Unit 6 Exam

Which acute medical event should the nurse identify as requiring self-management when planning care for a patient? a. Prenatal care b. Depression c. Diabetes d. Femur fracture

D A femur fracture is considered an acute medical event. Pregnancy is an expected and normal life event/condition. Depression and diabetes are considered disease states.

The nurse is reviewing the care plan for a patient experiencing difficulty coping with stress. Which action should the nurse implement to assist the patient? a. Identifying the cause of fear b. Accessing a community support group c. Identifying relaxation methods d. Reviewing an educational pamphlet

A Identifying the cause of a negative perception is the first step in helping an individual to be able to utilize coping strategies. Accessing a community support group is an example of accessing resources to enhance coping. Identifying relaxation methods is an example of developing an action plan. Reviewing an educational pamphlet is an example of using education to enhance coping.

A nurse and a student nurse are talking about healthcare coordination. Which statement should the nurse make about the subject? A. "Patients have needs beyond the healthcare system." B. "Patients should coordinate their own care." C. "Physicians are the only ones who coordinate care." D. "Community health nurses coordinate care for the patient."

A Many patients do have needs that go beyond what the healthcare system can offer, such as financial or social assistance. Patients do not have the healthcare knowledge to coordinate their care. Physicians and community health nurses are not the only ones involved in the coordination of health care.

A patient tells the nurse "My doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to learn a new way of thinking." Which response would be in keeping with the doctor's recommendations? a. Teaching the patient to recognize, reconsider, and reframe irrational thoughts b. Encouraging the patient to imagine being in calming circumstances c. Teaching the patient to use instruments that give feedback about bodily functions d. Provide the patient with a blank journal and guidance about journaling

A Meaning-focused coping leads the individual to focus on his/her own values and beliefs to modify the personal interpretation and response to a problem. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient's manner of thinking.

Which is one of the biggest challenges facing current nursing practice? a. The number of aging Americans living with chronic disease b. The number of patients entering into hospice programs c. The number of cancer patients receiving supportive care d. Reduced length of stay in hospice care

A Millions of Americans are living with one or more chronic debilitating diseases, and 7 out of 10 can expect to live with their diseases several years before dying. When coupled with the advancing age of the eight million baby boomers who now qualify for Medicare, this will soon create a huge demand on health-care resources and community-based services.

Mr. Walker is caring for his ailing wife, who was diagnosed with a terminal illness. Mr. Walker is talking with a nurse, and states, "I miss my old life. I don't see any of my friends anymore. Caring for my wife is much more difficult than I thought. I want things to be the way they used to be." Which emotional strain should the nurse realize that Mr. Walker is experiencing? A. Caregiver stress B. Remorse over being healthy C. Anger that his children are not helping D. Grief over losing his friends

A Mr. Walker is showing signs of caregiver stress because he expresses that he wants his situation to change. He is not remorseful about being healthy. No children are mentioned in the question. He has not lost his friends; he just does not see them any more.

After performing a screening assessment on a patient, which finding should be documented as a physiological stressor? A. Dementia B. Caregiving of parent C. Divorce D. Death of friend

A Physiological stressors have physical causes. Dementia is an example of a physiological stressor. Caregiving, divorce, and death of a friend are examples of psychological or emotional stressors.

A 20-year-old woman comes for preconceptual counseling. She wants to get pregnant soon. Which health-promoting habit would have the highest priority at this time? A. Immediate tobacco cessation B. Getting daily exercise C. Stopping all caffeine D. Avoidance of sweets

A Psychosocial factors affecting pregnancy include smoking, excessive use of caffeine, alcohol and drug abuse, psychological status including impaired mental health, an addictive lifestyle, spouse abuse, and noncompliance with cultural norms. Immediate tobacco cessation would be the highest priority because continued smoking could be teratogenic if the woman should become pregnant. Smoking causes vasoconstriction which restricts the amount of oxygen and nutrients to the rapidly growing fetus. Daily exercise promotes health but would not be the highest priority among these factors. Stopping caffeine and avoiding sweets are important and can be addressed after tobacco cessation.

The nurse is presenting an in-service on the importance of collaborative communication. The nurse includes which critical event identified by the Joint Commission as an outcome of poor communication among healthcare team members? a. The occurrence of a patient event resulting in death or serious injury b. Decreased ability to document expenses of care provided c. Longer time to begin surgical cases d. Increased time to discharge patients to outpatient care

A The Joint Commission has identified that poor communication is the primary factor in the occurrence of sentinel events, or events resulting in unintended death or serious injury to patients. Lack of documentation, longer time to begin surgery, and increased delays in discharge all contribute to the management of health care, but do not result in critical patient outcomes.

A patient is the primary caregiver for a disabled family member at home, and has now been unexpectedly hospitalized for surgery. What action can the nurse take to enhance the coping ability of the patient? a. Ask if there is another family member who can help at home while the patient is in the hospital. b. Plan to transfer the patient to a rehabilitation unit after surgery to allow uninterrupted time to recover. c. Coordinate an ambulance transfer of the family member to an alternate family member's home. d. Ask social services to assess what the patient's needs will be after discharge to home.

A The best action by the nurse is to help the patient develop an action plan to assess what resources may already be available to meet responsibilities at home. A long absence from the home on a rehabilitation unit does not address the immediate need to provide care for the disabled family member. An ambulance transfer to another family member is premature until the placement is identified as an appropriate placement based on the disabled person's needs, availability to provide the care by another, and distance of the transfer. Assessing the patient's needs after discharge does not address the immediate need to provide care for the disabled family person.

The embryonic period is critical because external and internal structures in the fetus are forming. When is it most important for the pregnant patient to avoid all teratogens? A. 4-8 weeks B. 8-12 weeks C. 12-16 weeks D. 16-20 weeks

A The embryonic period lasts from the beginning of the fourth week to the end of the eighth week. Teratogenicity is a major concern because all external and internal structures are developing in the embryonic period. A woman should avoid exposure to all potential toxins during pregnancy, especially alcohol, tobacco, radiation, and infectious agents. At the end of this period, the embryo has human features. The span of gestation from 8 to 12 weeks, from 12 to 16 weeks, or from 16 to 20 weeks is not within the embryonic stage of fetal development, when teratogenicity is of greatest concern.

What is the most prominent goal of palliative care? a. Integrate into chronic disease management sooner rather than later. b. Enroll the patient into the Medicare Hospice Benefit. c. Ensure that the patient has a 6-month prognosis. d. Reserve this type of care until the patient is actively dying.

A The goal of palliative care is to integrate symptom management interventions earlier into the course of chronic disease sooner rather than later. This helps to promote optimal quality of life.

A mother is talking with the community-based nurse concerning her adult son. The son is mentally challenged and not able to live on his own. The mother is concerned about her son's welfare when she is no longer able to care for him. What is the best response by the nurse? a. "Let's look into the community resources that are available to assist you." b. "You have raised your son well, and he will be okay on his own." c. "Contact your distant relatives to see if anyone would take your son." d. "There are places for mentally challenged adults; let's place him there."

A The mother, with the assistance of the nurse, can research resources in the community that will service and care for her son when she is no longer able to do so. How the son is raised does not mean that he will be okay on his own. Distant relatives may not want or be able to care for the son, so this may not be a viable option. Placing the son is too general of an option, and he may not do well in this setting.

The community health nurse is assessing a family who has a chronically ill child. The child needs special care, and the nurse has to coordinate the care for the home setting. What behavior will the nurse assess for to know that the family can care for the child? a. The family is willing to learn about the care and share the caregiving needs. b. The mother is going to care for the child and the family herself. c. The older siblings are going to care for the child while the parents are at work. d. An outside agency will be coming to the home three times a week to give care.

A The nurse will look for a family who is willing to provide care plus support each other in this need. Having a situation where just siblings or a mother or an outside agency give care puts an undue burden on the caregiver and brings disharmony to the family.

Nurses work to serve the population, and they know that which priority population needs to be served by care coordination? a. Most vulnerable and the frail b. Uninsured and the very young c. Underinsured and the elderly population d. Whole population of the community

A The priority population is the most vulnerable and the frail, because they have the most health-care needs. Other populations do need health care, but they do not always have immediate need of the health-care system.

For children and teens, which model includes school-based services? a. Social b. Integrated c. Medically-oriented d. Nurse-oriented

A The social models focus on community-based services, and the other models do not.

A patient uses rosary beads and attends mass once a week. This expression of spirituality is best described with which term? a. Religiosity b. Faith c. Belief d. Authenticity

A There are a few similar and related terms to spirituality worth mentioning to provide distinction and clarification. Faith, as defined by Dyess, refers to an "evolving pattern of believing, that grounds and guides authentic living and gives meaning in the present moment of inter-relating." Religiosity, another similar term, is an external expression (public or private), in the form of practicing a belief or faith, whereas spirituality is an internalized spiritual identity (or experiential). Specifically, religiosity is defined as "the adherence to religious dogma or creed, the expression of moral beliefs, and/or the participation in organized or individual worship, or sacred practices."

The nurse is admitting a prenatal patient for diagnostic testing. While eliciting the psychosocial history, the nurse learns the patient smokes a pack of cigarettes daily, drinks a cup of cappuccino with breakfast, has smoked marijuana in the remote past, and is a social drinker. Which action should the nurse first take? a. Strongly advise immediate tobacco cessation b. Elimination of all caffeinated beverages c. Serum and urine testing for drug use and alcohol use d. Referral to a 12-step program

A There are numerous risk factors for women and men affecting reproductive health and pregnancy outcomes. These can be categorized into biophysical, psychosocial, sociodemographic, and environmental factors. Some of the risk factors for human reproduction fit into multiple categories. Psychosocial factors cover smoking, excessive caffeine, alcohol and drug abuse, psychological status including impaired mental health, addictive lifestyles, spouse abuse, and noncompliance with cultural norms. Drinking a cup of a caffeinated beverage a day is not associated with adverse fetal outcomes usually. Serum and urine testing for drug/alcohol use is not required for stated marijuana use in the remote past. Patient referral to a 12-step program is usually advisable for current alcohol and/or drug use.

