrogen levels result in decreased vaginal lubrication and vaginal tissue thinning. These changes can result in painful sexual intercourse. Testosterone, growth hormone, and follicle-stimulating hormone (FSH) do not affect the vaginal tissues and do not cause painful intercourse when their levels decrease. Testosterone is responsible for sexual growth and development in males. Growth hormone is responsible for overall growth and development in an individual. FSH promotes sexual growth in females. p. 717

A patient sprained her ankle. The nurse instructs the patient to keep the leg elevated and applies cold compresses on the affected ankle. Which standard of practice is the nurse performing? Assessment Diagnosis Evaluation Implementation

Evaluation The nurse is delivering care to the patient; therefore the standard practiced by the nurse is implementation. Assessment is the process of collecting data related to the health and illness of the patient. Nursing diagnosis involves analyzing the assessed data. Evaluation refers to determining the effectiveness of the implemented patient care in meeting the patient goals. p. 2

A patient has a large facial scar after the removal of a tumor of the buccal mucosa. The patient is extremely depressed due to this facial disfiguration. Which nursing actions would be helpful in motivating the patient? Allow a negative natural reaction to show when seeing the patient. Examine the scar and assuring the patient that it is healing well. Tell the patient about a good plastic surgeon who can improve the appearance of the scar. Avoid looking at the patient. State that the scar does not look as bad as anticipated.

Examine the scar and assuring the patient that it is healing well. Tell the patient about a good plastic surgeon who can improve the appearance of the scar. State that the scar does not look as bad as anticipated. When dealing with a patient with a disturbed body image, the nurse should be aware that both verbal and nonverbal communication might affect the patient and family. The nurse should encourage the patient with positive expressions, such as telling him or her that the scar is healing well and that it can be further improved by a plastic surgeon. The nurse may reinforce that the patient's condition is better than originally anticipated, which creates a positive feeling in the patient and family. The nurse should be careful to control facial expressions and never exhibit disgust or discomfort, even if that is a natural reaction to the patient's condition. Showing negative reactions to the patient may further lower the self-esteem of the patient. By not looking directly at the patient, the nurse may create a feeling of nonacceptance in a patient with low self-esteem. pp. 706-707

Which positive concept of spiritual health is a patient expressing when she states that her husband loves her? Faith Hope Transcendence Connectedness

Faith Faith is confidence about something without firm physical evidence. The patient saying, "My husband loves me," indicates positive faith. Hope is a sense of motivation, which helps the patient to live for and look to the future during difficult times. Transcendence is a state of existence above and beyond the limits of material experience. Transcendence affects the spirituality and spiritual health of a person. Connectedness is described as a connection within oneself, with others, and with the environment. The patient's affirmation of his or her partner's love does not indicate hope, transcendence, or connectedness. p. 734

Certain cultural groups in the United States are disproportionately affected by infectious diseases such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). Which factors increase the risk for HIV and AIDS? Expectations about behavior by men or women in the culture Higher percentages of lesbian, gay, bisexual, or transgender individuals in the culture Genetic predisposition to the disease in the culture Communication patterns and language practiced by the culture Varied climate in different geographic locations

Expectations about behavior by men or women in the culture Communication patterns and language practiced by the culture Cultural factors such as gender, education, socioeconomic status, religion, language, and values influence the use of the health care system. Populations that are at increased risk for human immunodeficiency virus (HIV) include those who are intravenous drug users, those with hemophilia, and those who practice unprotected sex. Genetic factors often increase the risk for certain health problems such as cardiovascular disease or cancers, but do not usually increase the risk for HIV, because it is a viral infection and not a genetic disease. Climate does not increase the risk for HIV. p. 720

The nurse with specialized nursing skills is capable of identifying both patient-centered problems and problems related to the health care system. According to Benner, which specialist nurse possesses such skills? Expert nurse Proficient nurse Competent nurse Advanced beginner nurse

Expert nurse According to Benner, the expert nurse has specialized skills and is capable of identifying both patient-centered problems and problems related to the health care system. The expert nurse passes through five levels of proficiency when acquiring or developing these skills. The proficient nurse perceives the clinical situation as a whole, is able to assess an entire situation, and readily transfers knowledge gained from multiple previous experiences. The competent nurse is able to anticipate nursing care and establish long-range goals. The advanced beginner nurse has some level of observational experience with the situation and is able to identify meaningful aspects or principles of nursing care. p. 2

Contemporary nursing requires that the nurse has knowledge and skills for a variety of professional roles and responsibilities. What are the responsibilities of the nurse as a patient educator? Explain concepts and facts about health to patients. Protect the patient's human and legal rights. Teach the patient to self-administer insulin injections. Provide adequate information to the patient to help make treatment decisions. Prescribe appropriate medications.

Explain concepts and facts about health to patients. Teach the patient to self-administer insulin injections. The responsibilities of the nurse educator include explaining concepts and facts about health to patients. The nurse educator also plans teaching activities, such as teaching the patient to self-administer insulin injections. As a patient advocate, the nurse should protect the patient's human and legal rights and provide additional information to help a patient decide whether to accept a treatment. The nurse does not prescribe medications; however, the nurse is responsible for administering medications prescribed by the health care provider. p. 3

A Jamaican immigrant has been late to the last two clinic visits, which in turn had to be rescheduled. Which is the best action that the nurse could take to prevent the patient from being late to the next appointment? Give the patient a copy of the city bus schedule. Call the patient the day before the appointment as a reminder to be on time. Explore what has prevented the patient from being at the clinic in time for the appointment. Refer the patient to a clinic that is closer to the patient's home.

Explore what has prevented the patient from being at the clinic in time for the appointment. Present-time orientation is in conflict with the dominant organizational norm in health care that emphasizes punctuality and adherence to appointments. Nurses need to expect conflicts and make adjustments when caring for patients from certain ethnic groups. p. 108

A 45-year-old single mother lives with her 10-year-old son who has Down syndrome. The mother's facial expressions demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The nurse understands that the mother is experiencing caregiver role strain. What findings noted by the nurse indicate caregiver role strain? Fatigue and malaise Unkempt appearance Lack of interest in socialization The disease condition of the patient's son Single motherhood

Fatigue and malaise Unkempt appearance Lack of interest in socialization Physical symptoms such as fatigue and malaise indicate caregiver role strain. A lack of interest in grooming and socialization also indicate that the mother is overburdened with caregiving responsibilities. The disease condition of the son and single motherhood are causes of, not indicators of, caregiver strain in the mother. p. 777

A patient diagnosed with major depressive disorder has long-term low self-esteem related to negative view of the self. Which action would be the most appropriate cognitive intervention by the nurse? Promote active socialization with other patients. Role-play to increase assertiveness skills. Focus on identifying strengths and accomplishments. Encourage journaling of underlying feelings.

Focus on identifying strengths and accomplishments. Focusing on strengths and accomplishments to minimize the emphasis on failures assists the patient in altering distorted and negative thinking. The other interventions are important, but they are not designed to impact thoughts. p. 711

A 55-year-old male patient underwent a colostomy. Earlier he underwent coronary artery bypass graft (CABG) surgery. The nurse finds the patient depressed and weeping. The patient expresses that he is fed up with his poor health. He feels that he has become a burden on his family because he can't work now. The nurse finds that the patient's body language is suggestive of altered self-concept. Which behaviors suggest low self-esteem? Normal speech Frequent crying Hesitant speech Avoidance of eye contact Maintaining good eye contact

Frequent crying Hesitant speech Avoidance of eye contact Behaviors that are suggestive of altered self-esteem include frequent crying, hesitant speech, avoiding eye contact, slumped posture, and an unkempt appearance. Normal speech and maintaining good eye contact are suggestive of a normal and positive self-esteem. p. 708

What is true about the general practice of advance practice registered nurses? Function independently Function as unit directors Work in acute care settings Work in university settings

Function independently An advanced practice registered nurse functions independently as a clinician, educator, case manager, consultant, and researcher within his or her area of practice to plan or improve the quality of nursing care for the patient and family. p. 4

The nurse is working with a young childbearing family who has one child with a congenital heart disease. The parents are trying to determine the risks of a second child being born with congenital heart disease. Which information is important in assisting the parents in this decision? Genetics Genomics Evidence-based practice Safety

Genomics Genomics describes the study of all the genes in an individual and the interactions of these genes with one another and with that individual's environment. Genomic information allows health care providers to determine how genomic changes contribute to patient conditions and influence treatment decisions. p. 9

The nurse is caring for a patient and finds that the patient is uncomfortable in the hospital. Which intervention is most appropriate to ensure the patient's comfort? Leave the patient alone and give him or her time to adjust. Give adequate privacy to the patient. Administer pain medication. Allow visitors throughout the day to keep the patient engaged.

Give adequate privacy to the patient. In order to make the patient physically comfortable, the nurse must provide adequate privacy for the patient. At the same time, the nurse must regularly check on the patient and should be easily accessible to the patient. The nurse should not leave the patient completely alone, because it may make the patient feel isolated. Pain medications should be given only when necessary. The patient should have access to his family, but visitation should be controlled. p. 25

The nurse tries to calm down a patient diagnosed with cancer. The nurse asks the patient to have faith in God; however, the patient turns out to be an atheist. What does an atheist believe? A supernatural power governs the universe. God is the ultimate being in the universe. God does not exist. Sins from the past have to be faced in the current life.

God does not exist. Atheists do not believe in God. They often seek meaning in life through whatever they do and how they treat others. Many people believe in God as the Supreme Being controlling the universe or a supernatural power that governs the universe. People following Hinduism believe that sins from the past have to be dealt with in the present or future life. p. 734

Which events in life can alter the self-concept of a person significantly? Having a child Losing a child Being promoted at work Taking an exam at school Being diagnosed with a chronic illness

Having a child Losing a child Being promoted at work Being diagnosed with a chronic illness Having a child changes the role of a person to a parent and affects a person's self-concept. Losing a child brings shock and depression, which negatively influence the self-concept. Being promoted at work boosts an individual's self-concept. A diagnosis of a chronic illness may reduce the self-esteem of the patient considerably. Events such as taking an exam would not influence an individual's self-concept. p. 704

The nurse is learning about the different health care plans for the benefit of patients. Which provisions does the nurse classify under Managed Care Organization (MCO)? Health care providers are considered salaried employees. An MCO contracts with a single group practice. An MCO contracts with multiple group practices. An MCO offers a funded program for old people. An MCO limits an enrollee's choice to preferred hospitals.

Health care providers are considered salaried employees. An MCO contracts with a single group practice. An MCO contracts with multiple group practices. A Managed Care Organization (MCO) provides comprehensive preventive and treatment services to a specific group of people voluntarily enrolled in the plan. MCOs can have different structural models. Under the staff model, physicians are salaried employees of an MCO. An MCO with a group model contracts with a single group practice. An MCO with a network model may contract with multiple group practices. Medicare is a funded program for people in the United States who are above 65 years of age. In the case of a Preferred Provider Organization (PPO), the enrollee's choice is limited to the list of preferred hospitals. p. 16

The nurse works in a nurse-managed clinic. What is the purpose of nurse-managed clinics? Illness management Health education Diagnosis and treatment Health promotion Support for self-care and caregivers

Health education Health promotion Support for self-care and caregivers Nurse-managed clinics are managed by nurses. The nursing services focus on educating patients and promoting healthy practices. Nurse-managed clinics also provide services to assess and manage chronic diseases. They also provide assistance for self-care and support for caregivers. Illness management, diagnosis, and treatment are not performed in these clinics, because these activities require hospital-based care. p. 18

The nurse has been transferred from a hospital-based occupation to a population-based public health program. What are the key aspects of population-based programs that the nurse has to understand? Early diagnosis Health protection Health promotion Disease prevention Disability limitation

Health protection Health promotion Disease prevention Population-based programs are based on health care services that work to protect health, promote health, and prevent disease in communities. The focus is not on individualized care. Rather, the focus is on improving the health of the masses. Early diagnosis and disability limitations are part of individualized care, which usually occur in a hospital setting. p. 33

The nurse works in a primary health care center. For which service might the nurse be responsible in this health care setup? Respite care Health screening Mental health counseling Environmental surveillance

Health screening The primary health care center offers services such as health screening, routine physical examinations, diagnostic studies, and management of medical conditions. Respite care, mental health counseling, and environmental surveillance are not provided by primary health care centers. Respite care is provided by certain community agencies. Mental health counseling is provided by mental health care centers. Environmental surveillance is a part of community health in general. p. 18

The nurse works in a community with a high prevalence of cancer. What nursing interventions would be helpful in reducing cancer-related morbidity at the community level? Provide emotional support to the community. Perform yearly breast self-examinations. Help people quit smoking. Motivate the women to go for annual Pap smears. Encourage mammograms in sexually active women.

Help people quit smoking. Motivate the women to go for annual Pap smears. Though people who have cancer often suffer emotionally, and the nurse should provide emotional support to such patients, this will not reduce cancer-related morbidity. The nurse should encourage patients to quit smoking because smoking is a risk factor for developing cancer. Annual screenings for cervical cancer are performed by taking a Pap smear. The Pap smear helps to detect cancer early and ensures timely treatment. Women should be encouraged to perform a breast self-examination every month, rather than every year. Mammograms should be recommended to the entire community, not just sexually active women. p. 36

What is the importance of core measures? Help recognize prejudices, and assumptions about other people Help reduce mortality, complications, and inpatient readmissions Help provide care to fit with patient's own values, beliefs, and traditions Help assess social, cultural, and biophysical factors that influence patient treatment and care

Help reduce mortality, complications, and inpatient readmissions Core measures help to reduce mortality, complications, and inpatient readmissions. Cultural awareness helps to recognize prejudices, and assumptions about other people. Culturally congruent care helps to provide care to fit with patients' own values, beliefs, and traditions. Cultural skills help to assess social, cultural, and biophysical factors that influence patient treatment and care. p. 111

How can the nurse increase a patient's self-awareness? Help the patient define his or her problems clearly. Allow the patient to openly explore thoughts and feelings. Reframe the patient's thoughts and feelings in a more positive way. Have family members assume more responsibility during times of stress. Arrange for the patient to work with an occupational therapist.

Help the patient define his or her problems clearly. Allow the patient to openly explore thoughts and feelings. Reframe the patient's thoughts and feelings in a more positive way. Helping a patient define his or her problems, allowing the patient to explore his or her feelings, and reframing the patient's thoughts and feelings in a more positive way are techniques designed to promote self-awareness and a positive self-concept. Having a family member assume more responsibility does not help a patient achieve self-awareness; instead it is important to encourage a patient to assume more self-responsibility. p. 706

A patient who experienced a stomach ache was diagnosed with stomach cancer. The nurse finds that the patient is sad and feels hopeless about health and the future. What nursing interventions would be helpful for this patient? Help the patient set important goals. Spend time with the patient and teach coping strategies. Assess the potential for committing suicide. Encourage the patient to listen to music of his or her choice. Assess the potential for the presence of psychosis.

Help the patient set important goals. Spend time with the patient and teach coping strategies. Assess the potential for committing suicide. Setting important goals helps alleviate depression. Spending time and teaching coping strategies provide social, emotional, and moral support for the patient. Hopelessness is associated with suicidal tendencies; therefore, the nurse should look for suicidal signs in the patient. Listening to music may help in reducing anxiety but does not help in providing hope. Hopelessness is not a risk factor for the patient to become psychotic. p. 744

The nursing mentor observes that a nursing student is deficient in communication skills but is good at understanding nursing theories. How should the mentor intervene with respect to this student? Help the student build communication skills. Utilize the student's services for patient education and rehabilitation. Utilize the student's services for coordinating and managing patient care. Consider the lack of communication skills unimportant, because sound knowledge ensures a good patient-nurse relationship.

Help the student build communication skills. Communication is an important skill for nurses, so the mentor should help the student build communication skills. This student cannot be utilized for patient education, rehabilitation, or coordinating and managing patient care, because all these activities require good communication skills. Communication skills, not subject knowledge, ensure a good patient-nurse relationship. p. 3

The nurse is undergoing crisis intervention training. What activities are performed during a crisis intervention approach? Helping the patient make the mental connection between the stressful event and his or her reaction to it Helping the patient become aware of present feelings such as anger, grief, or guilt Helping the patient explore coping mechanisms, and identifying new methods of coping Helping the patient decrease social contacts to protect against further crisis Helping the patient to focus on all other problems including the crisis

Helping the patient make the mental connection between the stressful event and his or her reaction to it Helping the patient become aware of present feelings such as anger, grief, or guilt Helping the patient explore coping mechanisms, and identifying new methods of coping A crisis intervention is a specific type of psychotherapy. It can be provided by any trained member of the health care team. In most cases, the patient may be unaware of the complete picture. This approach helps the patient to make a mental connection between the stressful event and his reaction to it. Becoming aware of present feelings such as anger, grief, or guilt helps the patient to reduce tension. Through this approach, the patient may explore new coping mechanisms. The crisis intervention approach helps the patient to make social contacts and prevents isolation. The approach uses problem solving related to the specific crisis. p. 782

The nurse is educating a couple about sexually transmitted infections. Which sexual infections cannot be cured? Herpes Syphilis Chlamydia Gonorrhea Human papillomavirus infection

Herpes Human papillomavirus infection Sexually transmitted infections that cannot be cured include herpes and human papillomavirus. Syphilis, chlamydia, and gonorrhea are sexually transmitted infections caused by bacteria; they can be cured by antibiotics. Syphilis is caused by the bacteria Treponema pallidum. Chlamydia is caused by the bacteria Chlamydia trachomatis. Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. p. 719

The nurse is caring for a pregnant woman who is in labor. When the nurse asks the woman if she wants her husband to be near when she is delivering, the patient strongly objects. People of which cultures are likely to react in this way? Hindus Mexicans Muslims Filipinos Roman Catholics

Hindus Muslims Religious beliefs sometimes prohibit the presence of males, including husbands, from the delivery room. This often occurs among devout Muslims, Hindus, and Orthodox Jews. People from Mexico, the Philippines, and Roman Catholics are comfortable with the husband staying with them during childbirth. p. 103

A patient is diagnosed with end-stage renal disease. The patient tells the nurse, "I know I am going to be all right, and I will be healthy again. I believe in God, and He will make things right. My spouse and I are yet to tour the world." What kind of spiritual belief does this patient exhibit? Hope Self-transcendence Transcendence Agnosticism

Hope Hope is a belief that something positive is going to happen. It exists when faith and spirituality are present. Hope is comforting and energizing to people facing extreme emotional and physical distress, hardships, and personal challenges. It is a valuable resource motivating a person to achieve. Self-transcendence is a feeling and a sense of connecting to one's inner self. Transcendence is a feeling or experience beyond normal and above the material world. Agnosticism is a belief that there is no known ultimate reality. p. 734

A 15-year-old girl states that she is having unprotected intercourse with her boyfriend. She asks for more information about birth control methods. Which information should the nurse include in patient education? Condoms or diaphragms are the most effective methods. Hormonal methods offer little protection against sexually transmitted infections (STIs). Barrier methods offer some protection against STIs. Sterilization is an effective option that the patient should consider. The rhythm method is effective for preventing pregnancy.

Hormonal methods offer little protection against sexually transmitted infections (STIs). Barrier methods offer some protection against STIs. The most effective methods are longer-acting methods, such as an intrauterine device (IUD) or hormonal injection, which are not associated with the sexual act itself. Sterilization is the most effective method besides abstinence but would not be a good option for a young woman, because it is not easily reversible. Hormonal methods do not provide any barrier against sexually transmitted infections (STIs), whereas barrier methods may help reduce the risk. The rhythm method would not be an effective method of birth control for a 15-year-old girl. Couples who use this method need to understand the reproductive cycle of the woman's body and the subtle signs and signals that her body gives during the cycle. To prevent pregnancy, couples abstain from sexual intercourse during designated fertile periods. pp. 718, 728

A patient has leukemia and is in the terminal stage. The patient has opted for a service that provides palliative care at home. Which service has the patient selected? Hospice Respite care Assisted living Adult day care

Hospice Hospice is a service in which palliative care is provided to terminally ill patients in their homes. Respite care is a service that provides short-term relief to the family and caregivers of ill patients. Assisted living is an example of a service offered in a long-term care setting. Adult day care is a service that provides care to patients in a facility when their caregivers have other commitments. pp. 21-22

The nurse is caring for a patient who is a sex worker. Against which sexually transmitted diseases can the patient be vaccinated? Human immunodeficiency virus (HIV) Herpes Chlamydia Human papillomavirus (HPV) infection

Human papillomavirus (HPV) infection A vaccine is available for various strains of the human papillomavirus (HPV). This virus is known to cause cervical cancer in women and anogenital cancers and genital warts, which cause health concerns in males and females. There are no vaccines for human immunodeficiency virus (HIV), herpes, or chlamydia. However, chlamydia can be cured by antibiotics. HIV and herpes have no cure. Study Tip: The only vaccine currently available for the prevention of any sexually transmitted infection (STI) is for HPV (human papillomavirus) infection. HPV infection can cause cervical cancer, so the vaccination is also protective against cervical cancer. p. 719

A head nurse is explaining to student nurses about the different levels of interventions that are used to prevent stress. What activities are included in the primary level of prevention? Symptom management Identifying individuals who are at risk Identifying populations at risk of developing stress Teaching time-management techniques to patients Teaching relaxation techniques to patients

Identifying individuals who are at risk Identifying populations at risk of developing stress Nursing interventions to prevent stress are divided into three levels: primary, secondary, and tertiary. At the primary level, nursing activities are directed towards identifying individuals and populations who are possibly at risk. The secondary level involves actions directed towards the management of symptoms. The tertiary level interventions help the patient to readapt to the changes in health status. It includes relaxation and time-management techniques. p. 777

The nurse is attending to a 46-year-old female patient who suffers from chronic stress due to conflicts with her husband. Which physiological problems is the patient predisposed to? Hypertension Depression Sleep deprivation Bipolar disorder Chronic fatigue syndrome

Hypertension Depression Sleep deprivation Chronic fatigue syndrome When the stress response is chronically activated, the heart rate, blood pressure, and cardiac output are also chronically raised, which cause excessive wear and tear on the body. It can further lead to hypertension, depression, sleep deprivation and chronic fatigue. The chronic elevation of the heart rate, blood pressure, and cardiac output do not cause bipolar disorder, which is a psychiatric disorder. p. 774

A patient is diagnosed with a diabetic ulcer with gangrene to his foot. The primary health care provider advises surgery, but the patient refuses because removal of a body part is not permitted according his or her religious preference. Which concept justifies this scenario? Marginalization Iceberg analogy Intersectionality Health disparity

Iceberg analogy The concept of the iceberg analogy helps in understanding the visual and virtual aspects of the way we perceive things. The patient may have come to get relief from symptoms. However, the primary health care provider may think that the patient should consider undergoing surgery. These differences in perception reflect the iceberg analogy. Marginalization is the segregation of patients on the basis of political systems, labor markets, and positions of power. The division of the patients on the basis of gender, sexual orientation, occupation, class, and immigration status is called intersectionality. The differences in health due to social, economic, and/or environmental disadvantage is called health disparity. p. 106

What are the duties of a community health nurse as a caregiver in managing and caring for the health of the community? Identify deficient community resources. Ensure a traditional approach to problems. Avoid wasting time analyzing a program. Ensure appropriate care for patients and families. Recognize actual and potential health care needs.

