NURSING EXAM #3 Practice Questions

A caregiver asks a nurse to explain respite care. How would the nurse respond? A) "Respite care is a service that allows time away for caregivers." B) "Respite care is a special service for the terminally ill and their family." C) "Respite care is direct care provided to people in a long-term care facility." D) "Respite care provides living units for people without regular shelter."

A) "Respite care is a service that allows time away for caregivers." Respite care is provided to enable a primary caregiver time away from the day-to-day responsibilities of homebound patients.

The nurse practitioner sees patients in a community clinic that is located in a predominately White neighborhood. After performing assessments on the majority of the patients visiting the clinic, the nurse notes that many of the minority groups living within the neighborhood have lost the cultural characteristics that made them different. What is the term for this process? A) Cultural assimilation B) Cultural imposition C) Culture shock D) Ethnocentrism

A) Cultural assimilation When minority groups live within a dominant group, many members lose the cultural characteristics that once made them different in a process called assimilation. Cultural imposition occurs when one person believes that everyone should conform to his or her own belief system. Culture shock occurs when a person is placed in a different culture perceived as strange, and ethnocentrism is the belief that the ideas, beliefs, and practices of one's own cultural group are best, superior, or most preferred to those of other groups.

A nurse is using the ESFT model to understand a patient's conception of a diagnosis of chronic obstructive pulmonary disease (COPD). Which interview question would be MOST appropriate to assess the E aspect of this model—Explanatory model of health and illness? a) How do you get your medications? B) How does having COPD affect your lifestyle? C) Are you concerned about the side effects of your medications? D) Can you describe how you will take your medications?

B) How does having COPD affect your lifestyle? The ESFT model guides providers in understanding a patient's explanatory model (a patient's conception of her or his illness), social and environmental factors, and fears and concerns, and also guides providers in contracting for therapeutic approaches. Asking the questions: "How does having COPD affect your lifestyle?" explores the explanatory model, "How do you get your medications?" refers to the social and environmental factor, "Are you concerned about the side effects of your medications?" addresses fears and concerns, and "Can you describe how you will take your medications?" involves therapeutic contracting.

Nursing students are reviewing information about health care delivery systems in preparation for a quiz the next day. Which statements describe current U.S. health care delivery practices? Select all that apply. A) Access to care depends only on the ability to pay, not the availability of services. B) The Patient Protection and Affordable Care Act provides private health care insurance to underserved populations. C) Every health insurance plan in the Health Insurance Marketplace offers comprehensive coverage, from doctors to medications to hospital visits. D) The uninsured pay for more than one third of their care out of pocket and are usually charged lower amounts for their care than the insured pay. E) Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do. F) Quality of care can be defined as the right care for the right person at the right time.

C) Every health insurance plan in the Health Insurance Marketplace offers comprehensive coverage, from doctors to medications to hospital visits E) Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do. F) Quality of care can be defined as the right care for the right person at the right time. The Health Insurance Marketplace is designed to help people more easily find health insurance that fits their budget. Every health insurance plan in the Marketplace offers comprehensive coverage, from doctors to medications to hospital visits. Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do. Quality is the right care for the right person at the right time. Access to care depends on both the ability to pay and the availability of services. The Patient Protection and Affordable Care Act provides Medicaid or subsidized coverage to qualifying people with incomes up to 400% of poverty. The uninsured pay for more than one third of their care out of pocket and are often charged higher amounts for their care than the insured pay.

A nurse is caring for a patient in the shock or alarm reaction phase of the GAS. Which response by the patient would be expected? A) Decreasing pulse B) Increasing sleepiness C) Increasing energy levels D) Decreasing respirations

C) Increasing energy levels The body perceives a threat and prepares to respond by increasing the activity of the autonomic nervous and endocrine systems. The initial or shock phase is characterized by increased energy levels, oxygen intake, cardiac output, blood pressure, and mental alertness.

Even though the nurse performs a detailed nursing history in which spirituality is assessed on admission, problems with spiritual distress may not surface until days after admission. What is the probable explanation? A) Patients usually want to conceal information about their spiritual needs. B) Patients are not concerned about spiritual needs until after their spiritual adviser visits. C) Family members and close friends often initiate spiritual concerns. D) Illness increases spiritual concerns, which may be difficult for patients to express in words.

D) Illness increases spiritual concerns, which may be difficult for patients to express in words. Illness may increase spiritual concerns, which many patients find difficult to express. The other options do not correspond to actual experience.

A 36-year-old woman enters the emergency department with severe burns and cuts on her face after an auto accident in a car driven by her fiancé of 3 months. Three weeks later, her fiancé has not yet contacted her. The patient states that she is very busy and she is too tired to have visitors anyway. The patient frequently lies with her eyes closed and head turned away. What do these data suggest? A) There is no disturbance in self-concept. B) This patient has ego strength and high self-esteem but may have a disturbance of body image. C) The area of self-esteem has very low priority at this time and should be ignored until much later. D) It is probable that there are disturbances in self-esteem and body image.

D) It is probable that there are disturbances in self-esteem and body image. The traumatic nature of this patient's injuries, her fiancé's failure to contact her, and her withdrawal response all point to potential problems with both body image and self-esteem. It is not true that self-esteem needs are of low priority.

A patient whose last name is Goldstein was served a kosher meal ordered from a restaurant on a paper plate because the hospital made no provision for kosher food or dishes. Mr. Goldstein became angry and accused the nurse of insulting him: "I want to eat what everyone else does—and give me decent dishes." Analysis of these data reveals what finding? A) The nurse should have ordered kosher dishes also. B) The staff must have behaved condescendingly or critically. C) Mr. Goldstein is a problem patient and difficult to satisfy. D) Mr. Goldstein was stereotyped and not consulted about his dietary preferences.

D) Mr. Goldstein was stereotyped and not consulted about his dietary preferences. On the basis of his name alone, the nurse jumped to the premature and false conclusion that this patient would want a kosher diet.

A nurse ensures that a hospital room prepared by an aide is ready for a new ambulatory patient. Which condition would the nurse ask the aide to correct? A) The bed linens are folded back. B) A hospital gown is on the bed. C) Equipment for taking vital signs is in the room. D) The bed is in the highest position.

D) The bed is in the highest position. A properly prepared hospital room includes a bed in the lowest position for an ambulatory patient, an open bed with top linens folded back, routine equipment and supplies and special equipment and supplies assembled, and the physical environment of the room adjusted.

A college student visits the school's health center with vague complaints of anxiety and fatigue. The student tells the nurse, "Exams are right around the corner and all I feel like doing is sleeping." The student's vital signs are within normal parameters. What would be an appropriate question to ask in response to the student's verbalizations? A) "Are you worried about failing your exams?" B) "Have you been staying up late studying?" C) "Are you using any recreational drugs?" D )"Do you have trouble managing your time?"

A) "Are you worried about failing your exams?" Mild anxiety is often handled without conscious thought through the use of coping mechanisms, such as sleeping, which are behaviors used to decrease stress and anxiety. Based on the complaints and normal vital signs, it would be best to explore the patient's level of stress and physiologic response to this stress.

A nurse mentor is teaching a new nurse about the underlying beliefs of CHAs versus allopathic therapies. Which statements by the new nurse indicate that teaching was effective? Select all that apply. A) "CHA proponents believe the mind, body, and spirit are integrated and together influence health and illness." B) "CHA proponents believe that health is a balance of body systems: mental, social, and spiritual, as well as physical." C) "Allopathy proponents believe that the main cause of illness is an imbalance or disharmony in the body systems." D) "Curing according to CHA proponents seeks to destroy the invading organism or repair the affected part." E) "The emphasis is on disease for allopathic proponents and drugs, surgery, and radiation are key tools for curing." F) "According to CHA proponents, health is the absence of disease."

A) "CHA proponents believe the mind, body, and spirit are integrated and together influence health and illness." B) "CHA proponents believe that health is a balance of body systems: mental, social, and spiritual, as well as physical." E) "The emphasis is on disease for allopathic proponents and drugs, surgery, and radiation are key tools for curing." With CHA, mind, body, and spirit are integrated and together influence health and illness, and illness is a manifestation of imbalance or disharmony. Allopathic beliefs include: The main causes of illness are considered to be pathogens (bacteria or viruses) or biochemical imbalances, curing seeks to destroy the invading organism or repair the affected part, and emphasis is on disease and high technology. Drugs, surgery, and radiation are among the key tools for dealing with medical problems. According to allopathic beliefs, health is the absence of disease.

A nurse teaches problem solving to a college student who is in a crisis situation. What statement best illustrates the student's understanding of the process? A) "I need to identify the problem first." B) "Listing alternatives is the initial step." C ) "I will list alternatives after I develop the plan." D) "I do not need to evaluate the outcome of my plan."

A) "I need to identify the problem first." Although identifying the problem may be difficult, a solution to a crisis situation is impossible until the problem is identified.