The nurse is planning to teach a patient how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is teaching the patient to control which physiological function? a. Switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode. b. Alter the internal state by modifying electronic signals related to physiologic processes. c. Replace stress-producing thoughts and activities with daily stress-reducing thoughts and activities. d. Reduce catecholamine production and promote the production of additional β-endorphins.

A When the sympathetic nervous system is operative, the individual experiences muscular tension and an elevated pulse, blood pressure, and respiratory rate. Relaxation is achieved when the sympathetic nervous system is quieted and the parasympathetic nervous system is operative. Modifying electronic signals is the basis for biofeedback, a behavioral approach to stress reduction. Altering thinking and activities from more-stressful to less-stressful reflects the cognitive approach to stress management. Reducing catecholamine production is the basis for guided imagery's effectiveness.

What matters can palliative care be used to promote? (Select all that apply.) A. Physical functioning B. Reduction in disease exacerbations C. Improved quality of life D. Discussion on advance directives E. Surgical treatment plans versus medical

A, B, C, D If optimally delivered, palliative care can provide patients with aggressive symptom management while helping to restore and promote physical functioning. Management of symptoms helps to reduce the exacerbations that are common to chronic disease. Palliative care provides an opportunity to engage patients and families with earlier and supportive discussions about advance care planning. Palliative care supports an improved quality of life, whether the treatment plan is through surgical or medical intervention.

A 15-year-old pregnant patient asks the nurse how she can take care of herself and her baby at home. What education should the nurse include in this patient's teaching plan? (Select all that apply.) A. Healthy diet B. Physical activity C. Taking prenatal vitamins D. Avoiding alcohol E. Infant bathing

A, B, C, D Regular prenatal care helps to inform women about the steps they can take to ensure a healthy pregnancy. These include: consuming a safe and healthy diet, taking a prenatal vitamin with minimum daily folic acid requirements, getting regular exercise, avoiding an exposure to harmful environmental substances, avoiding alcohol and drugs, and managing pre-existing conditions. Knowledge of infant bathing does not enhance or hinder the patient from experiencing a healthy pregnancy and is not relevant at this time.

Caregivers are often categorized by their relationship to the person being cared for. Which of the following are the roles? (Select all that apply.) a. Grandparent b. Spouse c. Parent d. Adult children e. Neighbor/friend f. Young children

A, B, C, D, E All of these options can provide care whether it is on a temporary or permanent basis. Young children do not provide care.

The nurse is developing a teaching plan for a patient diagnosed with congestive heart failure. Which are the most appropriate teaching points to include that will assist in self-management of the disease? (Select all that apply.) a. Side effects of medications b. Activity restrictions c. Daily weights d. Increased sodium intake e. Blood pressure monitoring

A, B, C, E Congestive heart failure (CHF) is one of the most common complications of coronary artery disease in which the heart fails to pump efficiently enough to meet the metabolic demands of the body. Fluid overload is a common complication. As with most chronic conditions, patients with CHF benefit from education about their disease and self-managing diet, physical activity, weight, and medication adherence. Fluid retention occurs with increased sodium intake; therefore sodium is usually restricted in a congestive heart failure diet.

The nurse is planning care for the spiritual needs of a patient who has been newly diagnosed with a chronic illness. Which are appropriate nursing interventions for the spiritual care of this patient? (Select all that apply.) A. Shared laughter B. Shared tears C. Listening to the patient D. Administering medication E. Praying with the patient F. Ambulating the patient

A, B, C, E Spiritual care involves recognizing and honoring the religious beliefs and practices of those in our care but it can also be shared laughter or tears or remembering a patient's birthday. Spiritual care can be keeping vigil with a family as a loved one struggles to recover. It can be crying with that same family. It can be supporting a chronically ill individual who is struggling to redefine his worth and personal meaning in light of the illness and its demands. It can be a gentle backrub coupled with soothing words that allows a worried patient to sleep. It can be a shared prayer or religious reading that has special meaning to the patient. Spiritual care cannot be boxed in and narrowly defined. Spiritual care is not limited to those who believe a certain way or who define God according to a specific doctrine. Administering medication and ambulating the patient better address the physical needs versus spiritual needs of this patient.

When completing the FICA tool for spiritual assessment, which questions should the nurse ask the patient? (Select all that apply.) a. What things do you believe in that give meaning to life? b. Are you connected with a faith center in your community? c. How has your illness affected your personal beliefs? d. When was the last time you have been to church? e. What can I do for you?

A, B, C, E The FICA tool for spiritual assessment stands for Faith or beliefs, Importance and influence, Community, and Address. "When was the last time you have been to church?" is not a question included in the FICA assessment. The patient may attend community activities, besides church, that foster his/her spiritual well-being.

Which life events should the nurse recognize as being spiritually life changing? (Select all that apply.) a. Births b. Weddings c. Medical diagnoses d. Career day to day job duties e. Loss of independence

A, B, C, E The meaning and significance of the event might only be experienced by one individual; others who might be participants in the event might be left virtually untouched and unchanged. These life changing spiritual events include just about any occurrence that has intense and personal relevance to those involved in the event. Examples of spiritually life changing events include births, deaths, weddings, divorces, illnesses, diagnoses, and loss of abilities, loss of independence, death and so many more. These events, having the power to change individuals and families, also have the power to draw people toward the transcendent—for many people that transcendent is known as God but this is not universal. Day-to-day activities are not the best examples of spiritually life changing events.

What are the most important reasons for considering the use of palliative care in patient care management? (Select all that apply.) A. Patients live with multiple chronic diseases several years before dying. Correct B. Patients live with debilitating symptoms that interfere with the quality of life. Correct C. Palliative care is reserved for those patients who are considered terminally ill. D. Palliative care is used to reduce the symptoms associated with chronic disease. Correct E. Palliative care is recommended until cures for illnesses are discovered

A, B, D Because of the aging population in the United States, the older patient often lives with multiple diseases for several years before dying. These diseases produce symptoms that interfere with the activities of daily living and quality of life. Palliative care is symptom management and should be integrated into the management of chronic disease and not reserved only for terminal illness. Palliative care is utilized to help patients live as comfortably as possible (quality of life) for an unspecified amount of time, not just until cures are discovered.

Which factors should the nurse recognize put a patient diagnosed with diabetes at risk for inadequately self-managed blood glucose levels? (Select all that apply.) A. Obesity B. Desk job C. New car D. Busy lifestyle E. Regular exercise

A, B, D Effective self-management of diabetes is essential for patients to avoid complications. Several factors that put a client at risk for inadequately controlled blood glucose levels include: being overweight, sedentary lifestyle (desk job), and non-compliance with medication and self-monitoring. A busy lifestyle could hinder a patient from regularly checking blood sugar levels and attending office appointments. Important factors in the successful self-management of diabetes include regular visits to a provider, medication adherence, and setting realistic goals for engaging in health-promoting lifestyle behaviors (i.e., exercise and healthy diet). A new car indicates this patient has transportation to attend regular provider appointments.

A diabetic patient who is hospitalized asks the nurse what factors are associated with increased blood glucose while in the hospital. Which response(s) by the nurse are appropriate? (Select all that apply.) A. Blood sugar may be higher in the hospital due to decreased activity or rest. B. Stressors such as illness cause the release of hormones that increase blood sugar. C. Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful times. D. A patient's diet is different here in the hospital than at home, and that is the most likely because of the increased glucose level. E. Medications such as steroids may increase glucose levels

A, B, E The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels. Activity decreases blood glucose; therefore, increase in blood glucose while in the hospital could be related to inactivity. Steroids cause increases in blood glucose levels. The kidneys do not control blood glucose. A diabetic patient who is hospitalized will be on an appropriate diet to help control blood glucose.

A nurse mentor is explaining the benefits of collaborative practice to a nurse new to a facility. Which research-based benefits should the nurse identify as likely positive outcomes of collaboration? (Select all that apply.) A. Decreased length of stay for patients B. Decreased staff resignations C. Decreased use of pain medications D. Increased reimbursement from insurance carriers E. Increased patient follow-up appointments after discharge F. Increased job satisfaction of the staff

A, B, F Documented positive outcomes from collaboration include a shortened length of stay, increased job retention and decreased staff turnover, increased job satisfaction for registered nurses, and improved problem-solving skills. Identified research has not demonstrated less use of pain medication, increased reimbursement, or better follow-up by patients after discharge.

Coordination of healthcare services is complicated by which of the following? (Select all that apply.) A. Involving one or more services B. Too many community resources C. Poorly funded social programs D. Authority for managing services E. Too many nurses F. Lack of healthcare systems

A, C, D, F Coordination of services is complicated because it involves more than one service, poorly funded social programs, confusing chains of authority for managing services, and a lack of healthcare systems. Too many community resources and too many nurses are not complicating the healthcare system.

Which statement(s) by the nurse aim to help the patient to cope by addressing the mediators of stress? (Select all that apply.) A. "A divorce, while stressful, can be the beginning of a new, better phase of life." B. "You said you used to jog; getting back to aerobic exercise could be helpful." C. "Journaling gives one more awareness of how experiences have affected them." D. "Perhaps a short-term loan from your father will make your layoff less stressful." E. "Slowing your breathing by counting to three betweenA diabetic patient who is hospitalized asks the nurse what factors are associated with increased blood glucose while in the hospital. Which response(s) by the nurse are appropriate? (Select all that apply.) Blood sugar may be higher in the hospital due to decreased activity or rest. Correct Stressors such as illness cause the release of hormones that increase blood sugar. Correct Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful times. A patient's diet is different here in the hospital than at home, and that is the most likely because of the increased glucose level. Medications such as steroids may increase glucose levels breaths will calm you." F. "I have found a support group for newly divorced persons in your neighborhood."

A, C, D, F Stress mediators are factors that can help persons cope by influencing how they perceive and respond to stressors; they include personality, social support, perceptions, and culture. Suggesting that a divorce may have positive as well as negative aspects helps the patient to alter his perceptions of the stressor. Journaling increases self-awareness regarding how life experiences may have shaped how one perceives and responds to stress (or how one's personality affects how one responds to stressors). A loan could help the patient perceive a layoff differently by reducing the financial pressures that accompany it. Participation in support groups is an excellent way to expand one's support network relative to specific issues. However, neither aerobic exercise nor breath control exercises, while helpful in other ways, affect stress mediators.

