Chapter 4 - Theoretical Foundation of Nursing Practice

A senior nurse is teaching nursing theories to a group of nursing students. What are the components of nursing theories that explain a nursing phenomenon? Select all that apply. Concepts Definitions Corrections Assumptions Compositions

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A patient who is in the terminal stages of cancer has moderate pain and severe dyspnea. Her husband informs the nurse that she believes in prayer and her last wish is to die while listening to prayer. What should the nurse do first? Perform a prayer. Administer pain medications. Administer oxygen. Arrange for a chaplain.

3 Rationale The nurse should identify and prioritize the unmet needs of a patient. This patient is in the terminal stage of cancer and has severe dyspnea. Maintaining airway breathing and circulation is the most basic physiological need, and therefore the nurse should administer oxygen. Once this has been done, the nurse can take steps to fulfill other needs of the patient, including performing a prayer, administering pain medications, or arranging for a chaplain. p. 46

*Theory-based nursing practice uses a theoretical approach for nursing care. This approach moves nursing forward as a science. What does this suggest?* One theory will guide nursing practice. Scientists will decide nursing decisions. Nursing will only base patient care on the practice of other sciences. Theories will be tested to describe or predict patient outcomes.

4 *Rationale* There are multiple theories for the practice of nursing; these theories are tested to develop the evidence to describe or predict patient outcomes. p. 41, 42

The nursing student is studying Neuman's system model of nursing. Including the physiological, how many concepts interact with each other to form this system?

5 Rationale Betty Neuman's theory is based on stress and the patient's reaction to it. This theory has five components: physiological, psychological, sociocultural, developmental, and spiritual. These concepts interact with internal and external factors at all levels of prevention and with each other to achieve optimal wellness. p. 46

Which theory states that the patient adapts to changes in physiological needs, self-concept, and interdependent relations during health and illness? Roy's theory Orem's theory Peplau's theory Henderson's theory

Which theory states that the patient adapts to changes in physiological needs, self-concept, and interdependent relations during health and illness? Roy's theory Orem's theory Peplau's theory Henderson's theory

*Who used anthropology to form a theory of cultural care diversity and universality?* Leininger Roy King Orem

1 *Rationale* Leininger used her background in anthropology to form her theory of cultural care diversity and universality. Roy identified types of demands placed on the patient, assessed adaptation to demands, & helped the patient with adaptation. King used communication to help the patient reestablish positive adaptation to environment. Orem promoted patient care & helped the patient fully attain self-care. p. 48

What is middle-range theory? It addresses specific phenomena and reflects practice. It is the first level in theory development and describes a phenomenon. It provides a structural framework for broad concepts about nursing. It is linked to outcomes (consequences of specific nursing interventions).

1 Rationale A middle-range theory focuses on a specific field or phenomenon rather than the broad scope of nursing. A grand theory is systematic and broad in scope and provides a structural framework for nursing practice. A descriptive theory is the first level of theory development and describes the phenomena under study. A prescriptive theory details nursing interventions for a specific phenomenon and the expected outcome of the care. These theories help guide research. p. 44

The nurse is caring for a patient with cancer. Which nursing action would come under the first level according to Maslow's hierarchy of needs? Providing enteral nutrition Constantly assessing the presence of bedsores Providing support to the patient Using strategies to improve the patient's self-esteem

1 Rationale According to Maslow's hierarchy of needs, basic physiological needs like air, water, and food come under the first level. Providing enteral nutrition meets the first level of human needs. Constantly assessing the presence of bedsores is the nursing action, which addresses the safety needs of the patient. This action comes under the second level of Maslow's hierarchy. Providing support to the patient is an action to satisfy the love and belonging needs of the patient. Therefore, this action comes under the third level. Using strategies to improve self-esteem in the patient comes in level four of Maslow's hierarchy. p. 46

A patient is diagnosed with myocardial ischemia. His blood pressure reading is 180/100 mm Hg, and his total blood cholesterol is 300 mg/dL. The nurse teaches him simple exercises that help reduce his cholesterol level and increase his tolerance to stress through adaptation. Of which nursing theory is this an example? Roy's theory Leininger's theory Orem's theory Peplau's theory

1 Rationale According to Roy's model, the goal of nursing is to help the person adapt to changes in physiological needs, self-concept, role function, and interdependent relations during health and illness. Therefore, the nurse is applying Roy's theory here. Leininger's theory focuses on the importance of culture in caring for the patient. Orem's theory focuses on the patient's self-care needs, whereas Peplau's theory emphasizes the nurse-patient interpersonal relationship. p. 47

The nurse is using Orem's theory while delivering care to a patient. According to this theory, what should be the goal of the nursing interventions? Care for and help the patient attain complete self-care. Help the patient adapt to changes in physiological needs. Communicate with the patient to establish positive adaptation to the environment. Assist the patient to do activities independently and to gain strength.