A nurse practicing in a health care provider's office assesses self-concept in patients during the patient interview. Which patient is least likely to develop problems related to self-concept? A) A 55-year-old television news reporter undergoing a hysterectomy (removal of uterus) B) A young clergyperson whose vocal cords are paralyzed after a motorbike accident C) A 32-year-old accountant who survives a massive heart attack D) A 23-year-old model who just learned that she has breast cancer

A) A 55-year-old television news reporter undergoing a hysterectomy (removal of uterus) Based simply on the facts given, the 55-year-old news reporter would be least likely to experience body image or role performance disturbance because she is beyond her childbearing years, and the hysterectomy should not impair her ability to report the news. The young clergyperson's inability to preach, the 32 year old's massive myocardial infarction, and the model's breast resection have much greater potential to result in self-concept problems.

A nurse caring for culturally diverse patients in a health care provider's office is aware that patients of certain cultures are more prone to specific disease states than the general population. Which patients would the nurse screen for diabetes mellitus based on the patient's race? Select all that apply. A) A Native American patient B) An African-American patient C) An Alaska Native D) An Asian patient E) A White patient F) A Hispanic patient

A) A Native American patient C) An Alaska Native E) A White patient F) A Hispanic patient Native Americans, Alaska Natives, Hispanics, and Whites are more prone to developing diabetes mellitus. African Americans are prone to hypertension, stroke, sickle cell anemia, lactose intolerance, and keloids. Asians are prone to hypertension, liver cancer, thalassemia, and lactose intolerance.

A nurse caring for patients in a primary care setting submits paperwork for reimbursement from managed care plans for services performed. Which purpose best describes managed care as a framework for health care? A) A design to control the cost of care while maintaining the quality of care B) Care coordination to maximize positive outcomes to contain costs C) The delivery of services from initial contact through ongoing care D) Based on a philosophy of ensuring death in comfort and dignity

A) A design to control the cost of care while maintaining the quality of care Managed care is a way of providing care designed to control costs while maintaining the quality of care.

In order to provide culturally competent care, nurses must be alert to factors inhibiting sensitivity to diversity in the health care system. Which nursing actions are examples of cultural imposition? Select all that apply. A) A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. B) A nurse treats all patients the same whether or not they come from a different culture. C) A nurse tells another nurse that Jewish diet restrictions are just a way for them to get a special tray of their favorite foods. D) A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. E) A nurse directs interview questions to an older adult's daughter even though the patient is capable of answering them. F) A nurse refuses to care for a married gay man who is HIV positive because she is against same-sex marriage.

A) A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. D) A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. Cultural imposition occurs when a hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily, and when a Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. Cultural blindness occurs when a nurse treats all patients the same whether or not they come from a different culture. Culture conflict occurs when a nurse ridicules a patient by telling another nurse that Jewish diet restrictions are just a way for Jewish patients to get a special tray of their favorite foods. When a nurse refuses to respect an older adult's ability to speak for himself or herself, or if the nurse refuses to treat a patient based on that patient's sexual orientation, the nurse is engaging in stereotyping.

A nurse manager who works in a hospital setting is researching the use of energy healing to use as an integrative care practice. Which patient would be the best candidate for this type of CHA? A) A patient who is anxious about residual pain from cervical spinal surgery B) A patient who is experiencing abdominal discomfort C) A patient who has chronic pain from diabetes D) A patient who has frequent cluster headaches

A) A patient who is anxious about residual pain from cervical spinal surgery Energy healing is focused on pain that lingers after an injury heals, as well as pain complicated by trauma, anxiety, or depression. Nutritional and herbal remedies treat all chronic pain, but especially abdominal discomfort, headaches, and inflammatory conditions, such as rheumatoid arthritis.

A discharge nurse is evaluating patients and their families to determine the need for a formal discharge plan or referrals to another facility. Which patients would most likely be a candidate for these services? Select all that apply. A) An older adult who is diagnosed with dementia in the hospital B) A 45-year-old man who is diagnosed with Parkinson's disease C) A 35-year-old woman who is receiving chemotherapy for breast cancer D) A 16-year-old boy who is being discharged with a cast on his leg E) A new mother who delivered a healthy infant via a cesarean birth F) A 59-year-old man who is diagnosed with end-stage bladder cancer

A) An older adult who is diagnosed with dementia in the hospital B) A 45-year-old man who is diagnosed with Parkinson's disease F) A 59-year-old man who is diagnosed with end-stage bladder cancer The patients who are most likely to need a formal discharge plan or referral to another facility are those who are emotionally or mentally unstable (e.g., those with dementia), those who have recently diagnosed chronic disease (e.g., Parkinson's disease), and those who have a terminal illness (e.g., end-stage cancer). Other candidates include patients who do not understand the treatment plan, are socially isolated, have had major surgery or illness, need a complex home care regimen, or lack financial services or referral sources.

A nurse cares for patients in a chiropractic office. What patient education might this nurse perform? Select all that apply. A) Applying heat or ice to an extremity B) Explaining the use of electrical stimulation C) Teaching a patient relaxation techniques D) Teaching a patient about a prescription E) Explaining an invasive procedure to a patient F) Teaching about dietary supplements

A) Applying heat or ice to an extremity B) Explaining the use of electrical stimulation C) Teaching a patient relaxation techniques F) Teaching about dietary supplements Chiropractors may combine the use of spinal adjustments and other manual therapies with several other treatments and approaches including heat and ice, electrical stimulation, relaxation techniques, rehabilitative and general exercise, counseling about weight and diet, and using dietary supplements. Chiropractors do not prescribe medication or perform invasive procedures.

A nurse working in a primary care facility prepares insurance forms in which the provider is given a fixed amount per enrollee of the health plan. What is the term for this type of reimbursement? A) Capitation B) Prospective payment system C) Bundled payment D) Rate setting

A) Capitation Capitation plans give providers a fixed amount per enrollee in the health plan in an effort to build a payment plan that consists of the best standards of care at the lowest cost. The prospective payment system groups inpatient hospital services for Medicare patients into DRGs. With bundled payments, providers receive a fixed sum of money to provide a range of services. Rate setting means that the government could set targets or caps for spending on health care services.

A nurse is assessing a patient who complains of migraines that have become "unbearable." The patient tells the nurse, "I just got laid off from my job last week and I have two kids in college. I don't know how I'm going to pay for it all." Which physiologic effects of stress would be expected findings in this patient? Select all that apply. A) Changes in appetite B) Changes in elimination patterns C) Decreased pulse and respirations D) Use of ineffective coping mechanisms E) Withdrawal F) Attention-seeking behaviors

A) Changes in appetite B) Changes in elimination patterns Physiologic effects of stress include changes in appetite and elimination patterns as well as increased (not decreased) pulse and respirations. Using ineffective coping mechanisms, becoming withdrawn and isolated, and exhibiting attention-seeking behaviors are psychological effects of stress.

A nurse is telling a new mother from Africa that she shouldn't carry her baby in a sling created from a large rectangular cloth. The African woman tells the nurse that everyone in Mozambique carries babies this way. The nurse believes that bassinets are safer for infants. This nurse is displaying what cultural bias? A) Cultural imposition B) Clustering C) Cultural competency D) Stereotyping

A) Cultural imposition The nurse is trying to impose her belief that bassinets are preferable to baby slings on the African mother—in spite of the fact that African women have safely carried babies in these slings for years.

A nurse researcher keeps current on the trends to watch in health care delivery. What trends are likely included? Select all that apply. A) Globalization of the economy and society B) Slowdown in technology development C) Decreasing diversity D) Increasing complexity of patient care E) Changing demographics F) Shortages of key health care professionals and educators

A) Globalization of the economy and society D) Increasing complexity of patient care E) Changing demographics F) Shortages of key health care professionals and educators Trends to watch in health care delivery include globalization of the economy and society, increasing complexity of patient care, changing demographics, shortages of key health care professionals and educators, technology explosion, and increasing diversity.

A nurse witnesses a street robbery and is assessing a patient who is the victim. The patient has minor scrapes and bruises, and tells the nurse, "I've never been so scared in my life!" What other symptoms would the nurse expect to find related to the fight-or-flight response to stress? Select all that apply. A) Increased heart rate B) Decreased muscle strength C) Increased mental alertness D) Increased blood glucose levels E) Decreased cardiac output F) Decreased peristalsis

A) Increased heart rate C) Increased mental alertness D) Increased blood glucose levels The sympathetic nervous system functions under stress to bring about the fight-or-flight response by increasing the heart rate, increasing muscle strength, increasing cardiac output, increasing blood glucose levels, and increasing mental alertness. Increased peristalsis is brought on by the parasympathetic nervous system under normal conditions and at rest.