Identify deficient community resources. Ensure appropriate care for patients and families. Recognize actual and potential health care needs. As a caregiver, the various roles of the nurse involve assessing the resources needed for the community. The nurse should ensure appropriate care for patients and their families and recognize actual and potential health care needs. The nurse should look for newer and more effective approaches rather than rely only on traditional approaches. The nurse should spend time assessing the effectiveness of a program. It would help the nurse to understand the shortcomings of the program and take the necessary corrective actions. pp. 35

The nurse is working in a health care unit in which there have been rapid changes in health care technology systems in a short time. The nurse is unable to become comfortable with the new systems and is exhausted. The nurse feels a sense of failure and a lack of identity. What does the nurse do now? Identify limits and responsibilities at work. Spend more time at work to learn the new technology. Strengthen friendships outside of the workplace. Spend off-duty hours in activities such as sports, music, or painting. Spend on-duty hours researching the new technologies.

Identify limits and responsibilities at work. Strengthen friendships outside of the workplace. Spend off-duty hours in activities such as sports, music, or painting. The symptoms indicate that the nurse is experiencing burnout. The nurse should now make behavioral changes to cope with workplace stress. These include identifying the limits and responsibilities at work, which helps to focus the nursing efforts. Strengthening friendships outside of the workplace helps the nurse to obtain some relief from workplace stress. Spending off-duty hours engaged in interesting activities such as sports, music, or painting helps the nurse to de-stress. Spending more time at work to learn new technologies or do research would worsen the burnout. p. 782

On the basis of an assessment, the nurse identifies an increase in the immigrant population group in the community. How would the nurse determine some of the health needs of this population? Identify which two health needs the immigrant population views as most important. Apply information from Healthy People 2020. Determine how the population uses available health care resources. Identify perceived barriers to health care. Implement an exercise program to help with weight loss.

Identify which two health needs the immigrant population views as most important. Apply information from Healthy People 2020. Determine how the population uses available health care resources. Identify perceived barriers to health care. The first four options assess the health care needs of this population. It is necessary to identify their priorities and try to meet them, applying information from reliable guidelines such as Healthy People 2020. How or if a population uses available health care resources and the perceived barriers to health care are all important. These elements help identify factors that promote or impede health care for this group. Implementing an exercise program would be making an assumption before a complete assessment of needs has been performed. pp. 35

The nurse determines that a patient is experiencing repeated failures, having conflicts, with others, and is more dependent on his or her parents. Which component of self-concept is affected in the patient? Identity Self-esteem Body image Role performance

Identity Identity is defined as an internal sense of individuality, wholeness, and consistency of a person in different situations. The experiences of repeated failures, conflicts with others, and dependency on parents disturb the internal sense of individuality and consistency of an individual. Therefore, identity is affected in the patient. Self-esteem is an individual's overall feeling of self-worth or the emotional appraisal of self. Body image is the physical appearance, structure, and function of the person. The individual has significant roles throughout life. Failure in meeting role expectations results in deficits. p. 703

What are the chief factors that determine the self-concept of an individual? Age Identity Body image Gender Role performance

Identity Body image Role performance The way an individual identifies herself or himself, how the person perceives his or her body image, and the person's role performance determine the self-concept in the individual. Age and gender do affect the self-concept of a person, but they are not the main components. STUDY TIP: To memorize the chief factors that influence self-concept ( Identity, Body image, and Role performance), make up a mnemonic, such as IBiRp, then a silly sentence using the sounds of IBiRp, such as, "I may burp [IBiRp], but I have a healthy self-concept!" Learning doesn't have to be entirely serious. If you can remember concepts more easily using humor, use it! p. 703

In assessing a patient for self-concept and self-esteem, on what components should the nurse focus? Identity Body image Role performance Physical condition Medical condition

Identity Body image Role performance When assessing a patient's self-esteem, the nurse should focus on assessing individual components such as identity, body image, and role performance. This helps the nurse determine which factor is affecting the self-concept. The physical and medical conditions are not components of self-concept. p. 703-704

A patient with heart disease asks the nurse if medications for heart disease can cause erectile dysfunction. Which drugs can cause erectile dysfunction? Illicit drugs Antidiabetics Diuretic agents Antiplatelet drugs Antihypertensives

Illicit drugs Diuretic agents Antihypertensives Drugs that have been associated with erectile dysfunction include illicit drugs, diuretic agents, and antihypertensive medications. Antidiabetics and antiplatelet drugs are not associated with erectile dysfunction. Antidiabetic and antiplatelet drugs are associated with minor side effects such as nausea, diarrhea, and itchy skin. p. 722

The nurse is learning about health care settings and levels of health care services. Which actions should the nurse perform under preventive care? Intensive care Immunizations Family planning Cancer screening Mental health counseling

Immunizations Cancer screening Mental health counseling Immunizations deals with vaccinating patients against specific illnesses and are performed under preventive health care. Cancer screening helps in early detection of cancer patients; hence, it is a part of preventive care. Mental health counseling helps to prevent mental disorders and is preventive care. A patient in intensive care needs immediate medical attention after the occurrence of medical illness or accident and is performed under tertiary care. Family planning is meant for the health of the family and is performed under health promotion. p. 17

A patient in the emergency department has developed wheezing and shortness of breath. The nurse gives the ordered medicated nebulizer treatment now and in 4 hours. Which standard of practice is performed? Planning Evaluation Assessment Implementation

Implementation Implementation is coordinating care and completing the prescribed plan of care. p. 2

The registered nurse coordinates care delivery and uses strategies to promote health and a safe environment. Which American Nursing Association (ANA) standard of nursing practice is the registered nurse practicing? Planning Diagnosis Assessment Implementation

Implementation The registered nurse implements the identified plan, which includes care coordination, health teaching, health promotion, consultation, prescriptive authority, and treatment. Health teaching and health promotion include strategies for promoting health and a safe environment for the patient. Planning is prescribing strategies and alternatives to attain expected outcome. Diagnosis is analyzing data to determine problems. Assessment is collecting comprehensive patient data p. 2

The nurse has many roles to perform. Which statements illustrate the nurse's role as a patient caregiver? Reviews information, so the health care provider can make a decision about treatment Implements postoperative exercises for a patient who recently had surgery Provides measures that restore a patient's emotional, spiritual, and social well-being In a casual conversation, responds to patient questions regarding the need for an IV infusion Assists the patient in meeting therapeutic goals with minimal financial cost, time, and energy

Implements postoperative exercises for a patient who recently had surgery Provides measures that restore a patient's emotional, spiritual, and social well-being Assists the patient in meeting therapeutic goals with minimal financial cost, time, and energy Encouraging the patient to perform postoperative exercises is part of the nursing process and the nurse's responsibility as a caregiver. The nurse caregiver strives to meet all health care needs of the patient by providing measures that restore a patient's emotional, spiritual, and social well-being. In addition, the nurse assists in achieving the results with minimum possible financial cost. By reviewing information to help the health care provider make decisions, the nurse serves as an advocate; this is not a caregiver role. Responding to a patient's questions is a part of educating the patient, not giving care. pp. 3-4

What is the most common reason for elective cosmetic surgery? Improve self-image Remove deep acne scars Lighten the skin in individuals with pigmentation problems Prevent skin changes associated with aging

Improve self-image Improvement of body image is the most common reason for undergoing cosmetic surgery, because appearance is an important part of confidence and self-assurance. Acne scars, pigmentation problems, and wrinkling can also be treated with cosmetic surgery, but the surgery does not prevent the skin changes associated with aging. p. 703

The nurse understands that the health care system has many challenges. What are the current challenges facing leaders in health care? Improving access to health care Generating profits Providing high-quality care Reducing the cost of health care Increasing the focus on rehabilitation

Improving access to health care Providing high-quality care Reducing the cost of health care The challenges to health care leaders include reducing costs while maintaining high-quality care for patients, and improving access and coverage. Improving access to health care involves increasing the number of health care facilities and changing appropriate health policies to include more people. Reducing health care costs involves many elements from reforming insurance to changing incentives. Generating profits and focusing on rehabilitation are not major challenges for health care leaders. p. 14

A patient wishes to know about managed care organizations (MCO) in anticipation of enrolling in one. What does the nurse tell the patient? In an MCO, the focus is on health maintenance and primary care. In an MCO, all the care is provided by a primary health care practitioner. An MCO provides basic protection for medical, surgical, and psychiatric care costs. Generally, an MCO provides health assistance to low-income people with long-term care disabilities. MCOs provide comprehensive preventive and treatment services to those who are voluntarily enrolled.

In an MCO, the focus is on health maintenance and primary care. In an MCO, all the care is provided by a primary health care practitioner. MCOs provide comprehensive preventive and treatment services to those who are voluntarily enrolled.

The nurse is caring for a patient who lost his spouse in an accident. Which assessment findings would indicate ineffective coping in the patient? Accurate response to questions asked Inability to fall asleep at night Inappropriate laughing Lack of interest in food Inability to concentrate

Inability to fall asleep at night Inappropriate laughing Lack of interest in food Inability to concentrate Ineffective coping manifests as a change in sleep pattern. The patient may not be able to fall asleep at night. The patient may show inappropriate behavior such as laughing without a reason. The patient may have a change in appetite and may lack interest in food. The patient may not answer the questions properly due to an inability to concentrate. An accurate response to questions asked indicates effective coping. p. 782

A patient is diagnosed with depression. Which signs and symptoms is the nurse likely to find in the patient? Outgoing personality Loss of appetite Extreme fatigue Mentally alert Disheveled appearance

Loss of appetite Extreme fatigue Disheveled appearance A depressed patient may not take proper self-care. The patient may have a loss of appetite and complain of extreme fatigue. The patient may have a disheveled appearance due to poor personal hygiene. The patient will be withdrawn, not outgoing. There may be weight loss due to poor appetite. The patient may be confused and tired mentally. p. 777

The nursing department of a 600-bed urban hospital is planning to apply to the American Nurses Credentialing Center for Magnet status. Before applying, the administration decides to examine the quality of the nursing care provided in the hospital. Which data should be collected to assess the quality of nursing care? Incidence of pressure ulcers Nursing hours per patient per day Number of patients admitted to the hospital per day Average duration from admission to discharge of patients Education and certifications of the nurses working in the hospital

Incidence of pressure ulcers Nursing hours per patient per day Education and certifications of the nurses working in the hospital Achievement of Magnet status in a health care establishment requires excellence in nursing practice. This depends on quality patient care, nursing excellence, and innovations in professional practice. Assessment of the quality of nursing is important before an establishment applies for Magnet status. Quality indicators of nursing are the incidence of pressure ulcers, nursing hours per patient per day, and education and certification status of the nurses. The number of patients admitted to the hospital and duration of admission of the patient do not indicate nursing quality. p. 26

A 54-year-old woman is poor and suffering from tuberculosis. Other people with tuberculosis live in her area. What care should the nurse take when collecting information about the patient's medical history? Take a brief history to avoid unnecessary stress to the patient. Avoid questions about financial status of the patient. Include questions on current medications. Determine whether the illness is acute or chronic. Collect data on a comprehensive form that focuses on the specific needs of the vulnerable population with whom you work.

Include questions on current medications. Determine whether the illness is acute or chronic. Collect data on a comprehensive form that focuses on the specific needs of the vulnerable population with whom you work. Asking questions about current medications will help the health care provider plan other treatments for the patient. It is important to determine whether the illness is in the acute or chronic stage so that caregivers can take necessary precautions and strategize the treatment plan. Making use of the assessment form designed for vulnerable groups helps the caregivers understand their special needs. Assessment of these needs is more important than treating the illness. Often these special needs are the underlying cause of their illness. It is important to take a complete and detailed history that provides all the necessary information about the patient and his or her family to serve the patient better. Questions about financial status also should be asked to understand the patient's situation better. p. 34

What are the modes for stress intervention? Increase the resistance to stress. Identify the triggers to stress. Isolate oneself from others to de-stress. Decrease the number of situations that produce stress. Learn skills to reduce the body's response to stress.

Increase the resistance to stress. Decrease the number of situations that produce stress. Learn skills to reduce the body's response to stress. Stress intervention should be aimed at helping the patient to resume his or her normal life. There are three modes for stress intervention. These include increasing resistance to stress, decreasing stress-producing situations, and learning skills to reduce the body's physiological response to stress. Increasing resistance to stress helps in perceiving an event as less stressful. Decreasing stress-producing situations helps in preventing activation of the stress response. Learning skills to reduce the body's stress response helps with better coping. Identifying the triggers of stress is an activity during the assessment phase, and not of the intervention phase. Isolating oneself from others during stress is an unhealthy way of coping. p. 780

The nurse is assessing a patient who is under immense psychological stress. The nurse finds that the patient shows classic signs of the alarm reaction stage of general adaptation syndrome. What are the signs and symptoms of this stage? Increased heart rate Low blood pressure Constricted pupils Increased blood glucose levels Increased mental alertness

Increased heart rate Increased blood glucose levels Increased mental alertness The alarm reaction stage is the first stage of general adaptation syndrome, which is initiated due to a sudden increase in the activity of the pituitary gland in response to stress. Due to an increase in the hormonal levels and the activity of the autonomic nervous system, there is an increase in heart rate, blood pressure, and blood glucose levels. The person is highly alert and the pupils of the person dilate in order to increase the field of vision. p. 772

The nurse is explaining the physiological mechanism underlying the fight-or-flight mechanism to a patient. The nurse says that the medulla oblongata plays a major role in controlling the response of the body to a stressor. What are the functions of medulla oblongata when the body is stressed? Constricted pupils Increased respiratory rate Increased mental alertness Increased blood pressure Increased blood glucose levels

Increased respiratory rate Increased blood pressure Through its connection via the autonomic nervous system, the medulla oblongata is responsible for increasing respiratory rate, heart rate, blood pressure, and respirations as a response to stress. Increased alertness is due to the action of the reticular formation. Increased blood glucose levels occur due to the action of the pituitary. Dilated, not constricted, pupils are a response to stress. p. 772

Which factor will the nurse observe in the 22-year-old patient with low self-esteem who is in the intimacy-versus-isolation stage of psychosocial development, according to Erikson's theory of self-concept? Increased responsibilities Negative feelings about the sense of self Changes in appearance and physical endurance Need for the provision of a legacy for the next generation

Increased responsibilities The intimacy-versus-isolation stage of psychosocial development occurs from the mid-20s to the mid-40s. Due to increased responsibilities of caring for children and older adults, these individuals are said to be living in the sandwich generation. Therefore, increased responsibilities are found in this stage. Negative feelings about themselves result in role confusion in individuals from 12 to 20 years of age. Changes in appearance and physical endurance occur in individuals in the mid-40s to mid-60s age group. Failure to accept the changes results in self-absorption, not isolation. The need for the provision of a legacy for the next generation occurs in the psychosocial development stage of ego integrity versus despair. p. 702

A female Muslim patient is in the terminal stage of leukemia. What nursing interventions are appropriate considering the patient's religion? Induce a sense of hope. Avoid discussing death. Discourage visits by family and friends. Insist on adopting life-support measures. Get an appointment with a female health care provider only.

Induce a sense of hope. Avoid discussing death. Get an appointment with a female health care provider only. The Islamic religion promotes a sense of hope and does not encourage discussing death. Female Islamic patients prefer female health care providers. In Islam, family and friends usually visit ill people; hence, this should be permitted within medically accepted limits. Islam often does not permit life-support measures. p. 739

A 45-year-old single mother lives with her 10-year-old son who has Down syndrome. The patient's facial expressions and manners demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The patient states that she feels worthless and is overburdened with her responsibilities. What are the differential nursing diagnoses for this patient? Anemia Psychosis Depression Ineffective coping Caregiver role strain

Ineffective coping Caregiver role strain The patient feels worthless and is unable to cope with stressful events in her life; therefore, the diagnosis should be ineffective coping. The patient is feeling overburdened with the caregiving responsibilities of her son. Therefore, an additional diagnosis should be caregiver role strain. Anemia and depression are medical diagnoses and are not indicated in this case. p. 777

The nurse reviews the health history of a 24-year-old woman who indicates that she has had three new sexual partners since her previous examination 2 years ago. The nurse discusses the need for screening for sexually transmitted infection (STI) even though the patient denies symptoms or discomfort. Which is the most serious complication from untreated STIs in females? Genital discharge and dyspareunia Painful menstrual cycles Infertility and pelvic inflammatory disease Genital warts

Infertility and pelvic inflammatory disease Sexually transmitted infections (STIs) can certainly cause discharge, discomfort, and genital warts; however, the most serious complications from untreated bacterial STIs are damage to the reproductive organs and increased risks of pelvic inflammatory disease, ectopic pregnancy, and infertility. p. 719

A nursing student is doing a community health rotation in an inner-city public health department. The student investigates socio-demographic and health data of the people served by the health department and detects disparities in health outcomes between rich and poor. What does this example illustrate? Illness attributed to natural and biological forces Creation of the student's interpretation and descriptions of the data Influence of socioeconomic factors on morbidity and mortality Combination of naturalistic, religious, and supernatural modalities

Influence of socioeconomic factors on morbidity and mortality A health disparity exists in populations that have a significant increased incidence or prevalence of disease or increased morbidity, mortality, or survival rates compared to the health status of the general population. p. 101

The critical care nurse is using a computerized decision support system to correctly position ventilated patients to reduce pneumonia caused by accumulated respiratory secretions. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency? Patient-centered care Safety Teamwork and collaboration Informatics

Informatics Using decision support systems is an example of using and gaining competency in informatics. p. 8

Nurses at a community hospital are in an education program to learn how to use a new pressure-relieving device for patients at risk for bed sores. This is an example of which type of education? Continuing prerequisite education Graduate education Inservice education Professional registered nurse education

Inservice education Inservice education programs provide instruction or training by a health care agency or institution. An inservice program is held in the institution and is designed to increase the knowledge, skills, and competencies of nurses and other health care professionals employed by the institution. Prerequisite education is course work required prior to the nursing program. Graduate education is a formal program following a Bachelor of Science in Nursing (BSN) and professional registered nurse education is an undergraduate nursing education program. p. 4

Which process is involved in the ETHNIC mnemonic communication technique? Trust Calm Empathy Intervention

Intervention Intervention is one of the processes involved in the ETHNIC communication technique. It involves agreement on an appropriate intervention, which may incorporate alternate treatments. Calm is included in the C-LARA communication technique. Trust and empathy are aspects of the RESPECT communication technique. p. 109

The nurse attends to an Asian male patient at a clinic, who is joined by his family. The nurse finds that the patient speaks a different language and determines that he needs an interpreter. A male interpreter is appointed, as preferred by the patient. How should nurses communicate with this patient? Direct the questions to the interpreter. Introduce themselves to the interpreter. Introduce the interpreter to the patient before introducing themselves. Observe the patient's nonverbal and verbal behaviors. Ask the interpreter to ask the patient for feedback and clarification.