1 Rationale Different theories of nursing have different goals. Orem's theory focuses on patient self-care needs and its goal is to care for and help the patient attain complete self-care. Helping a person to adapt to changes in physiological needs is the goal of Roy's theory. According to King's theory, the nurse should use communication skills to help a patient reestablish positive adaptation to the environment. Henderson believed that nurses should work with other health care workers to assist the patient to do activities independently and help to gain strengths that the patient is lacking. p. 48

The nursing student is working on her project on interdisciplinary theories. While interviewing one of the in-service nurses, the nursing student asks for an example of feedback. Which statement is an example of feedback? The wife of a husband suffering asthma thanked the nurse for her husband's recovery. The nurse learned that scheduled positioning changes help reduce the risk of pressure ulcers. A patient with ischemic heart attack was stable after continued nursing care. During assessment of a patient, the nurse noticed that the patient was unable to walk properly.

1 Rationale Feedback is the response of the family members and other health care providers to the patient's health condition. The wife's response about her husband's improving condition is considered feedback. The knowledge that scheduled positioning changes help in reducing the risk of pressure ulcers is an example of nursing content. The stable condition of the patient after ischemic heart attack is an example of nursing output. The inability to walk is an example of nursing input. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 45

Which option is closely aligned with Leininger's theory? Caring for patients from unique cultures Understanding the humanistic aspects of life Variables affecting a patient's response to a stressor Caring for patients who cannot adapt to internal and external environmental demands

1 Rationale Leininger's theory of transcultural nursing focuses on the patient's culture and the impact of cultural heritage on health care needs and interventions. p. 48

*What is input?* It is data entering the system. It is the end product. It is data related to system functioning. It is product and information obtained from the system.

1 *Rationale A system functions on its content, input, output, and feedback. The components are interrelated and share a common purpose to form a whole; there is a continuous process of input, output, and feedback data. Input for the nursing process is the data or information that comes from a patient's assessment (i.e., how the patient interacts with the environment and the patient's physiological function). p. 45

The nurse is caring for a patient with a urinary tract infection. According to systems theory, which statement should be considered as an input from the patient? The patient reports difficulty with urination. The patient voided normally without any difficulty. The patient is feeling better and thanks the nurse for the intervention. The patient should be given a diuretic to assist with urination.

1 *Rationale* *Input is the data that is obtained after examining the patient. The statement that the patient has difficulty urinating is input data. Output is the result, and hence, an increase in urinary output can be considered as an output. The outcome for a patient who has difficulty urinating is an ability to urinate without difficulty. Thus, urination without difficulty is output data. The patient thanking the nurse because of improvement in the condition is the feedback, and the information that a diuretic should be given is content. p. 45

A group of researchers is conducting research on diabetic patients based on Orem's theory. What is the most probable topic of research? Self-administration of insulin Effective nurse-patient communication Pathological process in diabetes Medications for diabetes

1 *Rationale* Orem's theory focuses on the patient's self-care needs. Evidence gained by the research based on insulin self-administration would help in facilitating self-care in patients with diabetes. Research based on effective strategies to improve nurse-patient communication would be based on Peplau's theory. Studies based on pathological processes in diabetes would help to improve the descriptive theories based on diabetes. Research focused on medications for diabetes is useful for improving prescriptive theories. p. 48

Which term is referred to as the pattern of thoughts that describe the domain of a discipline? Paradigm Phenomena Nursing theory Peplau's theory

1 Rationale A paradigm is the term used to describe the pattern of thoughts that explain the domain of a particular discipline such as nursing. A phenomenon is the term, description, or label used to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations. A nursing theory is a conceptualization of some aspect of nursing that describes, explains, predicts, or prescribes nursing care. Peplau's theory is one of the nursing theories. p. 42

A patient is newly diagnosed with diabetes. The diagnosis has made the patient feel stressed, and the patient eats more carbohydrates. Which theory explains this phenomenon? Neuman's theory Orem's theory Peplau's theory Leininger's theory

1 Rationale This patient is newly diagnosed with diabetes and is under stress. The patient responds to stress by eating too many carbohydrates. This process is explained by Neuman's theory, which focuses on stress and the reaction of patients to that stress. Orem's theory focuses on the self-care needs of the patient. According to the theory, the patient should be able to manage health problems. Peplau's theory focuses on the nurse-patient interpersonal relationship. Leininger's theory focuses on providing culturally competent care. Unlike Neuman's systems model, Orem's theory, Peplau's theory, and Leininger's theory do not specifically explain the relationship between the stressor and the stress-related behavior. p. 47

A woman explains to a registered nurse that she is having irregular periods. She is anxious because her grandmother died of cervical cancer. According to Peplau's theory, what should the nurse do? Select all that apply. Discuss the nature of the problem. Explain the services available. Help the patient reduce anxiety. Explain to the patient that she is normal. Prescribe hormonal therapy to the patient.