A nurse decides to become a home health care nurse. Which personal qualities are key to being successful as a community-based nurse? Select all that apply. A) Making accurate assessments B) Researching new treatments for chronic diseases C) Communicating effectively D) Delegating tasks appropriately E) Performing clinical skills effectively F) Making independent decisions

A) Making accurate assessments C) Communicating effectively E) Performing clinical skills effectively F) Making independent decisions Nurses working in the community must have the knowledge and skills to make accurate assessments, work independently, communicate effectively, and perform clinical skills accurately. Community-based nurses may be researchers and occasionally delegate care, but these are not key qualities for this type of nursing.

A nurse is caring for an older adult in a long-term care facility who has a spinal cord injury affecting his neurologic reflex arc. Based on the patient's condition, what would be a priority intervention for this patient? A) Monitoring food and drink temperatures to prevent burns B) Providing adequate pain relief measures to reduce stress C) Monitoring for depression related to social isolation D) Providing meals high in carbohydrates to promote healing

A) Monitoring food and drink temperatures to prevent burns A patient with a damaged neurologic reflex arc would have a diminished pain reflex response, which would put the patient at risk for burns as the sensors in the skin would not detect the heat of the food or liquids. All patients should be provided adequate pain relief, but this is not the priority intervention in this patient. Monitoring for depression would be an intervention for this patient but is not related to the damaged neurologic reflex arc. A patient who is immobile should eat a balanced diet based on the Dietary Guidelines for Americans from the U.S. Department of Health and Human Services and U.S. Department of Agriculture.

After having an abortion, a patient tells the visiting nurse, "I shouldn't have had that abortion because I'm Catholic, but what else could I do? I'm afraid I'll never get close to my mother or back in the Church again." She then talks with her priest about this feeling of guilt. Which evaluation statement shows a solution to the problem? A) Patient states, "I wish I had talked with the priest sooner. I now know God has forgiven me, and even my mother understands." B) Patient has slept from 10 PM to 6 AM for three consecutive nights without medication. C) Patient has developed mutually caring relationships with two women and one man. D) Patient has identified several spiritual beliefs that give purpose to her life.

A) Patient states, "I wish I had talked with the priest sooner. I now know God has forgiven me, and even my mother understands." Because this patient's nursing diagnosis is Spiritual Distress: Guilt, an evaluative statement that demonstrates diminished guilt is necessary. Only answer a directly deals with guilt.

A patient who has been in the United States only 3 months has recently suffered the loss of her husband and job. She states that nothing feels familiar—"I don't know who I am supposed to be here"—and says that she "misses home terribly." For what alteration in self-concept is this patient most at risk? A) Personal Identity Disturbance B) Body Image Disturbance C) Self-Esteem Disturbance D) Altered Role Performance

A) Personal Identity Disturbance An unfamiliar culture, coupled with traumatic life events and loss of husband and job, result in this patient's total loss of her sense of self: "I don't know who I am supposed to be here." Her very sense of identity is at stake, not merely her body image, self-esteem, or role performance.

Nurses provide care to patients as collaborative members of the health care team. Which roles may be performed by the advanced practice registered nurse? Select all that apply. A) Primary care provider B) Hospitalist C) Physical therapist D) Anesthetist E) Midwife F) Pharmacist

A) Primary care provider D) Anesthetist E) Midwife The Advanced Practice Registered Nurse (APRN) is a registered nurse educated at the master's or post-master's level in a specific role and for a specific population. Whether they are nurse practitioners, clinical nurse specialists, nurse anesthetists, or nurse midwives, APRNs play a pivotal role in the future of health care. APRNs are often primary care providers and are at the forefront of providing preventive care to the public. Hospitalists are health care providers who provide care to patients when they visit the emergency department or are admitted to the hospital. A physical therapist completes a specific training program to learn to help patients restore function or to prevent further disability in a patient after an injury or illness. A pharmacist, prepared at the doctoral level, is licensed to formulate and dispense medications.

A certified nurse midwife is teaching a pregnant woman techniques to reduce the pain of childbirth. Which stress reduction activities would be most effective? Select all that apply. A) Progressive muscle relaxation B) Meditation C) Anticipatory socialization D) Biofeedback E) Rhythmic breathing F) Guided imagery

A) Progressive muscle relaxation B) Meditation E) Rhythmic breathing F) Guided imagery Relaxation techniques are useful in many situations, including childbirth, and consist of rhythmic breathing and progressive muscle relaxation. Meditation and guided imagery could also be used to distract a patient from the pain of childbirth. Anticipatory socialization helps to prepare people for roles they don't have yet, but aspire to, such as parenthood. Biofeedback is a method of gaining mental control of the autonomic nervous system and thus regulating body responses, such as blood pressure, heart rate, and headaches.

A patient is being transferred from the ICU to a regular hospital room. What must the ICU nurse be prepared to do as part of this transfer? A) Provide a verbal report to the nurse on the new unit. B) Provide a detailed written report to the unit secretary. C) Delegate the responsibility for providing information. D) Make a copy of the patient's medical record.

A) Provide a verbal report to the nurse on the new unit. The ICU nurse gives a verbal report on the patient's condition and nursing care needs to the nurse on the new unit. This information is not given to a unit secretary, nor is its provision delegated to others. The medical record is transferred with the patient; a copy is not made.

A nurse is counseling a husband and wife who have decided that the wife will get a job so that the husband can go to pharmacy school. Their three teenagers, who were involved in the decision, are also getting jobs to buy their own clothes. The husband, who plans to work 12 to 16 hours weekly, while attending school, states, "I was always an A student, but I may have to settle for Bs now because I don't want to neglect my family." How would the nurse document the husband's self-expectations? A) Realistic and positively motivating his development B) Unrealistic and negatively motivating his development C) Unrealistic but positively motivating his development D) Realistic but negatively motivating his development

A) Realistic and positively motivating his development a. The patient's self-expectations are realistic, given his multiple commitments, and seem to be positively motivating his development.

A nurse performing a spiritual assessment collects assessment data from a patient who is homebound and unable to participate in religious activities. Which type of spiritual distress is this patient most likely experiencing? A) Spiritual Alienation B) Spiritual Despair C) Spiritual Anxiety D) Spiritual Pain

A) Spiritual Alienation Spiritual Alienation occurs when there is a "separation from the faith community." Spiritual Despair occurs when the patient is feeling that no one (not even God) cares. Spiritual Anxiety is manifested by a challenged belief and value system, and Spiritual Pain may occur when a patient is unable to accept the death of a loved one.

A nurse is counseling parents attending a parent workshop on how to build self-esteem in their children. Which teaching points would the nurse include to help parents achieve this goal? Select all that apply. A) Teach the parents to reinforce their child's positive qualities. B) Teach the parents to overlook occasional negative behavior. C) Teach parents to ignore neutral behavior that is a matter of personal preference. D) Teach parents to listen and "fix things" for their children. E) Teach parents to describe the child's behavior and judge it. F) Teach parents to let their children practice skills and make it safe to fail.

A) Teach the parents to reinforce their child's positive qualities. C) Teach parents to ignore neutral behavior that is a matter of personal preference. F) Teach parents to let their children practice skills and make it safe to fail. a, c, f. The nurse should include the following teaching points for parents: (1) reinforce their child's positive qualities; (2) address negative qualities constructively; (3) ignore neutral behavior that is a matter of taste, preference, or personal style; (4) don't feel they have to "fix things" for their children; (5) describe the child's behavior in a nonjudgmental manner; and (6) let their child know what to expect, practice the necessary skills, be patient, and make it safe to fail.

A nurse who is newly hired to manage a busy pediatric office is encouraged to use a transactional leadership style when dealing with subordinates. Which activities best exemplify the use of this type of leadership? Select all that apply. A) The manager institutes a reward program for employees who meet goals and work deadlines. B) The manager encourages the other nurses to participate in health care reform by joining nursing organizations. C) The manager promotes compliance by reminding subordinates that they have a good salary and working conditions. D) The manager makes sure all the employees are kept abreast of new developments in pediatric nursing. E) The manager works with subordinates to accomplish all the nursing tasks and goals for the day. F) The manager allows the other nurses to set their own schedules and perform nursing care as they see fit.

A) The manager institutes a reward program for employees who meet goals and work deadlines. C) The manager promotes compliance by reminding subordinates that they have a good salary and working conditions. Instituting a reward program and reminding workers that they have a good salary and working conditions are examples of transactional leadership, which is based on a task-and-reward orientation. Team members agree to a satisfactory salary and working conditions in exchange for commitment and compliance to their leader. Encouraging nurses to participate in health care reform is an example of a transformational leadership style. Ensuring that employees keep abreast of new developments in nursing care is a characteristic of quantum leadership. The group and leader work together to accomplish mutually set goals and outcomes with the democratic leadership style, and the laissez-faire style encourages independent activity by group members, such as setting their own schedules and work activities.

A nurse is caring for a patient who has crippling rheumatoid arthritis. Which nursing intervention best represents the use of integrative care? A) The nurse administers naproxen and uses guided imagery to take the patient's mind off the pain. B) The nurse prepares the patient's health care provider-approved herbal tea and uses meditation to relax the patient prior to bed. C) The nurse administers naproxen and performs prescribed range-of-motion exercises. D) The nurse arranges for acupuncture for the patient and designs a menu high in omega-3 fatty acids.

