Topics EXAM3

____ 1. Critical thinking in nursing needs to include which of the following important variables? a. Consideration of ethics and responsible decision making b. Ability to act quickly, often on impulse c. Ability to determine the best nursing interventions regardless of patient's values and beliefs d. Flexible thinking that rarely follows a pattern or considers standards

1. ANS: A Feedback A Critical thinking in nursing is based on ethics and standards of the profession. B Critical thinking is consciously developed, complex, and purposeful, never impulsive. C Critical thinking and decision making are based on patient's values and beliefs. D Critical thinking is based on a decision-making model and nursing standards.

1. A "well-cultivated critical thinker" is an individual who does which of the following? (Select all that apply.) a. Raises questions b. Recognizes alternative ways to see problems c. Uses only logic to determine relevance of information d. Implements solutions to complex problems only as an individual e. Criticizes solutions and alternatives suggested by others

1. ANS: A, B Feedback Correct A critical thinker identifies clear and precise questions and is open-minded to alternative ways to see problems. Incorrect A critical thinker gathers and assesses all relevant information and will communicate with others as he or she formulates solutions. Critical thinking does not involve criticism of others' solutions and ideas, although it does include questioning and arriving at one's own conclusions.

1. A definition of nursing is essential because it (Select all that apply.) a. differentiates nursing from other health occupations. b. guides educational preparation and theory development. c. helps state nurse practice acts reflect the changing roles of nurses. d. clarifies the purposes and functions of the nurses. e. informs potential students of exactly what nurses do.

1. ANS: A, B, C, D Feedback Correct A definition is important because it allows nurses, other health care providers, policy makers, and others in the community to better understand what nurses do. Incorrect Although a definition clarifies the role of nursing, no definition can be so explicit that it explains everything a nurse does. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 114-115

1. Florence Nightingale established a school of nursing based on which of the following innovative principles? (Select all that apply.) a. The nursing school should be affiliated with a teaching hospital but independent of it. b. Professional nurses should be paid for their instruction in the school. c. Students should be selected to create a diverse student body. d. The curriculum should include theory and practical experience. e. Nurses should be trained in privately funded educational institutions.

1. ANS: A, B, D Feedback Correct Nightingale saw the benefit to affiliation with a teaching hospital but thought that the teaching mission should be separate from the service mission. Nightingale saw instruction as a valued activity worthy of reimbursement and involving more than allowing one to learn by watching. Nightingale thought that nursing was more than just on-the-job training and required knowledge upon which to base nursing activities. Incorrect Nightingale saw nursing as a profession for women only and that the women should be selected based on certain criteria. Nightingale thought that nursing education should be publicly funded.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 1. Which questions will aid the nurse in planning culturally congruent care? (Select all that apply.) a. "What do smiles, nods, and hand gestures mean?" b. "How are you usually addressed?" c. "How many health care professionals have you seen?" d. "What is eaten when one is sick?" e. "Who is involved in making decisions about health care?"

1. ANS: A, B, D, E Feedback Correct The questions allow the nurse to learn about the specific cultural expectations of the patient. Incorrect While it is important to know how many providers the patient has been seeing, this information is not related to culturally competent care.

1. Which behaviors foster active listening? (Select all that apply.) a. Encouraging the speaker by saying, "Tell me more" b. Limiting verbal ventilation because it is not focused c. Sitting in an open posture such as leaning forward d. Engagement in a task e. Good eye contact at eye level and nodding of the head

1. ANS: A, C, E Feedback Correct Active listening is a method of communicating interest and attention. Encouraging the speaker, using an open posture, eye contact, and nodding the head all communicate interest and attention. Incorrect Limiting verbal expression is likely to decrease the sharing of information by the patient. A task may serve as a distraction for the nurse and patient and may limit active listening.

19. Which of the following is the primary distinction between licensure and certification? a. Certification is required to practice nursing. b. Licensure is granted automatically on completion of an accredited nursing program. c. Certification validates a high level of proficiency. d. Licensure is voluntary.

19. ANS: C Feedback A Licensure, not certification, is required to practice nursing. B Licensure is not automatically granted on completion of a nursing program. C Certification validates a high level of proficiency and knowledge. D The NCLEX examination must be completed successfully. Certification is voluntary, but licensure is not.

1. Which of the following best describes Peplau's theory on therapeutic use of self? a. Putting patients' needs ahead of your own b. Providing excellent clinical skills to improve patients' health status c. Using excellent interpersonal skills to help patients improve their health status d. Self-protection through avoidance of a relationship with the patient

1. ANS: C Feedback A "Putting patients' needs ahead of your own" is not the best answer because although it is true that the patient's needs, not the nurse's, are met during the therapeutic relationship, nurses should not necessarily put all patient needs ahead of their own. B The theory focuses on therapeutic communication, not clinical skills. C Peplau's theory described "using one's personality and communication skills to help patients improve their health status" as therapeutic use of self. D The focus is the patient, not the nurse.

____ 1. Which illness has the characteristics of an acute illness? a. Exercise-induced asthma b. Type 2 diabetes c. Influenza d. Cleft palate

1. ANS: C Feedback A Exercise-induced asthma is a chronic condition because it requires ongoing health care services and affects the person for his or her entire life. B Type 2 diabetes is a chronic condition because it requires ongoing health care services and affects the person for his or her entire life. C Influenza symptoms are short-lived, and the person returns to his or her previous level of wellness. D Cleft palate is a chronic condition because it requires ongoing health care services and affects the person for his or her entire life.

1. In 1900, the primary reason for hospital-based nursing education programs was to a. educate nurses to care for patients in hospitals. b. provide educational opportunities for women. c. staff the hospitals that operated the education programs. d. provide standardized preparation for nurses.

1. ANS: C Feedback A Most nurses worked in homes and very few worked in hospitals. B The education for women was not a value of society at the time. C In the hospitals there were few paid staff nurses, and most of the care was provided by the nursing students. D The programs of study varied in length, and each school set its standards and requirements.

10. A contemporary view of the sick role includes a. patient as partner with the health care provider. b. patient as submissive to the health care provider. c. patient noncompliant with the health care provider. d. moving away from cultural values when making health care decisions.

10. ANS: A Feedback A A contemporary view of the sick role includes partnering with patients in making health care decisions. B Patient as submissive to health care provider is a paternalistic perspective. C Patients are expected to want to get well, and the patient who wants to get well will comply with the prescribed treatment. D All health care needs to be culturally sensitive.

10. When should the preparation for the termination phase of the nurse-patient relationship begin? a. In the orientation phase b. During the working phase c. As part of the termination phase d. Right before termination

10. ANS: A Feedback A During the orientation phase, the nurse gives the patient an estimated time frame for their relationship. This begins the preparation for termination. B Preparation for termination of the nurse-patient relationship begins in the orientation phase. C Preparation for termination of the nurse-patient relationship begins in the orientation phase. D Preparation for termination of the nurse-patient relationship begins in the orientation phase.

Which of the following is true about bachelor's of science in nursing (BSN) education? a. Faculty must be BSN prepared. b. It is recommended by professional organizations as preparation for entry into practice. c. It requires 3 years to complete. d. Faculty are not given full faculty status in the university.