Which are true statements about the definition of spirituality in nursing? (Select all that apply.) a. Patient's quality of life, health, and sense of wholeness are affected by spirituality. b. An exact definition was developed and adopted in the late 1980s. c. Encompasses principle, an experience, attitudes, and belief regarding God d. Head knowledge affects spirituality more than heart knowledge. e. Mind, body, spirit, love, and caring are interconnected.

A, C, E The concept of Spirituality is an elusive concept to define. Authors who write about spirituality in nursing advocate the position that a patient's quality of life, health, and sense of wholeness are affected by spirituality, yet still the profession of nursing struggles to define it. Why? There are a number of explanations for this. One explanation is that spirituality represents "heart" not "head" knowledge and "heart" knowledge is difficult to encapsulate into words. A second explanation is that spirituality is unique to each person so a precise definition is somewhat elusive. The definitions of spirituality encompass the following: a principle, an experience, attitudes and belief regarding God, a sense of God, the inner person. Most descriptions of spirituality include not only transcendence but also the connection of mind, body, and spirit, plus love, caring, and compassion and a relationship with the Divine.

The nurse should recognize which attributes and criteria are concepts of spirituality? (Select all that apply.) A. Spirituality is universal. B. Physical illness does not impact the spirit. C. Spirituality manifests whether a person acts on personal beliefs or not. D. Family and culture impact spiritual beliefs. E. Nurses should be aware of local community-based religious organizations.

A, D, E Spirituality is universal. All individuals, even those who profess no religious belief, are driven to derive meaning and purpose from life. Illness impacts spirituality in a variety of ways. Some patients and families will draw closer to God or however they conceive that Higher Power to be in an effort to seek support, healing, and comfort. Others may blame and feel anger toward that Higher Power for any illness and misfortune that may have befallen a loved one or their entire family. Still others will be neutral in their spiritual reactions. There has to be willingness on the part of patient and/or family to share and/or act on spiritual beliefs and practices. The nurse needs to be aware that specific spiritual beliefs and practices are impacted by family and culture. Community-based religious organizations can provide supportive care to families and patients and nurses need to be aware of these resources.

The nurse is developing a plan of care for a newly diagnosed hypertensive patient who is being discharged on medications and given the Dietary Approaches to Stop Hypertension (DASH) diet to follow. What statement by the patient signals to the nurse that the patient is motivated to learn? a. "I am sure the medications will help to bring down my blood pressure." b. "I can't wait to try the new recipes, and I'm hopeful I will lose weight." c. "Do I really need to follow the diet and take medications?" d. "I have my parents to blame for this. They both have high blood pressure."

B A patient who is motivated will see what the benefits of following the teaching will do for them and will most likely be able to manage their own care. The patient who believes medications are the only solution may not be motivated to follow the prescribed diet. Blaming the parents for their condition does not show accountability or motivation for change.

The nurse is assisting an older adult patient, diagnosed with type 2 diabetes, with self-injection of insulin. What is the most appropriate intervention for this patient at discharge? a. Arrange daily home visits for injections. b. Request an insulin pen prescription. c. Recommend upper arm injection sites. d. Supply patient with 100 unit insulin syringes.

B An insulin pen will be the most effective method for injection for an older adult secondary to reduced eyesight and dexterity compared to using syringes. A 100 unit syringe has very small calibration marks and numbers, making it more difficult for older adults to see the appropriate doses. Daily home visits are not usually paid for by insurance. Most patients must learn to administer medications themselves. The upper arm subcutaneous site is too difficult for self-administration and may not be feasible for an older adult.

The interprofessional core team includes members from which disciplines? a. Nursing, medicine, volunteers, and nutrition b. Medicine, nursing, social work, and clergy c. Medicine, nursing, physical therapists, and volunteers d. Nursing, home health aides, volunteers, and clergy

B An interprofessional team approach involving healthcare professionals from different disciplines is central to optimal palliative care practice and quality outcomes. The interdisciplinary core team includes members from medicine, nursing, social work, and clergy. Ancillary disciplines are also included. Volunteering is not considered a discipline in health care.

During a new nurse' orientation to the unit, a nurse explains why collaboration is valued. Which outcome is a key patient care outcome that occurs when collaboration is correctly used? A. Governmental accrediting agencies give more favorable reviews to the agency. B. There are fewer errors that occur in patient care. Correct C. Agencies can offer higher salaries due to the cross-training of staff. D. Ongoing education is not needed, because other specialties contribute to care decisions.

B Collaboration results in fewer errors in patient care due to the interactions between health providers of all disciplines and patient involvement in planning. A positive accreditation review benefits the agency directly and the patient only indirectly. Collaboration is not the same as cross-training, and ongoing education is an expectation of all professions.

End-of-life care is most synonymous with which type of care? A. Palliative care B. Hospice care C. Supportive care D. Quality of life

B End-of-life care is most synonymous with hospice care. Hospice care uses palliative care for the imminently dying by introducing a team of interdisciplinary healthcare professionals at the end of a patient's life. The Medicare Hospice Benefit requires that a patient have a prognosis of 6 months or less to be enrolled in this type of care. Palliative care is incorrect since it can be used to manage symptoms in patients who are living with symptomatic chronic disease several years before death. Supportive care is the type of care predominately used for patients with cancer and undergoing active cancer therapies. Quality of life can be enhanced through the implementation of all of these deliveries of care.

A nurse is working with a male patient being treated for erectile dysfunction. Which statement indicates that additional teaching is needed? a. "I like to go walking around my community each night after dinner." b. "I have a few drinks during the week when I go out after work." c. "I have maintained my weight for the past 5 years after losing 20 pounds." d. "I monitor my blood pressure at home using a portable cuff."

B Erectile dysfunction (ED) is a common problem affecting the male population and can be chronic or transient in nature. Alcohol use can affect ED, so the patient's reported alcohol intake indicates that additional teaching is warranted. Exercise, maintaining a healthy weight and monitoring of blood pressure are examples of appropriate activities.

An adult patient comes for a well-check up to the primary care provider's office. In completing the office admission form, the patient does not indicate gender on the form and seems somewhat agitated when providing the form back to the nurse. How should the nurse respond? a. Ask the patient to complete all of the information at this time. b. Ask the patient if you can assist with completing the form. c. The nurse should just indicate which gender she/he thinks is appropriate. d. Tell the patient that if the form is not completed, then the doctor will not see you.

B Gender identity is defined by the individual patient. The nurse should not designate this description or identity nor should the nurse tell the patient that if the form is not completed, that the patient will not be seen by the healthcare provider. Asking the patient to complete the information without acknowledging that the patient is exhibiting signs of distress is not therapeutic. The nurse should offer to provide assistance to the patient.

Student nurses are being questioned by the nursing instructor about the health-care coordination system. The instructor knows the students understand health-care delivery when making which statement? a. "Health care is available for everyone at every time." b. "Health-care needs are best met with a collaborative effort." c. "Health care is adequately meeting the needs of the homeless populations." d. "Health care needs are mostly in third world countries."

B Health-care needs many times are not met by one discipline. When a collaborative effort is used, the patient is better served. Health care is not available for everyone, nor is it meeting the needs of the homeless population. Health-care needs are worldwide, not just in third world countries.

The nurse is assessing a patient's readiness to be discharged and ability to manage care at home. What is the most appropriate question for the nurse to ask to determine the patient's learning needs before planning teaching activities? a. "What are your hobbies and occupation?" b. "What do you need to know before you go home from the hospital?" c. "Do you have any cultural or religious beliefs that you would like incorporated into your plan of care?" d. "What were your grades and learning style when you were in school?"

B Motivation and readiness to learn depend on what the patient values. The other questions are also important but do not address what information interests the patient most at present and will assist the patient in managing his own care.

Palliative care is used in the management of a patient with symptomatic chronic obstructive pulmonary disease (COPD). Which option does the nurse identify as being accurate? a. Palliative care is used when the patient is beginning to die. b. Palliative care is used to help manage the symptoms that often accompany COPD. c. Hospice nurses must be involved to provide palliative care in a cancer patient. d. Patient must be enrolled into the Medicare Hospice Benefit to receive palliative care.

B Palliation is the relief or management of symptoms without providing a cure. To palliate is to reduce the severity of an actual or potential life-threatening condition or a chronic debilitating illness. Palliation is not equivalent to cure, but it is the reduction of undesirable effects resulting from the incurable disease or condition.

A nursing instructor evaluates that a nursing student understands the concept of spirituality in nursing practice when the student makes which statement? A. A lack of spirituality theories has contributed to the omission of this aspect of care. B. A lack of spirituality assessment can have a negative impact on patient care. C. Spirituality assessment is not part of professional nursing care but should be included in holistic care. D. There are currently no nursing diagnoses addressing spirituality to include in the plan of care.

B Professional organizations have incorporated spirituality into holistic care and developed mandates to provide spiritual care because the lack of addressing spirituality may negatively impact patient care. Theory has contributed to the emphasis on spirituality in patient care and enhanced this concept in holistic care. Every professional document that focuses on standards of nursing practice includes a statement regarding nursing's responsibility to address spiritual concerns. In Nursing Intervention Classification, two standard nursing interventions are identified that directly relate to spiritual care.

The management of a community hospital is trying to encourage a more collaborative environment among staff members. Which concept is most important for management to develop first? a. Post educational posters about how well collaboration is being performed b. Highlight that no single profession can meet the needs of all patients c. Provide meetings for each department on how their role affects patients d. Begin implementing evaluations of collaborative skills on annual performance reviews

B Recognizing that collaboration needs all professions to provide patient-centered care is an important first step to implementing a different philosophy in the hospital. Posting an evaluation of performance before education will not encourage participation. Collaboration requires an understanding of more than your own discipline. It is unfair to evaluate staff on a requirement that they have not been introduced to.

When conducting a spiritual assessment of a hospitalized patient, the nurse should remain aware of which potential barrier to effective communication? a. Clarifying the meaning of a patient's statement. b. Multi-tasking while talking to the patient. c. Listening to patients' complete statements. d. Discussing patient's feelings while hospitalized.