A) The nurse administers naproxen and uses guided imagery to take the patient's mind off the pain. Adding guided imagery (CHA) to the administration of pain medications (allopathy) is an example of integrative care. A person who uses integrative care uses some combination of allopathic medicine and CHA.

A nurse is using time management techniques when planning activities for patients. Which nursing action reflects effective time management? A) The nurse asks patients to prioritize what they want to accomplish each day B) The nurse includes a "nice to do" for every "need to do" task on the list C) The nurse "front loads" the schedule with "must do" priorities D) The nurse avoids helping other nurses if scheduling does not permit it

A) The nurse asks patients to prioritize what they want to accomplish each day By asking the patient to prioritize what they want to accomplish each day, the nurse is demonstrating an effective time management technique. In order to manage time, the nurse should establish goals and priorities for each day, differentiating "need to do" from "nice to do" tasks; the nurse should include the patient in this process. The nurse should also establish a time line, allocating priorities to hours in the workday in order to keep track of falling behind and correct the problem before the day is lost. The nurse should use teamwork appropriately to enhance the schedule.

A nurse is caring for patients admitted to a long-term care facility. Which nursing actions are appropriate based on the religious beliefs of the individual patients? Select all that apply. A) The nurse dietitian asks a Buddhist if he has any diet restrictions related to the observance of holy days. B) A nurse asks a Christian Scientist who is in traction if she would like to try nonpharmacologic pain measures. C) A nurse administering medications to a Muslim patient avoids touching the patient's lips D) A nurse asks a Roman Catholic woman if she would like to attend the local Mass on Sunday. E) The nurse is careful not to schedule treatment and procedures on Saturday for a Hindu patient. F) The nurse consults with the medicine man of a Native American patient and incorporates his suggestions into the care plan.

A) The nurse dietitian asks a Buddhist if he has any diet restrictions related to the observance of holy days. B) A nurse asks a Christian Scientist who is in traction if she would like to try nonpharmacologic pain measures. D) A nurse asks a Roman Catholic woman if she would like to attend the local Mass on Sunday. F) The nurse consults with the medicine man of a Native American patient and incorporates his suggestions into the care plan. The nurse dietitian should ask a Buddhist if he has any diet restrictions related to the observance of holy days. Since Catholic Scientists avoid the use of pain medications, the nurse should ask a Christian Scientist who is in traction if she would like to try nonpharmacologic pain measures. A nurse administering medications to a Hindu woman avoids touching the patient's lips. A nurse should ask a Roman Catholic woman if she would like to attend the local Mass on Sunday. The nurse is careful not to schedule treatment and procedures on Saturday for a Jewish patient due to observance of the Sabbath. The nurse would appropriately consult with the medicine man of a Native American patient and incorporates his or her suggestions into the care plan.

A nurse is performing patient care for a severely ill patient who has cancer. Which nursing interventions are likely to assist this patient to maintain a positive sense of self? Select all that apply. A) The nurse makes a point to address the patient by name upon entering the room. B) The nurse avoids fatiguing the patient by performing all procedures in silence. C) The nurse performs care in a manner that respects the patient's privacy and sensibilities. D) The nurse offers the patient a simple explanation before moving her in any way. E) The nurse ignores negative feelings from the patient since they are part of the grieving process. F) The nurse avoids conversing with the patient about her life, family, and occupation.

A) The nurse makes a point to address the patient by name upon entering the room. C) The nurse performs care in a manner that respects the patient's privacy and sensibilities. D) The nurse offers the patient a simple explanation before moving her in any way. When assisting the patient to maintain a positive sense of self, the nurse should address the patient by name when entering the room; perform care in a manner that respects the patient's privacy; offer a simple explanation before moving the patient's body in any way; acknowledge the patient's status, role, and individuality; and converse with the patient about the patient's life experiences.

A nurse is a servant leader working in an economically depressed community to set up a free mobile health clinic for the residents. Which actions by the leader BEST exemplify a key practice of servant leaders? Select all that apply A) The nurse motivates coworkers to solicit funding to set up the clinic. B) The nurse sets only realistic goals that are present oriented and easily achieved. C) The nurse forms an autocratic governing body to keep the project on track. D) The nurse spends time with supporters to help them grow in their roles. E) The nurse first ensures that other's lowest priority needs are served. F) The nurse prizes leadership because of the need to serve others.

A) The nurse motivates coworkers to solicit funding to set up the clinic. D) The nurse spends time with supporters to help them grow in their roles. F) The nurse prizes leadership because of the need to serve others. In order to serve as servant leaders, nurses need to invest in those who support the organization's values, show passion, can play to their strengths, and demonstrate a positive attitude. They should develop their vision to see the future related to a current anticipated need, and motivate others to follow and engage. They also need to provide ongoing opportunities for collaborations, sharing, reflection, encouragement, and celebration, as well as hard work. The servant leader allows others to have a voice, to exercise control, and to practice leading themselves. The servant first makes sure that other people's highest priority needs are being served. The best test, and most difficult to administer, is: Do those served grow as people? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?

A nurse is teaching a patient a relaxation technique. Which statement demonstrates the need for additional teaching? A) "I must breathe in and out in rhythm." B) "I should take my pulse and expect it to be faster." C) "I can expect my muscles to feel less tense." D) "I will be more relaxed and less aware."

B) "I should take my pulse and expect it to be faster." No matter what the technique, relaxation involves rhythmic breathing, a slower (not a faster) pulse, reduced muscle tension, and an altered state of consciousness.

At a follow-up visit, a patient recovering from a myocardial infarction tells the nurse: "I feel like my life is out of control ever since I had the heart attack. I would like to sign up for yoga, but I don't think I'm strong enough to hold poses for long." What would be the nurse's best response? A) "Right now you should concentrate on relaxing and taking your blood pressure medicine regularly, instead of worrying about doing yoga." B) "There is a slower-paced yoga called Kripalu that focuses on coming into balance and relaxation that you could look into." C) "Ashtanga yoga is a gentle paced yoga that would help with your breathing and blood pressure." D) "Yoga is contraindicated for patients who have had a heart attack."

B) "There is a slower-paced yoga called Kripalu that focuses on coming into balance and relaxation that you could look into." Kripalu, or "gentle yoga," focuses on relaxation and coming into balance. Ashtanga focuses on synchronizing breath with a fast-paced series of postures. The nurse should not discourage the use of yoga in patients who are healthy enough to participate. Yoga is not contraindicated in patients with controlled high blood pressure.

Which statement or question MOST exemplifies the role of the nurse in establishing a discharge plan for a patient who has had major abdominal surgery? A) "I'll bet you will be so glad to be home in your own bed." B) "What are your expectations for recovery from your surgery?" C) "Be sure to take your pain medications and change your dressing." D) "You will just be fine! Please stop worrying."

B) "What are your expectations for recovery from your surgery?" The purpose of planning for continuity of care, commonly referred to in hospitals and community facilities as discharge planning, is to ensure that patient and family needs are consistently met as the patient moves from a care setting to home. Essential components of discharge planning include assessing the strengths and limitations of the patient, the family or support person, and the environment; implementing and coordinating the care plan; considering individual, family, and community resources; and evaluating the effectiveness of care. Answers a and c are not MOST reflective of the role of the nurse in discharge planning, although teaching and communication are elements of this process. The statement "You will just be fine! Please stop worrying." is a cliché and should not be used.

A nurse is providing health care to patients in a health care facility. Which of these patients are receiving secondary health care? Select all that apply. A) A patient enters a community clinic with signs of strep throat. B) A patient is admitted to the hospital following a myocardial infarction. C) A mother brings her son to the emergency department following a seizure. D) A patient with osteogenesis imperfecta is being treated in a medical center. E) A mother brings her son to a specialist to correct a congenital heart defect. F) A woman has a hernia repair in an ambulatory care center.

B) A patient is admitted to the hospital following a myocardial infarction. C) A mother brings her son to the emergency department following a seizure. F) A woman has a hernia repair in an ambulatory care center. Secondary health care treats problems that require specialized clinical expertise, such as an MI, a seizure, and a hernia repair. Treating strep throat is primary health care. Tertiary health care involves management of rare and complex disorders, such as osteogenesis imperfecta and congenital heart malformations.

A nurse working in a long-term care facility incorporates aromatherapy into her practice. For which patient would this nurse use the herb ginger? A) A patient who has insomnia B) A patient who has nausea C) A patient who has dementia D) A patient who has migraine headaches

B) A patient who has nausea Commonly used essential oils in a health care setting are ginger or peppermint for nausea and lavender or chamomile for insomnia.

A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish and the nurse speaks only English. What is the appropriate nursing intervention? A) Use short words and talk more loudly. B) Ask an interpreter for help. C) Explain why care can't be provided. D) Provide instructions in writing.