Introduce themselves to the interpreter. Observe the patient's nonverbal and verbal behaviors. Ask the interpreter to ask the patient for feedback and clarification. Nurses should use transcommunication skills to effectively provide care for this patient. Even if the interpreter is present, the nurses should introduce themselves to the patient. Observing the patient's nonverbal and verbal behaviors helps in communication. Requesting that the interpreter ask the patient for feedback at regular intervals helps to assess the clinical and cultural data in detail. As a rule, nurses should direct questions to the patient. As the primary caregivers, the nurses should first introduce themselves and then the interpreter. p. 110

The nurse is caring for a patient who refuses to eat until after the sun sets. Which religion does this patient most likely practice? Islam Sikhism Hinduism Catholicism

Islam Patients who practice Islam do not eat until after the sun goes down during the month of Ramadan. p. 739

The nurse is caring for a 45-year-old female patient who has been scheduled to undergo a cholecystectomy. The patient insists on having a female surgeon. People of which religion are most likely to exhibit this behavior? Hinduism Judaism Buddhism Islam Sikhism

Islam Sikhism Female members of Islam and Sikhism generally insist on having a female health care provider. Members of other religions generally do not have any gender preferences based on their religious beliefs. p. 739

What are the positive effects of spirituality on an individual? It affects health behaviors. It affects quality of life. It affects compliance. It affects education. It affects lifestyle.

It affects health behaviors. It affects quality of life. It affects lifestyle. Spirituality affects an individual's health behaviors, quality of life, and lifestyle in a positive way. Spirituality helps individuals maintain health, well-being, and cope with illness. Compliance and education are not entirely dependent on the spirituality of an individual. pp. 733-734

The nurse is caring for an infertile couple and learns that the couple is suffering from chlamydia. Which statement by the nurse about chlamydia is appropriate? It affects the genitourinary tract. There is no cure for this disorder. It does not cause ectopic pregnancy. The rectum is resistant to chlamydia infection. It may cause infection of the eyes and lungs in newborns.

It affects the genitourinary tract. It may cause infection of the eyes and lungs in newborns. Chlamydia infection affects the genitourinary system and causes conjunctivitis and pneumonia in newborns. Chlamydia can be cured with antibiotics. Chlamydia infection may cause pelvic inflammatory disease (PID), infertility, and ectopic pregnancy. Chlamydia also infects the rectum. p. 719

When caring for a patient who is suffering from a serious illness, the nurse encourages the patient to follow his spiritual practices. How does spirituality help in healing? It decreases the risk of infection in the patient. It helps to treat without any medication. It increases the pain threshold of the patient. It decreases stress and increases the immune response. It reduces perception of pain and anxiety.

It increases the pain threshold of the patient. It decreases stress and increases the immune response. It reduces perception of pain and anxiety. Nurses who support the spirituality of their patients realize that the patients' spirituality enables them to heal faster because such thinking increases the pain threshold. It decreases stress, increases the immune response, and reduces perception of pain and anxiety. Spirituality does not decrease the infection nor treat without medication. Treatment of infection is through administration of medications to kill the microorganisms. p. 734

A patient with newly diagnosed diabetes is sitting in the waiting area. She appears sad and anxious. The nurse talks to the patient and tries to make the patient laugh. How does laughter help a person during difficult times? It increases the pain threshold. It exercises the facial muscles. It boosts immunity. It reduces tension, stress, and anxiety. It increases oxygenation in the body.

It increases the pain threshold. It boosts immunity. It reduces tension, stress, and anxiety. Laughter has several therapeutic effects on a person's body, mind, and spirit. It increases the pain threshold and the body's immunity. It reduces tension, stress, and anxiety and improves the patient's mood. Exercising facial muscles through laughter does not help a depressed person. Laughter does not increase oxygenation in the body. p. 733

Based on knowledge of the developmental tasks of Erikson's industry-versus-inferiority stage, the nurse emphasizes proper technique for use of an inhaler with a 10-year-old boy. Why does the nurse do this? It increases the patient's self-esteem with the mastery of a new skill. It helps him to accept changes in his appearance and physical endurance. It helps him to experience success in role transitions and increased responsibilities. It helps him appreciate his body appearance and function.

It increases the patient's self-esteem with the mastery of a new skill. The developmental stage of industry versus inferiority (ages 8 to 12) is focused on incorporating feedback from peers and teachers, increasing self-esteem with the mastery of new skills, and promoting awareness of strengths and limitations. STUDY TIP: Role-play with your study group to memorize Erikson's stages. Pick an age group, but don't tell the group what it is. Then make statements consistent with the stage and have your study group guess the stage. For instance, if you were pretending to be an 8-year-old, you could say, "I had a great time playing with my friends today, and the teacher gave me a gold star when I finished my work!" p. 702

The nurse is educating a couple about the human immunodeficiency virus (HIV). Which statements by the nurse about HIV are appropriate? It is a blood-borne pathogen. It spreads through oral-genital sex. It is not found in bodily fluids. It causes ectopic pregnancy. Its risk can be reduced by the use of condoms.

It is a blood-borne pathogen. It spreads through oral-genital sex. Its risk can be reduced by the use of condoms. Human immunodeficiency virus (HIV) is primarily a blood-borne pathogen. It spreads through vaginal and anal intercourse and through oral-genital sex. The use of condoms reduces the incidence of HIV infection, whereas unprotected sex increases the risk of HIV transmission. Bodily fluids contain HIV, and any exchange of body fluids can result in HIV transmission. Unlike chlamydia, HIV infection is not known to cause ectopic pregnancy. p. 719

A patient tells the nurse that he has just received green card status in the United States and wishes to learn about the health care system in the country. The nurse explains to this patient about the various health care plans available in the United States. Which statements are true for the Medicare plan? It provides health coverage for children. It reimburses for all home health care services. It is a funded national health insurance program in the United States. It has the minimum waiting period for payment to health care providers. The payment for the plan is deducted on a monthly basis from the patient's social security check.

It is a funded national health insurance program in the United States. The payment for the plan is deducted on a monthly basis from the patient's social security check. Medicare is a federally administered program by the Commonwealth Fund or the Centers for Medicare and Medicaid Services (CMS). Medicare is a national health insurance program in the United States that is funded by through payroll deductions. Medicare reimburses for only selected home health services. The payment for this plan is deducted on a monthly basis from the patient's social security check. Medicare provides health coverage for people who are 65 years or older. It has a long waiting period (around 2 years) for payment to health care providers. p. 16

A 35-year-old woman comes to the clinic for her general health checkup. The patient wants information about intrauterine devices (IUDs). What information should the nurse include when teaching the patient about IUDs? It is an oral medication to be consumed regularly. It is a surgery in which fallopian tubes are ligated. It is a plastic contraceptive device that is inserted in the uterus through the cervical opening. It is a round rubber dome that is inserted in the vagina with spermicide and acts as a barrier during intercourse.

It is a plastic contraceptive device that is inserted in the uterus through the cervical opening. An intrauterine device (IUD) is copper or plastic and is inserted in the uterus through the cervical opening. Oral contraceptive pills are consumed on a daily basis for contraception. Tubal ligation is a surgery in which the fallopian tubes are ligated to avoid pregnancy. A diaphragm is a rubber dome that is inserted in the vagina with spermicide by the patient before intercourse. A diaphragm acts as a barrier during intercourse and the spermicide kills sperm that get past it. p. 718

A female patient is advised to use a diaphragm for contraception. The nurse understands that any weight change necessitates a resizing of the diaphragm. How much change in weight would be significant? Loss or gain of 4 lbs Loss or gain of 6 lbs Loss or gain of 8 lbs Loss or gain of 10 lbs

Loss or gain of 10 lbs A diaphragm is a round, rubber dome that is fitted into the cervical opening to provide contraception. It must be used with a contraceptive cream or jelly. It must be refitted if the patient has a weight gain or loss of 10 lbs. Weight changes of 4, 6, or 8 lbs have no adverse effect on the placement of the diaphragm and thus do not require the patient to be refitted. p. 718

The self-concept of an individual is influenced by various environmental, social, and psychological factors. How is a self-concept stressor defined? It is the inability of an individual to distinguish self-concept from self-esteem. It is an individual's belief that establishes that he or she is unworthy. It is a real or perceived change that threatens a person's identity and body image. It is the inability of an individual to reach an age-appropriate developmental stage.

It is a real or perceived change that threatens a person's identity and body image. Any real or perceived change in a person's life that would threaten or alter the person's identity, body image, or role performance is identified as a self-concept stressor. The ability to distinguish between self-concept and self-esteem does not alter a person's level of self-concept. A person's belief that he or she is unworthy indicates a low level of self-concept but is not necessarily a stressor. A person's inability to reach an age-appropriate developmental stage is not considered a self-concept stressor. p. 704

The nurse is discussing sexual issues with a patient. Which statements hold true about sexuality? It is influenced by personal beliefs. It is not affected by medications in use. It is influenced by the place where one lives. Pregnancy may affect sexual interest. It may be affected by chronic respiratory disease. Ethnicity plays a role in shaping sexual values.

It is influenced by personal beliefs. Pregnancy may affect sexual interest. It may be affected by chronic respiratory disease. Ethnicity plays a role in shaping sexual values. Sexuality is influenced by various factors. An individual's sexuality may be affected by personal beliefs and notions of sexual health. Pregnancy leads to fluctuation in sexual desire due to the hormonal and bodily changes that occur. In addition, presence of disease conditions may shift the focus and energy of the patient towards healing, thus affecting sexuality. The sociocultural environment of a person always influences conduct. The rules and norms of society often determine acceptable and nonacceptable behavior within the culture, thus affecting sexuality. Sexuality is affected by the medications in use. The global location of a person has not been found to affect sexuality. p. 716

A 55-year-old male patient underwent a colostomy. Earlier he underwent coronary artery bypass graft (CABG) surgery. The nurse finds the patient depressed and weeping. The patient expresses that he is fed up with his poor health. He feels that he has become a burden on his family because he can't work now. The nurse concludes that the patient is experiencing role performance issues. Which statement is true about role performance? It is an individual's holistic feeling of self-worth or emotional appraisal. It is the way an individual perceives his or her ability to responsibly carry out significant roles. It involves the ideas and views of an individual related to physical appearance, structure, and function. It is a conflict experienced when an individual has to perform two or more mutually exclusive responsibilities.

It is the way an individual perceives his or her ability to responsibly carry out significant roles. Role performance is the way in which an individual perceives his or her ability to carry out significant roles responsibly. Self-esteem is an individual's holistic feeling of self-worth or emotional appraisal. Body image involves ideas and views of an individual related to the body including physical appearance, structure, or function. Role conflict is a conflict a person experiences when he or she has to perform two or more mutually exclusive responsibilities. p. 704

The nurse is teaching a group of nursing students about the general adaptation syndrome (GAS). What is true about this phenomenon? It is triggered directly by a physical event. It consists of four stages of reaction to stress. It is triggered directly by a psychological event. It involves the autonomic nervous and endocrine systems. It is initiated by the pituitary gland after a physical injury.

It is triggered directly by a physical event. It involves the autonomic nervous and endocrine systems. It is initiated by the pituitary gland after a physical injury. The GAS is the body's response to stress. It is triggered directly by a physical event. It involves many body systems, especially the autonomic nervous and endocrine systems. When the human body is subjected to physical or emotional stress, the pituitary gland initiates the GAS. It consists of three stages including the alarm reaction, the resistance stage, and the exhaustion stage. The GAS can be initiated indirectly by a psychological stress. p. 772

The nurse is advising a young couple about healthy sexual practices. Which statement by the nurse about unprotected sex is appropriate? It reduces the risk of breast cancer. It might result in pregnancy. It carries the risk of infection. It reduces the pleasure of intercourse. It initiates premature ejaculation.

It might result in pregnancy. It carries the risk of infection. Unprotected sexual intercourse is associated with possible pregnancy and increases the risk of sexually transmitted infections. Unprotected sex is not known to be associated with breast cancer. Unprotected intercourse may increase the pleasure of sexual intercourse. It does not initiate premature ejaculation. p. 718

What information should the nurse include when providing information about Medicaid to a patient? It provides health insurance to low-income families. It includes supplemental coverage and long-term care assistance to older adults. The payment for Medicaid is deducted from the individual's account every month. It provides health assistance to low-income people with disabilities who require long-term care. It provides comprehensive preventive and treatment services to a group of volunteers.

It provides health insurance to low-income families. It includes supplemental coverage and long-term care assistance to older adults. It provides health assistance to low-income people with disabilities who require long-term care. Medicaid is a state-operated and federally funded program. It provides health insurance to low-income families. It also provides supplemental coverage and long-term care assistance to older adults and health assistance to low-income people with disabilities who require long-term care. It is a federally funded program; the payment is not deducted from the person's account. Managed care organizations (MCOs) provide comprehensive preventive and treatment services to a group of voluntarily enrolled people. p. 16

A patient who is diagnosed with diabetes mellitus is discharged to home. The primary health care provider asks the patient to continue the follow-up in a nurse-managed clinic. What could be one reason for referring the patient to the nurse-managed clinic? It provides management of chronic illness. It provides services for accident and illness prevention. It provides diagnostic services and treatment of illness. It provides mental health counseling to the community.

It provides management of chronic illness. Nurse-managed clinics provide services for chronic disease management and support for self-care and caregivers. It helps to provide continuity of care. Occupational health care centers provide services for accident and illness prevention in workplaces. The physician's office provides diagnostic services and treatment for illness. Mental health counseling can be provided by community health centers. p. 18

A patient who works in a coal mine is referred to an occupational health center. Which services are provided to ensure the safety of the patient? It provides coverage to pay the bills of patients who get ill or injured. It provides health promotion services through a school curriculum. It provides services to older patients or those unable to leave their homes. It provides services for health promotion, and accident and illness prevention.

It provides services for health promotion, and accident and illness prevention. Occupational care centers provide services for health promotion and accident and illness prevention in the workplace. Health insurance pays a portion of the bills of a patient who gets ill or injured. School health is a program that includes health promotion through the school curriculum. Block and parish nursing provide services to older patients or those unable to leave their homes. p. 18

When teaching a patient about the negative feedback response to stress, what does the nurse include to describe the benefits of this stress response? It results in the neurophysiological response. It reduces body temperature. It causes a person to be hypervigilant. It reduces the level of consciousness to conserve energy.

It results in the neurophysiological response. The process of negative feedback senses an abnormal state such as lowered body temperature and makes an adaptive response such as shivering to generate body heat to return the body to hormonal homeostasis. pp. 771-772

A patient has opted for a diaphragm as a mode of contraception. Which advice should the nurse provide to the patient? It should be used along with an intrauterine device (IUD). It should be used along with condoms. It should be refitted after pregnancy. It should be used with a contraceptive cream. It should be refitted after a significant change in weight.

It should be refitted after pregnancy. It should be used with a contraceptive cream. It should be refitted after a significant change in weight. Diaphragms require refitting after pregnancy and after a significant change in the patient's weight (more than a 10-lb gain or loss). Diaphragms are always used with contraceptive creams (spermicides) to ensure their effectiveness. An intrauterine device (IUD) is placed inside the uterus for its contraceptive effects. A patient using an IUD need not use a diaphragm. Although not necessary for contraception when using a diaphragm with spermicide, condoms can be used with a diaphragm and spermicide to decrease transmission of sexually transmitted infections. p. 718

The nurse is learning about the impact of different cultures on nursing. Which are benefits of culturally congruent care? It will help the nurse to interact with different people in their language. It will help the nurse to interpret the needs of the patient who belongs to a different culture. It will help the nurse to identify the similarities and differences of various patients across different cultures. It will help the nurse to deliver the specific kind of health care that is expected from patients who belong to a different culture. It will help the nurse to deliver different remedies for an illness as practiced in the patient's culture.

It will help the nurse to interpret the needs of the patient who belongs to a different culture. It will help the nurse to identify the similarities and differences of various patients across different cultures. It will help the nurse to deliver the specific kind of health care that is expected from patients who belong to a different culture. Culturally congruent nursing refers to a comparative study of cultures to understand similarities and differences across human groups. It helps the nurse to identify the needs of a patient who belongs to a different culture. Culturally congruent nursing can help the nurse to identify the similarities and differences in various patients across different cultures. It also helps the nurse to meet the health care expectations of patients who belong to different cultures. Culturally congruent nursing does not help the nurse to interact with people in different languages. The nurse does not deliver remedies common in different cultures. p. 103

Which statement is true regarding Magnet status recognition for a hospital? Nursing is run by a Magnet manager who makes decisions for the nursing units. Nurses in Magnet hospitals make all of the decisions on the clinical units. Magnet is a term that is used to describe hospitals that are able to hire the nurses they need. Magnet is a special designation for hospitals that achieve excellence in nursing practice.

Magnet is a special designation for hospitals that achieve excellence in nursing practice. Through a review process, hospitals that can demonstrate achievement of excellence in nursing practice can achieve Magnet status. The designation is given by the American Nurses Credentialing Center and focuses on demonstration of quality patient care, nursing excellence, and innovations in professional practice. p. 25

What are the objectives of performing community surveillance? Promote religious and ethical values. Maintain the level of health care in the community. Enhance collaboration among the community members. Develop sensitivity to changes in health status. Identify the factors that are responsible for changes in health status.

Maintain the level of health care in the community. Develop sensitivity to changes in health status. Identify the factors that are responsible for changes in health status. Community surveillance helps the nurse to maintain the level of health care in the community. It also helps to determine changes in the health trends of the community. This information can be used to plan health education programs. The nurse may also identify various factors that are responsible for changes in the health status of the community. Community surveillance does not promote religious or ethical values, nor does it enhance collaboration among the community members. p. 37

Which measures taken by the health care organizations would create an inclusive environment for patients belonging to the lesbian, gay, bisexual, transgender (LGBT) community? Identify on the basis of their appearance Make sure that they have access to unisex bathrooms Ensure that gender-inclusive language is used while talking Avoid enquiring about their gender to avoid discomfort Ensure that gender-inclusive information is asked in the hospital forms

Make sure that they have access to unisex bathrooms Ensure that gender-inclusive language is used while talking Patients belonging to the LGBT community may differ in appearance from the conventional male and female appearance and may feel uncomfortable using gender-specific restrooms. Therefore, the health care organizations should ensure that patients belonging to the LGBT community have access to unisex restrooms. Health care professionals should use neutral language while talking to patients, such as partner or a significant other instead of husband and wife, because LGBT patients may also be married. Health care organizations should not encourage identification of patients on the basis of their physical appearance, because the assumptions made may be wrong. Health care organizations should ensure that patients are asked about gender, because presumptions may cause errors in treatment. All the forms used in the hospital should have an LGBT query section to facilitate disclosure.�� �� Test-Taking Tip: The patients belonging to LGBT community may have an altered appearance and a conservative attitude. Answer the above question by keeping these tips in mind. p. 105

A patient with lung cancer is emotionally, economically, and socially disturbed. What is the role of the nurse as a caregiver? Provide financial aid. Manage the disease and symptoms. Help the patient establish and achieve goals. Avoid the patient's personal and family problems. Implement measures to restore emotional and social well-being.

Manage the disease and symptoms. Help the patient establish and achieve goals. Implement measures to restore emotional and social well-being. The primary role of the nurse is to manage the disease and symptoms, but as a caregiver, the nurse may deal with other issues, too. The nurse should motivate the patient and the family members to set goals and achieve them. The nurse should take steps to restore the patient's spiritual, emotional, and social well-being. The nurse cannot provide financial aid but can guide the patient to various assistive associations. The nurse may inquire about the patient's personal and family problems to evaluate and help sort out issues. p. 3

Which concept of intersectionality provides limited access from facets of society? Marginalization Under inclusion Social inequality Matrix of domination

Marginalization Marginalization is a concept of intersectionality that refers to groups that are left out or have limited access from facets of society. Under inclusion involves the concept of overlooking a particular group. Social inequality refers to unequal access to positions and services by certain groups. Matrix of domination refers to the privilege and support of powerful segments of society. p. 103

A 50-year-old female patient is admitted to the hospital for surgical management of breast cancer. On the second postoperative day, the nurse finds the patient crying. She tells the nurse that she had agreed to take care of her 8-month-old granddaughter, but knows she will be unable to do so. The patient also expresses concern about her looks and that she feels worthless. Identify the stressor that influenced the patient's self-esteem. Pain Job loss Mastectomy Repeated failures

Mastectomy Mastectomy is a surgical procedure for removal of affected breast tissues. Mastectomy has a negative effect on the physical appearance of a female and may be unacceptable to many women. This can be a major factor in lowering their self-esteem. Chronic illness and the idea of depending on others also lower self-esteem. In this case, there is no mention of pain, job loss, or repeated failure, which may also reduce self-esteem. p. 705

A 50-year-old patient is admitted with acute exacerbation of asthma. The patient is treated by a clinical nurse specialist with bronchodilators and oxygen therapy. The patient is clinically stable and is planned for discharge. The patient expresses thanks to the clinical nurse specialist for the care that all the nurses have provided. The patient's daughter is so inspired by their work that she now wishes to pursue a career in nursing. What are the minimal educational qualifications to become a clinical nurse specialist? Basic nurse education Registered nurse licensure Doctoral degree in nursing Master's degree in nursing

Master's degree in nursing A master's degree in nursing is the educational requirement for a clinical nurse specialist (CNS). Basic nursing education is not a graduate degree. Registered nurse (RN) licensure is not an educational qualification. A doctoral degree exceeds the qualifications for a CNS. p. 4

The nurse is outlining a plan of care for a 9-year-old patient. What primary developmental task for this patient should the nurse consider? Communication of likes and dislikes Mastery of new skill Acceptance of body changes Distinguishing self from environment

Mastery of new skill Based on Erikson's theory of development, during the ages of 6 to 12 years, the primary developmental task is to increase self-esteem. This is achieved through mastery of new skills such as reading, math, music, and sports. Communication of likes and dislikes is exhibited between 3 and 6 years of life. During the ages of 12 to 20 years, body changes and maturation are accepted. Between the ages of 1 and 3 years, the person distinguishes the self from the environment. p. 702

The nurse is teaching a patient with diabetes how to self-administer subcutaneous insulin. Which key element should the nurse keep in mind before teaching the patient about health care principles? Match the teaching with the patient's capabilities. Limit discussion of concepts and facts about health. Exclude family members from the teaching plan. Include facts about oral medications for diabetes.