10. ANS: B Feedback A Faculty in BSN programs have master's or doctorate degrees. B Many nursing organizations have advocated for the BSN as the beginning educational preparation for the profession of nursing. C The BSN degree requires 4 years to complete. D Faculty in nursing now have full faculty status.

__ 10. A nursing student says, "I can now see how developing care plans helps organize my thoughts and patient care." In which stage of Cohen's model of professional socialization is this student? a. Stage I: Unilateral dependence b. Stage II: Negativity/independence c. Stage III: Dependence/mutuality d. Stage IV: Interdependence

10. ANS: C Feedback A In stage I, students follow directions without questioning or understanding the reasoning behind the activity. B In stage II, the student would question authority figures and overestimate his or her abilities. C Students in stage III have a more reasoned evaluation of others' ideas. D Students in stage IV learn to make decisions in collaboration with others. PTS: 1 DIF: Cognitive Level: Application REF: p. 121

10. What is the primary method of obtaining patient data? a. Medical record b. Speaking with family c. Interview with patient d. Physical examination

10. ANS: C Feedback A The medical record is the third source, along with consultation. B The presence of others, even family, can obstruct the interview process. C The patient interview is the primary method of obtaining information. D The examination is the second process.

Which recommendation made by the 1965 American Nurses Association (ANA) position paper and other position papers of national nursing organizations is still an issue today? a. Education for nursing should take place in hospital-based programs. b. Minimum preparation for professional nursing practice should be the BSN degree. c. Minimum preparation for technical nursing practice should be the licensed practical/vocation nurse (LPN/LVN) diploma. d. Education for nursing must be evidence-based.

11. ANS: B Feedback A The ANA position paper advocated for education in colleges and universities. B The issue of minimum educational requirement for entry into practice is not likely to change until there are safeguards in place that ensure that all nurses currently in practice continue to feel that they are valued members of the profession. This provision continues to be controversial today. C The technical level of nursing was supported in community and junior colleges. D There is little evidence to support traditional educational methods used in nursing education.

11. What does the process of analysis of patient data directly result in? a. Validating actual problems or diagnoses b. Determining the nursing interventions of importance c. Identifying actual or potential problems amenable to nursing intervention d. Confirming the medical diagnosis

11. ANS: C Feedback A Analysis identifies both actual and potential problems. B Analysis identifies problems. The most important interventions are determined by identifying the most important problems and the interventions related to them. C Analysis will identify both actual and potential problems. These problems can be addressed through nursing interventions. D The identification of patient problems that nursing can intervene with is not related only to the medical diagnosis.

11. The nurse and patient may experience sadness during the termination phase. How can the nurse help the patient be successful in the termination phase of the nurse-patient relationship? a. Providing personal contact information so the patient can contact the nurse if needed b. Visiting the patient at home during off-duty time to help the transition to self-care c. Emphasizing the achievements the patient has made, including the ability for self-care d. Exchanging goodbye gifts as a sign that the relationship is terminated

11. ANS: C Feedback A Nurses should not maintain personal communication with patients after discharge. B The nurse respects professional boundaries. C Emphasizing the patient's achievement of goals and the reasons he or she does not need the nurse anymore is effective in the termination process. D Nurses should not exchange gifts with patients but should instead respect professional boundaries.

____ 11. A nursing student asks, "Since I work as a nurse technician in psychiatric nursing, may I spend part of my clinical rotation with a psychiatric home visiting nurse?" In which stage of Cohen's model of professional socialization is this student? a. Stage I: Unilateral dependence b. Stage II: Negativity/independence c. Stage III: Dependence/mutuality d. Stage IV: Interdependence

11. ANS: D Feedback A Students in stage I are dependent on faculty. B In stage II, students begin to question authority. C In stage III, students begin to develop critical thinking skills. D Students in stage IV often are self-directed and seek out appropriate learning opportunities that better round out their educational experience. PTS: 1 DIF: Cognitive Level: Application REF: p. 121

11. A patient tells the nurse, "I'll let you do whatever you think is best for me." The patient does very little independently without calling for assistance. The nurses conclude that the patient is demonstrating which personality characteristic? a. Acceptance b. Sense of control c. Coping d. Dependence

11. ANS: D Feedback A The person demonstrating acceptance will acknowledge the situation. B The person demonstrating sense of control would be actively seeking ways to manage the situation. C The person who is coping is looking to decrease the threat in the situation or to increase his or her resources to deal with the threat. D Some people assume a passive attitude and rely on others to care for them. This can occur with or without illness.

12. Which type of basic nursing education program graduates the largest number of RNs in the United States today? a. Diploma programs b. Associate degree programs c. BSN programs d. Nurse practitioner programs

12. ANS: B Feedback A Diploma programs are on the decline in enrollment and number of programs operating. B Associate degree programs graduate the most nurses today. C BSN program enrollments have increased but are still lower than associate degree program enrollments. D Nurse practitioner programs are advanced practice master's-level programs. The question refers to basic RN preparation.

12. A patient diagnosed with breast cancer responded by gathering information about treatment options and becoming involved in a self-help group. The nurse assesses that the patient is demonstrating which personality characteristic? a. Independence b. Hardiness c. Self-control d. Tolerance

12. ANS: B Feedback A Independence is not requiring or needing to rely on someone else. B Hardiness is the ability to feel capable of handling stressful life events. Hardy people are likely to perceive themselves as having some control over a situation even when they are ill. C Self-control is the ability to manage oneself in the situation. D Tolerance is the capacity to endure or adapt to a situation.

12. Benner describes five stages of nursing proficiency as students develop into expert nurses. Which of the following is not a stage of development described by Benner? a. Novice b. Inexpert beginner c. Competent practitioner d. Expert practitioner

12. ANS: B Feedback A Novice is the first stage in the theory. B The stages identified by Benner in her theory From Novice to Expert do not include inexpert beginner. C Competent practitioner is the third stage in Benner's theory. D Expert practitioner is the fifth stage in Benner's theory. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 121

12. A patient is being discharged from the hospital. Which statement by the nurse is appropriate for the termination phase of the nurse-patient relationship? a. "You must be happy to be going home. Here are the written diet and medication instructions." b. "It has been wonderful getting to know you. The best of luck when you get home." c. "During the past 3 days, you have learned how to inject insulin and how to make appropriate food choices. Remember that you have the unit telephone number if you have any questions." d. "You have done well learning a lot of new material and should be able to do well at home."

12. ANS: C Feedback A This response does not summarize what has occurred, which is an important part of the termination phase. B This response does not include a summary of the progress the patient has made, which is an important part of the termination phase. C Summarizing the gains the patient has made is important during the termination phase. D This response gives false reassurance about success at home.

12. Which of the following describes the primary difference between nursing diagnoses and medical diagnoses? a. Nursing diagnoses identify simple instead of complex problems. b. Nursing diagnoses must be verified by a physician. c. Nursing diagnoses, like medical diagnoses, identify medical diseases. d. Nursing diagnoses identify problems that can be treated with independent nursing actions.

12. ANS: D Feedback A Nursing diagnoses are not simple versus complex problems but the human response to disease. B Nursing diagnoses are identified by nurses and do not need to be verified by any other professional. C Nursing diagnoses identify the human effect of disease on the person. D Nursing diagnoses identify problems that nurses can treat within their scope of practice.