B Several barriers may result in the nurse's inability to be totally present and communicate effectively with the patient. First, the nurse may be distracted by other things and may not pay attention to the patient. Multi-tasking while trying to listen to a patient may be a barrier to effective communication. Second, the nurse may miss the meaning of the patient's message because of failure to clarify the meaning of a word, a phrase, or a facial expression. Third, the nurse may interject personal feelings and reactions into the patient's situation rather than allow the patient to explore and discuss his own feelings and reactions. The last barrier occurs when the nurse is busy formulating a response while the patient is still talking. In this instance, the nurse never hears the patient's message.

A nurse manager is looking to promote a culture of safety on the medical unit. Which action should the nurse manager implement? a. Focus on the number of medication errors occurring on the unit. b. Focus on adapting system changes. c. Providing incentives to nurses who don't make any medication errors. d. Placing nurses on restricted duty who have made medication errors.

B The Institute of Medicine (IOM) and QSEN initiative have switched their perspective from medication errors to systematic changes that focus on safety aspects. The nurse manager should not use rewards or incentives to motivate change of behavior as that would not promote a culture of safety if individuals feared retaliation or were treated differently for safe behavior practices.

A female infertility patient is found to be hypoestrogenic at the preconceptual clinic visit. She asks the nurse why she has never been able to get pregnant. Which is the best nursing response? a. Circulating estrogen contributes to secondary sex characteristics. b. Estrogen deficiency prevents the ovum from reaching the uterus and may be a factor in infertility. c. Hyperestrogen may be preventing the zona pellucida from forming an ovum protective layer. d. The corona radiata is preventing fertilization of the ovum.

B The cilia in the tubes are stimulated by high estrogen levels, which propel the ovum toward the uterus. Without estrogen, the ovum won't reach the uterus. The results of a series of events occurring in the ovary cause an expulsion of the oocyte from the ovarian follicle known as ovulation. The ovarian cycle is driven by multiple important hormones: (1) gonadotropic hormone, (2) follicle-stimulating hormone (FSH), and (3) luteinizing hormone (LH). The cilia in the tubes are stimulated by high (4) estrogen levels, which propel the ovum toward the uterus. The zona pellucida (inner layer) and corona radiata (outer layer) form protective layers around the ovum. If an ovum is not fertilized within 24 hours of ovulation by a sperm, it is usually reabsorbed into a woman's body. A patient who is hypoestrogenic would not have excess circulating estrogen. A patient with low estrogen would not be classified as hyperestrogenic. Without sufficient estrogen, there can be no fertilization of the ovum.

A nurse is talking with a woman who is caring for her elderly father. The woman states that she has very little time for herself or any of the activities she used to enjoy. What process is the nurse using to assess this situation? A. Understanding the father's wishes B. Cognitive ability of appraisal C. Diagnosing the father's health D. Understanding the woman's wishes

B The cognitive ability of appraisal allows the nurse to assess the woman's feelings and her ability to care for her father. Understanding the woman's or the father's wishes is good, but it is not a process of appraisal of the situation. Diagnosing the father's health is outside of the nursing realm.

When considering the trajectory of a specific disease, what is the most important concept? a. Hospital admissions b. Physical functioning c. Quality of life d. Symptom management

B The disease trajectory occurs from the onset of a life-limited diagnosis until death. Physical functioning determines the decline in the patient's physical status. Decline in status is used to determine when to intervene with palliative and end-of-life care.

Although sexual activity is considered a normative process, some individuals place themselves at increased risk for negative consequences related to this process. Which nonsexual behavior is likely to increase risk-taking activities? A. Having multiple sexual partners B. Using alcohol, marijuana, or illicit substances C. Having gay, lesbian, or bisexual partners D. Refraining from safe-sex practices such as condom use

B The influence of nonsexual high-risk behavior such as the use of alcohol, marijuana, and illicit substances increases sexual risk-taking behavior. The abuse of alcohol or drugs results in impaired judgment and less thoughtfulness related to the sexual act, particularly when substances are ingested close to the time of sexual activity. More varied sexual experiences and intercourse with multiple partners are significant individual sexual risk-taking behaviors. Gay, lesbian, and bisexual youth; men who have sex with men; and women who primarily have sex with women have been found to engage in more high-risk sexual practices. Youth in particular are less likely to engage in safer sex practices such as condom use. This is a sexual behavior that significantly increases the risk for contracting sexually transmitted infections, including human immunodeficiency virus (HIV) infection, and for unintended pregnancy.

An 8-year-old child is newly diagnosed with asthma. Which nursing intervention best promotes self-efficacy for the parents to help the child follow the prescribed treatments? a. Ask parents to list all possible triggers for asthma. b. Request a spacer for the metered dose inhaler. c. Suggest the parents enforce a strict exercise regimen. d. Recommend replacing carpeting in the home with wood flooring.

B The most realistic and helpful interventions will promote self-management. A spacer is helpful for children learning to use inhaled medication. Listing all the triggers for asthma may be overwhelming. The parents should focus on the individual triggers for the child. Enforcing a strict exercise regimen is restrictive and will not promote self-management. Environmental changes must be feasible and cost-effective. Replacing carpeting is optimal but may not be affordable.

A diabetic patient who is hospitalized tells the nurse, "I don't understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up." Which response by the nurse is appropriate? a. "It is probably just coincidental that your blood sugar is high when you are ill." b. "Stressors such as illness cause the release of hormones that increase blood sugar." c. "Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful times." d. "Your diet is different here in the hospital than at home, and that is the most likely cause of the increased glucose level."

B The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels. The increase in blood sugar is not coincidental. The kidneys do not control blood glucose. A diabetic patient who is hospitalized will be on an appropriate diet to help control blood glucose.

The coordination and continuity of health care transferred between different locations or different levels of care within the same location is known as which type of care coordination? A. Healthcare doctrine B. Transitional care C. Transactional care D. Multilevel care

B Transitional care transfers between different locations, as described in the chapter. Healthcare doctrine, transactional care, and multilevel care do not fit the definition of coordination and continuity of care.

The nurse is assessing the coping abilities of a patient recently diagnosed with a degenerative neuromuscular disease with no known cure. Which statement by the patient alerts the nurse that more intervention is needed? A. "I have decided to take some art lessons at the community center." B. "I am sleeping much better when I have two drinks and smoke before bed." C. "I am scheduling a family reunion for the upcoming holiday." D. "I have decided to sell my house and move into an apartment with my son."

B Using alcohol, smoking, or drugs to enhance sleep is not a positive coping mechanism, and it is also a safety hazard; other interventions should be enlisted to help the patient cope with the devastating diagnosis. Taking art lessons and planning a family reunion are positive ways to not focus on the illness and keep the patient from becoming more isolated. Moving in with a family member is a problem-solving strategy that allows the patient to maintain more control over the illness outcome.

The nurse is completing a care plan for a patient who is exhibiting poor coping after receiving a serious medical diagnosis. Which interventions should the nurse consider? (Select all that apply.) A. Recommend a glass of wine before dinner each night for relaxation. B. Compile a list of activities that are of interest to the patient. C. Review pamphlets about treatment options with the patient. D. Identify positive aspects of the illness, such as the chance to spend more time with family. E. Reinforce the fact that the medical team can make treatment decisions, so the patient does not need to worry.

B, C, D Interventions that develop an action plan (activities that the patient is still able to do), education about the illness (review of treatment options), and changing how the patient views some aspect of the illness (have more time with family members) are all interventions that help coping skills. Recommending the use of alcohol is not good, because the drinking may get out of control or the alcohol may interact with prescribed medications. Having the medical team make all decisions reinforces the lack of control the patient feels and encourages negative coping mechanisms of denial and avoidance.

Which action should the nurse take to monitor the effects of an acute stressor on a hospitalized patient? (Select all that apply.) a. Assess for bradycardia. b. Ask about epigastric pain. c. Observe for increased appetite. d. Check for elevated blood glucose levels. e. Monitor for a decrease in respiratory rate.

B, C, D The physiologic changes associated with the acute stress response can cause changes in appetite, increased gastric acid secretion, and elevation of blood glucose levels. Stress causes an increase in the respiratory and heart rates.

A nursing instructor and a student nurse are talking about caregivers and their role in the caring process. What are some of the emotions and obstacles that caregivers experience that the nursing instructor should include in the discussion? (Select all that apply.) A. Financial prosperity B. Anxiety C. Denial D. Social isolation E. Euphoria F. Understanding of the disease

B, C, D The caregiver experiences emotions such as anxiety and denial of the disease process and faces obstacles such as social isolation when caring for someone else. Financial prosperity is usually not occurring; quite the opposite is likely because a caregiver may be drained of his or her savings. A caregiver does not feel euphoria, because the caregiver is not happy about the situation. The caregiver may not understand the disease process and may not know what to expect as he or she assumes the caregiver role.

The nurse is completing a health history on a Mexican-American patient who works odd jobs as available and lives with multiple family members ranging from infant to older adults. One motor vehicle is shared between the family members, and the family shares a two-room apartment with one bathroom. What likely health disparities should the nurse investigate for this patient? (Select all that apply.) A. Comprehensive insurance B. Low income C. Lack of self-grooming D. Inadequate sleep E. Educational level

B, C, D, E Based on the patient's living arrangements and job status, the nurse should investigate possible health disparities such as low income, lack of grooming (only one bath available), inadequate sleep, and low educational level. Comprehensive insurance is not a health disparity but is an asset to ensure adequate health care.

Which activities are appropriate for the nurse to collaborate with a patient? (Select all that apply.) a. Prescribing a new medication dose b. Health promotion activities c. End-of-life comfort decisions d. Interpreting laboratory results e. Lifestyle changes to improve health

B, C, E Nurses should include patients and their families when exploring health promotion activities, end-of-life decisions, lifestyle changes, and treatment options. Prescribed medication doses are initiated by educated professionals, although the patient gives feedback on the effectiveness of medications. Patients are not trained to interpret lab results, but patients rely on health professionals to explain results to them.

2. The nurse is working with a patient who recently lost her spouse after a lengthy illness. The patient shares that she would like to sell her home and move to another state now that her spouse has passed away. Which of the following interventions would be considered a priority for this patient? (Select all that apply.) a. Notify the provider to evaluate for antidepressant therapy. b. Suggest that the patient consider a support group for widows. c. Suggest that the patient learn stress reduction breathing exercises. d. Suggest that the patient take prescribed antianxiety medications. e. Assist the patient in identifying support systems. f. Notify the provider to evaluate the need for antianxiety medications.