Match the teaching with the patient's capabilities. When the nurse teaches medical procedures, the teaching should always match the patient's capabilities, and complicated procedures should not be taught to the patient. The nurse should explain concepts and facts about health. The nurse should involve both the patient and family members when teaching. The teaching plan is about insulin injections, so facts about oral diabetic drugs should not be included. p. 3

A patient is diagnosed with pneumonia, and during data collection, the nurse finds that the patient is economically disadvantaged. Which type of health care plan would be beneficial for the patient's treatment? Medicaid Private insurance Long-term care (LTC) insurance Preferred provider organization (PPO)

Medicaid Medicaid is a federally funded, state-operated program that provides health insurance to low-income families diagnosed with long-term disabilities such as pneumonia. Therefore, a Medicaid health care plan would be beneficial for the patient's treatment. Private insurance policies are typically expensive, and patients have to meet deductibles before insurance pays. LTC insurance is very expensive, so this health care plan is not suitable. A preferred provider organization (PPO) health care plan limits an enrollee's choices to a list of preferred hospitals, physicians, and providers. It is also expensive and, therefore, not suitable for patients who are economically disadvantaged. p. 16

Which policy covers medical expenses for very poor children? Medicaid Medicare Long-term care (LTC) insurance State Children's Health Insurance Program (SCHIP)

Medicaid Medicaid is a federally funded, state-operated program that provides health insurance to the low-income population. Medicare is a policy for the elderly and disabled. LTC is supplemental insurance for long-term care services. The state children's health insurance policy (SCHIP) is a federally funded, state-operated program to provide health coverage for uninsured children. Children not poor enough to be covered by Medicaid are covered by this policy. p. 16

A community-based nurse plans to assess the health care needs of a particular community to ensure improved delivery of health care. How should the nurse assess the health care needs of this community? Monitor health status Collect data systematically Plan budget allocation Collect only voluntary reporting Access available health information

Monitor health status Collect data systematically Access available health information Monitoring the health status provides information about the most prevalent health problems of the community. Systematic data collection from various sources helps the nurse to collect information about the factors causing illness in the community. The nurse may also obtain health-related documentation about the community. Planning the budget allocation does not help in identifying the health care needs of the community. Even though voluntary reporting is helpful, the nurse should not rely only on this information. The nurse should also look for other factors that affect the health status of the community. pp. 37

A 40-year-old patient is diagnosed with colon cancer. While interacting with the patient, the nurse learns that he has a twin brother. Which nursing actions are appropriate for the patient's brother? Motivate the patient's brother to get a colonoscopy. Conclude that the patient's brother does not require intervention. Encourage the patient's brother to get an annual stool test. Avoid doing anything, because that is a responsibility of the health care provider. Avoid doing anything, because the nurse is responsible for the patient and not for the brother.

Motivate the patient's brother to get a colonoscopy. Encourage the patient's brother to get an annual stool test. Because the patient is suffering from colon cancer before the age of 50, it is likely that the patient's siblings have a higher risk of developing colon cancer. Therefore, the nurse should motivate the twin brother to also get a colonoscopy or other screening test, as recommended by current guidelines for higher-risk patients. If the patient had developed colon cancer after age 50, screening for the brother would be less urgent. However, early onset in the patient means the risk of colon cancer is higher for the brother. The nurse is as responsible as the primary health care provider for screening for family members who are at risk of colon cancer. The nurse should provide care to both the patient and his brother. p. 9

The nurse is developing a discharge plan for a patient. What should the nurse include in the discharge plan? Necessary rehabilitation techniques Counseling regarding nutrition and diet Documentation of necessary medical history Correct and effective use of medications Inclusion of diagnostic reports and tests

Necessary rehabilitation techniques Counseling regarding nutrition and diet Correct and effective use of medications The nurse prepares a discharge plan for a patient to ensure continuity of care. The plan includes necessary rehabilitation techniques to support adaptation to the environment. The nurse provides counseling regarding nutrition and diet to help the patient lead a healthy life. The plan also includes information about safe and effective use of medications. The patient's history is taken and diagnostic tests are performed when the patient is admitted. These are not included in the discharge planning. p. 19

The nurse is caring for a 50-year-old Hindu Asian male patient who is hospitalized following an incidence of high blood pressure. The nurse reviews the data and concludes that the patient's health care needs conflict with his health care practices. His cultural practices do not help him to maintain normal blood pressure and manage his diabetes. How should the nurse implement culturally congruent care? Negotiate for a change in the patient's cultural practices. Preserve the patient's values relevant to maintaining his health. Develop a standard care plan applicable for every patient. Modify the patient's lifestyle to develop a beneficial health care pattern. Explain to the patient that his cultural practices are unhealthy and need to change.

Negotiate for a change in the patient's cultural practices. Preserve the patient's values relevant to maintaining his health. Modify the patient's lifestyle to develop a beneficial health care pattern. The nurse may be able to negotiate a change in the patient's cultural practices to promote a desirable health outcome. The plan should preserve the patient's cultural values but still modify his lifestyle. This would help him reduce the conflicts between his health care needs and his practices. A standard care plan does not address cultural differences among patients. Insisting that the patient change all of his cultural practices likewise does not help the patient to honor his culture while improving his health. pp. 104, 108

The registered nurse prepares a mutually agreeable, culturally oriented patient-centered plan. Which step of the LEARN communication technique is the nurse using? Perception Negotiation Recommendation Acknowledgement

Negotiation Negotiation is the fifth step of the communication technique, which involves preparing a culturally oriented and patient-centered plan by mutual agreement with the patient. Perception involves explaining the nurse's perception of the problem to the patient. Recommendation is involving the patient and his or her family in making decisions. Acknowledgement is the recognition of the similarities and differences between the patient's perception and the nurse's perceptions. p. 108

The nurse is assessing a patient who developed posttraumatic stress disorder (PTSD) after witnessing a plane crash. What would be the findings in this patient? Nightmares of the plane crash Flashbacks of the plane crash Significant weight loss Hearing strange voices at night Seeing strange faces at night

Nightmares of the plane crash Flashbacks of the plane crash Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs when a person witnesses or experiences a traumatic event, in this case, the plane crash. It may manifest as nightmares, flashbacks, and intrusive recollections of the event. Patients may also respond by attempting suicide or by substance abuse. A significant weight loss is usually seen in patients with depression. Auditory and visual hallucinations are seen in patients with schizophrenia. p. 774

A patient mentions to the nurse that she recently lost her husband in a car accident. Which behaviors could the nurse identify as denial defense mechanisms? Not accepting the death of her spouse Not sleeping and eating Not disclosing her feelings to anyone Being speechless and numb Shouting and blaming God for her loss

Not accepting the death of her spouse Not disclosing her feelings to anyone A denial defense mechanism is a reaction to emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Not discussing the loss and not accepting the loss are both denial defense mechanism behaviors. Cessation of eating and sleeping is a conversion defense mechanism. Being speechless and numb are examples of dissociative defense mechanisms. Shouting and blaming God for the loss is an example of the displacement defense mechanism. p. 774

Which dietary practice is followed by a Hindu patient? Fasting on holy days Abstaining from alcohol and caffeine Refraining from eating meat products on Friday Not eating any meat

Not eating any meat Food and dietary practices are important components of some religious observations. The believers of some sects of Hinduism are vegetarians. They believe it is not right to kill any living creature for food. A patient who follows the Buddhism will fast on holy days. A patient who practices Mormonism abstains from alcohol and caffeine. Roman Catholic Christians often do not eat meat on Fridays, particularly during Lent. p. 745

A state nurse's association is evaluating nursing-sensitive outcomes at a nursing unit level of a hospital. What will be considered nursing quality indicators during evaluation? Number of patient falls Hospital turnover Restraint prevalence Nursing hours per patient Number of patients admitted in the hospital at a given point in time

Number of patient falls Restraint prevalence Nursing hours per patient The National Database of Nursing Quality Indicators (NDNQI) was developed by the American Nurses Association. The objective of NDNQI is to improve patient safety and quality care by measuring nursing-sensitive outcomes. The nursing-sensitive outcomes include patient falls, restraint prevalence, and nursing hours per patient. Hospital turnover and number of patients admitted are not included in the database, because these factors are not dependent on nursing-sensitive outcomes. p. 26

The nurse is planning to obtain a master's degree in nursing. Which role can the nurse with a master's degree in nursing fulfill? Nurse educator Nurse administrator Advanced practice registered nurse Nurse researcher Physical therapist

Nurse educator Nurse administrator Advanced practice registered nurse Nurse researcher A master's degree can be pursued after a baccalaureate program. With a master's degree in nursing, a nurse can become a nurse educator, nurse administrator, advanced practice registered nurse (APRN), and researcher. A physical therapist earns a degree in physical therapy, not nursing. pp. 9-10

The nurse educator is delivering a lecture on nursing as a profession to a group of nursing students who have recently joined the baccalaureate nursing degree course. The nurse educator is discussing nursing career options with the students. One of the students asks about the possible nursing careers that require a master's degree in nursing. Which career options should the nurse suggest? Nurse educator Registered nurse Nursing researcher Certified nurse assistant Advanced practice registered nurse

Nurse educator Nursing researcher Advanced practice registered nurse A master's degree is required for nursing careers as nurse educator, nursing researcher, or advanced practice registered nurse. the nurse with a baccalaureate nursing degree can pursue a career as a registered nurse after passing the nursing license exam. The certified nurse assistant must take a nurse assistant training program and pass a license exam. pp. 4-5

Which nursing roles may have prescriptive authority in their practice? Critical care nurse Nurse practitioner Certified clinical nurse specialist Charge nurse Orthopedic nurse

Nurse practitioner Certified clinical nurse specialist Nurse practitioners and certified clinical nurse specialists encompass the role and preparation of the advanced practice registered nurse. According to the American Nurses Association standards of practice, prescriptive authority may be granted to these nurses. p. 2

The nurses on an acute care medical floor notice an increase in pressure ulcer formation in their patients. The nurse consultant decides to compare two types of treatment. The first is the procedure currently used to assess for pressure ulcer risk. The second uses a new assessment instrument to identify at-risk patients. Which career does the nurse consultant exemplify? Clinical nurse specialist Nurse administrator Nurse educator Nurse researcher

Nurse researcher The nurse researcher investigates problems to improve nursing care and to further define and expand the scope of nursing practice. The nurse researcher often works in an academic setting, hospital, or independent professional or community service agency. p. 5

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. What does the supervising nurse recognize? Nurses who feel stress usually pass the stress along to their patients. A nurse who is stressed is ineffective as a nurse and should not be working. Nurses who talk about feeling stress are unprofessional and should calm down. Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.

Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring. Nurses frequently experience stress because of the rapid changes in health care technology, organizational restructuring, and when situations appear to be out of their personal control. p. 775

When the nurse uses information and technology to communicate, locate and use knowledge, reduce and eliminate errors, and help make decisions, in which area is the nurse is working? Integrated delivery system Health care patient system Nursing informatics Computerized nursing network

Nursing informatics Nursing informatics is the use of information, data, and technology to communicate, manage knowledge, mitigate errors, and support decision making. It requires knowledge, skills, and attitudes from the nurse to be able to effectively use information and technology. Nursing informatics is focused on the organization, analysis, and dissemination of information. pp. 26-27

Nursing is important in providing safe, patient-centered health care to the global community. Which statements are true about the nursing practice? Nursing practice helps shape health policy and health systems management. Nursing practice involves collaborative care of sick individuals of all ages, families, groups, and communities. Nursing practice involves helping a dying patient find relief from pain. Nursing practice involves interpreting clinical situations and making complex decisions based on knowledge and experience. Nursing practice does not incorporate ethical and social values but only knowledge of behavioral sciences.

Nursing practice helps shape health policy and health systems management. Nursing practice involves collaborative care of sick individuals of all ages, families, groups, and communities. Nursing practice involves helping a dying patient find relief from pain. Nursing practice involves interpreting clinical situations and making complex decisions based on knowledge and experience. Nursing is an art and a science. The practice of nursing incorporates elements including clinical practice, education, research, management, and administration, all of which directly or indirectly have prominence in providing safe, patient-centered health care. Helping a patient achieve the goals of the therapy and educating a patient are steps towards the mission. Interpreting clinical situations and making decisions that benefit patients are integral to nursing. Nursing practice involves collaborative care of individuals of all ages, families, groups, and communities, sick or well. Nursing practice incorporates ethical and social values with the knowledge of behavioral, biological, and physiological sciences. pp. 1-2

A 43-year-old female patient has come into the clinic for her annual physical examination. The patient has chronic arthritis, states that she feels incompetent doing simple tasks, and that she is a burden to others. Which techniques would the nurse perform to assess for low self-esteem? Observe patient's behavior. Ignore patient's nonverbal indicators of distress. Ask patient to explain thoughts and feelings about self. Ask family members to leave the room when assessing the patient. Note clues about both stressful and supportive relationships.

Observe patient's behavior. Ask patient to explain thoughts and feelings about self. Note clues about both stressful and supportive relationships. Observing the patient's behavior and asking the patient to explain his or her thoughts and feelings about himself or herself are assessment activities the nurse should perform. The nurse should also observe the clues about the stressful and supportive relationships to which the patient refers in conversations. In addition, the nurse should observe the patient's nonverbal behavior and ask the family members about the patient's behavioral changes. p. 707

A patient has been diagnosed with cervical cancer. The patient is a commercial sex worker. Which infection could be responsible for this malignancy? Chlamydia infection Gonorrhea infection Herpes simplex infection Papillomavirus infection

Papillomavirus infection Human papillomavirus causes cervical cancer in women and anogenital cancers and warts in both men and women. Chlamydia trachomatis infection does not cause malignancies but can cause urinary and pelvic symptoms. Neisseria gonorrhoeae infection causes urethritis and does not lead to any malignancy. Herpes simplex causes recurrent genital lesions. p. 719

The nurse is interviewing a 37-year-old patient who is not coping well with a recent loss of employment. Which activities should the nurse perform to assess coping in the patient? Observe the patient's appearance. Ask the patient about changes in eating patterns. Ask the patient about changes in his or her sleeping pattern. Ask the patient about his or her ability to remember a recent event. Observe the patient's response to the questions asked.

Observe the patient's appearance. Ask the patient about changes in eating patterns. Ask the patient about changes in his or her sleeping pattern. Observe the patient's response to the questions asked. A disheveled appearance and poor grooming indicate ineffective coping. Changes in eating patterns and a lack of interest in food may indicate the patient is not coping well. Ineffective coping can also alter the sleep pattern. The patient may sleep excessively. An inaccurate response to questions asked and the inability to concentrate indicate ineffective coping. p. 777

The senior nurse observes that a newly appointed American nurse is having trouble relating to a patient from a different culture. What advice can the senior nurse give this nurse to enhance cultural competency? Obtain in-depth knowledge about medical concepts and nursing care. Learn at least three foreign languages. Obtain sufficient knowledge about a patient's cultures and beliefs. Learn about various dialects prevalent in the country.

Obtain sufficient knowledge about a patient's cultures and beliefs. It is extremely important for the nurse to be culturally competent. The nurse should try to obtain knowledge about various cultures and cultural practices prevalent in the population, because this will help the nurse understand the patients better and provide better care. The nurse already has medical and nursing knowledge. It is not mandatory for nurses to know foreign languages, although that may be helpful in the long term. Knowledge about languages and dialects is not sufficient; the nurse should learn about and respect the culture. pp. 103-104

The nurse attends to an Asian male patient at a clinic, who is joined by his family. The nurse is developing a transcultural care plan that identifies both with the patient's native and American culture. Which nursing actions are required for providing culturally congruent care? Ignore cross-cultural learning. Obtain the patient's health beliefs. Self-examine the nurse's own culture. Assess cultural and biophysical factors that influence treatments. Work in the patient's culture and practice nursing within those cultural limitations.

Obtain the patient's health beliefs. Self-examine the nurse's own culture. Assess cultural and biophysical factors that influence treatments. The patient who identifies with both his native and American culture has obtained biculturalism. The goal of transcultural nursing is culturally congruent care. Obtaining the patient's health beliefs and self-examination of one's own culture help in delivering culturally congruent care. The nurse should also develop the skills of assessing cultural and biophysical factors that influence treatments and care for the patient. It is important to engage in cross-cultural learning. Working in another culture and learning about cultural differences is beneficial for the patient's health, but the practice should not be limited to the patient's culture. p. 103

The nurse is assessing an Asian patient in a day care center. The nurse is developing a transcultural care plan for the patient who identifies both with his native culture and the American culture. Which components should the nurse incorporate in order to provide culturally congruent care? Ignoring biophysical differences of patients from different cultures Obtaining knowledge of the patient's health beliefs Self-examining the nurse's own culture Working in another country to learn new nursing practices Being open and accepting of cultural differences

Obtaining knowledge of the patient's health beliefs Self-examining the nurse's own culture Being open and accepting of cultural differences The patient, who identifies with both his native culture and American culture, has attained biculturalism. The goal of transcultural nursing is to provide culturally congruent care. Obtaining knowledge of the patient's health beliefs (cultural knowledge) and self-examination of one's own culture (cultural awareness) are important for delivery of culturally congruent care. The nurse should be open and accepting of cultural differences (cultural desire) in order to understand them and should plan care accordingly. It is important to understand the biophysical differences of various cultures, because they may influence the care of the patient. It is not necessary to work within another country to learn new practices, but it is helpful to engage with others from different cultures. Test-Taking Tip: Culturally congruent care requires nurses to be aware of their own culture and simultaneously be aware of and open to other cultures. Knowing this, you can examine each choice individually to see if it supports culturally congruent care. p. 103

A 20-year-old patient is diagnosed with an eating disorder. Which nursing intervention would be best to address self-esteem? Offer independent decision-making opportunities. Review previously successful coping strategies. Provide a quiet environment with minimal stimuli. Support a dependent role throughout treatment.

Offer independent decision-making opportunities. Offering opportunities for decision making promotes a sense of control, which is essential for promoting independence and enhancing self-esteem. Reviewing successful coping strategies is a priority intervention for patients who cannot cope. Providing a quiet environment and supporting a dependent role throughout treatment won't address self-esteem. p. 712

Under supervision of the registered nurse, a nursing student is caring for a patient from different cultural background. Which action performed by the student nurse indicates the need for further teaching on transcultural nursing? Asking the patient open-ended questions Advocating for the patient considering his or her world view Offering generalized opinions during the assessment of the patient's world view Speaking to the patient's family members about the cultural aspects

Offering generalized opinions during the assessment of the patient's world view The nurse should avoid stereotypes or unwarranted generalizations to obtain an accurate assessment of the patient's unique characteristics and world view. The nurse should ask open-ended questions to a patient who is from different culture, to gain a better understanding about the perspective and needs. The nurse should advocate by gaining knowledge about the patient's world view to ensure that care is safe, effective, and culturally sensitive. In case of any doubt the nurse should speak to the patient's family members, peers, community regarding the world views of the patient's culture. p. 106

The nurse is gathering a sexual history from a 68-year-old man in a nursing home. Which is important for the nurse to keep in mind? Older adults are usually not part of a sexual minority group. Older adults sometimes do not reveal intimate details. Older men and women lose interest in sex. Older adults in nursing homes do not usually participate in sexual activity.