1 2 3 Rationale According to Peplau's theory, the nurse can act as a resource person, counselor, and surrogate. As the relationship develops, the nurse and patient can discuss problems and solutions mutually. Therefore, the nurse can discuss the nature of the problem, explain all the services available, and thus help the patient reduce anxiety. Having irregular menses is not a normal sign; its cause should be investigated. The registered nurse cannot prescribe hormone therapy to the patient. p. 48

The nursing student is working on a project about interdisciplinary theories. She has interviewed a few in-service nurses and has learned that the goal of the nursing process is to organize and deliver patient-centered care. As a system, which components does the nursing process include? Select all that apply. Input Output Feedback Delivery Rejection

1 2 3 Rationale The nursing process as a system consists of input, output, feedback, and content. Input is the information that is obtained by examining the patient. Output is the result of the nursing care, such as whether the patient's condition has improved, is stable, or has worsened. Feedback is the response of family members and health care providers to the patient's health condition. Content is the information obtained from the nursing process. Rejection is not a part of the nursing process. Test-Taking Tip: Even if you think you are unfamiliar with the specific material, use your best judgment or common sense to evaluate each option. For this question, you would be able to eliminate "Rejection" as incorrect just based on whether it seemed reasonable. p. 45

While working in a community health clinic, it is important to obtain nursing histories and get to know the patients. Part of history taking is to develop the nurse-patient relationship. Which statements apply to Peplau's theory when establishing the nurse-patient relationship? Select all that apply. An interaction between the nurse and patient must develop. The patient's needs must be clarified and described. The nurse-patient relationship is influenced by the patient's and the nurse's preconceptions. The nurse-patient relationship is influenced only by the nurse's preconceptions. The nurse-patient relationship should not establish trust.

1 2 3 Rationale There is continuous interaction by both the patient and the nurse throughout all phases of the nurse-patient relationship. One choice is incorrect because the focus is only on the nurse. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care. For this question, one choice is easily eliminated because of the word only. p. 47, 48

A senior nurse is explaining the importance of nursing theory to a group of nursing students. What statements are true about prescriptive theories? Select all that apply. Prescriptive theories are action-oriented. Prescriptive theories test the validity and predictability of a nursing intervention. Prescriptive theories are more limited in scope and less abstract. Prescriptive theories guide nursing research to develop specific nursing interventions. Prescriptive theories address a specific phenomenon and reflect practice.

1 2 4 Rationale A prescriptive nursing theory is action-oriented, and the purpose of the theory is to test whether a nursing intervention is valid and predictable. Thus, these theories can help develop specific nursing interventions. The middle-range theories are limited in scope and less abstract as they focus only on a specific aspect of nursing. The middle-range theories address a specific phenomenon and reflect practice. p. 44

A patient is bedridden after an accident and she needs to adapt to her surroundings for physiological, sociological, and psychological needs. The nurse has decided to apply Roy's theory to the patient's condition. Which statements apply to Roy's theory when establishing patient adaptations? Select all that apply. The nurse will determine which demands are causing problems for the patient. The nurse assesses how well the patient is adapting to problems. Adaptation to the basic physiological need should be the only goal of the nurse. Nursing care should be directed toward helping the patient adapt to changes. The need for nursing care arises only when the person cannot adapt to internal environmental demands.

1 2 4 Rationale According to Roy's theory, the goal of nursing care should be to help the patient adapt to changes. The nurse should determine which demands are causing the problem and should assess the patient's response to the changes that need to be adapted to. The nurse should directly care for the patient and help her adapt to the changes. The goal of nursing should not be limited to adaptation of basic physiological needs. It should also include developing a positive self-concept, performing social roles, and achieving balance between dependence and independence. The need for nursing care arises when the person cannot adapt to either internal or external environmental demands. Test-Taking Tip: Pay attention to key words within the question. For this one, the phrase, "when establishing patient adaptations" is key. Four of the choices use variations of the word adapt, but two of the choices also contain the word only. These cues can help you confirm that "the nurse assesses how well is the patient adapting to problems" and "nursing care should be directed toward helping the patient adapt to changes" as correct, getting you closer to a complete answer. p. 47

The nurse is caring for a woman with diabetes in a tertiary care setting and has educated her about the prevention of bedsores and foot care. After discharge, whom should the nurse contact for feedback about the patient's health? Select all that apply. The patient Family members The laboratory personnel The consulting health care professional The patient's friends

1 2 4 Rationale Feedback is useful in analyzing a system and how it functions. In nursing, feedback can be obtained from the person receiving services, his or her family members, and from any other consulting health care professionals. Outcomes are also a part of the feedback system and can be used to improve the services. In the nursing process, the outcomes reflect the patient's responses to nursing interventions. Therefore, in this case, feedback can be obtained from the patient, the family members, and the health care professional. The laboratory personnel and the patient's friends are not required for feedback and therefore should not be consulted. The laboratory personnel and the patient's friends are not with the patient all the time; therefore, they would not be helpful in giving feedback regarding the patient's health. p. 45