B, C, E Stress prevention management involves counseling, education, and implementation of techniques to manage problem-oriented and emotion-oriented stress. To prevent physical symptoms, relaxation and deep breathing are effective and individuals can learn to prevent the stress response through cognitive behavioral strategies. Medications are not indicated for patients with known stressors unless the stress is prolonged or the patient has ineffective coping mechanisms.

Many grandparents today are caring for grandchildren in place of a parent. Identify the reasons why this phenomenon is happening. (Select all that apply.) a. Children prefer living with their grandparents. b. Parents are incarcerated. c. Parents are deceased. d. Grandparents are better caregivers. e. Parents are mentally ill. f. Parents are substance abusers.

B, C, E, F Grandparents are usually caring for children because the parents are deceased, in prison, substance abusers, or mentally ill and cannot care for the children. The fact that children prefer to live with the grandparents or the grandparents may be better caregivers is not a main reason for this phenomenon to happen.

Care coordination models should be adopted in health-care facilities. If models are not put into practice, the shortcomings of the health-care system may display which of the following items? (Select all that apply.) a. Decrease in patients b. Fragmented services c. Low birth weight newborns d. Cost inefficiencies e. Poor health outcomes f. Increased pharmacy costs

B, D, E Fragmented services, cost inefficiencies, and poor health outcomes may be some of the shortcomings seen in health care without the proper model in place to guide the health-care delivery system.

The school nurse is assessing coping skills of high school students who attend an alternative school for students at high risk to not graduate. What is the priority concern that the nurse has for this student population? a. Altered vital sign readings b. Inaccurate perceptions of stressors c. Increased risk for suicide d. Decreased access to alcoholic beverages

C Adolescents with poor coping have increased risk for drug and alcohol use, risky sexual behaviors, and suicide. Pulse, respiratory rate, and blood pressure may change during stress, but patient safety is the priority concern. Adolescents may have inaccurate perceptions of stressors, and this actually increases the risk for unsafe behaviors. Adolescents under stress are more at risk for increasing their access to alcohol and illegal drugs.

A 15-year-old female patient has come to the office for her annual physical and first pelvic examination. In this situation, which nursing action is most important? A. Encourage the patient to ask questions about sexuality. B. Screen for possible abuse. C. Excuse the parent. D. Ensure the patient that all information will be kept confidential.

C Although all of these actions are important, in this situation the parent should be excused in order to allow the teen to discuss her sexual concerns without fear of repercussions. Adolescents may be concerned about their altered appearance and impulse control. This is the ideal time to encourage the patient to ask questions and reassure her that she does not appear ignorant. All patients should be screened for possible abuse, and this is the most appropriate time to do so. If the parent remains present, the patient may be reluctant to answer a question honestly about any history of childhood sexual abuse. The nurse must pose all questions to the patient in a nonjudgmental manner and ensure her that all answers will be kept strictly confidential.

An obstetric multipara with triplets is placed on bed rest at 24 weeks' gestation. Her perinatologist is managing intrauterine growth restriction with serial ultrasounds. This prescribed treatment is an example of which type of care? a. Antenatal diagnostics b. Primary prevention c. Secondary prevention d. Tertiary prevention

C An example of secondary prevention relating to reproductive health would be managing fetal intrauterine growth restriction by serial ultrasounds. This type of diagnostic maternal/fetal monitoring is performed to determine the best time for delivery due to potential fetal nutritional, circulatory, or pulmonary compromise. A cesarean section (operative delivery) may be performed if maternal or fetal conditions indicate that delivery is necessary. Antenatal diagnostics refers to prior to pregnancy. An example of primary prevention is teaching a high school class about reproductive health. An example of tertiary prevention would be aimed at improving health following an illness and/or rehabilitation.

A 45-year-old female patient, gravida 3 para 3, presents with complaints of decreased desire to engage in sexual activity with her husband as it is becoming more painful. What physical assessment data should the nurse focus on? a. Urine culture to identify potential STD. b. Obtain vital signs as a baseline to rule out infection. c. Prepare for a vaginal exam. d. Inspection of the abdomen for pelvic mass.

C Based on the patient's reported complaint and obstetrical history, it may be likely that the patient has a pelvic prolapse. Therefore, a vaginal exam would be indicated to help identify possible anatomical changes. There is no clinical data that supports a potential pelvic mass and inspection alone would not confirm this finding. Obtaining vital signs as well as a urine culture may be needed, but the focus should be on determination of physical findings related to the pelvic area.

Two nurses are discussing the important attributes of care coordination. Which attribute of care coordination should be included in the discussion? A. Community based B. Hospital based C. Team based D. Health insurance based

C Care coordination should be team based, or interdisciplinary. This allows the care to extend over several disciplines for a broader approach. Care that is community based, hospital based, or health insurance based would be too broad and might not serve the patient well.

Which behavior by a nurse indicates the effective strategy for collaboration with other professionals? A. Strongly defends own professional role B. Avoids conflict C. Negotiates with others D. Aggressively presents a personal view of a situation

C Conflicts may arise during collaboration, requiring the skill of negotiation. Strongly defending the professional role does not allow for input from other disciplines. Avoiding conflict does not allow proper representation of the nursing role. Collaboration should not be based on personal views.

Which term is the conglomerate of morals, values, beliefs, norms, and meanings that a group of people share and communicate from one generation to the next? A. Language B. Religion C. Culture D. Customs

C Culture is a blend of everything an individual experiences throughout the lifespan. Norms, values, beliefs, meanings, and morals are shared and taught to young persons. As an individual grows, he or she reflects on the teachings and molds them to fit his or her personal development.

After a management decision to admit terminal care patients to a medical unit, the nursing manager notes that nursing staff on the unit appear tired and anxious. Staff absences from work are increasing. The nurse manager is concerned that staff may be experiencing stress and burnout at work. What action would be best for the manager to take that will help the staff? a. Ask administration to require staff to meditate daily for at least 30 minutes. b. Have a staff psychologist available on the unit once a week for required counseling. c. Have training sessions to help the staff understand their new responsibilities. d. Ask support staff from other disciplines to complete some nursing tasks to provide help.

C Feeling unprepared for work responsibilities contributes to stress and poor coping in the workplace. Administration cannot require that staff participate in meditation or counseling sessions, although these can be recommended and encouraged. Asking other disciplines to assume nursing tasks is not appropriate for their scope of practice.

In order to fully understand the concept of sexuality, it is necessary to become familiar with the terms used when discussing this topic. Which term best describes how one views oneself as masculine or feminine? A. Sexual identity B. Sexual orientation C. Gender identity D. Sexual behavior

C Gender identity is socially derived from experiences with family, friends, and society. Sexual identity is defined as whether one is male or female based on biological sexual characteristics. Sexual orientation is how one views oneself in terms of being emotionally, romantically, or sexually attracted to an individual of a particular gender. Sexual behavior is how one responds to sexual impulses and desires.

Which statement by a nursing student demonstrates an understanding of collaboration? A. "Collaboration is a new way of interacting with physicians." B. "Collaboration means that the care team can make all of the decisions for the patient." C. "Collaboration with patients has been used by nurses throughout the history of nursing." D. "Collaboration is an outdated concept that has been replaced by managed care."

C History shows that from the time of Florence Nightingale, nurses have worked with patients to assess their needs and wants. Collaboration with fellow care providers such as physicians is not a new concept; it is becoming more prevalent. To correctly use collaboration, the team does not make decisions without including the patient.

A nursery nurse performing the first physical assessment of the newborn observes that there is no clear identification of genitalia as being either female or male. How should the nurse identify this newborn? a. Gender neutral b. Bisexual c. Observation of intersex d. Asexual

C Intersex represents a group of conditions where the external genitalia of an infant does not appear as either male or female and/or is not consistent with genetic sex or organs. The nurse cannot attribute sexual preference such as asexual or bisexual. Gender neutral does not apply to this clinical situation.

The emergency department nursing assessment of a pregnant female at 35 weeks gestation reveals back pain, blood pressure 150/92, and leaking of clear fluid from the vagina. Which complication of pregnancy does the nurse suspect? a. Ectopic pregnancy b. Spontaneous abortion c. Premature rupture of membranes d. Supine hypotension

C Leaking of clear fluid from the vagina with back pain and elevated BP is associated with premature rupture of membranes, a complication of pregnancy. An ectopic pregnancy usually manifests as unilateral pain early in the pregnancy. Vaginal bleeding is a classic sign of miscarriage, or spontaneous abortion, not leaking of clear fluid. This patient's blood pressure is elevated. Supine hypotension occurs when the woman is lying supine; then low blood pressure occurs due to the decrease in venous return from the gravid uterus placing pressure on the vena cava.

A patient who had been complaining of intolerable stress at work has demonstrated the ability to use progressive muscle relaxation and deep breathing techniques. He will return to the clinic for follow-up evaluation in 2 weeks. Which data will best suggest that the patient is successfully using these techniques to cope more effectively with stress? a. The patient's wife reports that he spends more time sitting quietly at home. b. He reports that his appetite, mood, and energy levels are all good. c. His systolic blood pressure has gone from the 140s to the 120s (mm Hg). d. He reports that he feels better and that things are not bothering him as much.

C Objective measures tend to be the most reliable means of gauging progress. In this case, the patient's elevated blood pressure, an indication of the body's physiologic response to stress, has diminished. The wife's observations regarding his activity level are subjective, and his sitting quietly could reflect his having given up rather than improved. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiologic changes from stress and may not reflect improved coping with stress. The patient's report that he feels better and is not bothered as much by his circumstances could also reflect resignation rather than improvement.

The nurse is assessing a patient's coping abilities related to expected placement in a long-term care facility. Which risk factor is of most concern to the nurse? A. The patient's family members all live several hours away. B. The patient is a retired police officer. C. The patient was recently diagnosed with Alzheimer disease. D. The patient will need assistance in moving from his home.

C Poor cognition is a key risk factor for poor coping because the patient has difficulty assessing a situation and making decisions that allow a sense of control. Limited support is a risk factor, but decreased cognition adds to the patient's inability to understand changes. A retired police officer would typically have experienced stress and have some strengths in managing stress. Needing assistance to move is a short-term need; the inability to understand the need for the move or a new situation because of poor cognitive function is the greater concern.