13. A mother asks the nurse if her 5-year-old can visit his twin brother in the pediatric intensive care unit (PICU) after cardiac surgery. The nurse denies the request because hospital policy states that children younger than 12 years of age are not allowed to visit the PICU. This illustrates which of Benner's stages of nursing proficiency? a. Novice b. Advanced beginner c. Competent practitioner d. Proficient practitioner

13. ANS: A Feedback A At the novice stage, nurses have little background on which to base clinical behavior and therefore depend rather rigidly on established rules. B Nurses at the advanced beginner stage base decisions on both theory and principles but may have difficulty formulating priorities or alternative actions. C Nurses at the competent practitioner stage have feelings of mastery and can examine the needs of everyone in the situation before making decisions. D Nurses at the proficient practitioner stage see patient situations holistically and easily recognize priorities of care. PTS: 1 DIF: Cognitive Level: Application REF: p. 121

13. Which of the following is an effective way to maintain safe professional boundaries? a. Never accepting small gifts from patients b. Finding ways to satisfy your needs through personal relationships outside of nursing c. Avoiding caring for patients who ask personal questions about you d. Sharing your personal stories so that patients will feel understood and trusting

13. ANS: B Feedback A There are many other possibilities for violating professional boundaries; gifts are only one small way and, on occasions when the gift is not valuable and can be shared with the entire staff, may be accepted. B Respecting professional boundaries means that the nurse recognizes the vulnerability of the patient and the power that comes from the nurse's personal knowledge about the patient. Finding ways to satisfy personal needs outside of the professional relationship will prevent the nurse from becoming inappropriately involved with the patient. C Avoidance is not a helpful response to any nurse-patient problem. D The nurse should stay focused on the patient.

13. Which of the following is a correctly stated nursing diagnosis? a. Fluid volume deficit b. Hypovolemia related to vomiting c. Fluid volume deficit related to vomiting as evidenced by increased heart rate and decreased urine output d. Hypovolemia related to nausea as evidenced by restlessness and anxiety

13. ANS: C Feedback A "Fluid volume deficit" is incomplete; it contains only the diagnostic label. B "Hypovolemia related to vomiting" is incomplete; it contains only the diagnostic label and the etiology. C "Fluid volume deficit related to vomiting as evidenced by increased heart rate and decreased urine output" contains the diagnostic label, the etiology, and the defining characteristics. D The etiology of "hypovolemia related to nausea as evidenced by restlessness and anxiety" is incorrect.

13. Who is credited with developing the model of associate degree nursing education? a. Esther Lucille Brown b. Annie W. Goodrich c. Mildred Montag d. National League for Nursing

13. ANS: C Feedback A Esther Lucille Brown wrote the Brown Report. B Annie W. Goodrich was the first dean of nursing. C Mildred Montag developed a model of associate degree nursing. D The National League for Nursing did not develop the model of associate degree nursing.

13. A patient was diagnosed with ovarian cancer 5 years ago. She underwent chemotherapy and radiotherapy, but cancer returned 2 years ago with metastases to the bone and possibly the lung. She says the cancer is "no longer curable, but treatable." During this time the patient's daughter was critically injured in a car accident and now lives with a traumatic brain injury, needing round-the-clock care. Her husband had an affair. She continues to work and volunteers with various community groups. Which phenomenon is the patient demonstrating? a. Resourcefulness b. Independence c. Acceptance d. Resilience

13. ANS: D Feedback A The patient has not demonstrated that her ability to continue work and activities is due to her use of resources. B Independence is not requiring or needing to rely on someone else. C Acceptance means the person acknowledges the situation for what it is. D Resilience is the successful adaptation despite challenging or threatening circumstances. The patient has faced difficult, adverse, and traumatic events in her life but continues to participate and contribute.

14. Which of the following is most important in order for a new staff nurse to communicate therapeutically with patients? a. Focusing interactions on educating patients about their treatments b. Becoming aware of own feelings about illness and death c. Sharing information about the intimate details of one's own life d. Presenting himself or herself as a knowledgeable and experienced clinician

14. ANS: B Feedback A Although education is important for patients, this does not help the nurse understand his or her feeling and responses. B Reflection will allow the nurse to develop self-awareness, which will help him or her become a better advocate for the patients. C Sharing intimate personal information is not therapeutic. D As a new nurse, knowledge and experience may be limited; portraying more knowledge and experience than one has is deceitful.

14. A mother asks the nurse if her 5-year-old can visit his twin brother in the PICU after cardiac surgery. The nurse denies the request because hospital policy states that children younger than 12 years of age are not allowed to visit the PICU but suggests that the mother visit with the child in the visitor's lounge and talk to him about what is happening with his brother. This illustrates which of Benner's stages of nursing proficiency? a. Novice b. Advanced beginner c. Competent practitioner d. Proficient practitioner

14. ANS: B Feedback A Nurses at the novice stage would deny the request on the basis of the established rules. B Nurses at the advanced beginner stage base their decisions on theory and principles but have difficulty viewing many nursing actions as equally important. The nurse would still likely deny the request but, knowing the needs of the mother and child, suggest an alternative means of visiting. C Nurses at the competent practitioner stage have feelings of mastery and can examine the needs of everyone in the situation before making decisions. D Nurses at the proficient practitioner stage see patient situations holistically and easily recognize priorities of care. PTS: 1 DIF: Cognitive Level: Application REF: p. 122

14. A patient is admitted with the diagnosis of bronchitis, congestive heart failure, and fever. The nurse's assessment finds a temperature of 101° F, peripheral edema, and rhonchi. Which of the following is the best etiology to support the nursing diagnosis of ineffective airway clearance? a. Peripheral edema b. Retained secretions c. Bronchitis d. Congestive heart failure

14. ANS: B Feedback A Peripheral edema is related to the accumulation of fluid in the feet and legs but has nothing to do with the airway. B The nursing diagnosis indicates that "something" may be blocking the airway. Respiratory secretions are the only choice that could block the airway. C Bronchitis is a medical diagnosis. D Congestive heart failure is a medical diagnosis.

14. A patient in whom metastatic cancer is diagnosed tells the nurse, "God has never let me down before. I'll pray for strength." This patient's illness behavior is being influenced by a. resiliency. b. sense of control. c. spirituality. d. depression.

14. ANS: C Feedback A Resiliency is survival under trying circumstances. B Sense of control is feeling that one can control a situation. C Spirituality is an inner strength related to a belief in and connectedness to a higher power. D Depression involves feelings of loss, grief, and despair.

14. What is the purpose of articulated models or systems for nursing education? a. Increasing curriculum similarities in nursing programs b. Allowing nurses to work in nursing as they gain additional education c. Increasing the numbers of nursing education programs d. Facilitating opportunities for nurses to move up the educational ladder with ease

14. ANS: D Feedback A Articulation has not made the programs more similar. B Although articulation models allow a person to move with greater ease from one level to another with less repetition of coursework, articulation systems do not address the ability to work and attend school simultaneously any more than any other nursing education program. C Articulation model educational programs have been slow to develop because of the work required to keep all the courses congruent with each other, and increased educational programs have not resulted. D Articulated models allow a nursing student/nurse to enter and leave at different points. Articulated systems provide flexibility for the nurse to gain more education.