B) Ask an interpreter for help. The nurse should ask an interpreter for help. Many facilities have a qualified interpreter who understands the health care system and can reliably provide assistance. Using short words, talking loudly, and providing instructions in writing will not help the nurse communicate with this patient. Explaining why care can't be provided is not an acceptable choice because the nurse is required to provide care; also, since the patient doesn't speak English, she won't understand what the nurse is saying.

A nurse who is comfortable with spirituality is caring for patients who need spiritual counseling. Which nursing action would be most appropriate for these patients? A) Calling the patient's own spiritual adviser first B) Asking whether the patient has a spiritual adviser the patient wishes to consult C) Attempting to counsel the patient and, if unsuccessful, making a referral to a spiritual adviser D) Advising the patient and spiritual adviser concerning health options and the best choices for the patient

B) Asking whether the patient has a spiritual adviser the patient wishes to consult Even when a nurse feels comfortable discussing spiritual concerns, the nurse should always check first with patients to determine whether they have a spiritual adviser they would like to consult. Calling the patient's own spiritual adviser may be premature if it is a matter the nurse can handle. The other two options deny patients the right to speak privately with their spiritual adviser from the outset, if this is what they prefer.

A college freshman away from home for the first time says to a counselor, "Why did I have to be born into a family of big bottoms and short fat legs! No one will ever ask me out for a date. Oh, why can't I have long thin legs like everyone else in my class? What a frump I am." What type of disturbance in self-concept is this patient experiencing? A) Personal Identity Disturbance B) Body Image Disturbance C) Self-Esteem Disturbance D) Altered Role Performance

B) Body Image Disturbance This patient's concern is with body image. The information provided does not suggest a nursing diagnosis of Personal Identity Disturbance, Self-Esteem Disturbance, or Altered Role Performance.

A nurse asks a 25-year-old patient to describe himself with a list of 20 words. After 15 minutes, the patient listed "25 years old, male, named Joe," then declared he couldn't think of anything else. What should the nurse document regarding this patient? A) Lack of self-esteem B) Deficient self-knowledge C) Unrealistic self-expectation D) Inability to evaluate himself

B) Deficient self-knowledge The patient's inability to list more than three items about himself indicates deficient self-knowledge. There are not enough data provided to determine whether he lacks self-esteem, has unrealistic self-expectations, or is unable to evaluate himself.

A nurse is interviewing a patient who just received a diagnosis of pancreatic cancer. The patient tells the nurse "I would never be the type to get cancer; this must be a mistake." Which defense mechanism is this patient demonstrating? A) Projection B) Denial C) Displacement D) Repression

B) Denial Denial occurs when a person refuses to acknowledge the presence of a condition that is disturbing, in this case receiving a diagnosis of pancreatic cancer. Projection involves attributing thoughts or impulses to someone else. Displacement occurs when a person transfers an emotional reaction from one object or person to another object or person. Repression is used by a person to voluntarily exclude an anxiety-producing event from conscious awareness. In the case described in question 9, the patient is not blocking out the fact that the diagnosis was made, the patient is refusing to believe it.

A nurse who is a discharge planner in a large metropolitan hospital is preparing a discharge plan for a patient after a kidney transplant. Which actions would this nurse typically perform to ensure continuity of care as the patient moves from acute care to home care? Select all that apply. A) Performing an admission health assessment B) Evaluating the nursing plan for effectiveness of care C) Participating in the transfer of the patient to the postoperative care unit D) Making referrals to appropriate facilities E) Maintaining records of patient satisfaction with services F) Assessing the strengths and limitations of the patient and family

B) Evaluating the nursing plan for effectiveness of care D) Making referrals to appropriate facilities F) Assessing the strengths and limitations of the patient and family The primary roles of the discharge planner as patients move from acute to home care are evaluating the nursing plan for effectiveness of care, making referrals for patients, and assessing the strengths of patients and their families. Although in smaller facilities a discharge planner may perform an admission health assessment and assist with patient transfers, it is not the usual job of the discharge planner. In most facilities, maintaining records of patient satisfaction is the role of the public relations manager or office manager.

A nurse manager who is attempting to institute the SBAR process to communicate with health care providers and transfer patient information to other nurses is meeting staff resistance to the change. Which action would be most effective in approaching this resistance? A) Containing the anxiety in a small group and moving forward with the initiative B) Explaining the change and listing the advantages to the person and the organization C) Reprimanding those who oppose the new initiative and praising those who willingly accept the change D) Introducing the change quickly and involving the staff in the implementation of the change

B) Explaining the change and listing the advantages to the person and the organization Change is ubiquitous, as is resistance to change. The manager should explain the proposed change to all affected, list the advantages of the proposed change for all parties, introduce the change gradually, and involve everyone affected by the change in the design and implementation of the process. The manager should not use the reward/punishment style to overcome resistance to change.

A nurse working in a pediatric clinic provides codes for a patient's services to a third-party payer who pays all or most of the care. This is an example of what mode of health care payment? A) Out-of-pocket payment B) Individual private insurance C) Employer-based group private insurance D) Government financing

B) Individual private insurance The four basic modes of paying for health care are out-of-pocket payment, individual private insurance, employer-based group private insurance, and government financing. With individual private insurance, members pay monthly premiums either by themselves or in combination with employer payments. These plans are called third-party payers because the insurance company pays all or most of the cost of care. Out-of-pocket payment is paying for health care with cash payments. Employer-based private insurance is employer-sponsored coverage and government financing is provided through Medicare and Medicaid, and other federally funded programs.

A nurse is caring for patients in a primary care center. What is the most likely role of this nurse based on the setting? A) Assisting with major surgery B) Performing a health assessment C) Maintaining patients' function and independence D) Keeping student immunization records up to date

B) Performing a health assessment Performing patient health assessments is a common role of the nurse in a primary care center. Assisting with major surgery is a role of the nurse in the hospital setting. Maintaining patients' function and independence is a role of the nurse in an extended-care facility, and keeping student immunization records up to date is a role of the school nurse.

A new nurse manager at a small hospital is interested in achieving Magnet status. Which action would help the hospital to achieve this goal? A) Centralizing the decision-making process B) Promoting self-governance at the unit level C) Deterring professional autonomy to promote teamwork D) Promoting evidence-based practice over innovative nursing practice

B) Promoting self-governance at the unit level Magnet hospitals use a decentralized decision-making process, self-governance at the unit level, and respect for and acknowledgment of professional autonomy. In Magnet hospitals, 14 characteristics, the Forces of Magnetism, have been recognized that identify quality patient care, excellent nursing care, and innovations in professional nursing practice.

A nurse works for a health care provider who practices the naturopathic system of medicine. What is the focus of nursing actions based on this type of medical practice? Select all that apply. A) Treating the symptoms of the disease B) Providing patient education C) Focusing on treating individual body systems D) Making appropriate interventions to prevent illness E) Believing in the healing power of nature F) Encouraging patients to take responsibility for their own health

B) Providing patient education D) Making appropriate interventions to prevent illness E) Believing in the healing power of nature F) Encouraging patients to take responsibility for their own health Naturopathic medicine is not only a system of medicine, but also a way of life, with emphasis on patient responsibility, patient education, health maintenance, and disease prevention. Its principles include minimizing harmful side effects and avoiding suppression of symptoms, educating patients and encouraging them to take responsibility for their own health, treating the whole person, preventing illness, believing in the healing power of nature, and treating the cause of a disease or condition rather than its symptoms.

A charge nurse in a busy hospital manages a skilled nursing unit using an autocratic style of leadership. Which leadership tasks BEST represent this style of leadership? Select all that apply. A) The charge nurse polls the other nurses for input on nursing protocols. B) The charge nurse dictates break schedules for the other nurses. C) The charge nurse schedules a mandatory in-service training on new equipment. D) The charge nurse allows the other nurses to divide up nursing tasks. E) The charge nurse delegates nursing responsibilities to the staff. F) The charge nurse encourages the nurses to work independently.

B) The charge nurse dictates break schedules for the other nurses. C) The charge nurse schedules a mandatory in-service training on new equipment. E) The charge nurse delegates nursing responsibilities to the staff. Autocratic leadership involves the leader assuming control over the decisions and activities of the group, such as dictating schedules and work responsibilities, and scheduling mandatory in-service training. Polling other nurses is an example of democratic leadership, which is characterized by a sense of equality among the leader and other participants, with decisions and activities being shared. In laissez-faire leadership, the leader relinquishes power to the group and encourages independent activity by group members. Examples of laissez-faire leadership style are allowing the nurses to divide up the tasks and encouraging them to work independently.

A 16-year-old patient has been diagnosed with Body Image Disturbance related to severe acne. In planning nursing care, what is an appropriate goal for this patient? A) The patient will make above-B grades in all tests at school. B) The patient will demonstrate, by diet control and skin care, increased interest in control of acne. C) The patient reports that she feels more self-confident in her music and art, which she enjoys. D) The patient expresses that she is very smart in school.