The nurse is developing a care plan for a patient with ineffective coping skills. Which intervention would be an example of a problem-focused coping strategy? a. Scheduling a regular exercise program b. Attending a seminar on treatment options c. Identifying a confidant to share feelings d. Attending a support group for families

C Problem-focused strategies are used to find solutions or improvement to the underlying stressor, such as accessing community resources or attending educational seminars. Exercise, emotional support, and support groups are emotion-based strategies that create a feeling of well-being.

A nurse working with a family whose child has recently told them that he identifies with the LGBTQ community asks the nurse to explain how this happened considering the fact that the child was raised as a male and played with appropriate toys. What is the best nursing response to the family's concerns? a. Tell them that there is no need for concern for their child has shared this information with them. b. Ask the parents if they ever noticed something different about their son as he was growing up. c. Explain that sexual orientation changes can occur over time. d. Suggest that this behavior may be temporary.

C Sexual orientation and gender identification is now thought of as a fluid concept, with the term sexual fluidity being used to convey this meaning for individuals who identify with other than heterosexual relationships. The nurse should respond to the parent's concerns and not minimize their reaction but rather let them know that it is the chosen response of their child. Relating the sexual orientation or gender identification to how one was raised indicates an implied bias. Telling the family that the behavior may be temporary is not correct.

A female patient comes to the clinic after missing one menstrual period. She lives in a house beneath electrical power lines which is located near an oil field. She drinks two caffeinated beverages a day, is a daily beer drinker, and has not stopped eating sweets. She takes a multivitamin and exercises daily. She denies drug use. Which finding in the history has the greatest implication for this patient's plan of care? a. Electrical power lines are a potential hazard to the woman and her fetus. b. Living near an oil field may mean the water supply is polluted. c. Alcohol exposure should be avoided during pregnancy due to teratogenicity. d. Eating sweets may cause gestational diabetes or miscarriage.

C Stages of development include ovum, embryonic, and fetal. The beginning of the fourth week to the end of the eighth week comprise the embryonic period. Teratogenicity is a major concern because all external and internal structures are developing in the embryonic period. A pregnant woman should avoid exposure to all potential toxins during pregnancy, especially alcohol, tobacco, radiation, and infections during embryonic development. Living in a house beneath power lines is not the greatest implication in this patient's plan of care as there are no definite risks to the developing fetus. Living near an oil field has no definite risks to the fetus. Eating sweets may contribute to maternal obesity, large for gestational age fetus, and maternal gestational diabetes but does not have the immediate implication of a daily beer drinker which can cause fetal alcohol syndrome.

A female patient comes to the clinic at 8 weeks' gestation. She lives in a house beneath electrical power lines, which is located near an oil field. She drinks two caffeinated beverages a day, is a daily beer drinker, and has not stopped eating sweets. She takes a multivitamin and exercises daily. She denies drug use. Which finding in the history has the greatest implication for this patient's plan of care? A. Electrical power lines are a potential hazard to the woman and her fetus. B. Living near an oil field may mean the water supply is polluted. C. Drinking alcohol should be avoided during pregnancy because of its teratogenic effects. D. Eating sweets may cause gestational diabetes or miscarriage.

C Stages of development include the ovum, the embryo, and the fetus. The embryonic period lasts from the beginning of the fourth week to the end of the eighth week of gestation. Teratogenicity is a major concern because all external and internal structures are developing in the embryonic period. During pregnancy, a woman should avoid exposure to all potential toxins, especially alcohol, tobacco, radiation, and infectious agents. Living beneath power line or near an oil field is not teratogenic in itself. Stopping sweets can be addressed after the alcohol cessation is addressed.

Which statement is true regarding the concept of care coordination? a. There is minimal risk for individuals across the life cycle. b. Due to enhanced technological ability, services are able to be provided to all those in need. c. Most vulnerable populations have the highest need. d. Costs of services are easily maintained.

C The concept of care coordination is an important aspect for all individuals as there is the potential for everyone to experience a risk at one time that may require at best a temporary need for coordination of services. Although technological advances have advanced, there are still limitations and barriers to providing coordination of care services to all in need. Vulnerable populations have the highest need and costs of services are cost-intensive.

The nurse is counseling a woman who is caring for her 83-year-old father. The father has had mental changes and is becoming more confused. The father lives with the daughter in her home. The nurse knows the daughter understands the father's care needs when she states which of the following? a. "Dad will only need my help for a short time, and then he will get better." b. "I can leave dad alone during the day; I'll just deadbolt the door." c. "I can send dad to the adult daycare; that way I can work and care for him at night." d. "Dad misses mom since she passed; he will be okay in a few weeks."

C The father will be cared for at the adult daycare, and it is a nice alternative for the daughter. She will be able to work and know that her father is safe during the day. The daughter thinking the father will be okay in a few days is not realistic, nor can she deadbolt the door and lock him in the house.

The nurse is assessing a patient's spirituality and observes the patient meditating before any treatments. What is the nurse's best action? a. Document that the patient is not religious. b. Offer the patient a copy of the Bible to read. c. Arrange for quiet time for the patient as needed. d. Limit the time patient can meditate before procedures.

C The nurse can best promote the patient's spirituality practices by arranging for the patient to be left alone when possible to meditate. Meditation is an exemplar of spirituality, not necessarily of the Christian faith. The Bible is most often read by believers in the Christian faith. Meditation does not imply that the patient is not religious. Time for meditation should not be limited, whenever possible.

A young wife is talking with the nurse about her husband who is returning from the military. The wife confides that her husband is physically okay but is behaving differently. What is the nurse's best response? a. "He is just trying to adjust to civilian life again; he'll be okay." b. "You should observe him closely, because he could attack you." c. "Many times people need care for emotional trauma." d. "Talk with your physician to get medication, and then put it in his food."

C The nurse is alerting the young wife to the fact that people who have experienced emotional trauma need care too. The nurse does not know how the husband is adjusting so the other options are incorrect.

A family is talking with a nurse because a family member is experiencing a chronic illness. The family asks the nurse how they should cope with their changing roles. What is the nurse's best response? A. "Don't worry about the role changes; everyone will know what to do." B. "I know you are worried about this, so you should talk with the physician." C. "The family should discuss the changing roles and what is needed for everyone." D. "As the nurse, I can decide about the role changes and what would be best for the family."

C The nurse should encourage the family to discuss the changes and what everyone needs and wants with this new situation. This approach will allow every family member to recognize their own needs in addition to the changing needs of the family. Everyone may not know what to do, so answer A is incorrect. Talking to the physician is fine, but he or she will not take on the role of problem solver for the family. The nurse does not have the right to decide for the family; decisions about role changes have to be made by the family members.

A patient has not been sleeping well because he is worried about losing his job and not being able to support his family. The nurse takes the patient's vital signs and notes a pulse rate of 112 beats/min, respirations are 26 breaths/min, and his blood pressure is 166/88 instead his usual 110-120/76-84 range. Which nursing intervention or recommendation should be used first? a. Go to sleep 30-60 minutes earlier each night to increase rest. b. Relax by spending more time playing with his pet dog. c. Slow and deepen breathing via use of a positive, repeated word. d. Consider that a new job might be better than his present one.

C The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident in his elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system (i.e., Benson's relaxation response) will counter the sympathetic nervous system's arousal, normalizing these vital-sign changes and reducing the physiologic demands stress is placing on his body. Other options do not address his physiologic response pattern as directly or immediately.

The nurse and physician are explaining that home care that will be needed by a patient after discharge. The patient's spouse states angrily that it will not be possible to provide the care recommended. What is the best response by the nurse? a. "Let me review what is needed again." b. "It is important that you do what the physician has prescribed." c. "What concerns do you have about the prescribed care?" d. "I can come back after you talk with your spouse about the care."

C The patient needs to be the focus of developing care plans, and communication is an important part of collaboration with the patient to discover barriers for the patient to follow recommendations. It is important to either provide solutions to the barriers or present other options. Reviewing the care again does not demonstrate willingness to have the patient be part of the team. Insisting that the patient do what is prescribed is autocratic and does not recognize the role the patient has in their care. Leaving the patient and spouse with the situation unresolved fosters distrust and more anger.

Optimal symptom management is primarily based upon which type of care? A. Physician-directed care B. Nurse-directed care C. Evidence-based practice D. Hospice-directed care

C The use of the best evidence can support high-quality interventions that are used in optimal symptom management and improved quality of life. Physician-directed care and Nurse-directed care are incorrect since palliative care is an interdisciplinary team approach to care. Hospice-directed care is incorrect as it is for the terminally ill and dying patient.

The nurse is caring for a patient with a progressive, degenerative muscle illness. The patient states that she would like to remain in her home with her daughter as long as possible. What action should the nurse take? a. Teach the patient muscle strengthening and stretching exercises. b. Tell the patient to make plans to move to an assisted-living facility. c. Discuss resources to help the patient and make appropriate referrals. d. Ask the patient to come in for daily physical therapy.

C To honor the patient's request to stay at home the nurse should make appropriate referrals for needed evaluation and assistance. Most nurses will not have the expertise to teach appropriate exercises for degenerative illness. Asking the patient to move to an assisted-living facility does not account for the patient's request. The patient has not been assessed for the need of daily therapy, and it is not likely that a patient with a degenerative illness will be able to make daily appointments for treatment as the illness progresses.

A patient who was recently diagnosed with diabetes is having trouble concentrating. This patient is usually very organized and laid back. Which action should the nurse take? a. Ask the healthcare provider for a psychiatric referral. b. Administer the PRN sedative medication every 4 hours. c. Suggest the use of a home caregiver to the patient's family. d. Plan to reinforce and repeat teaching about diabetes management.

D Because behavioral responses to stress include temporary changes such as irritability, changes in memory, and poor concentration, patient teaching will need to be repeated. Psychiatric referral or home caregiver referral will not be needed for these expected short-term cognitive changes. Sedation will decrease the patient's ability to learn the necessary information for self-management.

The nurse is discussing care coordination with a patient. The patient asks the nurse to explain care coordination. What is the nurse's best response? a. "Care coordination is a cost effective method created by the community." b. "Care coordination forces the health-care facilities in the community to work together." c. "Care coordination exists for the children and uninsured in the community." d. "Care coordination allows health-care services to work together in the community."