Older adults sometimes do not reveal intimate details. Older adults are sometimes hesitant to reveal information relating to sexual issues because they are embarrassed. It is important that the nurse include a sexual history as a routine aspect of assessment to communicate that sexual activity is normal. Studies have shown an increase in sexual dysfunction with aging but no decrease in sexual activity or interest. p. 718

What is evidence-based practice? Nursing care based on tradition Scholarly inquiry of nursing and biomedical research literature Optimal patient care based on current research Quality nursing care provided in an efficient and economically sound manner

Optimal patient care based on current research Evidence-based practice integrates the best current evidence with clinical expertise, patient/family preferences, and values for delivery of optimal health care. It is based on research, not tradition. It is a patient care, not a type of literature. Quality care provided in an efficient and economically sound manner is a standard of nursing care. p. 8

A patient in the terminal stages of cancer has been discharged from the hospital and is advised to seek supportive care at home. To ensure quality of life, with whom should the community nurse collaborate? Pastoral care Hospice staff Social workers Surgical oncologist Radiation oncologist

Pastoral care Hospice staff Social workers The nurse should initiate a plan of support for end-of-life care to the patient and provide support to the family. It can be done by collaborating with pastoral care, hospice staff, and social workers. There is no need for collaboration with surgical oncologists or radiation oncologists, because the cancer has reached a terminal stage and the patient has been discharged. p. 37

The nurse is reviewing the reports of four patients scheduled for different programs. According to the chart, which patient requires secondary acute care? Patient 1 Patient 2 Patient 3 Patient 4

Patient 3

The nurse is reviewing the reports of four patients scheduled for different programs. According to the chart, which patient requires secondary acute care? Patient 1 Patient 2 Patient 3 Patient 4

Patient 3 Secondary acute care is required when a patient receives short-term treatment for an urgent medical condition or during recovery from surgery. The patient with acute problems is usually scheduled for radiological procedures such as an x-ray or CT scan. Therefore, patient 3 requires secondary acute care. Patient 1, scheduled for nutritional counseling, requires primary care, which focuses on improving health outcomes by providing counseling regarding nutrition. Patient 2, scheduled for blood pressure and cancer screening, requires preventive care, which focuses on measures to prevent the progression of hypertension or cancer. Patient 4, scheduled for cardiovascular and pulmonary rehabilitation, requires restorative care, which focuses on helping each patient obtain and maintain the highest level of function. p. 17

The nurse is learning about the global nursing shortage that has led to fewer nurses in the workplace. Which essential skills should the nurse learn to ensure professional and efficient patient management? Patient education Tactless nurturing Time management Compassionate care Therapeutic communication

Patient education Time management Compassionate care Therapeutic communication Patient education will help in health promotion, disease prevention, and providing the required patient awareness regarding health care needs. Effective time management will ensure that work is efficiently completed in time, so a limited number of nurses can handle a large number of patients. Compassionate care is essential, because patients should get a positive image of nursing and a feeling that they received quality care. Therapeutic communication helps in promoting the emotional and physical well-being of the patient. Tactless nurturing will not help in a rapid-discharge and high-tech health care environment, because nurses need to relate to their patients on a human, caring level to ensure patient satisfaction. p. 5

The nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which option is an appropriate goal for restorative care? Patient will be able to walk 200 feet without shortness of breath. Wound will heal without signs of infection. Patient will express concerns related to return to home. Patient will identify strategies to improve sleep habits.

Patient will be able to walk 200 feet without shortness of breath. Restorative interventions focus on returning a patient to his or her previous level of functioning or a new level of function limited by his or her illness or disability. The goal of restorative care is to help individuals regain maximal functional status and enhance quality of life by promoting independence. p. 20

The nurse is caring for a patient who has been admitted to the hospital with terminal leukemia. The patient has expressed a preference for nonpharmacological pain control. The nurse refers to articles and systematic reviews to learn the best possible nonpharmacological methods to treat cancer pain. How would the nurse's actions be categorized, according to the QSEN competencies? Patient-Centered Care Teamwork and Collaboration Evidence-Based Practice Safety

Patient-Centered Care Evidence-Based Practice Evidence-Based Practice refers to incorporating better quality interventions based on research. Referring to articles and systematic reviews to determine optimal care for a patient is an example of Evidence-Based Practice. Patient-Centered Care refers to providing care with respect to patients' needs, values, and preferences. Teamwork and Collaboration refers to work with a health care team to achieve the best quality of patient care. Safety refers to performing interventions that minimize risks. p. 8

The nurse is discussing dimensions of patient-centered care identified by the Picker Institute. What could be said about the Physical Comfort dimension in patient-centered care? Patients need to know at all times whom to call for help. Patients look to care providers to share their fears and concerns. Patients often need help with completing activities of daily living. Patients expect privacy and to have their cultural values respected. Patients want to be informed and share in decisions about their care.

Patients often need help with completing activities of daily living. Patients expect privacy and to have their cultural values respected. The Physical Comfort dimension states that patients often need help with completing activities of daily living and expect privacy and to have their cultural values respected. The Coordination and Integration of Care dimension states that patients need to know at all times whom to call for help. The Emotional Support and Relief of Fear and Anxiety dimension states that patients look to care providers to share their fears and concerns. The Respect for Patients' Values, Preferences, and Expressed Needs dimension states that patients want to be informed and share in decisions about their care. p. 25

The community health nurse is conducting a program on health and fitness awareness for medically underserved people. Who would be categorized as medically underserved? People belonging to a different culture People of a poor socioeconomic status People who are not willing to be treated for their illnesses People who use complementary and alternative treatments for their illnesses

People of a poor socioeconomic status Medically underserved people are those who lack the financial resources required for proper health care. Unemployment, low-paying jobs, and rising health care costs have all increased the population of medically underserved people in the United States. People not belonging to the dominant culture are not necessarily poor or unable to bear health care costs. People who prefer not to be treated and those who opt for alternate treatment methods are not categorized as medically underserved. p. 7

The nurse is delivering a lecture on stress and anxiety. The nurse explains that a person's behavior due to stress is very much based on stress appraisal. What does the nurse mean by the term stress appraisal? Tension-producing stimuli Perception of the impact of stress on oneself Experience to which a person is exposed due to a stimulus Deciding how to act as a response to stress Behavior that occurs when existing coping mechanisms to stress fail

Perception of the impact of stress on oneself Deciding how to act as a response to stress Stress appraisal means the perception of stress. Stress appraisal is how people interpret the impact of the stress on themselves or on what is happening and what they are able to do about it. A stressor is a tension-producing stimulus. Stress is defined as an experience to which a person is exposed due to an abnormal stimulus. When stress is overwhelming and the existing coping mechanisms fail, then crisis occurs. p. 773

The registered nurse is planning to pursue a career as a certified nurse midwife. What are the duties of a certified nurse midwife? Perform Papanicolaou (Pap) smear tests. Perform hysterectomies. Perform normal delivery procedures. Prescribe medications for minor vaginal infections. Treat pregnancy-related emergencies such as abruptio placenta and eclampsia.

Perform Papanicolaou (Pap) smear tests. Perform normal delivery procedures. Prescribe medications for minor vaginal infections. A certified nurse midwife (CNM ) is an advanced practice registered nurse who is also educated in midwifery and is certified by the American College of Nurse-Midwives. The duties of a certified nurse midwife involve conducting routine gynecological procedures such as Pap smears, performing normal deliveries, and caring for minor vaginal infections. A CNM assists the health care provider during hysterectomy surgery and in treating pregnancy-related emergencies such as eclampsia. p. 4

There is an outbreak of acute gastroenteritis in a school. What are the interventions a community health nurse would perform as an epidemiologist? Perform active case finding. Provide health teaching. Set up self-help groups. Track incidence rates of illness. Arrange for individual interactions.

Perform active case finding. Provide health teaching. Track incidence rates of illness. As an epidemiologist, the nurse should try to determine the number of gastroenteritis cases. The nurse must teach the staff about the various factors that contribute to the development of gastroenteritis. Setting up self-help groups is not useful in acute gastroenteritis outbreak because this disease is an acute and self-limiting condition. Individual interactions are required in a nursing role, not in the role of an epidemiologist. p. 37

A 50-year-old male patient comes for a follow-up visit a few months after a myocardial infarction. The nurse plans to interview the patient to assess his sexual health using the PLISSIT model. Which components are included in the PLISSIT model of assessment? Palliation Permission Limited information Specific suggestions Intravenous therapy

Permission Limited information Specific suggestions The PLISSIT model is used for sexual assessment of the patient. P stands for permission from the patient to discuss sexual history. LI stands for limited information regarding sexual health problems. SS stands for specific suggestions made when the nurse is clear about the problem. IT stands for intensive therapy by a professional. Palliation and intravenous therapy are not part of the PLISSIT model. p. 723

How does the nurse ensure that he or she meets the goals related to self-concept alterations in an acute care setting? Plan for the patient's discharge to home. Make referrals to other health care professionals. Schedule routine follow-up appointments. Renew prescriptions. Schedule diagnostic tests periodically.

Plan for the patient's discharge to home. Make referrals to other health care professionals. Schedule routine follow-up appointments. In an acute care setting in which the length of stay for the patient is short, the nurse should arrange for the patient's discharge to home, make appropriate referrals to other health care professionals, and schedule routine follow-up appointments to evaluate progress. Renewing prescriptions and scheduling diagnostic tests would help the patient's medical condition, not his or her self-concept. pp. 712-713

The nurse is learning about rehabilitation services that are provided to patients in different settings. Which actions should the nurse perform as a part of rehabilitation services? Wound care Physical therapy Administration of IV fluids Speech therapy Drug-dependence counseling

Physical therapy Speech therapy Drug-dependence counseling Physical therapy is performed as part of rehabilitation before and after bone and joint surgeries to ensure effective restoration of joint function. Speech therapy is a form of training to help patients with speech disorders communicate better. Drug-dependence counseling helps in drug and addiction rehabilitation and helps the patient to become free from drug dependence. Wound care and administration of IV fluids require specialized nursing abilities and are performed by a registered nurse. These activities are usually performed in extended care facilities. p. 20

A patient is experiencing chronic stress. Which gland in the patient's body will initiate the general adaptation syndrome (GAS)? Parotid gland Pituitary gland Pineal gland Adrenal gland

Pituitary gland The general adaptation syndrome is a three-stage reaction that describes how the body responds to stressors through different stages. When the body encounters a physical demand such as an injury, the pituitary gland initiates the GAS. The parotid gland secrets saliva and is not related to the GAS. The pineal and adrenal glands do not initiate the GAS. STUDY TIP: Remember that the pituitary gland is also called the master gland because it controls so many functions. It is vital in the process of homeostasis, and adapting to chronic stress is definitely part of homeostasis. p. 772

Which structures in the body control the response to a stressor? Pons Thyroid gland Pituitary gland Medulla oblongata Reticular formation

Pituitary gland Medulla oblongata Reticular formation Response to stress works through a negative feedback system. The structures that control these responses are the pituitary gland, medulla oblongata, and reticular formation. The pituitary gland is a small gland situated below the hypothalamus. It produces hormones necessary for adaptation to stress. The reticular formation is a small cluster of neurons situated in the brainstem and spinal cord that monitors the physiological status of the body. The medulla oblongata is situated in the lower part of brainstem and controls blood pressure, heart rate, and respirations. The pons and thyroid gland are not activated during a stress response. p. 772

A patient has a lung infection. Which nursing standards of practice should the nurse adopt while caring for this patient? Planning Diagnosis Assessment Collaboration Environmental health

Planning Diagnosis Assessment The standards of practice are planning, diagnosis, and assessment. Planning refers to developing a plan that prescribes strategies and alternatives to attain the expected outcome. Diagnosis involves assessing the data to identify the nature and cause of the illness. Assessment involves collecting data pertaining to patient's health or situation. Collaboration and environmental health are care standards of professional performance. Collaboration is a process in which the nurse works jointly with a health care consumer, the family, and others. A registered nurse should adopt an environmentally healthy and safe approach. p. 2

What factors should the nurse look for when assessing the emotional development of a 15-year-old patient? Positive feelings of self Maturation Goals for the future Acceptance of bodily changes Enhanced self-awareness

Positive feelings of self Maturation Goals for the future Acceptance of bodily changes Eric Erickson's fifth stage of the psychosocial theory of development involves identity versus role confusion. The nurse should look for positive feelings of self and maturation level in the patient. The nurse should ask the patient if he or she has planned any goals in the future. The patient should also have an acceptance of the changes that occur in the body. Failure to attain any of these benchmarks may lead to role confusion in the patient. Enhanced self-awareness is the task of the Erickson's third stage, initiative versus guilt, in which the ability to complete a particular task increases awareness of the adolescent's own capabilities. p. 702

While performing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. Which response is this? The fight-or-flight response The general adaptation syndrome The exhaustion stage Posttraumatic stress disorder (PTSD)

Posttraumatic stress disorder (PTSD) PTSD originates with a person's experiencing or witnessing a traumatic event and responding with intense fear or helplessness. The car accident is the traumatic event that is causing intense fear or helplessness in this patient. p. 774

A patient has non-Hodgkin's lymphoma and is in the terminal stage. The patient is spiritually depressed and not ready to face death. What restorative care options can the nurse use to care for this patient? Prayer Diet therapy Supporting grief work Meditation Guided imagery

Prayer Supporting grief work Meditation Guided imagery Spiritual care is important for a person with terminal illness. Prayer reinforces one's belief in God or a higher being and is one of the most effective coping resources. It provides the patient with inner strength and a sense of peace and serenity. A patient with terminal illness needs time and the nurse's support to grieve, and the nurse should support the patient in a spiritual and therapeutic manner. Meditation and guided imagery reduce stress, pain, and blood pressure and provide increased spirituality. Diet therapy is not an option for restorative care. pp. 745-746

Which nursing interventions support(s) a healing relationship with a patient? Praying with the patient Giving pain medications before a painful procedure Telling a patient that it is time to take a bath before the family arrives Making the patient's bed following the hospital protocol Helping a patient see positive aspects related to a chronic illness

Praying with the patient Helping a patient see positive aspects related to a chronic illness Praying with patients and mobilizing the patient's hope create a healing relationship. p. 734

The nurse practitioner is assessing a patient who has been admitted for congestive cardiac failure. The nurse suspects a pulmonary pathology and asks for a chest x-ray to confirm the findings. Which standard of practice is the nurse performing? Assessment Diagnosis Prescriptive authority Implementation

Prescriptive authority The nurse practitioner has prescriptive authority and can call for investigative procedures such as chest x-rays to confirm the assessment findings. Assessment is the process of collecting data related to the health and illness of the patient. Nursing diagnosis involves analyzing the assessed data. Implementation is the process of delivering care according to the care plan. p. 2

An emergency department nurse is caring for a patient who was severely injured in a car accident. The patient's family is in the waiting room. They are crying softly. The nurse sits down next to the family, takes the mother's hand, and says, "I can only imagine how you're feeling. What can I do to help you feel more at peace right now?" What is the nurse demonstrating in this example? Prayer Presence Coaching Instilling hope

Presence The nurse demonstrates presence in this situation by establishing a therapeutic relationship and being with the mother during a particularly stressful time. p. 744

In planning nursing care for an 85-year-old male, what is the most important, basic need that must be met? Assurance of sexual intimacy Preservation of self-esteem Expanded socialization Increase in monthly income

Preservation of self-esteem Self-esteem is essential for physical and psychological health across the life span. p. 704

Managed Care Organizations (MCOs) are important components of the health care system. What are the services provided by MCOs? Preventive services Treatment services Direct specialist care Tertiary care Coverage of the whole population

Preventive services Treatment services Managed care organizations (MCOs) provide comprehensive preventive and treatment services. MCOs do not include direct specialist care; a referral is needed to access specialists. The focus of MCOs is on primary care, not on tertiary care. MCOs do not cover the whole population; they serve groups of voluntarily enrolled people. p. 16

The nurses set up flu vaccine clinics in local churches and senior citizen centers. This activity is an example of which level of prevention? Primary care Secondary care Tertiary care Restorative care

Primary care Primary health care focuses on improved health outcomes for an entire population. It includes primary care and health education, proper nutrition, maternal and child health care, family planning, immunizations, and control of diseases. Flu vaccines are related to controlling the spread of a disease, in this case the flu. p. 32

A female Islamic patient is in the terminal stage of leukemia. The patient wants to end her life due to her suffering and hopelessness. Furthermore, she is not responding to pharmacological interventions. What should the nurse suggest to the caregivers to promote spirituality? Promote faith healing. Encourage family and friends to visit. Suggest the patient considers euthanasia. Discuss the imminence of death. Convince the patient that hope of survival is minimal.

Promote faith healing. Encourage family and friends to visit. Muslims believe in faith healing, and therefore it should be promoted. The patient is in the terminal stages of illness. The nurse should promote spiritual health in the patient by permitting family and friends to visit. Muslims do not encourage euthanasia. They do not discuss death and hope for the best outcome. Therefore, the nurse should not discuss death but should encourage hope for a good outcome. p. 739

A patient experiencing a stomachache was diagnosed with stomach cancer. The patient became anxious after the diagnosis. What nursing interventions would be helpful for this patient? Promote measures to reduce anxiety. Encourage the use of effective coping skills. Assess the potential for committing suicide. Assess the potential for psychosis. Encourage the patient to listen to music.

Promote measures to reduce anxiety. Encourage the use of effective coping skills. Encourage the patient to listen to music. The nurse should promote measures to reduce anxiety because anxiety further deteriorates health. Encouraging coping skills boosts emotional support for the patient. Listening to music decreases anxiety and helps the patient to relax. Suicidal tendencies should be evaluated only if the patient shows signs of depression. Psychosis is usually due to a neurotransmitter disturbance and is not secondary to malignancies. p. 733

Due to a shortage of staff, the nurse has been on duty for both morning and night shifts for the last 2 days. Which role performance is the nurse experiencing? Role strain Role conflict Role overload Role ambiguity

Role overload Every person undergoes numerous role changes throughout life. Role overload is not being able to meet the demands of work and carve out some personal time for family. Therefore, the nurse is experiencing role overload in this situation. Role strain is the expression of feelings of frustration due to an illness or inadequate satisfaction. Role conflict occurs when a person has to assume two or more roles that are inconsistent and contradictory. Role ambiguity is unclear role expectations that create stress and confusion. p. 706

In a community, a large population of people have arthritis. What nursing interventions would be helpful in reducing the incidence and impact of arthritis? Promote stress management. Teach correct body mechanics. Teach management of daily activities. Educate about the availability of mechanical appliances. Encourage advertisements that promise a cure for arthritis.

Promote stress management. Teach correct body mechanics. Teach management of daily activities. Educate about the availability of mechanical appliances. Stress is an important factor in the development of arthritis, and the nurse should educate the community about how to manage stress effectively. The nurse should also teach patients about proper body mechanics and how to better manage daily activities because they directly affect the joints. There are various mechanical appliances that help people suffering from arthritis. Therefore, patients should be informed about these devices. Advertisements often give false claims of curing arthritis, and the nurse should caution patients against such ads. p. 36

The nurse is placed in a community clinic and works with vulnerable populations. What should the nurse keep in mind when assessing these patients? Provide legal or financial advice to the patient if required. Provide a linguistically and culturally competent assessment. Conduct an organized and complete history and assessment. Assess only the chief complaints of the patients that are needed to assess health. Learn as much as possible about the culture of the people visiting the center.

Provide a linguistically and culturally competent assessment. Conduct an organized and complete history and assessment. Learn as much as possible about the culture of the people visiting the center. While working with a vulnerable group, it is extremely important to provide a linguistically and culturally competent assessment. The vulnerable group may have multiple risk factors. Therefore, the nurse should take an organized and complete history and assessment. Knowing about the culture of the community helps the nurse to perform a better assessment. The patient may discuss his financial or legal troubles. The nurse may connect the patient to someone who can help. pp. 34

A patient with asthma approaches a primary care center for management of the illness. What is the role of the nurse practitioner during the patient's visit for primary care? Provide direct medical care. Provide comprehensive care. Refer the patient to a health care provider. Establish a collaborative provider-patient relationship. Perform preliminary laboratory tests and get the health care provider's opinion.

Provide direct medical care. Provide comprehensive care. Establish a collaborative provider-patient relationship.

An elderly patient has been put on a potentially toxic drug for treatment of arthritis. The patient and family have expressed concern about the drug. What is the role of the nurse in this particular situation? Give the drug in a very low dose. Obey the health care provider's instruction. Do not speak out against policies or actions. Provide information so the patient can decide whether to accept the treatment or refuse.

Provide information so the patient can decide whether to accept the treatment or refuse. The patient has been put on a potentially toxic drug. Because the patient is elderly, the nurse should act as an advocate and take measures to protect the patient's rights. Therefore, the nurse may provide information that will help the patient decide whether to take the treatment. The nurse should not give the drug in a low dose, because that may not serve the purpose of administering it. The nurse should obey the instructions by the health care providers only after ensuring that the patient's concerns are addressed. At times, in order to protect human rights, the nurse needs to speak out against policies. p. 3

A Japanese patient is admitted to the hospital after a fall. The patient doesn't understand English. Which should the nurse do to promote communication? Use sign language. Provide language assistance to the patient. Ask a nurse who speaks Japanese to take over. Check the patient physically and start treatment of the disorder. Try to learn Japanese.

Provide language assistance to the patient. Ask a nurse who speaks Japanese to take over. Whenever a patient faces language barriers, the nurse should make language assistance available to the patient. This service is free for all patients. A patient may ask a family member to interpret instead of a translator. Nurses who know the patient's language may be asked to take over to help provide better care. Sign language is unreliable for assessment of the patient. Checking the patient physically and starting treatment without communication is inappropriate and can violate patient rights. Learning a new language is a time-consuming process and will not help this patient. pp. 104, 108

The nurse usually is assigned multiple patients at one time. What should the nurse do to ensure individual patient satisfaction? Provide quality care to each patient. Ensure that patients leave with a positive image of nursing. Provide quick and hurried treatment to the less needy. Manage time and approach all patients with compassion. Minimize contact time with each patient to ensure care for all.

Provide quality care to each patient. Ensure that patients leave with a positive image of nursing. Manage time and approach all patients with compassion. The nurse caring for multiple patients at a time should understand that all patients are equally important. All should receive quality care, so they leave the health care setting with a positive image of nursing. Time management and a compassionate approach are keys to achieving these goals. However, the nurse should not cut down contact time with each patient; rather, the nurse should optimize contact time so all can be cared for and should deliver care in an organized manner, rather than in a hurried or rushed manner. p. 5

The nurse is being appointed as nurse educator in a nursing school. What are the responsibilities of the nurse educator? Manage patient care and delivery of special nursing services. Provide students with practical and theoretical knowledge. Provide care to patients using a holistic approach. Provide surgical anesthesia under the guidance and supervision of an anesthesiologist.