B) The patient will demonstrate, by diet control and skin care, increased interest in control of acne. All of these patient goals may be appropriate for the patient, but the only goal that directly addresses her body image disturbance is "the patient will demonstrate by diet control and skin care, increased interest in control of acne."

A school nurse is teaching parents how to foster a healthy development of self in their children. Which statement made by one of the parents needs to be followed up with further teaching? A) "I love my child so much I 'hug him to death' every day." B) "I think children need challenges, don't you?" C) "My husband and I both grew up in very restrictive families. We want our children to be free to do whatever they want." D) "My husband and I have different ideas about discipline, but we're talking this out because we know it's important for Johnny that we be consistent."

C) "My husband and I both grew up in very restrictive families. We want our children to be free to do whatever they want." Each option with the exception of c correctly addresses some aspect of fostering healthy development in children. Because children need effective structure and development, giving them total freedom to do as they please may actually hinder their development.

A nurse is interviewing a newly admitted patient. Which question is considered culturally sensitive? A) "Do you think you will be able to eat the food we have here?" B) "Do you understand that we can't prepare special meals?" C) "What types of food do you eat for meals?" D) "Why can't you just eat our food while you are here?"

C) "What types of food do you eat for meals?" Asking patients what types of foods they eat for meals is culturally sensitive. The other questions are culturally insensitive.

A nurse working in an emergency department assesses how patients' religious beliefs affect their treatment plan. With which patient would the nurse be most likely to encounter resistance to emergency lifesaving surgery? A) A patient of the Adventist faith B) A patient who practices Buddhism C) A patient who is a Jehovah's Witness D) A patient who is an Orthodox Jew

C) A patient who is a Jehovah's Witness Patients who practice the Jehovah's Witness faith believe blood transfusions violate God's laws and do not allow them. The other religious groups do not restrict modern lifesaving treatment for their members.

A nurse is assessing the developmental levels of patients in a pediatric office. Which person would a nurse document as experiencing developmental stress? A) An infant who learns to turn over B) A school-aged child who learns how to add and subtract C) An adolescent who is a "loner" D) A young adult who has a variety of friends

C) An adolescent who is a "loner" The adolescent who is a loner is not meeting a major task (being a part of a peer group) for that level of growth and development.

A nurse is performing an assessment of a woman who is 8 months pregnant. The woman states, "I worry all the time about being able to handle becoming a mother." Which nursing diagnosis would be most appropriate for this patient? A) Ineffective Coping related to the new parenting role B) Ineffective Denial related to ability to care for a newborn C) Anxiety related to change in role status D) Situational Low Self-Esteem related to fear of parenting

C) Anxiety related to change in role status The most appropriate nursing diagnosis is Anxiety, which indicates situational/maturational crises or changes in role status. Ineffective Coping refers to an inability to appraise stressors or use available resources. Ineffective Denial is a conscious or unconscious attempt to disavow the knowledge or meaning of an event to reduce anxiety, and leads to detriment of health. Situational Low Self-Esteem refers to feelings of worthlessness related to the situation the person is currently experiencing, not to the fear of role changes.

A hospice nurse is caring for a patient who is dying of pancreatic cancer. The patient tells the nurse "I feel no connection to God" and "I'm worried that I find no real meaning in life." What would be the nurse's best response to this patient? A) Give the patient a hug and tell him that his life still has meaning. B) Arrange for a spiritual adviser to visit the patient. C) Ask if the patient would like to talk about his feelings. D) Call in a close friend or relative to talk to the patient.

C) Ask if the patient would like to talk about his feelings. When caring for a patient who is in spiritual distress, the nurse should listen to the patient first and then ask whether the patient would like to visit with a spiritual adviser. To arrange for a spiritual adviser first may not respect the wishes of the patient. A hug and false reassurances do not address the diagnosis of spiritual distress. Talking to friends or relatives may be helpful, but only if the patient desires their visits.

Mr. Brown's teenage daughter had been involved in shoplifting. He expresses much anger toward her and states he cannot face her, let alone discuss this with her: "I just will not tolerate a thief." Which nursing intervention would the nurse take to assist Mr. Brown with his deficit in forgiveness? A) Assure Mr. Brown that many parents feel the same way. B) Reassure Mr. Brown that many teenagers go through this kind of rebellion and that it will pass. C) Assist Mr. Brown to identify how unforgiving feelings toward others hurt the person who cannot forgive. D) Ask Mr. Brown if he is sure he has spent sufficient time with his daughter.

C) Assist Mr. Brown to identify how unforgiving feelings toward others hurt the person who cannot forgive. Helping Mr. Brown identify how his unforgiving feelings may be harmful to him is the only nursing intervention that directly addresses his unmet spiritual need concerning forgiveness. Assuring Mr. Brown that many parents would feel the same way or that many teenagers shoplift out of rebelliousness may make him feel better initially, but neither option addresses his need to forgive. Suggesting that Mr. Brown may not have spent enough time with his daughter is likely to make him feel guilty.

A mother of a 10-year-old daughter tells the nurse: "I feel incompetent as a parent and don't know how to discipline my daughter." What should be the nurse's first intervention when counseling this patient? A) Recommend that she discipline her daughter more strictly and consistently. B) Make a list of things her husband can do to give her more time and help her improve her parenting skills. C) Assist the mother to identify both what she believes is preventing her success and what she can do to improve. D) Explore with the mother what the daughter can do to improve her behavior and make the mother's role as a parent easier.

C) Assist the mother to identify both what she believes is preventing her success and what she can do to improve. The first intervention priority with a mother who feels incompetent to parent a daughter is to assist the mother to identify what is preventing her from being an effective parent and then to explore solutions aimed at improving her parenting skills. The other interventions may prove helpful, but they do not directly address the mother's problem with her feelings of incompetence.

A home health care nurse is scheduled to visit a 38-year-old woman who has been discharged from the hospital with a new colostomy. Which duties would the nurse perform for this patient in the entry phase of the home visit? Select all that apply. A) Collect information about the patient's diagnosis, surgery, and treatments. B) Call the patient to make initial contact and schedule a visit. C) Develop rapport with the patient and her family. D) Assess the patient to identify her needs. E) Assess the physical environment of the home. F) Evaluate safety issues including the neighborhood in which she lives.

C) Develop rapport with the patient and her family. D) Assess the patient to identify her needs. E) Assess the physical environment of the home. In the entry phase of the home visit, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes, plans and implements prescribed care, and provides teaching. In the pre-entry phase of the home visit, the nurse collects information about the patient's diagnoses, surgical experience, socioeconomic status, and treatment orders. In the pre-entry phase, the nurse also gathers supplies needed, makes an initial phone contact with the patient to arrange for a visit, and assesses the patient's environment for safety issues.

An RN on a surgical unit is behind schedule administering medications. Which of the RN's other tasks can be safely delegated to a UAP? A) The assessment of a patient who has just arrived on the unit B) Teaching a patient with newly diagnosed diabetes about foot care C) Documentation of a patient's I & O on the flow chart D) Helping a patient who has recently undergone surgery out of bed for the first time

C) Documentation of a patient's I & O on the flow chart Documenting a patient's I & O on a flow chart may be delegated to a UAP. Professional nurses are responsible for the initial patient assessment, discharge planning, health education, care planning, triage, interpretation of patient data, care of invasive lines, administering parenteral medications. What they can delegate are assistance with basic care activities (bathing, grooming, ambulation, feeding) and things like taking vital signs, measuring intake and output, weighing, simple dressing changes, transfers, and post mortem care.

A man who is a declared agnostic is extremely depressed after losing his home, his wife, and his children in a fire. His nursing diagnosis is Spiritual Distress: Spiritual Pain related to inability to find meaning and purpose in his current condition. What is the most important nursing intervention to plan? A) Ask the patient which spiritual adviser he would like you to call. B) Recommend that the patient read spiritual biographies or religious books. C) Explore with the patient what, in addition to his family, has given his life meaning and purpose in the past. D) Introduce the belief that God is a loving and personal God.

C) Explore with the patient what, in addition to his family, has given his life meaning and purpose in the past. The nursing intervention of exploring with the patient what, in addition to his family, has given his life meaning and purpose in the past is more likely to correct the etiology of his problem, Spiritual Pain, than any of the other nursing interventions listed.

A nurse cares for dying patients by providing physical, psychological, social, and spiritual care for the patients, their families, and other loved ones. What type of care is the nurse providing? A) Respite care B) Palliative care C) Hospice care D) Extended care

C) Hospice care The hospice nurse combines the skills of the home care nurse with the ability to provide daily emotional support to dying patients and their families. Respite care is a type of care provided for caregivers of homebound ill, disabled, or older adults. Palliative care, which can be used in conjunction with medical treatment and in all types of health care settings, is focused on the relief of physical, mental, and spiritual distress. Extended-care facilities include transitional subacute care, assisted-living facilities, intermediate and long-term care, homes for medically fragile children, retirement centers, and residential institutions for mentally and developmentally or physically disabled patients of all ages.