D Care coordination allows all health-care/community services to work together so that patient and family needs can be met. Care coordination does not focus on cost methods. Cost coordination does not exist just for children or the uninsured. No one service is forced to work with another service.

A student nurse asks why care coordination is now a top priority for health system redesign. What is the nursing instructor's best response? A. "Patients like to be cared for by more than one service agency." B. "Care coordination increases confusion about who is responsible for the patient." C. "Community services are lacking, and care coordination helps to fill the void." D. "Every patient will need coordinated care services at some time in life."

D Care coordination is more prominent in healthcare design today because patients will need coordination of services to promote optimal healthcare outcomes. Community services are not always lacking but may be restricted by financial resources. Care coordination should not increase confusion but should rather lessen it. Patients are usually knowledgeable about the service agencies that are available to care for them.

A nursing instructor is talking about care coordination with nursing students. The instructor stresses which of the following to the students concerning care coordination? a. "A patient must ask for what they need in order to coordinate care." b. "The nurse does most of the work in care coordination." c. "Medical diagnoses are an integral part of care coordination." d. "Collaboration is a significant part of care coordination."

D Collaboration is a big part of care coordination. Without the collaboration, there would be no care coordination. Patients asking for their needs to be met does not collaborate care. Nurses do not do all the work in care collaboration. Medical diagnoses are one small part that drives the need for care collaboration.

Comfort care is an intervention carried out by which professional discipline? A. Medicine B. Clergy C. Volunteers D. Nursing

D Comfort care is a term that is often used by physicians and nurses in the context of dying, terminally ill, or seriously ill patients. Yet, comfort care is predominantly used by nurses, who attend to the dying patient and family by providing physical comfort measures, such as repositioning, mouth care, and skin care, while valuing the ongoing medical management of the patient's symptoms. Therefore, the other answers are incorrect—it is primarily the nurse who provides comfort care.

The nurse has been asked to administer a coping measurement instrument to a patient. What education would the nurse present to the patient related to this tool? a. "This tool will let us compare your stress to other patients in the hospital." b. "This tool is short because it only measures the negative stressors you are experiencing." c. "You will need to ask your parents about stressors you had as a child to complete this tool." d. "This tool will help assess recent positive and negative events you are experiencing."

D Coping measurement tools measure recent positive and negative life events as perceived by the individual. There is no objective scale for comparison with other patients because each person reacts differently to stressors. Both negative and positive events are assessed. Childhood stressors are not part of this type of evaluation as they are intended to measure recently occurring events.

Which statement by a student nurse demonstrates understanding of managing patient care for a patient with a chronic disease? A. "Chronic disease management is best handled with one expert provider taking the lead role in the treatment plan." B. "A care giver-centered approach is best for managing the complexities of chronic disease care." C. "Current healthcare trends are evolving toward the paternalistic approach to care of the patient with chronic illness." D. "The patient and family should develop a partnership when developing a plan of care for a loved one with a chronic illness."

D Data show that approximately 90% of all healthcare expenditures are for the prevention and treatment of chronic disease, with 12% of the population accounting for more than 40% of healthcare spending. This shift toward chronic disease care has required healthcare systems to revamp their approaches to medical treatment. The paternalistic approach, which views the provider as "expert" and the patient as "passive recipient" of medical advice, works well in acute illness but is largely ineffective at treating chronic diseases that require daily management by patients and their caregivers. Rather, evidence suggests that patient-centered approaches, which emphasize patient-provider partnerships where patients are active participants in their care, are most effective for addressing chronic disease.

A patient has come to the health clinic for an annual checkup. He reports increased stress at work and having to work a lot of mandatory overtime. He has not been able to do his usual daily exercise for several weeks. What is the best response by the nurse? A. "There are other ways you can reduce your stress, such as cutting back on your work hours." B. "Have you considered a medication to help you sleep at night?" C. "Including exercise in your schedule will just increase the stress from work." D. "Regular exercise would be good because it helps the body deal with stress."

D Exercise is a form of emotion-based coping that increases a feeling of well-being. Cutting back on hours may not be an option in his current work climate, although it might help reduce stress. There are other nonpharmacological methods that may help with stress, such as music or meditation, which would not involve possible side effects from medications. Exercise will decrease feelings of stress when balanced with the time requirements of the stressor.

The nurse at the family planning clinic conducts a male history for infertility evaluation. Which finding has the greatest implication for this patient's care? a. Practice of nightly masturbation b. Primary anovulation c. High testosterone levels d. Impotence due to alcohol ingestion

D Factors affecting male infertility include impotence due to alcohol. Nightly masturbation and high testosterone levels do not have the greatest implication on male infertility in a patient with admitted alcohol issues. Primary anovulation refers to female infertility, so it is not a consideration for male infertility.

A patient tells the nurse, "I'm told that I should reduce the stress in my life, but I have no idea where to start." Which would be the best initial nursing response? a. "Why not start by learning to meditate? That technique will cover everything." b. "In cases like yours, physical exercise works to elevate mood and reduce anxiety." c. "Reading about stress and how to manage it might be a good place to start." d. "Let's talk about what is going on in your life and then look at possible options."

D In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. As a result, further assessment is indicated before potential solutions can be explored. Suggesting further exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.

When developing a plan of care to promote self-management, which patient is least likely to be affected by depression? a. A 55-year-old employed female b. A 35-year-old Hispanic male c. A 40 year old with 5th grade education d. A 42 year old with private insurance

D Individuals most affected by depression are midlife adults ages 45-64, women, minorities, individuals without a high school education, and individuals without health insurance. Treatment for depression includes the use of medication and psychological therapy. Additionally, patients must learn to manage moods including suicidal thoughts, recognize triggers and relapse, and set goals for behavioral management of their disease.

A nurse working in a free clinic has recognized the need for health promotion for pregnant teenagers. The nurse works to develop a consortium of healthcare experts from several disciplines across the region to work toward improving the nutrition of pregnant teenagers. This is an example of what type of collaboration? A. Nurse-patient collaboration B. Nurse-nurse collaboration C. Intraprofessional collaboration D. Interorganizational collaboration

D Interorganizational collaboration occurs between regional, national, or international organizations to achieve a common goal. Nurse-patient collaboration occurs when a nurse is working directly with a patient. Nurse-nurse collaboration occurs between nurses and among professionals in nursing management projects. Intraprofessional collaboration occurs among members of a professional discipline.

A nurse has begun working on a new unit with high-acuity patients. She also has care responsibilities for her children and her aging parents. The nurse is experiencing signs of being overwhelmed. What counsel by the nurse manager would help the nurse cope with her work stress? A. Take some time off to decide if she really wants to be a nurse. B. Encourage her to catch up on her documentation responsibilities while taking her lunch break. C. Enlist the help of other family members in the care of her children so she can focus on work. D. Request that another nurse help her focus on essential aspects of care rather than optional aspects of care.

D Learning to prioritize care to what is essential to perform versus what would be nice to perform but could be eliminated on stressful days will help the nurse manage her physical and emotional resources at work. Taking time off does not address the underlying issue of how to handle work stress. Periodic breaks in a work day, such as a meal break, allow the staff to refocus and maintain energy to complete their work. Support from family may help address stressors at home but does not help manage stress at work.

A newly licensed nurse is assigned to an experienced nurse for training on a medical unit of a hospital. What type of nurse-to-nurse collaboration does this assignment demonstrate? a. Interprofessional b. Shared governance c. Interorganizational d. Mentoring

D Mentoring is a collaborative partnership between a novice nurse and an expert nurse to help transition a nurse through career development, personal growth, and socialization into the profession. Interprofessional collaboration is working with several disciplines. Shared governance is a type of management for nursing. Interorganizational collaboration often includes teams from inside and outside an organization to meet a common goal.

Many middle-aged adults are called the "sandwich" generation because they are caring for their children and their aging parents. What is the priority reason for aging parents needing care? a. Mental clarity b. Immobility c. Blindness d. Multiple chronic illnesses

D Multiple chronic illnesses come with the aging process. Middle-aged adults are becoming the caregivers for the generation before them and the one after them. Mental clarity is a positive aspect of aging and does not need care. Immobility and blindness do not always mean that the person needs direct care.

A female college student is planning to become sexually active. She is considering birth control options and desires a method in which ovulation will be prevented. To prevent ovulation while reaching 99% effectiveness in preventing pregnancy, which option should be given the strongest consideration? a. Intrauterine device b. Coitus interruptus c. Natural family planning d. Oral contraceptive pills

D Oral contraceptive pills prevent ovulation and are 99% effective in preventing pregnancy when taken as directed. Intrauterine devices, coitus interruptus, and natural family planning will not prevent ovulation while reaching 99% effectiveness in preventing pregnancy, so they are not recommended for this college student.

The nurse is working with a college student who is planning to become sexually active. She is requesting a reliable method of birth control that could be easily discontinued if necessary. Which is the best option for this college student? A. Intrauterine device (IUD) B. Coitus interruptus C. Natural family planning D. Oral contraceptive pills

D Oral contraceptive pills prevent ovulation, are easy to stop, and are 99% effective in pregnancy prevention. Intrauterine devices, coitus interruptus, and natural family planning will not prevent ovulation; they should not be recommended for this college student who desires a reliable method of birth control that can be easily discontinued.

The student demonstrates a lack of understanding of palliative care when making which statement? a. "Palliative care is designed to promote comfort." b. "Palliative care is designed to reduce disease exacerbations." c. "Palliative care is designed to decrease acute care hospital admissions." d. "Palliative care is designed to promote a cure for chronic disease."

D Palliation is the reduction of symptoms without elimination of the cause. Palliative care refers to the provision of care for patients who are diagnosed with a disease or condition without a cure.

Today most patients are living for several years before dying with multiple chronic conditions, such as COPD, congestive heart failure, diabetes, and obesity. These concomitant diseases contribute to multiple symptoms that interfere with the patient's quality of life. What type of care would you consider for this patient? a. End-of-life care b. Supportive care c. Comfort care d. Palliative care

D Palliative care provides optimal symptom management in the setting of multiple chronic conditions. The relief and management of these symptoms help to promote improved quality of life for the patient and help to maintain physical functioning.