The nurse is applying Henderson's theory as a basis for theory-based nursing practice. Which other elements are important for theory-based nursing practice? Select all that apply. Knowledge of nursing science Knowledge of related sciences Knowledge about current health care issues Knowledge of standards of practice Knowledge of bias

1 2 4 Rationale Henderson's theory is an example of a grand theory. Regardless of which particular nursing theory is selected, the nurse must use knowledge from nursing and related sciences, experience, and standards of practice when providing care. p. 44

The nurse is studying the theories of nursing. Which would the nurse categorize as phenomena of nursing? Select all that apply. Self-care Nursing care Pathophysiological processes Client response to stress Sociocultural factors affecting health

1 2 4 Rationale Nursing theories focus on the phenomena of nursing and nursing care. A phenomenon is the term, description, or label given to describe an idea or response to or about an event, situation, process, group of events, or group of situations. Examples of nursing phenomena include caring, self-care, and patient responses to stress. Pathophysiological processes and sociocultural factors affecting health are not phenomena but concepts that help describe a phenomenon. p. 42

The nurse is learning about nursing theories and their focus on the phenomena of nursing and nursing care. What would the nurse describe as a phenomenon of nursing? Self-care Nursing care Pathophysiological processes Client response to stress Sociocultural factors affecting health

1 2 4 Rationale Nursing theories focus on the phenomena of nursing and nursing care. A phenomenon is the term, description, or label given to describe an idea or responses to or about an event, a situation, a process, a group of events, or a group of situations. Examples of nursing phenomena include caring, self-care, and the patient responding to stress. Pathophysiological processes and sociocultural factors affecting health are not phenomena but concepts that help describe a phenomenon. p. 42

What are the phases of Peplau's theory? Select all that apply. Orientation Termination Proposition Working phase Assumptions

1 2 5 Rationale Peplau's theory states the importance of developing a good nurse-patient interpersonal relationship in caring for a patient. This theory has four phases including orientation, working phase, and termination. Propositions or assumptions are not phases of Peplau's theory. These refer to the taken-for-granted statements that explain the concepts, definitions, and purposes of a nursing theory. p. 48

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

1 2 5 Rationale Theory-generating research identifies observations or describes phenomena. It contributes to the scientific knowledge base of nursing. Relationships of the phenomena to practice and testing specific phenomena are part of the theory-testing research activities. pp. 41-42, 49

The nurse is caring for a patient admitted to the hospital after complaints of chest pain and shortness of breath. She remained in ICU for two days due to her elevated blood pressure of 190/100 mm Hg but has since been placed on a medical floor. According to systems theory, what factors constitute the input component? Select all that apply. Blood pressure of 190/100 mm Hg Antihypertensive drugs administered in the ICU History of chest pain History of shortness of breath Improvement from health interventions given in the ICU

1 4 5 Rationale According to systems theory, the nursing process has four components including input, output, feedback, and content. Input is any information or data obtained after assessing the patient's health. This includes information about the patient's physiological function or information about the interaction between the patient and the environment. Therefore, the information about blood pressure, history of chest pain, and breathlessness constitute input data. Antihypertensive drugs and the interventions that were given to the patient are the data included in the content information. p. 45

Why is nursing research important in the profession of nursing? Select all that apply. Research can lead to new theories. Research helps to test all components of a theory. Research is not done in nursing. Research determines the accuracy of a theory. Research helps in testing a theory before it is implemented.

1 4 5 Rationale Research that tests nursing theories determines how accurately a theory describes a nursing phenomenon. Testing helps to develop evidence for describing or predicting patient outcomes. The researcher has a theoretical idea of how patients describe or respond to a phenomenon and subsequently generates research questions or hypotheses to test the assumptions of the theory. Research is useful to test a theory before it is implemented. No single study tests all components of a theory. p. 41

As an art, nursing relies on knowledge gained from practice and reflection on past experiences. As a science, what does nursing rely on? Select all that apply. Experimental research Nonexperimental research Research from other disciplines Professional opinions

1, 2, 3 Rationale As a science, the field of nursing relies on knowledge gained through nursing research, other disciplines, and scientifically tested theories applied in the practice setting. p. 41

What are the links of the meta-paradigm of nursing? Select all that apply. Person Nursing Research Environment Knowledge developmen

1, 3, 4 Rationale A paradigm is a pattern of thoughts that describes the domain of a particular discipline such as nursing. The meta-paradigm of nursing has four links including person, health, nursing, and environment or situation. Research and knowledge development are not links of the nursing meta-paradigm; they are elements of the nursing paradigm that direct the activity of the nursing profession. p. 42

Henderson's theory focuses on the basic needs of the patient, which are divided into five domains: physiological, psychological, sociocultural, spiritual, and developmental. According to this theory, how many basic needs does a person have? Record your answer using a whole number.