Provide students with practical and theoretical knowledge. The nurse educator is responsible for educational activities conducted in schools of nursing. If they are educators in clinical care institutions, they often participate in the development of nursing policies and procedures. In schools of nursing, the nurse educator imparts practical and theoretical knowledge to students. The nurse educator is not responsible for managing patient care, proving holistic care, or providing surgical anesthesia. The nurse administrator manages patient care. The nurse practitioner provides holistic care to patients. The certified registered nurse anesthetist provides surgical anesthesia. pp. 4-5

The health care provider asks the certified registered nurse anesthetist (CRNA) to provide spinal anesthesia to a patient who is scheduled for a hernia operation. What is the CRNA's next step? Provide the anesthesia under the supervision of a senior nurse. Inform the health care provider that the CRNA has the right to provide spinal anesthesia only in a tertiary setup. Provide the anesthesia under the supervision of a primary health care provider with knowledge of surgical anesthesia. Inform the health care provider that the CRNA's services are restricted to nonsurgical procedures.

Provide the anesthesia under the supervision of a primary health care provider with knowledge of surgical anesthesia. A certified registered nurse anesthetist (CRNA) is trained at an anesthesia-accredited program. The nurse has the right to provide surgical anesthesia under the supervision of a primary health care provider with knowledge of surgical anesthesia. The CRNA should provide anesthesia only under the supervision of a primary health care provider. The CRNA can provide anesthesia even in a primary set-up, under supervision. CNRA services may be utilized even for surgical procedures. p. 4

The examination for registered nurse licensure is exactly the same in every state in the United States. What should the public understand about this exam? Guarantees safe nursing care for all patients Ensures standard nursing care for all patients Ensures that honest and ethical care is provided Provides a minimum standard of knowledge for a registered nurse in practice

Provides a minimum standard of knowledge for a registered nurse in practice Registered nurse (RN) candidates must pass the NCLEX-RN ® that the individual state boards of nursing administer. Regardless of educational preparation, the examination for RN licensure is exactly the same in every state in the United States. This provides a standardized minimum knowledge base for nurses. Successfully passing the NCLEX-RN does not guarantee safe, standard, nor ethical practice. These are evaluated by the employer. p. 9

Which option below is an example of the nurse participating in primary care activities? Providing prenatal teaching on nutrition to a pregnant woman during the first trimester Working with patients in a cardiac rehabilitation program Assessing a patient at an emergent care facility Providing home wound care to a patient

Providing prenatal teaching on nutrition to a pregnant woman during the first trimester Primary care activities are focused on health promotion. Health promotion programs contribute to quality health care by helping patients acquire healthier lifestyles. Health promotion activities keep people healthy through exercise, good nutrition, rest, and the adoption of positive health attitudes. p. 17

While teaching about Quality and Safety Education for Nurses (QSEN) competencies, the nurse states, "This competency uses tools such as flowcharts and diagrams to make the process of care explicit." Which QSEN competency is the nurse referring to? Quality Improvement Patient-Centered Care Evidence-Based Practice Teamwork and Collaboration

Quality Improvement Quality Improvement is the Quality and Safety Education for Nurses (QSEN) competency that uses tools such as flowcharts and diagrams to make the care process explicit. The Patient-Centered Care competency involves family and friends in care and elicits the patient's values and preferences, providing care with respect for the diversity of the human experience. Evidence-Based Practice demonstrates knowledge of basic scientific methods, appreciates the strengths and weaknesses of scientific bases for practice, and recognizes the importance of regularly reading relevant journals. Teamwork and Collaboration recognizes the contributions of other health team members and the patient's family members and discusses effective strategies for communicating and resolving conflict. p. 8

Which force of magnetism is associated with the component that focuses on structure and processes, and demonstration of positive clinical, workforce, patient, and organizational outcomes? Quality of Care Image of Nursing Management Style Quality Improvement

Quality of Care Empirical Quality Results is the component of the Magnet model that focuses on structure and processes, and demonstration of positive clinical, workforce, and patient and organizational outcomes. The force of magnetism associated with this component is Quality of Care. Image of Nursing is the force of magnetism associated with the component Structural Empowerment. Management Style is the force of magnetism associated with the component Transformational Leadership. Quality Improvement is the force of magnetism associated with the component New Knowledge, Innovations, and Improvements. p. 26

Which communication technique is demonstrated when the nurse connects with a patient on a social level? Rapport Support Empathy Partnership

Rapport Having a rapport helps the nurse to connect to the patient on a social level. Support involves recognizing barriers in care and adherence and helping the patient to overcome them. Empathy is required to understand the patient's rationale for his or her illness. Partnership is needed to negotiate roles when necessary and be flexible with respect to the issues of control. p. 109

While assessing a patient with a psychiatric disorder, the nurse seeks the patient's point of view. Which process of the RESPECT mnemonic is the nurse employing? Rapport Support Empathy Explanations

Rapport Seeking the patient's point of view during the assessment indicates an effort to build rapport. Asking and trying to understand the barriers to care and adherence indicates an effort to provide support. Verbally acknowledging and legitimizing the patient's feelings indicates empathy. Using verbal clarification techniques indicates the use of explanations as they apply to the RESPECT mnemonic. p. 109

A group of health care professionals in the medical-surgical unit of a 600-bed urban hospital is working to assess and improve the quality of health care delivery. The staff nurse has been told to collect the data required to assess the quality of health care delivery. Which relevant data is the nurse expected to collect? Rate of infections after surgery Readmission rates of patients Time frame for returning to work after discharge The number of health care providers in the hospital Average number of patients admitted in the hospital per day

Rate of infections after surgery Readmission rates of patients Time frame for returning to work after discharge The meaning of quality in a health care delivery system is the "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (IOM, 2001). To assess the quality of health care delivery, the data on the infection rates after surgery should be collected, which would indicate the sanitation of the hospital and whether proper aseptic methods are used during procedures. The readmission rates and time frame for returning to work after discharge indicate the effectiveness of health care delivery. The number of health care providers and number of patients admitted to the hospital are not indicators of the quality of health care delivery. pp. 23-24

A patient with mouth cancer is advised to undergo radiation therapy. However, the patient refuses to do so. The primary health care provider gives the patient and family other treatment options. Which step of the LEARN mnemonic is the primary health care provider performing? Listen Explain Negotiate Recommend

Recommend The "recommend" step involves suggestion to the patient and/or the family members when appropriate. As the primary health care provider is involving the patient and the family members, he or she is performing the "recommend" step of the LEARN mnemonic. The "listen" step involves paying attention to the patient's grief or complaint. The "explain" step involves the primary health care provider's description of his or her perception of the patient's complaints. Negotiating involves arriving at a mutually agreeable, culturally oriented, and patient-centered plan. p. 108

The nurse educator is delivering a lecture on nursing as a profession to a group of nursing students who have recently joined the baccalaureate nursing degree course. The nurse is explaining the nursing processes by giving examples. Which examples should the nurse give while explaining nursing assessment? Recording body temperature two hours after administering antipyretic medication. Teaching the patient about the lifestyle changes required to reduce the risks of having coronary artery disease. Asking the patient about hygiene and sanitation in the patient's community. Asking the patient to demonstrate the technique of breast self-examination after teaching the technique. Identifying the signs of respiratory distress in a hospitalized patient.

Recording body temperature two hours after administering antipyretic medication. Asking the patient about hygiene and sanitation in the patient's community. Identifying the signs of respiratory distress in a hospitalized patient. The nurse is responsible for collecting comprehensive data about the patient's health. The nurse records the body temperature after 2 hours to assess the effectiveness of the antipyretic medication. The nurse also asks the patient about the hygiene of the surrounding environment to assess the risk of acquiring infections caused by unhygienic surroundings. Nursing assessment also includes identifying the signs of a particular condition. Teaching a patient about the lifestyle changes required to reduce risks of ischemic heart disease is an example of the nursing process of implementation, not assessment. Asking the patient to demonstrate a technique after teaching it forms a part of the evaluation process, not the assessment process. p. 2

A 45-year-old single mother lives with her 10-year-old son who has Down syndrome. The patient's facial expressions and mannerisms demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The nurse understands that the patient is experiencing caregiver role strain. What interventions should the nurse plan for the mother and son? Refer the son to respite care. Refer the patient to support groups. Prescribe antidepressants to the patient. Admit the patient to the psychiatric ward. Advise the patient to do yoga and meditation.

Refer the son to respite care. Refer the patient to support groups. Advise the patient to do yoga and meditation. The priority nursing intervention should be the son, who has Down syndrome. The son can participate in respite care. This would reduce the caregiver burden much more successfully than in-home services. Other measures that can reduce stress in the mother include referring her to support groups to seek help. These groups help to lower stress related to caregiving. The patient can also do yoga and meditation to manage stress. Prescribing antidepressants to the mother is not required as she is not depressed. The patient does not suffer from a psychiatric illness; therefore, admission to a psychiatric ward is not required. p. 781

A person tries to meet the strenuous demands of employment while taking care of a family of six and manages to fulfill the responsibilities with great difficulty. What kind of role performance stressor is affecting this person? Role conflict Role ambiguity Role overload Role strain

Role overload When the expectations and responsibilities of a role are unmanageable, it is referred to as role overload. A person may experience role overload when trying to meet employment demands and caring for a family. Role conflict happens when a person has to assume two or more inconsistent and mutually exclusive roles. Role ambiguity occurs when a person is confused and not sure of his or her role. Role strain results from role conflict and role ambiguity combined. p. 706

The nurse manager is teaching about levels of stress prevention according to the Neuman Systems Model. What information does the nurse include in the teachings? Secondary prevention occurs before definitive symptoms appear. Rehabilitation of physically challenged persons is called tertiary prevention. Polio vaccination to children with Down syndrome is tertiary prevention. Prevention of diseases is primary prevention and stress prevention is tertiary prevention.

Rehabilitation of physically challenged persons is called tertiary prevention. According to the Neuman Systems Model, there are three levels of prevention: primary, secondary, and tertiary. Tertiary prevention starts as a person recovers from irreversible damage. One of the examples of tertiary prevention includes rehabilitation of a physically handicapped person. Secondary preventive measures, including investigations and treatment, are taken after the symptoms have occurred. In primary prevention, measures are taken before the occurrence of symptoms and providing vaccination is one such measure. Stress prevention is a form of primary prevention. p. 778

A depressed patient is crying and verbalizes feelings of low self-esteem and self-worth such as, "I'm such a failure—I can't do anything right." What would be the best nursing intervention? Remain with the patient until he or she stops crying. Tell the patient that it is not true and that every person has a purpose in life. Review recent behaviors or accomplishments that demonstrate skills and abilities. Reassure the patient that you know how he or she is feeling and that things will get better.

Remain with the patient until he or she stops crying. Demonstrating acceptance of the patient by supportively sitting with him or her builds a therapeutic nurse-patient relationship. The nurse's presence signals value and allows the patient to explore issues of self-concept and self-esteem. p. 706-707

A patient states, "My religion does not permit me to bathe today." What would be the most appropriate nursing action? Tell the patient that the health care provider has prescribed a bath today. Insist that a bath be taken because it is the patient's scheduled bath day. Call an appropriate cleric and ask whether the patient is telling the truth. Request a clarification of the patient's beliefs and adapt a plan for bathing accordingly.

Request a clarification of the patient's beliefs and adapt a plan for bathing accordingly. A patient's religious and cultural preferences should be considered when providing hygiene. Facility schedules should not take priority over the patient's religious beliefs nor should the health care provider's instructions. Verifying the patient's beliefs with a member of the clergy is inappropriate. pp. 738-739

An older Chinese woman is admitted to the hospital after a hip fracture. Once the fracture has healed, the nurse encourages the patient to walk about the room. The patient refuses to walk without her son. What should the nurse do in this scenario? Leave the patient alone but understand that the patient has no self-confidence. Respect the patient's wish and ask her to walk when her son is present. Explain to the patient calmly that she can't be dependent on her son. Tell the patient that she needs to walk now and that it is inappropriate to be dependent on her son.

Respect the patient's wish and ask her to walk when her son is present. In some cultures, families make decisions together. This patient may only be comfortable when her son is present, so the nurse should respect her wishes and come back when the son is there. It would be wrong to describe the woman as lacking confidence. It is not therapeutic to speak sternly with the patient and tell her that she is dependent on others. p. 105

A patient's caregiver wants to know if there are support services that would give him some time off from caregiving. Which services can the nurse suggest? Hospice Respite care Nursing clinics Assisted living

Respite care Respite care is a service that gives time off to the caregivers of patients. This service can be provided at home or in a day care center. Professionals take care of the patient while the caregiver completes his or her chores or handles other responsibilities. Hospice is a service in which terminally ill patients receive palliative care in their homes. Nursing clinics diagnose and treat medical conditions. Assisted living is associated with long-term care facilities where patients live with other individuals in a home-like surrounding. pp. 21-22

A patient admitted to the hospital wants to know about respite care. What does the nurse explain to this patient about respite care? Respite care is included in Medicare. Respite care gives the caregiver time to run errands or socialize. Respite care is provided only in the long-term care facility, which resembles the home. Respite care provides the caregiver some time off from providing care to the ill person. Respite care can include overnight care.

Respite care gives the caregiver time to run errands or socialize. Respite care provides the caregiver some time off from providing care to the ill person. Respite care can include overnight care. Respite care is a program in which the caregiver can get some time off from providing care to the ill person. This provides short-term relief to the caregiver. Respite care can include overnight care, and it can be provided at home, in a day care setting, or in a health care institution. The caregiver can use this time to care for himself or herself, to run errands, or have some social time. Respite care is not included in Medicare. p. 22

The nurse is learning about the effects of health care reform. Which type of actions should the nurse perform in response to health care reform? Revise practice standards. Change nursing education. Oppose current trends. Continue with existing guidelines. Explore new methods of providing care.

Revise practice standards. Change nursing education. Explore new methods of providing care. Health care reform will cause changes in the delivery of nursing care, and more services will be in community-based care settings. Revising practice standards will help to comply with the increasing focus on health promotion, disease prevention, and illness management. Changing nursing education will help nurses to be more efficient in dealing with the health care reform, because nurses are required to be more adept at assessing resources, service gaps, and how the patient adapts to returning to the community. Exploring new methods of providing care will enable nurses to provide care according to changing health care needs, because many nurses may need to work in community health centers, schools, and senior centers. Opposing current trends will not help improve the quality of nursing care, whereas accepting health care reform will be beneficial to all. Existing guidelines would be considered old and redundant under health care reform, and adopting new measures to suit the changes will help. pp. 7, 9

A couple wishes to prevent conception using natural contraceptive methods based on the menstrual cycle. Which factors indicate the fertile period? Rhythm of the menstrual cycle Cervical mucus Urinary frequency Breast tenderness Basal body temperature

Rhythm of the menstrual cycle Cervical mucus Basal body temperature The factors that indicate the fertile period of the menstrual cycle are the regularity of the menstrual cycle, consistency of the cervical mucus, and changes in basal body temperature. The regularity of the menstrual cycle can be affected by many factors, including illness and emotional stressors. Cervical mucus changes in color and consistency throughout the menstrual cycle and can be used to estimate the fertile period. Basal body temperature usually increases during the ovulation period. Urinary frequency and breast tenderness do not provide information about the fertile period. An increase in urinary frequency is associated with urinary tract infections and sexually transmitted infections. Breast tenderness occurs during the first trimester of pregnancy, and it can be a symptom of premenstrual syndrome or fibrocystic breast disease. p. 718

A 20-year-old woman who lives with her parents gives birth to a baby. Around the same time, her parents adopt a 5-year-old child. The young woman is overwhelmed and has difficulty balancing her role as a mother with her role as a sister. What kind of role performance stressor does the woman experience? Role conflict Role ambiguity Role strain Role overload

Role conflict Role conflict happens when a person has to assume two or more inconsistent roles. This new mother is trying to cope with the physical and psychological burdens of raising a child and is stressed by the addition of a new relationship with a young sibling, creating role conflicts. Role ambiguity occurs when a person is confused and not sure of his or her role. Role strain results from role conflict and role ambiguity. When a person has more responsibilities within a role than she can manage, she experiences role overload. Test-Taking Tip: Think about the words used as the basis of the question. Notice the emphasis given to two life events (a birth and a new sibling), then on "difficulty balancing," and "role as a mother with her role as a sister." The key words and ideas in the question lead you to the answer of role conflict. p. 705

A single mother expresses that she feels inefficient because she is unable to balance her work and family roles. She takes care of her 5-year-old son without any support. She works as a store manager in a retail outlet. What are the role stressors that are responsible for her current state of mind? Sick role Role conflict Role ambiguity Altered self-concept Role overload

Role conflict Role overload Role conflict occurs when a person has to perform two or more roles that are mutually exclusive. When an individual tries to assume many roles and responsibilities that are unmanageable, it can result in role overload. Role strain is a combination of role conflict and role ambiguity. Role ambiguity occurs when the expectations of a role are not very clear and the person is unsure of what he or she is expected to do (which is not apparent in this case). The sick role refers to the expectations of others and the society as to how the person should behave when he or she is sick. Altered self-concept is not a role stressor; it is the outcome of prolonged stress. pp. 705-706

A 50-year-old female patient is admitted to the hospital for surgical management of breast cancer. The patient is now at home after a successful operation. During a home visit, the patient breaks down and expresses that she is overburdened with responsibilities. She takes care of her 8-month-old granddaughter as well as her 80-year-old mother who has Alzheimer's disease. What stressors is the patient facing? Sick role Role performance Role conflict Role overload Role ambiguity

Role conflict Role overload Role conflict results when a person has to handle two different responsibilities that are mutually exclusive. Role overload is having more roles and responsibilities than one can handle. The sick role refers to the expectations of others when a person is sick. Role performance is the way in which a person perceives his or her ability to carry out significant roles. Role ambiguity involves unclear role expectations. pp. 705-706

The nurse is caring for an older-adult couple in a community-based assisted living facility. During the family assessment, the nurse notes that the couple has many expired medications and multiple medications for their respective chronic illnesses. They indicate that they go to two different health care providers. The nurse begins to work with the couple to determine what they know about their medications and helps them decide on one care provider rather than two. This is an example of which competency for QSEN? Patient-centered care Safety Teamwork and collaboration Informatics

Safety Helping patients understand the consequences and complications of multiple medications helps to build the competency in safety. p. 8

Which parameters are included in the Resident Assessment Instrument/Minimum Data Set (RAI/MDS) protocol? Fatigue Schizophrenia Patient age above 40 Fracture of femur Urinary incontinence

Schizophrenia Fracture of femur Urinary incontinence The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) protocol is used to determine the functional ability and overall well-being of a patient in a care facility. It consists of assessments of mood, behavior, activity pattern, and psychosocial well-being. Therefore, schizophrenia, fracture of femur, and presence of urinary incontinence are parameters assessed in an RAI/MDS. The age of the patient and presence of fatigue are not included in the assessment. p. 21

The nurse is caring for a Korean woman who has just delivered her first baby. Which soup should the nurse anticipate the family to provide as the first meal to the woman? Tomato soup Sweet corn soup Seaweed soup Hot garlic soup

Seaweed soup Koreans believe that seaweed soup should be given to a woman immediately postpartum because it cleans the blood and helps healing and lactation. Tomato, sweet corn, and hot garlic soups can be given later but are not specifically part of the Korean culture. p. 106

While caring for a pregnant patient who is in the first trimester of pregnancy, the nurse discusses sexual activity during pregnancy with the patient. During which trimester are pregnant women most likely to experience increased libido? First trimester Second trimester Third trimester It is unaffected during pregnancy.

Second trimester During the second trimester of pregnancy, patients are most likely to experience an increased libido due to an increased blood supply to the pelvic area to nourish the placenta. In the first trimester, there is usually a decrease in libido due to nausea and vomiting. In the third trimester, a comfortable position for sex is difficult. Therefore, sexual desire is usually not equal during all trimesters of pregnancy. p. 720

A neighborhood with old homes is undergoing a lot of restoration. Lead paint was used in the buildings. The clinic is initiating a lead screening program. This activity is an example of which level of prevention? Primary prevention Secondary prevention Tertiary prevention Disease prevention

Secondary prevention Screening for lead levels is a health-screening program that leads to early-intervention activities. pp. 32

A patient expresses the desire to learn how to meditate. What does the nurse need to do first? Answer the patient's questions. Help the patient get into a comfortable position. Select a teaching environment that is free from distractions. Encourage the patient to meditate for 10 to 20 minutes twice a day.