15. Which of the following is an important advantage of distance learning? a. It allows access to adult learners who are geographically unable to participate in a traditional classroom setting. b. It allows students to set their own learning objectives. c. It allows a student to take courses without clinical components. d. It allows universities to offer more classes with fewer faculty.

15. ANS: A Feedback A Distance education allows flexibility, particularly for working people in locations where there is no campus, and enables them to return to school. B The requirements are just as stringent as traditional courses, but the method of participation is flexible. C Distance learning does not negate the need for clinical components of courses. D Faculty requirements are the same.

15. Why is the etiology of the nursing diagnosis statement important? a. If the etiology is incorrect, the nursing interventions are likely to be ineffective. b. The etiology will be the same each time the nursing diagnosis is identified. c. The etiology is necessary to identify the defining characteristics. d. The etiology determines whether the problem can be solved.

15. ANS: A Feedback A On the basis of the etiology, different interventions would be selected; for example, anxiety versus fatigue. B The etiology can vary although the same diagnosis is identified. For example, the etiology of the nursing diagnosis of ineffective breathing pattern could be either fatigue or anxiety. C The etiology is not necessary to identify the defining characteristics that are the signs and symptoms of the nursing diagnosis. D The resolution of the problem is not determined by the etiology.

15. A mother asks the nurse if her 5-year-old can visit his twin brother in the PICU after cardiac surgery. The nurse knows that hospital policy states that children younger than 12 years of age are not allowed to visit the PICU. After considering the needs of the patient and his brother, the nurse suggests that the brother can visit for 5 minutes. This illustrates which of Benner's stages of nursing proficiency? a. Advanced beginner b. Competent practitioner c. Proficient practitioner d. Expert practitioner

15. ANS: B Feedback A Nurses at the advanced beginner stage base their decisions on theory and principles but may have difficulty viewing many nursing actions as equally important. B Nurses at the competent practitioner stage will examine the needs of everyone in the situation before making a decision. The nurses may or may not allow the visit, but only after examining the needs of everyone and other exigencies involved. C Nurses at the proficient practitioner stage see patient situations holistically and easily recognize priorities of care. D Nurses at the expert practitioner stage have expertise that allows them to select actions based on the patient's complete experience.

15. During report, a nurse complains about a 3-year-old boy, saying "He sure knows when to pour on the tears. There's nothing wrong until he sees you; then the tears start, but they stop as soon as you leave or his mother comes. He's just spoiled because they have a nanny at home who waits on him hand and foot." This is an example of a. lack of understanding of child development. b. frustration that the mother is not present. c. assessment of the child's behavior. d. stereotyping because the child has a nanny.

15. ANS: D Feedback A The response does not reflect lack of knowledge about child development, assessment of the behavior, or a response to the mother's not being present. B The response does not reflect lack of knowledge about child development, assessment of the behavior, or a response to the mother's not being present. C The response does not reflect lack of knowledge about child development, assessment of the behavior, or a response to the mother's not being present. D Stereotypes are simplistic and illogical images used to describe groups of people.

15. A patient in whom cancer has just been diagnosed tells the nurse, "Just get out of here and leave me alone! Let me suffer alone. God is punishing me." The nurse determines that the most appropriate nursing diagnosis for this patient is a. risk for loneliness. b. powerlessness. c. dysfunctional grieving. d. spiritual distress.

15. ANS: D Feedback A The risk for loneliness is when a person may experience a vague sense of unpleasantness. B Powerlessness is a perceived lack of control in the current situation. This patient may feel powerless, but the reference to God's punishment makes spiritual distress a more likely diagnosis. C Dysfunctional grieving is the unsuccessful use of intellectual and emotional responses to deal with a loss. D Spiritual distress is the inability to experience and integrate meaning and purpose in life through connectedness with self, others, or a power greater than oneself.

16. Which of the following is an appropriate intervention for the nursing diagnosis of spiritual distress? a. Never pray with patients or share readings that can have a religious connection. b. Inform patients of the prevalent religious beliefs that exist in the locale where they are being treated. c. Consider patients' religious beliefs when planning care. d. Reassure patients that they should not blame God for their illness.

16. ANS: C Feedback A It is acceptable to pray with patients or share readings with them if requested by the patient and the nurse is comfortable doing so. B The nurse should help the patient to tap into his or her own spirituality, not create one for them or influence the patient. C Helping patients engage spiritually assures holistic care. D Nurses should recognize that blaming God is a sign of spiritual distress.

16. A patient is admitted with asthma. The nurse's assessment finds a temperature of 99° F, wheezing, speaking in three-word phrases, and respiratory rate of 16 breaths per minute. Which of the following are the best defining characteristics to support the diagnosis of ineffective airway clearance related to inflammation and constriction of the bronchial tree? a. Elevated temperature and respiratory rate b. Diagnosis of asthma with wheezing c. Wheezing and speaking in three-word phrases d. Limited vocalization and fever

16. ANS: C Feedback A Neither the temperature nor the respiratory rate is outside of the norms of an adult. B The medical diagnosis is not a defining characteristic. C The constriction causes wheezing and difficulty vocalizing. D There is no fever.

16. A mother asks the nurse if her 5-year-old can visit his twin brother in the PICU after cardiac surgery. The nurse knows that hospital policy states that children younger than 12 years of age are not allowed to visit the PICU. The nurse grants the request. This illustrates which of Benner's stages of nursing proficiency? a. Advanced beginner b. Competent practitioner c. Proficient practitioner d. Expert practitioner

16. ANS: C Feedback A Nurses at the advanced beginner stage base their decisions on theory and principles but may have difficulty viewing many nursing actions as equally important. B Nurses at the competent practitioner stage will examine the needs of everyone, as well as other exigencies involved, before making a decision. C Nurses at the proficient practitioner stage see the patient situations holistically and easily recognize the priorities of care. The nurse is more concerned about patient outcomes than institutional rules. D Nurses at the expert practitioner stage have expertise that allows them to select actions based on the patient's complete experience.

16. All levels of nursing educational programs can be accredited by which organization? a. American Association of Colleges of Nursing (AACN) b. Commission on Collegiate Nursing Education (CCNE) c. National League for Nursing Accrediting Commission (NLNAC) d. National League for Nursing Councils of Education Programs (NLNCEP)

16. ANS: C Feedback A The AACN does not accredit educational programs. B Although the CCNE accredits educational programs, it only accredits bachelor's and higher degree programs. C The NLNAC accredits LPN/LVN, associate degree, BSN, and MSN programs. D The NLNCEP develops accreditation programs and criteria for different levels of education but does not carry out the accreditation process.

16. A nurse comments in private about a patient: "That lady with six kids is pregnant again! It makes me sick to see these people on welfare taking away from our tax dollars. I don't know how she can continue to do this." The best response by a nurse peer is to a. ignore the biased statements. b. accept the comments as self-disclosure. c. offer neutral responses. d. convey acceptance of the patient.