14 Rationale Henderson's theory is based on the individual needs of a person. According to this theory, each person has 14 basic needs that are divided into five domains: physiological, psychological, sociocultural, spiritual, and developmental. This theory defines nursing as assisting an individual—well or sick—in performing activities that would contribute to health, recovery, or a peaceful death. p. 46

*A patient who is bedridden after an accident has become very quiet and is not interacting with her family or hospital staff. The nurse is focusing on efforts to develop effective nurse-patient communication. Which theory is useful for developing interpersonal relationships?* Leininger's theory Roy's theory Peplau's theory Nightingale's theory

2 *Rationale* Peplau's theory focuses on developing interpersonal relationships among the nurse, the patient, and the patient's family. Following this theory, the nurse acts as a counselor, a resource person, and a surrogate. Thus, the nurse helps the patient reduce the anxiety related to health care problems. Leininger's theory focuses on cultural diversity and providing culturally specific health care. Roy's theory deals with helping the patient to adapt to changes, and Nightingale's theory focuses on environmental factors influencing the patient's health status. STUDY TIP: Have each member of a study group write what they think is the focus of Orem's, Leininger's, Peplau's, and other theories. Compare your responses and summarize each theory on a notecard for review. p. 47

What is descriptive theory? It addresses specific phenomena and reflects practice. It is the first level in theory development and describes a phenomenon. It provides a structural framework for broad concepts about nursing. It is linked to outcomes (consequences of specific nursing interventions).

2 Rationale A descriptive theory is the first level of theory development and describes the phenomena under study. A grand theory is systematic and broad in scope and provides a structural framework for nursing practice. A middle-range theory focuses on a specific field or phenomenon rather than the broad scope of nursing. A prescriptive theory details nursing interventions for a specific phenomenon and the expected outcome of the care. These theories help guide research. Test-Taking Tip: If you are unfamiliar with the term in the question, review the responses and look for similar terms in the responses to match those in the question. In this case, the question asks about descriptive theory, and the correct choice explains that it describes a phenomenon. p. 44

A patient with leukemia is admitted to a hospital. The nurse is developing strategies to help the patient cope with the prognosis. Which theory could help the nurse in developing the strategies? Grand theory Mishel's theory Peplau's theory Descriptive theory

2 Rationale Mishel's theory on uncertainty focuses on dealing with uncertainty in disease processes such as cancers. Therefore, this theory can assist the nurse in developing strategies to help the patient deal with the uncertainty of the prognosis of leukemia. A grand theory does not guide the nursing interventions but provides a structural framework for broad, abstract ideas about nursing. They are extremely comprehensive. They do not specifically help in developing strategies to increase coping. Peplau's theory focuses on the nurse-patient interpersonal relationship; increasing coping skills is just one aspect of the theory. Descriptive theories explain phenomena that would be helpful to explain in nursing assessments. They are not useful for guiding nursing actions. However, they would be helpful in explaining the phenomena of stress and coping but may not be helpful to the nurse in developing strategies for coping. p. 47

A patient with diabetes is controlling the disease with insulin and diet. The nursing health care provider is focusing efforts on teaching the patient self-management. Which nursing theory is useful in promoting self-management? Neuman's theory Orem's theory Roy's theory Peplau's theory

2 Rationale Orem's theory of self-care provides a solid theoretical background for self-management for a variety of diseases. This theory shows the nurse how to direct the patient toward self-management to promote health and/or sustain wellness. STUDY TIP: Have each member of a study group write what they think is the focus of Orem's, Leininger's, Peplau's and other theories. Compare your responses and summarize each theory on a notecard for review. p. 48

Which statement about theory-based nursing practice is incorrect? It contributes to evidence-based practice. It provides a systematic process for designing nursing interventions. It is not linked to nursing outcomes. It guides the nurse's assessment.

2 Rationale Theory-based nursing practice does reflect nursing outcomes. For example, prescriptive theories address specific nursing interventions and predict the patient response. Test-Taking Tip: Reread the question if the answers do not seem to make sense because you may have missed words such as not or except in the statement. For this question, the question asked for the incorrect response. p. 44

*What is output?* It is data entering the system. It is the end product. It is data related to system functioning. It is product and information obtained from the system.