A nurse is performing spirituality assessments of patients living in a long-term care facility. What is the best question the nurse might use to assess for spiritual needs? S) Can you describe your usual spiritual practices and how you maintain them daily? B) Are your spiritual beliefs causing you any concern? C) How can I and the other nurses help you maintain your spiritual practices? D) How do your religious beliefs help you to feel at peace?

C) How can I and the other nurses help you maintain your spiritual practices? Questioning how the staff can meet patients' spiritual practices assesses spiritual needs. Asking the patient to describe spiritual practices assesses spiritual practices. Asking about concerns assesses spiritual distress, and asking about feeling at peace assesses the need for forgiveness.

A nurse who is caring for patients on a pediatric ward is assessing the children for their spiritual needs. Which is the most important source of learning for a child's own spirituality? A) The child's church or religious organization B) What parents say about God and religion C) How parents behave in relationship to one another, their children, others, and to God D) The spiritual adviser for the family

C) How parents behave in relationship to one another, their children, others, and to God Children learn most about their own spirituality from how their parents behave in relationship to one another, their children, others, and God (or a higher being). What parents say about God and religion, the family's spiritual advisor, and the child's church or religious organization are less important sources of learning.

A nurse is providing a lecture on CHAs to a group of patients in a rehabilitation facility. Which teaching point should the nurse include? A) CHAs are safe interventions used to supplement traditional care. B) Many patients use CHA as outpatients but do not wish to continue as inpatients. C) Many nurses are expanding their clinical practice by incorporating CHA to meet the demands of patients. D) Most complementary and alternative therapies are relatively new and their efficacy has not been established.

C) Many nurses are expanding their clinical practice by incorporating CHA to meet the demands of patients. Many nurses are expanding their clinical practice by incorporating CHA. Although CHA may seem totally safe, some therapies have led to harmful and, at times, lethal outcomes. Many patients use these types of therapies as outpatients and want to continue their use as inpatients. Although the use of most complementary and alternative therapies predates modern medicine, it was not until recently that nursing and medical schools began to teach about their use.

A nurse who was raised as a strict Roman Catholic but who is no longer a practicing Catholic stated she couldn't assist patients with their spiritual distress because she recognizes only a "field power" in each person. She said, "My parents and I hardly talk because I've deserted my faith. Sometimes I feel real isolated from them and also from God—if there is a God." Analysis of these data reveals which unmet spiritual need? A) Need for meaning and purpose B) Need for forgiveness C) Need for love and relatedness D) Need for strength for everyday living

C) Need for love and relatedness The data point to an unmet spiritual need to experience love and belonging, given the nurse's estrangement from her family and God after leaving the church. The other options may represent other needs this nurse has, but the data provided do not support them.

A nurse is performing a psychological assessment of a 19-year-old patient who has Down's syndrome. The patient is mildly developmentally disabled with an intelligence quotient of 82. He told his nurse, "I'm a good helper. You see I can carry these trays because I'm so strong. But I'm not very smart, so I have just learned to help with the things I know how to do." What findings for self-concept and self-esteem would the nurse document for this patient? A) Negative self-concept and low self-esteem B) Negative self-concept and high self-esteem C) Positive self-concept and fairly high self-esteem D) Positive self-concept and low self-esteem

C) Positive self-concept and fairly high self-esteem The data point to the patient having a positive self-concept ("I'm a good helper") and fairly high self-esteem (realizes his strengths and limitations). The statement "But I'm not very smart" is accurate and is not an indication of a negative self-concept.

A 33-year-old businessperson is in counseling, attempting to deal with a long-repressed history of sexual abuse by her father. "I guess I should feel satisfied with what I've achieved in life, but I'm never content, and nothing I achieve makes me feel good about myself.... I hate my father for making me feel like I'm no good. This is an awful way to live." What self-concept disturbance is this person experiencing? A) Personal Identity Disturbance B) Body Image Disturbance C) Self-Esteem Disturbance D) Altered Role Performance

C) Self-Esteem Disturbance This patient's self-concept disturbance is mainly one of devaluing herself and thinking that she is no good. This is a Self-Esteem Disturbance.

A nurse is guiding a patient in the practice of meditation. Which teaching point is most useful in helping the patient to achieve a state of calmness, physical relaxation, and psychological balance? A) Teach the patient to always lie down in a comfortable position during meditation. B) Teach the patient to focus on multiple problems that the patient feels demand attention. C) Teach the patient to let distractions come and go naturally without judging them. D) Teach the patient to suppress distracting or wandering thoughts to maintain focus.

C) Teach the patient to let distractions come and go naturally without judging them. Meditators should have an open attitude by letting distractions come and go naturally without judging them. They should also maintain a specific, comfortable posture lying down, sitting, standing, walking, etc.; focus attention on a mantra, object, or breathing; and not suppress distracting or wandering thoughts; instead they should gently bring attention back to focus.

A nurse caring for patients in a hospital setting uses anticipatory guidance to prepare them for painful procedures. Which nursing intervention is an example of this type of stress management? A) The nurse teaches a patient rhythmic breathing to perform prior to the procedure. B) The nurse tells a patient to focus on a pleasant place, mentally place himself in it, and breathe slowly in and out. C) The nurse teaches a patient about the pain involved in the procedure and describes methods to cope with it. D) The nurse teaches a patient to create and focus on a mental image during the procedure in order to be less responsive to the pain.

C) The nurse teaches a patient about the pain involved in the procedure and describes methods to cope with it. Anticipatory guidance focuses on psychologically preparing a person for an unfamiliar or painful event. When the patient know what to expect—for example, when the nurse tells the patient about the pain he or she should expect to experience during a procedure, and describes related pain relief measures—the patient's anxiety is reduced. Rhythmic breathing is a relaxation technique, focusing on a pleasant place and breathing slowly in and out is a meditation technique, and focusing on a mental image to reduce responses to stimuli is a guided imagery technique.

A nurse is preparing an infant and his family for a hernia repair to be performed in an ambulatory care facility. What is the primary role of the nurse during the admission process? A) To assist with screening tests B) To provide patient teaching C) To assess what has been done and what still needs to be done D) To assist with hernia repair

C) To assess what has been done and what still needs to be done Although all the actions may be performed by the ambulatory care nurse, it is the nurse's primary responsibility to assess what has been done and to tailor the care plan to the patient's needs. Screening tests and teaching are usually completed before the patient enters an ambulatory care facility.

A nurse is teaching a novice nurse how to provide care for patients in a culturally diverse community health clinic. Although all these actions are recommended, which one is MOST basic to providing culturally competent care? A) Learning the predominant language of the community B) Obtaining significant information about the community C) Treating each patient at the clinic as an individual D) Recognizing the importance of the patient's family

C) Treating each patient at the clinic as an individual In all aspects of nursing, it is important to treat each patient as an individual. This is also true in providing culturally competent care. This basic objective can be accomplished by learning the predominant language in the community, researching the patient's culture, and recognizing the influence of family on the patient's life.

A nurse interviews a patient who was abused by her partner and is staying at a shelter with her three children. She tells the nurse, "I'm so worried that my husband will find me and try to make me go back home." Which data would the nurse most appropriately document? A) "Patient displays moderate anxiety related to her situation." B) "Patient manifests panic related to feelings of impending doom." C) "Patient describes severe anxiety related to her situation." D) "Patient expresses fear of her husband."

D) "Patient expresses fear of her husband." Fear is a feeling of dread in response to a known threat. Anxiety, on the other hand, is a vague, uneasy feeling of discomfort or dread from an often unknown source. Panic causes a person to lose control and experience dread and terror, which can lead to exhaustion and death; that is not the case in this situation.

A sophomore in high school has missed a lot of school this year because of leukemia. He said he feels like he is falling behind in everything, and misses "hanging out at the mall" with his friends most of all. For what disturbance in self-concept is this patient at risk? A) Personal Identity Disturbance B) Body Image Disturbance C) Self-Esteem Disturbance D) Altered Role Performance

D) Altered Role Performance Important roles for this patient are being a student and a friend. His illness is preventing him from doing either of these well. This self-concept disturbance is basically one that concerns role performance.

A nurse is caring for a postoperative patient who is experiencing pain. Which CHA might the nurse use to ensure active participation by the patient to achieve effective pre- or postoperative pain control? A) Acupuncture B) TT C) Botanical supplements D) Guided imagery

D) Guided imagery Imagery involves using all five senses to imagine an event or body process unfolding according to a plan. A patient can be encouraged to "go to a favorite place." With the other modalities, the patient is more passive.