16. ANS: D Feedback A To ignore the statements will not help this nurse become aware of stereotypes. B These statements do not qualify as self-disclosure. C Offering neutral responses will not help the nurse become aware of stereotyping. D Acceptance conveys neither approval nor disapproval of personal beliefs. Nonjudgmental acceptance means that the nurse acknowledges that all people have rights to be different and to express their differences. Nurses should convey acceptance of people as they are even if they disagree with specific beliefs and/or practices.

17. Which of the following is a part of the history of doctoral education in nursing? a. The nurse scientist program was discontinued after more universities began offering doctoral programs in nursing. b. The first doctoral degree (PhD) was offered at the University of Pittsburgh. c. The number of doctoral programs in nursing has doubled since 1990. d. The largest numbers of doctoral programs are practice-focused.

17. ANS: A Feedback A In the 1970s, there was a major increase in doctoral programs in nursing. This provided an education in nursing that developed research skills and provided nursing faculty. Therefore, the nurse scientist program was discontinued in 1975. B The first doctoral degree in nursing (PhD) was offered at New York University in 1934. Teachers College at Columbia had offered a degree in nursing education (EdD). C In 1990, there were 48 doctoral programs in nursing, and by 2007 there were 166, actually more than tripling the number. D Sixty-eight percent of the doctoral programs are research-focused, while 32% are practice-focused.

17. Which of the following patient problems is given the highest priority by the nurse? a. Anxiety related to hospitalization as manifested by hyperactive state b. Impaired tissue perfusion, cerebral, related to hypoxia as manifested by decreased level of consciousness c. Impaired skin integrity related to surgical incision d. Risk for fluid volume overload related to imbalance in antidiuretic hormone as manifested by peripheral edema and decreased sodium

17. ANS: B Feedback A Anxiety is a psychological, not a physical or life-threatening, problem. B Impaired tissue perfusion, cerebral, is life threatening and would take priority. C Impaired skin integrity has a potential for harm but does not take priority over cerebral tissue perfusion problems. D Risk for fluid volume overload related to imbalance in antidiuretic hormone as manifested by peripheral edema and decreased sodium is a potential problem and does not take priority over actual problems.

____ 17. A patient is in the intensive care unit after a myocardial infarction and refuses to stay in bed, saying, "I have to be up and walking around. When I stayed in bed after having my babies 40 years ago, I got so weak I could hardly move." This patient's illness behavior is being influenced by a. hardiness. b. past experiences. c. culture. d. role expectations.

17. ANS: B Feedback A Hardiness is the resistance to stressful events. B The patient is basing what she thinks she needs to do on experiences she had 40 years ago after she had delivered her children. C She does not say she bases her need to get up on cultural beliefs. D She does not base her need to be up on an expectation that she should be.

17. Which of the following best illustrates nonjudgmental acceptance by the nurse? a. Using professional influence to change a patient's morality to be more in keeping with societal norms b. Changing your assignment if you discover that you have negative feelings toward your patient's lifestyle c. Demonstrating caring behavior in spite of negative feelings d. Avoiding all negative feelings about the patient

17. ANS: C Feedback A The nurse should not attempt to change a patient's belief system or morality. B We cannot control our feelings but need to be able to control our behaviors. C Acceptance indicates neither approval nor disapproval of patient's beliefs, behaviors, or lifestyles. D Prejudices are strong, and we may be unaware of them. It is impossible to control all negative feelings, but it is professional to acknowledge them and continue to provide safe and effective care.

17. A 5-year-old with a twin brother is admitted to the PICU after cardiac surgery. Hospital policy does not allow individuals younger than 12 years of age to visit the PICU. The nurse recognizes the needs of the patient and his brother and suggests that the mother bring her son to visit his brother briefly in the afternoon when the unit is usually quiet. This illustrates which of Brenner's stages of nursing proficiency? a. Advanced beginner b. Competent practitioner c. Proficient practitioner d. Expert practitioner

17. ANS: D Feedback A Nurses at the advanced beginner stage base their decisions on theory and principles but may have difficulty viewing many nursing actions as equally important. B Nurses at the competent practitioner stage will examine the needs of everyone, as well as other exigencies involved, before making a decision. C Although nurses at the proficient practitioner stage see patient situations holistically, easily recognize the priorities of care, and allow rules to be bent, they may not suggest bending rules for the desired patient outcome. D Nurses at the expert practitioner stage have expertise that allows them to select actions based on the entire patient's complete situation, including the needs of family members. PTS: 1 DIF: Cognitive Level: Application REF: p. 122

18. Using Hagerty and Patusky's theory of human relatedness (2003), the nurse-patient relationship has been reconceptualized by approaching a. each patient contact as one step in a lengthy relationship-building process. b. patients with a sense of the patient's autonomy, choice, and participation. c. the relationship as one in which the nurse has the power. d. the nurse-patient contact as an opportunity to streamline caregiving.

18. ANS: B Feedback A Each contact should be approached as an opportunity for connection and goal achievement and not a lengthy process. B The relationship between the nurse and the patient is on a more equitable basis than the traditional nurse-patient relationship. C The relationship should be equitable. D The reconceptualization does not streamline caregiving.

18. Which of the following illustrates an effective strategy for a registered nurse student returning for a bachelor's of science in nursing (BSN)? a. Get reacquainted with the library; expect to spend many hours there doing research. b. Be open to information that does not seem to be readily applicable to your current position. c. Start a program only if you have a great deal of free time to devote to classes on campus. d. Use your co-workers as a sounding board to relieve frustration.

18. ANS: B Feedback A Many BSN courses use online learning and are user-friendly for working students; research today is much easier with the Internet. B Nurses returning to school for the BSN degree need to keep an open mind for information that might not seem readily applicable to their work setting. C Many courses are online or Web assisted; nurses cannot wait for conditions to be perfect to return to school. D Staying positive and open to feedback from instructors will pay more dividends than complaining. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 123

18. Which of the following patient problems is given the highest priority by the nurse using Maslow's hierarchy of needs? a. Anxiety related to fear of the hospital b. Ineffective airway clearance related to retained secretions c. Fluid volume excess related to third spacing of fluid (edema) d. Ineffective thermoregulation related to fever

18. ANS: B Feedback A Psychological safety is a not higher level need than oxygenation. B The need for oxygen is one of the most basic needs according to Maslow's hierarchy. C Although fluid volume excess related to third spacing of fluid (edema) concerns a basic need, it is not as life threatening as lack of oxygen. D Although ineffective thermoregulation related to fever concerns a basic need, it is not as life threatening as lack of oxygen.

18. A Caucasian nurse is caring for a Native American after a stroke. The nurse finds the patient sleeping while holding several small feathers bound by a beaded leather thong. The nurse should consider the possibility that this is a. an interesting trinket to brighten the environment. b. a gift from his grandchildren to make him feel closer to the family. c. an important item used in native healing practices. d. an item that might introduce microorganisms into the hospital environment.

18. ANS: C Feedback A Although the object's meaning is unknown, the implication is that it is not important. B Although the object's meaning is unknown, the implication is that it is not important. C Because the patient is of a different culture than the nurse, the nurse should clarify with either the patient or family what the meaning and importance of the item is and how it should be treated. D Although the object's meaning is unknown, the implication is that it is not important.