2 *Rationale* A system functions on its content, input, output, and feedback. The components are interrelated and share a common purpose to form a whole; there is a continuous process of input, output, and feedback data. Output is the end product of a system. In the case of the nursing process, it is whether the patient's health status improves, declines, or remains stable as a result of nursing care. p. 45

*What is the goal of Watson's theory?* To develop interaction between the nurse and patient To promote health, restore the patient's health, and prevent illness To focus on caring as a means of coping with illness To facilitate the reparative processes of the body by manipulating the patient's environment

2 *Rationale* Jean Watson's theory is related to the humanistic aspects of life. The main goal of Watson's theory is to promote health, restore the patient's health, and prevent illness. Developing a nurse-patient relationship is the main goal of Peplau's theory. Focusing on caring and personal concern is the goal of Benner and Wrubel's theory. Facilitating the reparative processes of the body by manipulating the patient's environment is a goal of Nightingale's theory. p. 43

*A theory is a set of concepts, definitions, relationships, and assumptions. What does a theory do?* It formulates legislation. It explains a phenomenon. It measures nursing functions. It reflects the domain of nursing practice.

2 *Rationale* Theories are designed to explain a phenomenon such as self-care or caring. A theory is a way of seeing through a set of relatively concrete and specific concepts and the propositions that describe or link the concepts. p. 41

Which theories describe the life processes of an older adult facing chronic illness? Systems theories Developmental theories Interdisciplinary theories Health and wellness models

2 Rationale Developmental theories describe and predict behavior and development at various phases of the life continuum, as in the phase of older adulthood. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience. p. 46

The nurse finds that an elderly patient is underweight, malnourished, and cachexic. The patient does not have a family but does have a close friend who visits often. The patient appears depressed and complains about not achieving enough during life. Which of the patient's needs falls under the third level of Maslow's hierarchy? Need for nutrition Need for the visiting friend Need for a sense of achievement Need for a sense of usefulness

2 Rationale Maslow's hierarchy involves five levels. The first level involves basic needs including food, air, and water. The second level includes safety and security needs. The third level includes love and belonging needs such as friendship. The fourth level includes self-esteem needs such as self-confidence, sense of achievement, usefulness, and self-worth. The final level includes the need of self-actualization. Therefore, the need for meeting the friend comes under the third level of hierarchy. Nutritional needs come under the first level and the need for a sense of achievement and usefulness are fourth-level needs. p. 46

The nurse is caring for a patient who has electively terminated a pregnancy. During the caring process, the patient shares her feelings and emotions with the nurse, which results in the nurse developing a bond with the patient. Which nursing theory would be most appropriate to help develop an interpersonal relationship? Nightingale's theory Peplau's theory Neuman's theory Henderson's theory

2 Rationale Peplau's theory is to develop interactions between the nurse and the patient. This theory mainly focuses on the nurse developing a therapeutic relationship with the patient to help promote health and prevent sickness. Although Nightingale's theory does promote a relationship between the patient and the nurse, its primary focus is to facilitate the reparative processes of the body by doing manipulations in the environment. Neuman's theory also promotes a therapeutic relationship between the nurse and the patient, but its primary focus is attaining total wellness by much needed interventions. Henderson's theory mainly focuses on working independently with other health care providers and helping the patient to gain independence. A secondary area of concern may be to promote a patient-nurse relationship. p. 47, 48

Which statement is true regarding the nursing process? It is the end product of a system. It is the product and information obtained from a system. It is the information that comes from a patient's assessment. It is the information provided to a system about its functions.

2 Rationale The nursing process includes the product and information obtained from the system. It is the information about the nursing interventions for patients with specific health problems. Output is the end product of a system. Input is the information that comes from a patient's assessment. Feedback serves to provide information to a system about its functions. p. 45

The nursing student is working on her project on interdisciplinary theories. A senior nurse whom the nursing student had interviewed introduces her to an elderly woman who has been admitted to the hospital for fever. The nursing student finds that the woman lives in a high-crime area. According to Maslow's hierarchy of needs, which needs are the priority for this woman? Esteem and self-esteem needs Basic physiological needs Safety and security needs Self-actualization needs

2 Rationale The patient is admitted to the hospital now and not in her home environment where safety is a priority, so the priority need now is physiological due to her admitting diagnosis of fever. At home, the patient's priority is likely safety, followed by self esteem and self actualization. Test-Taking Tip: For questions concerning Maslow's hierarchy of needs, recall the needs in order of highest priority first. Is there any indication that basic physiological needs are not being met? If not, then proceed to the next need in the sequence: safety. Ah-ha! The question offers the clue about the patient living in a high-crime area, and so you have the answer. p. 46

The nurse is caring for a devout Hindu patient who is vegetarian. The patient was given nonvegetarian food and is very upset about it. Which of the statements of Leininger's theory should the nurse apply while planning a diet plan for the patient? Select all that apply. The nurse should stabilize the patient or situation. The nurse should serve as a resource person, counselor, and surrogate. The nurse needs to know the patient's individual needs and how to respond to them. The nurse should integrate the patient's cultural traditions, values, and beliefs into the care plan. The nurse should explain the benefits of a nonvegetarian diet to the patient.