Which patient would benefit most from a plan of care that includes self-management? A. Patient hospitalized with femur fracture B. Patient diagnosed with pulmonary embolus C. Patient experiencing chest pain D. Patient with chronic heart failure

D Patients diagnosed with a chronic disease who are not suffering acute exacerbations are the best candidates for self-management. A patient with chronic heart failure can be educated about signs/symptoms and the treatment plan to manage the condition outside of the hospital. Patients with a femur fracture need acute care and assisted rehabilitation. Pulmonary embolism and chest pain are emergent conditions that require skilled, acute care.

A nurse is reviewing the concept of professional collaboration. Which patient scenario should the nurse identify as the best example of professional collaboration? a. The nurse, physician, and physical therapist have all visited separately with the patient. b. The nurse, physical therapist, and physician have all developed separate care plans for the patient. c. The nurse mentions to the physical therapist that the patient may benefit from a muscle strengthening evaluation. d. The nurse and physician discuss the patient's muscle weakness and initiate a referral for physical therapy.

D Professional collaboration includes team management and referral to needed providers to meet patient needs. Each discipline retains responsibility for their own scope of practice but recognizes the expertise of other providers. Working separately does not develop a comprehensive plan of care. Casual mentioning of patient needs does not follow professional communication channels and frequently delays needed interventions.

A registered nurse (RN) is reviewing the concept of collaboration. Which statement correctly describes the RN nursing' role in collaboration? a. State boards of nursing mandate that collaboration can only occur in hospitals. b. Collaboration should occur only with physicians. c. Collaboration occurs only between nurses with the same level of education. d. Collaboration may occur in health-related research.

D RNs collaborate with many different persons, including patients, managers, educators, and researchers. Collaboration does not occur only with physicians or nurses of equivalent educational background, but with anyone who is working toward meeting patient goals. Collaboration occurs in any healthcare setting as well as community and home settings.

A married couple present to the preconceptual clinic with questions about how a fetus's chromosomal sex is established. What is the best response by the nurse? A. At ovulation, chromosomal sex is established. B. At ejaculation, chromosomal sex is established. C. At climax, chromosomal sex is established. D. At fertilization, chromosomal sex is established

D Remember that the primary spermatocyte contains two sex chromosomes, one X chromosome and one Y chromosome, and the primary oocyte contains two sex chromosomes, both X chromosomes. During the first reduction division, two secondary spermatocytes are produced, one X and one Y, establishing X and Y cell lines. The X-bearing cell line is established during oogenesis. Female gametes will all be X bearing and male gametes will be either X or Y bearing. A female develops through the fertilization of the ovum by an X-bearing sperm producing an XX zygote; a male is produced through the fertilization of a Y-bearing sperm producing an XY zygote. Therefore, at fertilization, chromosomal sex is established. Chromosomal sex is not established at ovulation, ejaculation, or climax, so these choices are erroneous.

A patient has begun smoking again and drinks six alcoholic beverages per day since experiencing the loss of his job. The nurse recognizes that the patient is exhibiting symptoms of which type of stress? A. Psychological B. Emotional C. Physiological D. Behavioral

D Signs and symptoms of behavioral stress include smoking, overeating, and substance abuse. Substance abuse is not a symptom of psychological, emotional, or physiological stress.

The nurse is obtaining a sexual history from an adolescent patient. Which finding has the greatest implication for this patient's care? a. Patient denies any sexual activity. b. Patient states that he/she uses "safe sex" practices. c. Patient states that he/she is in a monogamous relationship. d. Patient has been intimate with more than one person in the last year.

D The Center for Disease Control (CDC) had identified the 5P's with regard to obtaining information for a sexual history. They focus on partners, practices, protection from infection, past history of infection, and prevention of pregnancy. An individual who has had more than one partner within the time frame should be questioned regarding condom use. Denial of sexual activity is part of the patient's self-disclosure. The patient stating that he/she is in a monogamous relationship again represents self-disclosure. Use of "safe sex" practices may need to be further explored but it does not have the greatest implication at this point.

A patient has been admitted to an acute care hospital unit. The nurse explains the hospital philosophy that the patient be an active part of planning their care. The patient verbalizes understanding of this request when they make which statement? a. "I will have to do whatever the physician says I need to do." b. "Once a plan is developed, it cannot be changed." c. "My insurance will not pay if I don't do what you want me to do." d. "We can work together to adjust my plan as we need to."

D Treatment plans need to be developed, evaluated, and adapted as needed based on the patient status and willingness to complete the prescribed care. Stating that the patient has to do whatever the care provider prescribes does not include the principle of collaboration. Care plans can be altered based on patient status. Insurance providers do not determine a patient's ability to complete prescribed care, although they do reimburse for standard care given.

When developing a plan of care, the nurse should consider which attribute of the concept of spirituality? a. Spirituality is not a well-known universal concept. b. Chronic versus acute illnesses affect spirituality. c. Convincing patients to pray is a priority intervention. d. Referrals may be needed to spiritual counselors.

D The attributes of the concept of spirituality in the context of nursing care are described below. • Spirituality is universal. All individuals, even those who profess no religious belief, are driven to derive meaning and purpose from life. • Illness impacts spirituality in a variety of ways. Some patients and families will draw closer to God or however they conceive that higher Power to be in an effort to seek support, healing, and comfort. Others may blame and feel anger toward that Higher Power for any illness and misfortune that may have befallen a loved one or their entire family. Still others will be neutral in their spiritual reactions. • There has to be willingness on the part of patient and/or family to share and/or act on spiritual beliefs and practices. • The nurse needs to be aware that specific spiritual beliefs and practices are impacted by family and culture. • The nurse needs to be willing to assess the concept of spirituality in patients and families and based on this ongoing assessment to integrate the spiritual beliefs of patients and families into care. • The nurse needs to be willing to refer the patient or family to a Spiritual Expert i.e., a Minister, Priest, Rabbi, an Imam. • Community-based religious organizations can provide supportive care to families and patients and nurses need to be aware of these resources.

As the profession of nursing evolved to incorporate evidence-based practice, which statement is true about spirituality? A. Evidence-based care focuses solely on the physical effects of health and illness. B. An emphasis was placed on spirituality as nursing education moved into colleges and universities. C. Spirituality was incorporated back into care when a concrete definition had been established. D. Spirituality commonly encompasses a concept or belief about God and the inner person.

D The definitions of spirituality encompass the following: a principle, an experience, attitudes and belief regarding God, a sense of God, the inner person. According to Mary Elizabeth O'Brien, "Spirituality, as a personal concept, is generally understood in terms of an individual's attitudes and belief related to transcendence (God) or to the nonmaterial forces of life and of nature." O'Brien concluded that most descriptions of spirituality include not only transcendence but also the connection of mind, body, and spirit, plus love, caring, and compassion and a relationship with the Divine. Throughout history, spirituality has not been a focus of nursing care as evidence-based practice has emerged. However, spirituality and its significance were never totally removed from nursing practice. In the 1970s and 1980s, spirituality was virtually removed from nursing curricula as the education of nurses moved increasingly into colleges and universities. The concept of Spirituality is an elusive concept to define. Authors who write about spirituality in nursing advocate the position that a patient's quality of life, health, and sense of wholeness are affected by spirituality, yet still the profession of nursing struggles to define it.

A nurse is reviewing concepts related to physiological responses that occur during sexual acts. Which statement should the nurse identify as not being accurate? a. During resolution, ADH and oxytocin are released. b. Most often in males, orgasm occurs with ejaculation. c. Genital congestion occurs as part of a reflexive response. d. Dopamine secretion acts as an inhibitory transmitter.

D The general phases of sexual arousal include motivation, arousal, genital congestion, orgasm and resolution. Dopamine secretion is considered to be an excitatory and released during the arousal stage. Orgasm and ejaculation occur more frequently in males. Genital congestion is under reflexive autonomic response.

Human sexuality is interrelated with a variety of other nursing concepts that may affect sexuality or be affected by healthy sexual functioning. Prompt diagnosis and treatment of potential concerns related to concept overlap is an important nursing function. Which other concept is most likely to overlap with sexuality? A. Stress B. Gas exchange C. Pain D. Reproduction

D The most obvious overlap between concepts is that of sexuality and reproduction. An example may be the use of contraceptives in order to avoid pregnancy. Women who are unable to conceive a child may experience emotional distress. A sexual relationship is likely to change as pregnancy advances. If a patient is feeling stress because of other life issues, this is likely to have a negative impact on his or her sexual relationships. The patient who has poor gas exchange may encounter challenges with sexual activity related to hypoxia. One physiological barrier to healthy sexual functioning is pain. Both chronic pain and pain during intercourse can negatively affect a patient's sexual relationship.

An older patient presents to the outpatient clinic with a chief complaint of headache and insomnia. In gathering the history, the nurse notes which factors as contributing to this patient's chief complaint? a. The patient is responsible for caring for two school-age grandchildren. b. The patient's daughter works to support the family. c. The patient is being treated for hypertension and is overweight. d. The patient has recently lost her spouse and needed to move in with her daughter.

D The stress of losing a loved one and having to move are important contributing factors for stress-related symptoms in older people. Caring for children will increase the patient's sense of worth. Being overweight and being treated for hypertension are not the most likely causes of insomnia or headache. The patient's daughter may have added stress due to working, but this should not directly affect the patient.

A patient tells the nurse, "I am not a religious person. I believe things happen in life out of pure coincidence." Which evaluation of this patient's spirituality is true? A. This patient is not a spiritual person. B. This patient is more likely to suffer from depression. C. This patient will experience difficulty coping with life changes. D. This patient experiences emotions and should be asked about effects of health changes

D This patient will still experience emotions and effects of health changes even though he does not identify himself as spiritual. Every person is believed to have a spiritual nature, a sense that there is more than what is experienced day to day, month to month, year to year until death. Spirituality encompasses the mundane activities of life that keep us grounded as well as those magnificent times and experiences when our inner most spirit soars with any number of emotional responses including exquisite joy, dark and deep sorrow, laughter and fun, and all emotions in between. There is no direct evidence to believe this patient will suffer from depression or have difficulty coping. A patient may have healthy coping abilities without identifying with a religion.