18. In 2004, the AACN proposed a new doctoral degree, the doctor of nursing practice (DNP). What is the focus of the DNP degree in nursing? a. Nursing research b. Nursing quality improvement c. Advanced clinical practice d. Nursing theory development

18. ANS: C Feedback A The research degree is the PhD. B There is not a nursing doctoral degree designed specifically to address quality improvement. C The DNP degree is designed to be a clinical practice degree. It would replace the master's degree for nurse practitioners and nurse-midwives, placing them on equal footing with other disciplines. D The PhD degree is most appropriate for theory development and advancement.

19. A nurse observes a new graduate nurse being harassed by co-workers when asking questions or requesting help. What action by the nurse is best? a. Do not intervene, because it will only invite more harassment. b. Ask the nursing manager to intervene on behalf of the new nurse. c. Respectfully confront the staff and explain that this behavior is not part of nursing. d. Teach the new nurse to stand up for himself or herself when harassed. This is bullying behavior by the staff, and often the new nurse cannot handle it alone. If the new nurse cannot manage this with mentoring of the seasoned nurse, the other nurse should help the new nurse report this behavior to the management staff.

19. ANS: C Feedback A By not getting involved, the nurse is silently accepting that this behavior is alright. B The manager may need to become involved, but not as the first step. The responsible, professional nurse would try to intervene first. C Harassment and bullying is antithetical to nursing and should not be tolerated; however, colleagues should be addressed respectfully. D The new nurse may need to learn self-assertive skills; however, the nurse should intervene to stop the behavior. PTS: 1 DIF: Cognitive Level: Application REF: p. 126

19. A young girl from a Middle Eastern country is in the process of dying. Her parents ask the nurses to allow her to be prepared for death by being dressed in a specific garment and headdress every day. The parents cannot be there every day to do this and ask the nurses to apply the attire. Which actions by the nurses demonstrate culturally competent care? a. Allowing the parents to dress the patient in the garment and headdress when they are by her side b. Consulting the chaplain as to the meaning of the ritual in the Middle East c. Informing the parents that hospital policy requires all patients to wear hospital garments d. Learning how to apply the garment and headdress properly

19. ANS: D Feedback A Allowing the parents to dress the child when they are by her side does not assure the daily cultural expectations of the family. B While the meaning of the ritual would be nice to know, whether the nurses know the meaning does not make the ritual any less culturally important to the family. C Informing the parents that hospital policy requires all patients to wear hospital garments totally disregards the desires of the family. D By learning how to dress the patient, the nurses are acknowledging the importance of culture for this family.

19. Which is true of verbal and nonverbal communication? a. Verbal messages are more important than nonverbal cues. b. Individuals can exercise more control over nonverbal communication. c. Verbal and nonverbal communication always match. d. The nonverbal communication may be a more reliable message.

19. ANS: D Feedback A The nonverbal message may tell much more than the verbal one. B Individuals can exercise more control over verbal communication than nonverbal communication. C Verbal and nonverbal communication are not always congruent. D Nonverbal communication includes gestures, posture, facial expressions, eye contact, and actions, among other things. Although the verbal message using words may be short, the nonverbal message can tell much more about the person's feelings.

19. The identification of nursing diagnosis and goal setting should ideally be a collaborative process between the nurse and which other party? a. Physician b. Nurse manager c. Patient's family d. Patient

19. ANS: D Feedback A The physician does not set nursing goals. B The nurse manager does not set nursing goals. C The family does not set goals for the patient. D Nursing goals should be agreed on jointly by the nurse and the patient.

____ 2. Which illness has the characteristics of a chronic illness? a. Lupus b. Bronchitis c. Chicken Pox d. Gastroenteritis

2. ANS: A Feedback A Lupus requires long-term treatment and impacts a person for his or her entire life. Previously, the life expectancy was as short as a few months after diagnosis. B Bronchitis is an acute illness with symptoms that are short-lived, and the person returns to his or her previous level of wellness once he or she is no longer ill. C Chicken pox is an acute illness with symptoms that are short-lived, and the person returns to his or her previous level of wellness once he or she is no longer ill. D Gastroenteritis is an acute illness with symptoms that are short-lived, and the person returns to his or her previous level of wellness once he or she is no longer ill.

2. Therapeutic use of self involves a. forming a relationship based on the nurse's knowledge, attitudes, and skills to communicate effectively. b. providing a safe environment based on the use of environmental manipulation and verbal limit setting. c. evaluation of nurse-patient interactions and the creation of social alliances. d. determining whether it is necessary to listen to the patient and provide feedback.

2. ANS: A Feedback A Therapeutic use of self as defined by Peplau included using communication skills to help patients. B Therapeutic use of self does not involve the manipulation of the environment. C Therapeutic use of self does not involve the creation of social alliances. D Therapeutic use of self involves listening and providing feedback to the patient.

2. The nurse is admitting a patient for surgery. The patient is twisting a handkerchief over and over while saying, "I'm going to have a little mole removed. I'm not worried. The surgery will take only an hour, and then I will go home. I've never been sick a day in my life, so I'll be fine." The nurse finds the following during her physical assessment: blood pressure is 150/90; temperature is 98.6° F; pulse is 88 beats per minute; respiration is 20 breaths per minute; black, brown, and red pigmented pea-sized raised area on her shoulder. Which of the above information would be considered objective data? (Select all that apply.) a. Twisting handkerchief b. Blood pressure 150/90 c. "I'm having this little mole removed." d. Patient is worried. e. Patient is exhibiting denial.

2. ANS: A, B Feedback Correct Twisting handkerchief and blood pressure 150/90 are measurable or observable data. Incorrect "Patient is worried" is subjective data, and "I'm having this little mole removed" is the patient's description of what is going to occur. ""Patient is worried" is incorrect because this is a conclusion the nurse might make based on the subjective and objective data. "Patient is exhibiting denial" is incorrect because this is a conclusion or inference that the nurse might make based on the data.

_ 2. A patient recently lost a job as a salesperson. Which behaviors would indicate that the patient is experiencing stress? (Select all that apply.) a. Patient describes the desire to sleep a great deal due to fatigue. b. Patient states a decrease in participating in usual church activities. c. Patient seems to have difficulty selecting items from a menu. d. Patient is reading the newspaper and online job listings daily. e. Patient continues to spend time with her dog at the dog park.

2. ANS: A, B, C Feedback Correct Excessive sleepiness/fatigue, decrease in social activities and participation in usual events, and difficulty making decisions are correct because stress affects a person physically, emotionally, and cognitively. Incorrect Reading the job listings and spending time with the dog at the park indicate the patient is managing the situation.

22. The best definition of ethnocentrism is a. a tendency to compare the behavior of others with your own cultural values. b. an astute awareness of your own personal biases regarding other cultures. c. a tendency to view your own culture as superior to others. d. the ability to incorporate patients' cultural beliefs and values into health teaching.

22. ANS: C Feedback A A tendency to compare the behavior of others with one's own cultural beliefs describes cultural relativism. B Ethnocentrism implies a lack of awareness of one's own biases. C Ethnocentrism describes a tendency to view your own culture as superior to others. D The ability to incorporate patients' cultural beliefs and values into health teaching describes culturally sensitive care, not ethnocentrism.