Select a teaching environment that is free from distractions. A quiet environment without distractions enhances learning and is essential for meditation. p. 745

What term describes how one thinks of oneself? Self-awareness Self-concept Self-esteem Self-expression

Self-concept Self-concept is how one thinks of oneself. It is subjective and is a mixture of conscious and unconscious thoughts, attitudes, and perceptions. Self-awareness is having knowledge about one's feelings, thoughts, and attitudes. Self-esteem is how one feels about oneself. Self-expression is expressing one's own character, feelings, thoughts, and mind-sets. p. 701

The nurse asks the patient, "How do you feel about yourself?" What is the nurse assessing? Identity Self-esteem Body image Role performance

Self-esteem Self-esteem is how a person feels about himself or herself. Asking open-ended questions about self-esteem is important during the nursing assessment. p. 708

What elements influence the achievement of identity in a person? Sexuality Gender Ethnicity Place of birth Physical appearance

Sexuality Gender Ethnicity Identity is the individual's sense of individuality. Sexuality and gender are essential components of identity. Ethnicity or racial differences are integral to a person's identity because they identify a person within an established set of values, traditions, customs, and rituals. The place of birth and physical appearance do not necessarily influence identity. p. 703

A 50-year-old male patient comes for a follow-up visit a few months after a myocardial infarction. The nurse plans to interview the patient to assess his sexual health. During assessment, the patient expresses that he is not able to perform well sexually. Which explanation should the nurse give to the patient? The patient's sexuality is affected by his age and is absolutely normal. The patient must undergo surgery and extensive medication therapy to get back to normal. Sexuality can be affected by ailments such as myocardial infarction, but the patient should return to normal soon. Sexuality can be affected by ailments such as myocardial infarction, and the damage is permanent.

Sexuality can be affected by ailments such as myocardial infarction, but the patient should return to normal soon. Sexuality may be altered by disease states such as myocardial infarction, unstable angina, diabetes, and spinal cord injury. Medications such as antihypertensives also alter sexual function. These alterations are usually temporary and resolve with time. Because the patient is only 50 years old, his decline in sexual activity is not related to age alone. The patient doesn't need to undergo surgery or medication therapy; he should return to normal without them. p. 726

A patient is diagnosed with breast cancer. She is upset about the diagnosis. What is the type of crisis the patient is experiencing? Situational crisis Adventitious crisis Developmental crisis Maturation crisis

Situational crisis The patient is experiencing a situational crisis due to the diagnosis. Situational crises are responses to various situations in life, including a job change, chronic illness, or a motor vehicle accident. An adventitious crisis arises from a major natural disaster or a man-made disaster. A developmental or maturation crisis occurs due to a new developmental stage, such as marriage or the birth of a child. p. 774

Many nurses are known for their achievements. Which statements are true regarding Mary Mahoney? She was the founder of the American Red Cross. She was the first professionally trained African-American nurse. She proposed the concept of health promotion by modifying the patient's environment. She focused on respecting an individual irrespective of color, race, or background. She opened an establishment that focused on the health needs of poor people who lived in tenements in New York City.

She was the first professionally trained African-American nurse. She focused on respecting an individual irrespective of color, race, or background. Mary Mahoney was the first professionally trained African-American nurse. She was concerned with relationships between cultures and races. As a noted nursing leader, she initiated an awareness of cultural diversity and respect for the individual, regardless of background, race, color, or religion. Clara Barton was the founder of the American Red Cross. Florence Nightingale's concept of nursing was to promote health by modifying the patient's environment. In the late 19th century, Lillian Wald and Mary Brewster opened the Henry Street Settlement, which focused on the health needs of poor people who lived in the tenements in New York City. p. 6

Which interventions should the nurse implement while caring for a patient with a disturbed body image who has undergone a modified radical mastectomy? Explore the need for opioid and nonnarcotic analgesics. Show acceptance of breast surgery when providing care. Ask the patient to identify personal strengths and talents. Assist the patient in developing a realistic perception of or her body. Tell the patient that her feelings are similar to feelings of other people in the same situation.

Show acceptance of breast surgery when providing care. Ask the patient to identify personal strengths and talents. Assist the patient in developing a realistic perception of or her body. Tell the patient that her feelings are similar to feelings of other people in the same situation. The nurse implements various interventions to enhance the patient's self-concept. These include showing acceptance of the breast surgery while providing care. This results in reducing the emotional response to the loss of breasts. The nurse should assist the patient in developing a realistic perception of her body because it increases the acceptance of the present physical appearance. The nurse tells the patient that her feelings are similar to feelings of other people who underwent a modified radical mastectomy; this promotes new social interactions. Opioid and nonnarcotic analgesics are needed to decrease acute pain due to surgery. Therefore, exploring the need for analgesics has no role in improving body image. Personal strengths and talents help a person to cope with low self-esteem. Therefore, the nurse should ask the patient to identify personal strengths and talents to enhance self-esteem. p. 707

A patient is scheduled for colostomy in 2 days. The nurse finds the patient very anxious, stressed, and states, "How am I going to live with a poop bag for the rest of my life?" What nursing actions would influence the patient's self-concept and prepare her for an altered body image? Showing the patient a colostomy bag and where it is fitted on the abdomen Showing the patient a video about a healthy functioning body after a colostomy Teaching the patient to do relaxation exercises to deal with anxiety Informing the surgeon about the patient's stress and anxiety Introducing the patient to other patients who have colostomies

Showing the patient a video about a healthy functioning body after a colostomy Introducing the patient to other patients who have colostomies Informing the patient with a practical and realistic approach, such as by showing her a video on her future condition, may help her prepare for the outcomes. The patient may have a better sense of well-being if she interacts with other people with the same problem. Showing the bag and where it is fitted would have no effect on the patient's self-concept. Teaching the patient relaxation exercises would be helpful in reducing the patient's anxiety, but it would not positively affect the self-concept of the patient. It is the nurse's duty to help prepare the patient for surgery psychologically, so the problem should not be reported to the health care provider. p. 712

Which concept of intersectionality involves unequal access to resources and services? Overinclusion Marginalization Social inequality Matrix of domination

Social inequality Social inequality is the concept of intersectionality that involves groups with unequal access to resources, services, and positions. Overinclusion addresses groups that have been overlooked in research and the design of interventions. Marginalization the concept of intersectionality that provides limited access or exclusion from different facets of the society such as a political system, labor market, or positions of power. Matrix of domination is a concept of intersectionality that involves the groups with a larger system of power and more privileges than other groups in the society. p. 103

During an interview of a 35-year-old male patient, the nurse finds that the patient has multiple sex partners and is at risk for contracting a sexually transmitted infection (STI). Which symptom should the nurse look for in the patient? Diarrhea Vomiting Pain in the testicles Sores on the penis

Sores on the penis The presence of sores on the penis is a symptom of sexually transmitted infections (STI). STI present with few symptoms and most of them are related to the genital area. Diarrhea and vomiting indicate a gastrointestinal problem. Pain in the testicles is not commonly seen in STIs. It may occur due to injury to the testes or in the case of testicular torsion. p. 719

A tearful parent of a 10-year-old boy diagnosed with cancer is in the hospital lobby. The nurse comforts the parent, who says that life would be meaningless without the child. What trait is the parent exhibiting? Loss of belief in religion Fear of death Transcendence Spiritual distress

Spiritual distress When a person loses the ability to integrate meaning and purpose in life, he or she is said to be in spiritual distress. It causes the person to lose faith, doubt religion, and lose hope. A person who loses belief in religion finds himself or herself in conflict with the self and the religious belief system. The parent does not exhibit a loss of belief in religion or a fear of death. Transcendence is a feeling or experience beyond normal and above the material world. p. 741

A 25-year-old patient is in the emergency department and states that she has had a cough and fever for the past 3 days. While performing a physical assessment, the nurse finds several bruises that are in various stages of healing and suspects that the patient may be a victim of sexual abuse. Which is the nurse's first action? Refer the patient to a sexual counselor. Tell the patient about the safe house for women. Ask the patient to describe how she got the bruises. Report the abuse immediately to the proper authorities.

Tell the patient about the safe house for women.

A patient was diagnosed with cervical cancer and underwent a hysterectomy. During assessment in the recovery room, the patient tells the nurse, "I don't believe in God anymore. I can't believe I can never have a child. Why me? I can never be the same person again." What does this reaction suggest? Atheism due to illness Spiritual distress due to loss of purpose in life Awareness about loss of uterus Risk of spiritual distress due to surgery

Spiritual distress due to loss of purpose in life Spiritual distress results when the patient loses the purpose and meaning of life, loses hope, and loses connectedness with the self and, in this case, with God. A patient suffering from spiritual distress demonstrates a loss of belief in life, self, or God as a result of a health complication. Atheism, wherein a person does not believe in a god or another supreme being usually does not result from surgery or a health condition. The patient has lost her uterus and is upset about it. However, the reaction is more suggestive of spiritual distress. The patient is not in the at-risk stage of spiritual distress but is actually experiencing the spiritual distress. p. 734

The nurse is explaining to a patient about the various factors that could induce stress. Which examples should the nurse provide to explain situational factors? Stress caused due to aging Stress caused due to sudden transfer of a job Stress caused due to having a new child in the family Stress caused due to health-related problems in obese people Stress caused due to caregiving responsibilities for a family member who has had a stroke

Stress caused due to sudden transfer of a job Stress caused due to health-related problems in obese people Stress caused due to caregiving responsibilities for a family member who has had a stroke Situational stress arises from a change in current conditions. A job transfer may be stressful because it requires a relocation. Adjusting to a chronic illness such as obesity can also cause stress because it may mean increased expenses and a change in lifestyle. The treatment and illness of the self or a family member is stressful due to the uncertainties associated with them. Stress caused due to aging and due to having a new child in the family are examples of maturational factors that cause stress. p. 775

What stressors is a patient likely to experience in an acute care setting? Stress related to diagnostic tests and results Stress related to the family's response to the patient's condition Stress related to an altered body image Stress related to lifestyle modifications Stress related to socialization

Stress related to diagnostic tests and results Stress related to an altered body image Stress related to lifestyle modifications Stressors affecting a patient in an acute care setting are fear and anxiety related to diagnostic tests and their results. There is also potential fear and stress about a disturbed body image due to surgery or other physical condition. The patient also experiences the stress of adapting to an altered lifestyle because of the medical or physical condition. The patient may not be greatly affected by what the family thinks about his or her condition. Stress related to socialization is more common in elderly patients. p. 712

While conducting surveillance for complications of cigarette smoking, the nurse found a high risk of lung cancer in two patients in a small community of 150 people. What should the community health nurse do? Study the incidence of lung carcinoma. Act as a change agent in the community. Help the high-risk patients to make decisions about further care. Encourage people to switch to e-cigarettes. Discourage the people of the community from smoking cigarettes.

Study the incidence of lung carcinoma. Act as a change agent in the community. Help the high-risk patients to make decisions about further care. Discourage the people of the community from smoking cigarettes. Here, the nurse should play the role of an epidemiologist. She should study the incidence of lung carcinoma of and discourage patients from smoking cigarettes. As a counselor, she should not make decisions but rather help patients reach decisions that are best for them. The nurse should also act as a change agent and identify new approaches to current problems. The nurse cannot control the sale of cigarettes but can collaborate with politicians to discuss the disadvantages of smoking cigarettes. p. 37

A patient is shifted to a tertiary care center for further management. Which service is a part of tertiary care? Home care Subacute care Mental health counseling Spinal cord injury programs

Subacute care Secondary and tertiary care are mainly concerned with diagnosis and treatment of various medical conditions. Subacute care is an example of a tertiary service. Home care is an example of restorative care, which is provided to help a patient regain maximum functional status. Mental health counseling is an example of preventive care, which helps prevent the onset or progression of a disease. A spinal cord injury program is an example of restorative care. p. 17

A head nurse is teaching the physiology of fight-or-flight responses to student nurses. Which system is responsible for these phenomena? Renin-angiotensin system Respiratory system Sympathetic nervous system Parasympathetic nervous system

Sympathetic nervous system People experience stress in day-to-day activities. Stress stimulates thinking processes and helps people to be alert. The fight-or-flight response helps a person to prepare for action. These responses occur because of the arousal of the sympathetic nervous system. The renin-angiotensin system helps in maintaining electrolyte and fluid balance. The respiratory system does not initiate fight-or-flight responses. The parasympathetic system counteracts the action of the sympathetic nervous system. STUDY TIP: If you confuse the sympathetic with the parasympathetic nervous system, use this mnemonic: the parasympathetic system can be nicknamed the "rest-and-digest system." Notice the r in parasympathetic and in rest. There is no r in sympathetic, so you can recall that sympathetic refers to the fight-or-flight system. p. 771

A patient is admitted to the hospital for cardiac surgery. The patient is very apprehensive and emotionally overwhelmed. Based on the eight dimensions of patient care, what does the nurse do while providing emotional support to the patient? Talk to the patient and share the patient's fears and concerns. Explain to the patient and his or her family how to manage care independently. Help the patient understand the impact of the illness on the patient and his or her family. Explain the procedures and tests in a language that the patient can understand. Identify staff that can alleviate the patient's fear about paying for medical care needs.

Talk to the patient and share the patient's fears and concerns. Help the patient understand the impact of the illness on the patient and his or her family. Identify staff that can alleviate the patient's fear about paying for medical care needs. According to the eight dimensions of patient care, it is necessary to provide emotional support to the patient. Emotional support includes talking to the patient and sharing the patient's fears and concerns. The nurse should also help the patient understand the impact of the illness onthe patient's and his or her family's life. Many times this fear may be about paying the medical care bills, so the nurse should identify staff that can alleviate the patient's fear about paying for medical care. Explaining to the patient and the family how to manage care independently is included in the informational, communicational, and educational aspects of patient care. Similarly, explaining procedures and tests in a language the patient can understand is a part of the informational, communicational, and educational aspects of patient care. p. 25

The nurse is caring for a patient with hypertension. Which nursing intervention indicates that the nurse is providing patient-centered care focused on transition and continuity? Involving the patient's family members in decision making Respecting the patient's cultural values while providing care Teaching the patient about the administration of medications In simple language, explaining the tests and procedures required

Teaching the patient about the administration of medications Teaching the patient about medication administration indicates that the nurse is providing patient-centered care focused on transition and continuity. Patients have the right to decide if the family members are to be involved in the decision-making processes related to their care. Therefore, the nurse should always ask the patient whether to pass the care-related information to the family. Respecting the cultural values of the patient while providing care indicates patient-centered care focused on physical comfort. Explaining, in simple language, the tests and procedures required indicates patient-centered care focused on information, communication, and education. p. 25

An older adult is receiving hospice care. Which nursing intervention(s) help(s) the patient cope with feelings related to death and dying? Teaching the patient how to use guided imagery Encouraging the family to visit the patient frequently Taking the patient's vital signs every time the nurse visits Teaching the patient how to manage pain and take painmedications Helping the patient put significant photographs in a scrapbook for the family

Teaching the patient how to use guided imagery Encouraging the family to visit the patient frequently Helping the patient put significant photographs in a scrapbook for the family Guided imagery and encouraging connectedness with family members reduce anxiety and enhance coping. p. 745

The nurse cares for a family of four, offering routine medical care throughout the year. Which member of the family does the nurse expect to exhibit the highest levels of self-esteem? The 42-year-old father The 8-year-old boy The 15-year-old girl The 71-year-old grandmother

The 8-year-old boy Low self-esteem is a risk factor for health problems, so the nurse would monitor this in a family that he or she sees often. Self-esteem is highest in childhood. When a person reaches adolescence, self-esteem levels decline. Self-esteem then gradually rises during adulthood and again declines slightly in old age. The pattern may vary slightly in individuals but seems unaffected by gender, socioeconomic status, and ethnicity. The 8-year-old boy is in the childhood stage and thus is expected to show the highest levels of self-esteem in the family. The father will have high self-esteem but it may not be as high as in the child. The girl, an adolescent, will generally have a low level of self-esteem. The grandmother is elderly and thus is expected to have a lower level of self-esteem. p. 702

When developing an appropriate outcome for a 15-year-old girl, what primary developmental task of adolescence should the nurse consider? The ability to form a sense of identity The ability to create intimate relationships The ability to separate from parents and live independently The ability to achieve a positive self-esteem through experimentation

The ability to form a sense of identity Understanding developmental tasks across the life span is essential in designing nursing care. Adolescents are focused on establishing their identities outside of their families and should be supported in meeting this developmental task. STUDY TIP: Think of individuals you know at each developmental stage. Ask yourself if they have accomplished the developmental task for that stage. Considering the stages and tasks in relation to the individuals you know helps anchor the stages and tasks in your mind. pp. 702-703

The nurse is teaching a patient how to use a condom. Which statement by the nurse about using a condom is appropriate? The air should be squeezed out of the condom. The condom should be applied when the penis is hard. The condom should be unrolled to the base of the penis. The condom should be pulled out during ejaculation. Massage oils should be used for lubrication.

The air should be squeezed out of the condom. The condom should be applied when the penis is hard. The condom should be unrolled to the base of the penis. The air in the condom should be squeezed out. It should be put on as soon as the penis becomes hard and before making any contact with vagina, anus, or mouth. It should be unrolled to the base of the penis to prevent any leakage. The condom should be pulled out after ejaculation and not during ejaculation; pulling it out during ejaculation may cause the semen to pass into the partner. Only water-based lubricants should be used with a condom. Massage oils should not be used, because they may contribute to the condom breaking. p. 728

A child performs poorly in mathematics and finds it difficult to improve even after spending more time studying. Which behavior shows that the child is using compensation as a defense mechanism? The child is taking lessons from an experienced math tutor. The child is practicing more music because the patient is good at music. The child is taking herbal supplements to improve memory. The child is eating nutritious food and practicing yoga.

The child is practicing more music because the patient is good at music. In compensation, a person makes up for a deficiency by strongly emphasizing a feature that is considered an asset. The child uses musical skill as compensation for poor performance in math. Taking math lessons is not a defense mechanism; it is a corrective action to improve competency in math. Taking herbal supplements, eating nutritious food, or practicing yoga are emotion-focused coping skills. p. 774

Several staff members complain about a patient's constant questions such as "Should I have a cup of coffee or a cup of tea" and "Should I take a shower now or wait until later?" Which interpretation of the patient's behavior helps the nurses provide optimal care? Asking questions is attention-seeking behavior. The inability to make decisions reflects a self-concept issue. A dependence on staff must be stopped immediately. Indecisiveness is aimed at testing how the staff reacts.

The inability to make decisions reflects a self-concept issue. Patients with deficits in self-concept often have difficulty making decisions. It is essential for the nurse to remain accepting of the patient and to support him or her in decision making. pp. 702, 704

A family of three consisting of a husband, wife, and son were involved in a motor vehicle accident. The husband and wife did not sustain any major injuries, but the child died. What could be the possible outcome of this accident? The husband may have a situational crisis. The wife may have a developmental crisis. The husband may have a developmental crisis. The husband and wife may have an adventitious crisis.

The husband may have a situational crisis. A situational crisis occurs when external sources such as a job change, motor vehicle crash, death, or severe illness trigger stress. Therefore, all the people who survived the accident may have a situational crisis. A developmental crisis occurs when there is a change in the developmental stage of a person such as a marriage, the birth of a child, or retirement that requires new coping styles. Therefore, the husband and wife will not have a developmental crisis. An adventitious crisis occurs in situations of a major natural disaster, man-made disaster, or a crime of violence. Therefore, none of the survivors will have an adventitious crisis. p. 782

Which parameter indicates a high quality of nursing care provided in the care unit? The high number of patient falls The high number of patients developing pressure ulcers The low rate of hospital-acquired infections The low rate of patient admissions

The low rate of hospital-acquired infections As per the National Database of Nursing Quality Indicators (NDNQI), there are some parameters on which the quality of care offered by nurses can be judged. Some of these parameters are falls, falls with injury, hospital-acquired infections, pressure ulcers, psychiatric patient assault rate, and restraint prevalence. A low rate of hospital-acquired infections indicates that the quality of nursing care is good. A high number of patient falls and high number of patients developing pressure ulcers indicate subpar nursing care. The low rate of patient admissions is not related to the quality of nursing care being provided. p. 26

A 50-year-old patient is admitted with acute exacerbation of asthma. The patient is treated with bronchodilators and oxygen therapy. The patient is clinically stable and is planned for discharge. Who is responsible for teaching the patient about managing asthma at home? The staff nurse The nurse educator The nurse administrator The clinical nurse specialist

The nurse educator Patient education is a major role of the nurse educator. The nurse educator is responsible for teaching the patient about the new prosthesis and the related postoperative care. The other types of nurses have different responsibilities. The staff nurse is responsible for providing basic care to a group of patients in a hospital setting based on standards of professional practice. The nurse administrator is responsible for managing the quality of patient care provided by the nurses. The nurse administrator also manages the different nursing services that are delivered within a health care establishment. The clinical nurse specialist is an expert clinician in a particular area and provides specialized care. pp. 2-3

The nurse is working with the county health department on a task force to fully integrate the goals of Healthy People 2020. How does the nurse determine which goals need to be included or updated? The nurse assesses the health care resources within the community. The nurse assesses the existing health care programs offered by the county health department. The nurse compares existing resources and programs with the Healthy People 2020 goals. The nurse initiates new programs to meet Healthy People 2020 goals. The nurse compares the goals of Healthy People 2010 when initiating the program goals.

The nurse assesses the health care resources within the community. The nurse assesses the existing health care programs offered by the county health department. The nurse compares existing resources and programs with the Healthy People 2020 goals. The nurse must first assess for existing health care resources and educational programs in existence. Then he or she must compare these resources and programs with Healthy People 2020 goals. These processes determine if any new goals need to be added or updated. p. 31

A young Hindu woman, who is a mother of two children, is admitted to the intensive care unit with myocardial infarction. The patient's family seems to be very sad and refuses to leave the patient. How can the nurse help the patient and her family cope with this difficult time? The nurse can ask the family to wait in the waiting room and not visit the patient. The nurse can motivate the family to chant religious prayers beside the patient. The nurse can talk to the children and instill hope about the patient's condition. The nurse should deny religious rituals in the hospital because they are not allowed. The nurse should make sure a female health care provider is treating the patient.