2 3 4 Rationale Leininger's theory deals with protecting the traditions and cultural beliefs of the patient. While creating the diet plan, the nurse should safely integrate the patient's cultural traditions, values, and beliefs. The nurse serving as a resource person, counselor, and surrogate helps in planning the patient's diet. Knowing the patient's individual needs and responding to them is a part of nursing care and will help the nurse in planning the patient's diet. Stabilizing the patient or situation does not help the nurse plan an appropriate diet. Explaining the benefits of having a non-vegetarian diet is not providing culturally competent care. p. 48

*A community nurse is scheduled to give vaccines to a group of individuals belonging to a particular village. These people tell the nurse that they are willing to take the vaccines only in the presence of the pastor of their church, who has gone to another village and will return in a day. In compliance with Leininger's theory, what should the nurse do?* Explain to the villagers that the vaccinations can be given safely even in the absence of the pastor. Give the vaccine to the people on the scheduled day. Listen to the villagers and give them the vaccines on the next day in the presence of the pastor. Contact the pastor and ask him to come back, because the people from the village need his presence during the vaccinations.

3 *Rationale* The major concept of Leininger's theory is cultural diversity, and the goal of nursing care is to provide the patient with culturally specific nursing care. In this scenario, the nurse should respect the villagers' faith and listen to them. The nurse can give them the vaccine the next day in the presence of the pastor. The nurse should not try to explain or convince them to take the vaccinations in the absence of the pastor, because it is against their wishes. The nurse should comply with the villagers and should not give them the vaccines unless they are willing to accept them. Contacting the pastor and asking him to come back is not an appropriate nursing action. p. 48

*What is feedback?* Data entering the system The end product Data related to system functioning Product and information obtained from the system

3 A system functions on its content, input, output, and feedback. The components are interrelated and share a common purpose to form a whole; there is a continuous process of input, output, and feedback data. Feedback serves to inform a system about how it functions. p. 45

To practice in today's health care environment, nurses need a strong scientific knowledge base from nursing and other disciplines such as the physical, social, and behavioral sciences. Which need does this statement identify? Systems theories Developmental theories Interdisciplinary theories Health and wellness models

3 Rationale As the health system evolves and the health care needs of the patient focus on health promotion, illness prevention, and treatment, more disciplines are involved in patient care. To be effective in practice nurses need to be aware of theoretical approaches of care arising from other disciplines and from nursing. Test-Taking Tip: Key terms in the question offer valuable clues. For this question, the phrase "and other disciplines" is key. Recalling the meaning of interdisciplinary ( Inter means between; so interdisciplinary means between disciplines.) gives you the answer! p. 45

The nurse is caring for a patient with Guillain-Barré syndrome. The nurse is explaining the pathological process underlying the disease to the patient's parents. What type of theory would be most helpful to the nurse when gaining knowledge about the underlying pathology of the disease? Grand theories Middle-range theories Descriptive theories Prescriptive theories

3 Rationale Descriptive theories describe phenomena and speculate as to why they occur. They do not direct nursing actions. Grand theories are extremely comprehensive and provide a structural framework for broad and abstract ideas of nursing. Middle-range theories focus on specific fields of nursing. Prescriptive theories address the nursing interventions for a phenomenon. p. 44

The nurse plans to teach a diabetic patient about self-administration of insulin injections so that the patient is able to administer his own insulin. Which nursing theory most aptly describes this scenario? Henderson's theory Peplau's theory Orem's theory Leininger's theory

3 Rationale The nurse is promoting patient self-care by teaching self-administration of insulin. This aids the patient in becoming more independent in caring for himself. Orem's theory emphasizes promotion of self-care. Henderson's theory focuses on health, wellness, and illness prevention. Peplau's theory focuses on developing a therapeutic relationship between the patient and the nurse. Leininger's theory focuses on providing culturally competent care. p. 48

What is true about grand theory? It addresses specific phenomena and reflects practice. It is the first level in theory development and describes a phenomenon. It provides a structural framework for broad concepts about nursing. It is linked to outcomes (consequences of specific nursing interventions).

3 Rationale A grand theory is systematic and broad in scope and provides a structural framework for nursing practice. A middle-range theory focuses on a specific field or phenomenon rather than the broad scope of nursing. A descriptive theory is the first level of theory development and describes the phenomena under study. A prescriptive theory details nursing interventions for a specific phenomenon and the expected outcome of the care. These theories help guide research. Test-Taking Tip: If you are unfamiliar with the term in the question, review the responses and look for similar terms in the responses to match those in the question. In this case, the question asks about grand theory. You know grand can mean large or expansive, and the correct answer includes the term broad. p. 44

What are the demands of Roy's adaptation model that can be useful in helping the patient? Select all that apply. Economical Pathological Physiological Psychological Dependence-independence

3 4 5 What are the demands of Roy's adaptation model that can be useful in helping the patient? Select all that apply. Economical Pathological Physiological Psychological Dependence-independence

The nurse is discussing Orem's nursing theory with a colleague. Which statements about this theory are true? Select all that apply. The goal of nursing care is to provide culturally competent care. Orem's theory focuses on interpersonal relations between the nurse, the patient, and the patient's family. Orem's theory focuses on the patient's self-care needs. The goal is to help the patient perform self-care and manage his or her health problems. Nursing care aims to increase the patient's ability to independently meet his or her own needs.