Why is accreditation of nursing education programs is important? (Select all that apply.) a. It assures students that their educational program is offering quality education. b. Acceptance into graduate programs in nursing depends on graduation from an accredited program. c. It serves as stimulus for programs to initiate periodic self-examination and self-improvement. d. It has established standards to allow graduates to take licensure examinations. e. Graduating from an accredited program ensures successful completion of the licensure exam.

2. ANS: A, B, C Feedback Correct For an educational program to be accredited, it must meet criteria that protect the quality of education. Graduate programs use the program's accreditation status to assure the quality of education the potential student has received in preparation for graduate study. As part of the accreditation process, the educational program must complete a self-study and show how the school meets each standard. Incorrect The standards that educational programs need to meet to allow their graduates to take the licensure examination are determined by each state, not by accrediting bodies. Graduation from any program of nursing does not guarantee passage of the licensure exam.

2. Which of the following behaviors of a student indicate that the student has taken responsibility for his or her own professional socialization? (Select all that apply.) a. Projecting a professional appearance in class b. Attending class, quietly listening to the lectures c. Taking responsibility to request alternative dates for examinations in order to work d. Taking responsibility to learn the expectations of the faculty in each course e. Accepting constructive criticism without becoming defensive

2. ANS: A, D, E Feedback Correct Part of being a professional is to look and behave like a professional. Each teacher may have different expectations and it is the student's responsibility to seek clarification as a professional. It is through feedback that one is able to improve as a professional. If students become defensive, they may not hear all the feedback, positive and negative. Incorrect Although class attendance is important, asking questions and initiating discussions create a dynamic learning environment. A professional is not merely an academic spectator. Taking responsibility for organizing one's work to meet deadlines reflects professional behavior. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 118-119

2. A nursing student asks a faculty member how to improve critical thinking. Which response by the faculty is best? a. "Don't worry too much; it will come with time and experience." b. "Pay close attention to how you solve problems; assess your own style of thinking." c. "Spend time shadowing an experienced nurse to see how it is done." d. "Use ethical standards to guide how you approach patient situations."

2. ANS: B Feedback A Although time and experience are important in developing critical thinking, people actually must actively consider how they think in order to improve critical thinking. B Making thinking a focus of concern and actively thinking about it is the best advise the faculty can give. C While observing an experienced nurse may be helpful, the student needs to be an active participant to improve critical thinking. D Using ethical and professional standards is a part of critical thinking, but that is only a portion of what makes a good critical thinker.

2. Which of the following nursing leaders is credited with being one of the earliest nursing educators in the world? a. Isabel Hampton Robb b. Mary Adelaide Nutting c. Melinda Anne Richards d. Annie W. Goodrich

2. ANS: B Feedback A Robb studied nursing education. B Mary Adelaide Nutting was a professor at Teachers College in 1907, and she was also the first nursing professor. C Richards was the first trained nurse educated in the United States. D Goodrich became the first dean of the Yale School of Nursing in 1924.

2. Which of the following are examples of open-ended questions? (Select all that apply.) a. "Ms. Goode, did you have a productive therapy session?" b. "How are you?" c. "How do you feel about staying with your daughter?" d. "What would you like to discuss today while we take a walk?" e. "Are you having that problem with arthritis in your hand again?"

2. ANS: B, C, D Feedback Correct The questions "How are you?" "How do you feel about staying with your daughter?" and "What would you like to discuss today while we take a walk?" require the patient to answer by providing data and not just a yes or no answer. Incorrect The statements "Ms. Goode, did you have a productive therapy session?"and "Are you having that problem with arthritis in your hand again?" do not require more than yes or no answers.

20. Which of the following statements has all of the necessary criteria for a well-written outcome? a. Patient will consume 50% of meals with no nausea and vomiting by 24 hours postsurgery. b. Therapist will report improvement in patient's range of motion on a daily basis. c. Patient will ambulate in the halls a little today. d. Patient's condition will improve before discharge.

20. ANS: A Feedback A "Patient will consume 50% of meals with no nausea and vomiting by 24 hours postsurgery" is specific, measurable, and has a specific time frame. B Outcomes should be patient focused. C "Patient will ambulate in the halls a little today" is nonspecific and not measurable. D "Patient's condition will improve before discharge" is nonspecific, is nonmeasurable, and has no time frame.

20. The purpose of mandatory continuing education for license renewal is to a. ensure that nurses remain up to date in knowledge. b. ensure that nurses remain competent in psychomotor skills. c. ensure that nurses attend regular staff development meetings. d. ensure consistency between states regarding continuing education requirements.

20. ANS: A Feedback A Mandatory continuing education is a state government's way of ensuring that nurses remain up to date. B Ensuring that nurses remain competent in psychomotor skills is not a test of psychomotor competency. C Staff development deals with competency and institutional updates. D The number of continuing education hours required varies among states.

20. A new graduate nurse is in the fifth week of working on a busy surgical unit. The nurse tells a friend about witnessing some patient care that was "appalling." What should the nurse do? a. Return to school to obtain a master's of science in nursing (MSN) and leave bedside nursing. b. Talk to the other nurses involved in the situation about the concerns. c. Report the behavior to the nurse manager of the unit. d. Accept that this is the reality of nursing in a busy unit.

20. ANS: B Feedback A Returning to school will not help the nurse resolve the reality of this situation. B Talking to the other nurses involved allows this nurse to take responsibility for feelings and get support. C Reporting the behavior without attempting to resolve it with the nurses involved appears to be overreacting and may appear as if the nurse is not a team player. D Disengaging mentally and emotionally may result in dropout. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 128

20. An English-speaking nurse gave a non-English-speaking Asian patient instructions about preparing an abdominal surgical site. The nurse showed the patient how the bottle of povidone-iodine was to be used in cleansing the area. The patient smiled and nodded throughout the instructions. The patient did not respond when asked if he had any questions. When the nurse left the room, the patient promptly drank the bottle of povidone-iodine. Which action would be most effective in preventing this error? a. Giving the patient written instructions in his language b. Using a medical interpreter to give the preoperative instructions c. Having the patient sign a statement that he understood the instructions d. Using illustrations to show the patient the procedure

20. ANS: B Feedback A The patient may not be able to read in his language but may not indicate that to the nurse. B The use of the interpreter assures that the patient has received the correct information in a manner he can understand. C Having the patient sign a statement does not indicate that he understood. He may sign because he feels that this is expected. D Although illustrations may help, the use of an interpreter is still the best action to ensure understanding.

20. Which of the following could be considered congruent communication? a. The nurse manager states, "Come by my office anytime." Then she keeps her door closed and does not answer phone calls. b. As a co-worker hurries down the hall, he asks, "Is there anything you need help with?" c. As she drops a stack of charts loudly on the desk, a co-worker states, "This is going to be a wonderful day." d. The nurse manager sits with you in the nurse's lounge and asks, "Is there anything you would like to talk about?"

20. ANS: D Feedback A The verbal message is that she is available, but the closed door indicates otherwise. B The verbal message is willingness to help; the nonverbal message is, "I hope you do not ask." C The dropping of the charts loudly indicates frustration and is incongruent with the message "This is going to be a wonderful day." Sarcasm is incongruent communication. D The nurse manager's verbal message matches the nonverbal message. This is the definition of congruent communication.