The nurse can motivate the family to chant religious prayers beside the patient. The nurse can talk to the children and instill hope about the patient's condition. To honor their religion, the patient and the family, being followers of Hinduism, should be allowed to chant prayers and hymns near the patient. The nurse should try to comfort the children, who may be in shock, by instilling hope that patients like their mother can recover in a matter of time. The family should be allowed to visit the patient. Denial of rituals may cause spiritual distress in the patient and the family. Therefore, the patient and the family should be allowed to perform religious rituals if safe for the patient. A female Hindu patient may not necessarily ask for a female health care provider. p. 739

The nurse finds that a patient has not understood the health education provided on personal hygiene. How does the nurse ensure that the patient understands the teachings? The nurse provides reading material on personal hygiene. The nurse clarifies the information and requests a teach back. The nurse provides a video demonstration of personal hygiene. The nurse requests that a family member help the patient understand.

The nurse clarifies the information and requests a teach back. If the patient does not understand instructions, the nurse should clarify the information and request that the patient teach back the instructions. This approach helps the nurse ascertain whether the patient has understood the teachings or not. Providing reading material and a video demonstration on personal hygiene to the patient reinforces the teaching but does not necessarily ensure that the patient has understood. Requesting that a family member help the patient understand will not help the nurse to assess the patient's understanding. pp. 100, 111

An elderly patient who is a devout Christian is admitted to the hospital with partial paralysis. The patient's son visits the patient daily and is very supportive. What nursing actions demonstrate the nurse's caring presence? The nurse offers to read the Bible to the patient. The nurse checks the patient's vital signs twice daily. The nurse discusses physical therapy options with the patient's son. The nurse answers the patient's questions promptly and appropriately. The nurse informs the health care provider about the patient's progress.

The nurse offers to read the Bible to the patient. The nurse discusses physical therapy options with the patient's son. The nurse answers the patient's questions promptly and appropriately. Establishing a caring presence provides hope for recovery and contributes to physical, mental, and spiritual well-being. Behaviors that establish the nurse's presence include doing things that help the patient's physical and spiritual well-being such as reading a sacred text to the patient, involving the family in making decisions and planning care, and answering the patient's questions promptly. Simply checking vital signs and exchanging health information with the patient or health care provider is not being present to attend to the patient's spiritual needs. p. 744

A patient newly diagnosed with type 2 diabetes says, "My blood sugar was just a little high. I don't have diabetes." How does the nurse respond? "Let's talk about something cheerful." "Do other members of your family have diabetes?" "I can tell that you feel stressed to learn that you have diabetes." The nurse responds with silence.

The nurse responds with silence. The nurse understands that denial is a defense mechanism that assists in coping with a shock. Therapeutic use of silence gives patients the time to process their thoughts. STUDY TIP: Did you catch that? Silence can be an appropriate response to a patient in denial about his or her diagnosis. Think of silence as the audio equivalent of presence. Both are powerful tools. Try silence as a response the next time you hear someone make a statement that communicates denial. p. 777

The nurse administrator in a 600-bed urban hospital is addressing a group of nurses and explaining strategies to improve patient-centered care. Which strategies proposed by the nurse administrator are appropriate? . The nurse should provide thorough information about health care delivery and encourage the patient to participate in the decision-making process. The nurse should administer analgesics whenever a patient complains of pain. The nurse should be able to diminish all fears and concerns of the patient about the health care provided. The nurse should always involve the family members in the decision-making process regarding the patient's care. The patient should be assured that the nursing professional would be around to help.

The nurse should provide thorough information about health care delivery and encourage the patient to participate in the decision-making process. The nurse should be able to diminish all fears and concerns of the patient about the health care provided. The patient should be assured that the nursing professional would be around to help. To improve patient-centered care, it is important that the nurse treat the patient with respect and dignity. The patient should be informed about every step of the health care delivery process. Another strategy to improve patient-centered care is to provide emotional support to the patient and relieve his or her anxiety. The nurse should be able to alleviate all doubts or fears related to the patient's condition and the care provided. The nurse should ensure that patient issues are addressed as soon as possible. Whenever a patient complains of pain, it is important that the nurse assess the pain first before administering any medication. Alternative, nonpharmacological pain treatment is preferred over pain-relieving drugs. Patients have the right to decide if the family members are to be involved in the decision-making processes related to their care. Therefore, the nurse should always ask the patient whether to pass the care-related information to the family. p. 25

The nurse is assessing a patient who lost his fingers in an accident with a meat mincer. What patient behavior is suggestive of an altered self-concept? The patient does not make eye contact while talking. The patient discusses prosthetics with the nurse. The patient still cannot believe he was so careless. The patient states that he wants to be left alone. The patient informs a co-worker that he will be back to work in a few days.

The patient does not make eye contact while talking. The patient still cannot believe he was so careless. The patient states that he wants to be left alone. Avoiding eye contact, excessive self-criticism, and denial of self-expression are all signs of altered self-concept. A patient who discusses treatment options and future goals has a high self-concept and has a good chance of a speedy recovery. The patient who is positive about going to work and not blaming others for his condition also has a very good self-concept. p. 708

A patient who is spiritually distressed comes for a follow-up. What observations by the nurse indicate positive outcomes in the patient? The patient expresses increased hope of becoming healthy. The patient's relationship with his partner is satisfactory. The patient is compliant with his medication regimen. The patient is not talking to his family and friends. The patient remains at home and watches TV all day.

The patient expresses increased hope of becoming healthy. The patient's relationship with his partner is satisfactory. The patient is compliant with his medication regimen. When evaluating for goal-directed outcomes, the nurse should check for an increase in hope; a purpose in life; increased connectedness with the self, others, a god, or another spiritual state; and an increase in overall health. Goals set during the planning phase should be the benchmark for assessing the extent of positive outcomes of care. Patients who are hope for good health and who have an increased level of connectedness to their partners exhibit positive outcomes. The patient with positive outcomes tends to become compliant with the prescribed medication regimen. Patients who avoid family and friends and who remain at home with a single activity exhibit a further need for spiritual intervention. p. 741

For what should the nurse look when assessing an altered self-concept in a patient? The patient has a slumped posture. The patient is overly apologetic. The patient has a well-groomed appearance. The patient uses hesitant speech. The patient avoids eye contact.

The patient has a slumped posture. The patient is overly apologetic. The patient uses hesitant speech. The patient avoids eye contact. A patient who has an altered self-concept exhibits behaviors such as a slumped posture, is generally overly apologetic, and is hesitant while speaking. The patient may have difficulty in sharing views and opinions and usually avoids eye contact. Having a well-groomed appearance is a sign that the patient has a good self-concept. p. 708

A patient states that he does not believe in the existence of God. What does this statement indicate about the patient? The patient is an academic. The patient is an atheist. The patient is an agnostic. The patient is an anarchist.

The patient is an atheist. Atheists do not believe in the existence of God. p. 734

A patient experienced asystole because of an acute heart attack. The patient recovered due to prompt resuscitative measures. What statements made by the patient would suggest that the patient had a near-death experience (NDE)? The patient saw a bright light. The patient met her dead parents. The patient heard her spouse calling. The patient felt as if she slept for too long. The patient felt as if she was pulled out of her body.

The patient saw a bright light. The patient met her dead parents. The patient felt as if she was pulled out of her body. Patients who undergo a near-death experience tell similar stories about seeing a bright light, meeting people who are already dead, and seeing themselves pulled out of, or rising above, their bodies. The nurse can identify a near-death experience by the stories the patient tells. Patients usually do not recall someone calling them or that they slept too long after an NDE. p. 736

A 38-year-old patient who is a Jehovah's Witness is involved in a major motor vehicle accident. The patient was brought to the emergency department and was found to have lost too much blood, thus requiring a blood transfusion. What nursing action should be taken in such a situation? An immediate blood transfusion should be started. The patient's family should be notified of the situation. Only red blood cells should be transfused. The patient should be asked to decide about the transfusion.

The patient should be asked to decide about the transfusion. The nurse should be aware that Jehovah's Witnesses do not accept blood and blood products, because they strongly believe in not ingesting blood in any form. A patient's beliefs and principles of life should be honored and the patient should be allowed to decide if he or she wants a transfusion or not. Making a decision on behalf of the patient that is against the patient's life principles or religious practices may significantly affect his or her spiritual well-being and purpose of life. The patient's family may be consulted, but the patient should be allowed to participate in decision making. No blood components, not even red blood cells, are accepted by Jehovah's Witnesses. p. 738

A patient is diagnosed with breast cancer. She is upset about the diagnosis. What assessment findings indicate ineffective coping related to the stress of her illness? The patient gives appropriate answers to the questions asked. The patient sleeps excessively. The patient laughs inappropriately. The patient shows lack of interest in food. The patient has lost 11 lbs (5 kg) of weight in 2 weeks.

The patient sleeps excessively. The patient laughs inappropriately. The patient shows lack of interest in food. The patient has lost 11 lbs (5 kg) of weight in 2 weeks. Sleeping excessively is an ineffective coping mechanism to escape reality. Laughing inappropriately is an inappropriate behavior and indicates ineffective coping. A lack of interest in food may indicate depression and ineffective coping. Similarly, weight loss may be a sign the patient is not coping well. Giving appropriate answers to questions indicates the patient is able to concentrate and implies that the patient is coping well with the illness. p. 777

The nurse is assigned to care for a patient who has low self-esteem after undergoing a right leg amputation. The goal for the patient is that the patient's self-esteem will improve in 2 weeks. What are the expected outcomes to achieve the goal? The patient will have difficulty in making eye contact. The patient will verbalize acceptance of the prosthetic leg. The patient will become less depressed. The patient will interact in a social setting. The patient will talk about his or her feelings.

The patient will verbalize acceptance of the prosthetic leg. The patient will interact in a social setting. The patient will talk about his or her feelings. Expected outcomes for a patient with low self-esteem include nonverbal behaviors that indicate positive self-esteem. The expected outcomes include the patient verbalizing acceptance of the use of the prosthetic leg, having social interactions, and making eye contact. The patient will talk about his or her feelings. Ambiguous outcomes such as "become less depressed" don't provide the patient with small, manageable goals. pp. 711-712

The nurse is examining a patient who just had a spontaneous abortion. What observations suggest to the nurse that the patient has good self-esteem post incident and is coping well? The patient's husband stays by her side and holds her hand. The patient seems depressed but is asking the health care provider about conceiving again. The patient does not want to conceive another child. The patient does not talk to anybody about the incident. The patient asks the health care provider about permanent contraception methods.

The patient's husband stays by her side and holds her hand. The patient seems depressed but is asking the health care provider about conceiving again. The fact that the patient's spouse is supportive helps her cope with the stress and loss of self-esteem. Healthy social support from family and loved ones has a very positive effect on a person's self-esteem. The patient's willingness and ability to make decisions about conceiving again show that the patient has a good self-esteem level. A patient who does not want to conceive another child may be depressed and fears that she could face the situation again. If the patient does not talk to anybody about the incident, she may not want to face the emotions related to the incident. Asking the health care provider about permanent contraceptive methods indicates that the patient does not want to go through the process of childbirth again. This behavior may indicate that the patient has low self-esteem and is not coping well. p. 706

The nurse is working in a health clinic on a Navajo reservation. The nurse plans care for the patients knowing which statement below is true? The patients may not be on time for their appointments. The patients most likely do not trust the doctors and nurses. The patients probably are not comfortable if they have to remove their undergarments. Terminally ill patients probably want to receive the sacrament, the anointing of the sick.

The patients may not be on time for their appointments. In Navajo culture, punctuality is not important, thus Navajos may not always be on time for appointments. p. 739

Which options are characteristics of managed care systems? The provider receives a predetermined payment for each patient in the program. Payment is based on a set fee for each service provided. The system includes a voluntary prescription drug program for an additional cost. The system tries to reduce costs while keeping patients healthy. The focus of care is on prevention and early intervention.

The provider receives a predetermined payment for each patient in the program. The system tries to reduce costs while keeping patients healthy. The focus of care is on prevention and early intervention Managed care programs have administrative control over primary health care services for a defined patient population. The provider or health care system receives a predetermined capitated payment for each patient enrolled in the program. In this case, the managed care organization assumes the financial risk in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care. If people remain healthy, the cost of medical care declines. Systems of managed care focus on containing or reducing costs, increasing patient satisfaction, and improving the health or functional status of the individual. p. 15

A patient just gave birth to a beautiful baby. The mother says, "It's like a miracle. I don't have words to explain this feeling. My baby is perfect, like something out of this world. Thank you, God." What kind of feeling did the patient just experience? Self-transcendence Transcendence Connectedness Hope

Transcendence Transcendence is a feeling or experience beyond normal and above the material world. It induces positive feelings by allowing people to have new experiences and new perspectives that are beyond the ordinary. Self-transcendence is a feeling and a sense of connecting to one's inner self. Through connectedness, a person feels connected to himself or herself, to others, and to a Supreme Being or God. Hope is a feeling of expectation or desire for positive things to happen. p. 734

While evaluating a student nurse's performance, the head nurse finds that the student nurse has identified errors and hazards in care and has designed and tested interventions. What does the head nurse infer from this evaluation? The student nurse is using evidence-based practice. The student nurse is applying quality improvement. The student nurse is providing patient-centered care. The student nurse is working in an interdisciplinary team.

The student nurse is applying quality improvement. Identifying errors and hazards in care, and designing and testing interventions to change processes means that the student nurse is applying quality improvement in practice. If the student nurse integrates the best research with clinical practice and patient values, it indicates the use of an evidence-based practice. If the student nurse coordinates continuous care, communicates effectively, and educates patients, the nurse is providing patient-centered care. If the student nurse integrates care and ensures continuous and reliable care, he or she is working in an interdisciplinary team. p. 23

The nurse is teaching a group of students about different coping mechanisms. What is true about ego-defense mechanisms? They can lead to mania in a person. They are used by people unconsciously. They can lead to major depression in a person. They usually do not lead to psychiatric disorders. They offer psychological protection from a stressful event.

They are used by people unconsciously. They usually do not lead to psychiatric disorders. They offer psychological protection from a stressful event. Ego-defense mechanisms are one of the coping mechanisms people use unconsciously. Psychiatric disorders usually do not occur because of ego-defense mechanisms. The defense mechanisms regulate emotional distress and help a person cope with stress indirectly. They offer psychological protection from a stressful event. They do not result in mania or depression in the patient. p. 774

The nurse is communicating with a gay patient. Which statements hold true for this patient group? They belong to a sexual minority. They do not readily seek preventive care. They are comfortable revealing their sexual orientation. They are concerned about discrimination. They are more prone to getting sexually transmitted diseases.

They belong to a sexual minority. They do not readily seek preventive care. They are concerned about discrimination. Gay patients belong to a sexual minority group often described as lesbian, gay, bisexual, or transgender (LGBT). Current evidence indicates that they experience decreased access to health care and do not readily seek preventive care (Lim et al., 2014; Williamson, 2010), and may limit access to health care due to the fear of discrimination. Although a lot of advancements and modernization has happened, somehow the sexual minority group is not yet well accepted, and hence many of them are not comfortable revealing their sexual orientation. Sexually transmitted diseases can occur in any sexually active person irrespective of the category they belong to. p. 718

A woman wishes to use hormonal contraceptives. How do they work? They cause thinning of the lining of the uterus. They prevent ovulation. They reduce sperm motility. They act as a spermicidal barrier. They thicken the cervical mucus.

They cause thinning of the lining of the uterus. They prevent ovulation. They thicken the cervical mucus. Hormonal contraceptives work by thinning the uterus so that the fertilized ovum does not get implanted. They also prevent ovulation and thicken the cervical mucus, preventing sperm cells from ascending into the uterus. Hormonal contraceptives do not affect the motility of sperm and do not have any spermicidal effect. Spermicidal creams and jellies kill sperm cells before they enter the uterus. Test-Taking Tip: On questions about one type of contraceptive, the incorrect choices may be true for other methods of contraception. For instance, in this question, "act as a spermicidal barrier" is correct for condoms and "reduce sperm motility" is correct for spermicides. As you choose responses, be sure you know which contraceptive method the question is about. p. 718

When treating a patient who is a Muslim, what factors should the nurse keep in mind? They consume alcohol in moderation. They do not eat pork. They do not pray 5 times a day. They do not eat meat on Fridays. During Ramadan, they eat only after sunset.

They do not eat pork. During Ramadan, they eat only after sunset. Muslims do not eat pork; they consider it taboo. During Ramadan, they eat only after sunset and fast for the whole month. Islam prohibits alcohol consumption. Muslims usually pray 5 times a day. Followers of Islam have no restrictions regarding eating meat on Friday. Some Christians do not eat meat on Fridays during Lent. p. 739

While caring for a Muslim female patient, which religious beliefs and practices should the nurse keep in mind? They do not practice euthanasia. Health and spirituality are two different issues. Women prefer female health care providers. During the month of Ramadan, they do not eat until sundown. Medicines are not accepted because they believe that chemicals are harmful to the body.

They do not practice euthanasia. Women prefer female health care providers. During the month of Ramadan, they do not eat until sundown. Islam does not allow euthanasia or mercy killing. The women of this religion prefer a female health care provider. Therefore, the nurse must arrange for female health care providers so that the patient is comfortable. Ramadan is a holy month for the followers of Islam. During Ramadan, the followers of Islam do not eat and drink until sundown. Therefore, the nurse must take additional care during this month. Muslims believe that health and spirituality are connected. Buddhists will reject some medications because they believe that chemical substances in the body are harmful. p. 739

What roles do nurses play in providing quality care to all populations? They partner with political decision makers. They partner with major insurance providers. They practice to the full extent of their education and training. They partner with physicians and other health care providers. They improve data collection for planning and policy making.

They practice to the full extent of their education and training. They partner with physicians and other health care providers. They improve data collection for planning and policy making. To have a health care system with quality care for all populations, nurses need to practice to the full extent of their education and training, become full partners with physicians and other health care providers, and improve data collection, which in turn helps workforce planning and policy making. Partnering with political decision makers and major insurance providers is not a nursing role. p. 15

The patient tells the nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO? This health plan is for people who cannot afford their own health insurance. This health plan is operated by the government to provide health care to older adults. This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose. This is a fee-for-service plan in which you can choose any physician or hospital.

This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose. Preferred provider organization (PPO) plans limit the enrollee's choice to a list of preferred providers such as hospitals and physicians. A participant pays more to use a provider not on the preferred list. PPO plans focus on health maintenance. p. 16

A senior nurse is talking with student nurses about spirituality. What are the different conceptual elements in spirituality? Transcendence Faith and hope Inner strength and peace Meaning and purpose in life Connectedness Culture

Transcendence Faith and hope Inner strength and peace Meaning and purpose in life Connectedness Spirituality has five constructs or conceptual elements. Transcendence is the belief that there is an external force beyond the material world. Faith refers to the firm belief despite any evidence of physical presence. Hope is a source that gives energy to move forward in life. Inner strength is a source of positive energy that drives a person in difficult times. Inner peace provides a calm, positive, and peaceful feeling. A spiritual person strives to find meaning and purpose in order to live a meaningful life. Connectedness refers to feeling connected with oneself, with others, and with an unseen force. Culture is not a part of spirituality. p. 734

A patient complains of dyspareunia. She is diagnosed with sexual dysfunction related to decreased sexual desire. Which instructions should be provided to the patient? Perform exercise to increase sexual desire. Use contraceptive medications and devices. Avoid the overuse of alcohol and cigarettes. Use water-soluble lubricants before sexual intercourse. Explore alternative, acceptable, and more satisfying sexual practices.

Use water-soluble lubricants before sexual intercourse. Explore alternative, acceptable, and more satisfying sexual practices. Dyspareunia is painful sexual intercourse. The goal for treatment would be to devise a plan to decrease pain and to obtain greater satisfaction during sexual activity. The use of lubrication may ease sexual intercourse, making it less painful. Teaching alternative and less painful practices also adds to the plan. Exercising, use of contraception, or asking patients to avoid alcohol and cigarettes may not be useful in this type of sexual dysfunction but may be useful in dysfunctions related to lifestyle. p. 717

A male patient approaches the nurse for advice on permanent methods of contraception. What should the nurse suggest to the patient? Tubal ligation Vasectomy Subdermal implants Transdermal skin patches

Vasectomy Vasectomy is a permanent method of contraception in males. In the procedure, the vas deferens, which carries the sperm away from the testicles, is cut and tied. Tubal ligation is a surgical procedure done in females that involves cutting the fallopian tube. Subdermal implants and transdermal skin patches are hormonal methods for temporary contraception. p. 718

A 54-year-old woman is poor and suffering from tuberculosis. Other people with tuberculosis live in her area. What should the nurse include in her assessment of the community? Water and sanitation facilities Economic status Transportation Communication skills Number of schools in the vicinity

Water and sanitation facilities Economic status Transportation The nurse should assess the available water and sanitation facilities to check the level of hygiene among the people. This will help curb the spread of diseases. Assessing economic status helps determine the standard of living of the people in the community. It also helps to determine whether they can afford medical services. Transportation needs to be assessed to see if patients can conveniently reach the hospital when necessary. Assessment of communication skills or number of schools does not help improve the health condition of the community. pp. 37