A nurse asks a patient who has few descriptors of his self to list facts, traits, or qualities that he would like to be descriptive of himself. The patient quickly lists 25 traits, all of which are characteristic of a successful man. When asked if he knows anyone like this, he replies, "My father; I wish I was like him." What does the discrepancy between the patient's description of himself as he is and as he would like to be indicate? A) Negative self-concept B) Modesty (lack of conceit) C) Body image disturbance D) Low self-esteem

D) Low self-esteem The nurse can obtain a quick indication of a patient's self-esteem by using a graphic description of self-esteem as the discrepancy between the "real self" (what we think we really are) and the "ideal self" (what we think we would like to be). The nurse would have the patient plot two points on a line—real self and ideal self (Fig. 41-5). The greater the discrepancy, the lower the self-esteem; the smaller the discrepancy, the higher the self-esteem.

A nurse is responsible for preparing patients for surgery in an ambulatory care center. Which technique for reducing anxiety would be most appropriate for these patients? A) Discouraging oververbalization of fears and anxieties B) Focusing on the outcome as opposed to the details of the surgery C) Providing time alone for reflection on personal strengths and weaknesses D) Mutually determining expected outcomes of the care plan

D) Mutually determining expected outcomes of the care plan Nurses preparing patients for surgery should mutually determine expected outcomes of the care, as well as encourage verbalizations of feelings, perceptions, and fears. The nurse should explain all procedures and sensations likely to be experienced during the procedures, and stay with the patient to promote safety and reduce fear.

The Roman Catholic family of a baby who was born with hydroencephalitis requests a baptism for their infant. Why is it imperative that the nurse provides for this baptism to be performed? A) Baptism frequently postpones or prevents death or suffering. B) It is legally required that nurses provide for this care when the family makes this request. C) It is a nursing function to assure the salvation of the baby. D) Not having a Baptism for the baby when desired may increase the family's sorrow and suffering.

D) Not having a Baptism for the baby when desired may increase the family's sorrow and suffering. Failure to ensure that an infant baptism is performed when parents desire it may greatly increase the family's sorrow and suffering, which is an appropriate nursing concern. Whether baptism postpones or prevents death and suffering is a religious belief that is insufficient to bind all nurses. There is no legal requirement regarding baptism, and although some nurses may believe part of their role is to ensure the salvation of the baby, this function would understandably be rejected by many.

A visiting nurse is performing a family assessment of a young couple caring for their newborn who was diagnosed with cerebral palsy. The nurse notes that the mother's hair and clothing are unkempt and the house is untidy, and the mother states that she is "so busy with the baby that I don't have time to do anything else." What would be the priority intervention for this family? A) Arrange to have the infant removed from the home. B) Inform other members of the family of the situation. C) Increase the number of visits by the visiting nurse. D) Notify the care provider and recommend respite care for the mother.

D) Notify the care provider and recommend respite care for the mother. A person providing care at home for a family member for long periods of time often experiences caregiver burden, which may be manifested by chronic fatigue, sleep disorders, and an increased incidence of stress-related illnesses, such as hypertension and heart disease. The nurse should address the issue with the primary care provider and recommend a visit from a social worker or arrange for respite care for the family. b. No matter what the technique, relaxation involves rhythmic breathing, a slower (not a faster) pulse, reduced muscle tension, and an altered state of consciousness.

A nurse is caring for patients of diverse cultures in a community health care facility. Which characteristics of cultural diversity that exist in the United States should the nurse consider when planning culturally competent care? Select all that apply. A) The United States has become less inclusive of same-sex couples. B) Cultural diversity is limited to people of varying cultures and races. C) Cultural diversity is separate and distinct from health and illness. D) People may be members of multiple cultural groups at one time. E) Culture guides what is acceptable behavior for people in a specific group. F) Cultural practices may evolve over time but mainly remain constant.

D) People may be members of multiple cultural groups at one time. E) Culture guides what is acceptable behavior for people in a specific group. F) Cultural practices may evolve over time but mainly remain constant. A person may be a member of multiple cultural, ethnic, and racial groups at one time. Culture guides what is acceptable behavior for people in a specific group. Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group's needs. The United States has become more (not less) inclusive of same-sex couples. The definition of cultural diversity includes, but is not limited to, people of varying cultures, racial and ethnic origin, religion, language, physical size, biological sex, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location. Cultural diversity, including culture, ethnicity, and race, is an integral component of both health and illness.

A hospital nurse is admitting a patient who sustained a head injury in a motor vehicle accident. Which activity could the nurse delegate to licensed assistive personnel? A) Collecting information for a health history B) Performing a physical assessment C) Contacting the health care provider for medical orders D) Preparing the bed and collecting needed supplies

D) Preparing the bed and collecting needed supplies The nurse may delegate preparation of the bed and collection of needed supplies to unlicensed personnel but would perform the other activities listed.

A nurse manager of a busy cardiac unit observes disagreements between the RNs and the LPNs related to schedules and nursing responsibilities. At a staff meeting, the manager compliments all the nurses on a job well done and points out that expected goals and outcomes for the month have been met. The nurse concludes the meeting without addressing the disagreements between the two groups of nurses. Which conflict resolution strategy is being employed by this manager? A) Collaborating B) Competing C) Compromising D) Smoothing

D) Smoothing The manager who resolves conflict by complimenting the parties involved and focusing on agreement rather than disagreement is using smoothing to reduce the emotion in the conflict. The original conflict is rarely resolved with this technique. Collaborating is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. Competing results in a win for one party at the expense of the other group. Compromising occurs when both parties relinquish something of equal value.

A nurse states, "That patient is 78 years old—too old to learn how to change a dressing." What is the nurse demonstrating? A) Cultural imposition B) Clustering C) Cultural competency D) Stereotyping

D) Stereotyping Stereotyping is assuming that all members of a group are alike. This is not an example of cultural competence nor is the nurse imposing her culture on the patient. Clustering is not an applicable concept.

A nurse is asked to act as a mentor to a new nurse. Which nursing action is related to this process? A) The nurse mentor accepts payment to introduce the new nurse to his or her responsibilities B) The nurse mentor hires the new nurse and assigns duties related to the position C) The nurse mentor makes it possible for the new nurse to participate in professional organizations D) The nurse mentor advises and assists the new nurse to adjust to the work environment of a busy emergency department

D) The nurse mentor advises and assists the new nurse to adjust to the work environment of a busy emergency department Mentorship is a relationship in which an experienced person (the mentor) advises and assists a less experienced person (protégé). This is an effective way of easing a new nurse into leadership responsibilities. An experienced nurse who is paid to introduce an employee to new responsibilities through teaching and guidance describes a preceptor, not a mentor. The nurse mentor does not hire or schedule new nurses. Nurses do not need mentors to join professional organizations.

A patient states she feels so isolated from her family and church, and even from God, "in this huge medical center so far from home." A nurse is preparing nursing goals for this patient. Which is the best goal for the patient to relieve her spiritual distress? A) The patient will express satisfaction with the compatibility of her spiritual beliefs and everyday living. B) The patient will identify spiritual beliefs that meet her need for meaning and purpose. C) The patient will express peaceful acceptance of limitations and failings. D) The patient will identify spiritual supports available to her in this medical center.

D) The patient will identify spiritual supports available to her in this medical center. Each of the four options represents an appropriate spiritual goal, but identifying spiritual supports available to this patient in the medical center demonstrates a goal to decrease her sense of isolation.

A nurse is counseling an older woman who has been hospitalized for dehydration secondary to a urinary tract infection. The patient tells the nurse: "I don't like being in the hospital. There are too many bad bugs in here. I'll probably go home sicker than I came in." She also insists that she is going to get dressed and go home. She has the capacity to make these decisions. What is the legal responsibility of the nurse in this situation? A) To inform the patient that only the primary health care provider can authorize discharge from a hospital B) To collect the patient's belongings and prepare the paperwork for the patient's discharge C) To request a psychiatric consult for the patient and inform her PCP of the results D) To explain that the choice carries a risk for increased complications and make sure that the patient has signed a release form

D) To explain that the choice carries a risk for increased complications and make sure that the patient has signed a release form The patient is legally free to leave the hospital AMA; however, patients who leave the hospital AMA must sign a form releasing the health care provider and hospital from legal responsibility for their health status. This signed form becomes part of the medical record.

A nurse manager is attempting to update a health care provider's office from paper to electronic health records (EHR) by using the eight-step process for planned change. Place the following actions in the order in which they should be initiated: A) The nurse devises a plan to switch to EHR. B) The nurse records the time spent on written records versus EHR. C) The nurse attains approval from management for new computers. D) The nurse analyzes all options for converting to EHR. E) The nurse installs new computers and provides an in-service for the staff. F) The nurse explores possible barriers to changing to EHR G) .The nurse follows up with the staff to check compliance with the new system. H) The nurse evaluates the effects of changing to EHR.

b, f, d, c, a, e, h, g. Planned change involves the following steps: (1) recognize symptoms that indicate a change is needed and collect data, (2) identify a problem to be solved through change, (3) determine and analyze alternative solutions, (4) select a course of action from possible solutions, (5) plan for making the change, (6) implement the change, (7) evaluate the change, and (8) stabilize the change.