3, 4, 5 Rationale Orem's theory was developed by Dorothea Orem. The theory focuses on the patient's self-care needs. In this theory, the goal is to help the patient perform self-care and manage his or her own health problems. According to the theory, the nurse helps the patient to increase the ability to meet his or her needs independently. The goal of Leininger's theory is to provide culturally competent care. Peplau's theory focuses on interpersonal relations between the nurse, the patient, and the patient's family. STUDY TIP: Have each member of a study group write what they think is the focus of Orem's, Leininger's, Peplau's, and other theories. Compare your responses and summarize each theory on a notecard for review. p. 48

What is true about a prescriptive theory? It addresses specific phenomena and reflects practice. It is the first level in theory development and describes a phenomenon. It provides a structural framework for broad concepts about nursing. It is linked to outcomes (consequences of specific nursing interventions).

4 Rationale A prescriptive theory details nursing interventions for a specific phenomenon and the expected outcome of the care. A grand theory is systematic and broad in scope and provides a structural framework for nursing practice. A middle-range theory focuses on a specific field or phenomenon rather than the broad scope of nursing. A descriptive theory is the first level of theory development and describes the phenomena under study. These theories help guide research. p. 42

A group of nurse researchers is working on a project that aims to improve nursing interventions to help patients with paralysis regain their mobility. The purpose of the research is to design interventions that would help patients regain strength and independence as soon as possible. Which nursing care theory would be most appropriate to the nurse researchers working on this project? Watson's theory King's theory Peplau's theory Henderson's theory

4 Rationale Henderson's theory promotes assisting patients in gaining independence, strength, and self-sufficiency. The researchers should apply this theory to improve nursing interventions that help the paralytic patients recover from their decreased mobility. Watson's theory deals with promoting, restoring, and preventing illness. King's theory deals with using communication to help the patient reestablish positive adaptation to the environment. Peplau's theory deals with developing interactions between the nurse and the patient. p. 46

The nurse is consulting with a patient who lives alone after the death of a spouse 3 years ago. The patient, who has no children and few close friends, reports good physical health but has been feeling listless. What should be the priority in nursing care for this patient, according to Maslow's hierarchy of needs? Physiological needs Spiritual needs Self-esteem needs Psychological needs

4 Rationale The nurse should be able to prioritize the needs of a patient. This patient seems to have no immediate physical needs but is feeling lonely and may have psychological needs that should be the priority of nursing care. Although spiritual and self-esteem needs are important, they are above physiological and psychological needs in the hierarchy of care and should not be the first priority in nursing care. p. 46

What are components of the nursing paradigm? The person, health, the environment, and theory Health, theory, concepts, and the environment Nurses, physicians, health, and patient needs The person, health, the environment/situation, and nursing

4 Rationale The nursing paradigm focuses on the person, health, the environment/situation, and nursing. All the elements interact with one another with the patient being central. p. 42

In order to care for a wide variety of patients from various cultural backgrounds, the nurse should have a thorough knowledge of culturally competent care. On which theory is this statement based? Systems theory Interdisciplinary theory Developmental theory Psychological theory

4 Rationale Theoretical models that explain or predict patient responses related to any physiological, psychological, sociocultural, developmental, and spiritual domain come under psychological theories. Culturally competent care is based on behavioral responses of people across varied cultures. Thus, it can be explained under psychosocial theories. Systems theory explains the components of a theory that are interrelated to form a whole. An interdisciplinary theory explains the systematic view of a phenomenon. Developmental theories explain the processes that start with conception and continue until death. p. 46

What is content? Content is data entering the system. Content is the end product. Content is data related to system functioning. Content is product and information obtained from the system.

4 Rationale A system functions on its content, input, output, and feedback. The components are interrelated and share a common purpose to form a whole; there is a continuous process of input, output, and feedback data. The content is the product and information obtained from the system. p. 45

The nurse is studying the effectiveness of breathing exercises for asthmatic patients. Which theories should the nurse consider to find the effectiveness of a particular intervention? Grand theories Middle-range theories Descriptive theories Prescriptive theories

4 Rationale Prescriptive theories are action oriented and validate a nursing intervention. Thus, the nurse should refer to descriptive theories to find the efficacy of an intervention. Grand theories do not provide guidance for specific nursing interventions. Middle-range theory tends to focus on a specific field of nursing, rather than reflect on a wide variety of nursing care situations. Descriptive theories explain why a phenomenon occurs. These theories do not guide nursing interventions. p. 44