Which of the following strategies may help to overcome reality shock in the novice nurse? a. Participating in a preceptorship b. Returning to school immediately after graduation c. Moving frequently from job to job d. Becoming emotionally involved with patients

21. ANS: A Feedback A Participating in a preceptor program can help a novice assimilate more smoothly into the registered nurse (RN) role. B Prematurely returning to school is often an avoidance mechanism. C Moving frequently from job to job can increase the risk of burnout. D Nurses should not become overly emotionally involved with patients. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 128

21. Why is a basic understanding of ethnopharmacology part of being a culturally competent nurse? a. Significant differences among ethnic groups have been found in relation to the effects of medications. b. Ethnopharmacology is a new area of study important to all nurses. c. Nurses should know how medications may affect individual patients to properly administer the medication. d. Pharmacology is a significant aspect of nursing practice.

21. ANS: A Feedback A The absorption, metabolism, distribution, and elimination of medications have been demonstrated to differ among ethnic groups. Nurses need to be aware of these ethnic differences to provide quality care. B The importance is not that it is new, but that ethnopharmacology is significant to the care nurses provide. C Although nurses should know how to administer medication properly to any patient, the nurse also needs to understand the different responses including those based on ethnicity. D Although the understanding of pharmacology is significant, the nurse needs to understand ethnopharmacology to be culturally competent.

21. A nurse is irrigating pressure ulcers on a patient's coccyx. When the patient asks how they are healing, the nurse grimaces and says, "Oh, they're doing just fine." This is a. incongruence between verbal and nonverbal messages. b. a confirming statement. c. objectivity in responding to the question. d. the therapeutic use of humor.

21. ANS: A Feedback A The words say, "It's OK," but the facial grimaces say it is not. B The verbal and nonverbal messages do not match. C Objectivity is not found in the statement. D There is no use of humor.

21. A patient is in respiratory distress and placed on oxygen. Which is the most appropriate short-term goal? a. Nasal cannula remains in place. b. Patient completes morning care and eats breakfast. c. Patient verbalizes that he is breathing better after lunch. d. Patient maintains an oxygen saturation of 90% during the shift.

21. ANS: D Feedback A "Nasal cannula remains in place" is not a patient goal, and there is no time frame. B "Patient completes morning care and eats breakfast" is broad, and there is no time frame. C Although there is a short time frame, the goal "patient verbalizes that he is breathing better after lunch" lacks specificity. D "Patient maintains an oxygen saturation of 90% during the shift" involves a specific goal for the patient in a short time frame.

22. Context is one of the five major elements of communication identified by Ruesch. Which of the following is part of the context of communication? a. Information about the sender b. Attitude of the receiver c. Response of the receiver d. Content of the message

22. ANS: B Feedback A Information about the sender is not part of the context of the communication. B Context refers to the environment in which the interaction occurs. This includes the mood and the relationship between the sender and receiver. C The response of the receiver is not part of the context of communication. D The content of the message is not part of the context of communication.

Black illustrates concepts of preventing burnout by using the example of a flight attendant instructing persons to "put your own oxygen mask on first." What does this statement mean? a. Oxygen is the most important element of life. b. Airway is always a priority in patient care. c. Taking care of yourself will enable you to be a better nurse. d. Ask others for help if you feel overwhelmed by your first position as a nurse.

22. ANS: C Feedback A "Putting your own oxygen mask on first" is about self-care, not oxygen. B "Putting your own oxygen mask on first" is a metaphor for self-care. C Taking care of yourself will allow you to better care for others. D Although finding a mentor is important to self-care, "putting your own oxygen mask on first" does not specifically address this concern. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 128

22. Which of the following is an appropriate long-term goal to measure diabetes control for a patient in whom diabetes has been newly diagnosed? a. Patient will inject insulin twice daily. b. Patient will keep appointments with physician over the next 6 months. c. Patient's A1c will be 5% at 1 year postdiagnosis. d. Patient's recorded blood glucose will be between 60 and 120 mg/dL each day.

22. ANS: C Feedback A Taking the insulin is important but does not indicate how well blood glucose was controlled. B Although keeping appointments is important for diabetes management, this does not indicate blood glucose control. C "Patient's A1c will be 5% at 1 year postdiagnosis" reflects the best indicator of long-term control of blood glucose level and therefore diabetes management. This goal is specific and easily measurable. D "Patient's recorded blood glucose will be between 60 and 120 mg/dL each day" is a short-term measure of blood glucose control.

23. Which of the following is an independent nursing intervention? a. Teaching a patient with congestive heart failure to weigh herself daily b. Recommending an extra dose of diuretic to the patient whose weight has increased 2 pounds overnight c. Changing the first surgical dressing on a patient after surgery d. Transferring a patient out of the intensive care unit 2 days after vascular surgery

23. ANS: A Feedback A Teaching requires no supervision, and nurses can carry out teaching interventions independently. B Prescribing medication is not a nursing intervention. C "Changing the first surgical dressing on a patient after surgery" is a dependent nursing action. D "Transferring a patient out of the intensive care unit 2 days after vascular surgery" is a dependent nursing intervention.

23. The nurse finds a patient sitting in bed, rocking back and forth, wringing her hands and repeating rapidly, "I can't breathe. My heart is pounding. I think I'm going to die." Her physician is called to the bedside and tells the nurse, "She is having an anxiety attack." What assessment can be made by the nurse? a. Severe anxiety is present in this patient. b. Cultural factors control anxiety levels. c. Focusing on discharge instruction will ease the anxiety. d. The level of anxiety cannot be determined at this point.

23. ANS: A Feedback A With increased anxiety, one observes rapid speech, increased purposeless body movements, and subjective statements of discomfort. B Although cultural factors may influence how anxiety is expressed, they do not control anxiety. C If a person is experiencing anxiety, he or she will not be able to focus on receiving information, including discharge instructions. D The level of anxiety can be determined on the basis of the observation of the patient's behavior.

23. A new mother says to the nurse, "It really hurts me to breastfeed. I think I should wean my baby." The most appropriate response by the nurse is, a. "It is good to wean the baby early because it is easier on you." b. "If I understand you, it hurts when you breastfeed. Tell me how and when it hurts." c. "It is your decision to make whether you breastfeed." d. "You should continue to breastfeed because it is much better for the baby."

23. ANS: B Feedback A Saying "It is good to wean the baby early because it is easier on you" gives a response before the situation is clarified and closes off continued communication. B The nurse is gaining feedback that helps the nurse understand more about the situation from the patient's perspective and keeps communication open. C Saying "It is your decision to make whether you breastfeed" gives a response before the situation is clarified and closes off continued communication. D Saying "You should continue to breastfeed because it is much better for the baby" gives a response before the situation is clarified and closes off continued communication.

24. A patient has been diagnosed with angina. As he talks with the nurse, he asks several good questions about angina and seems able to concentrate on the explanations. He seems eager to learn how to manage his condition. What assessment can be made by the nurse? a. Severe anxiety is present. b. Mild anxiety is present. c. Moderate anxiety is present. d. The level of anxiety cannot be determined.

24. ANS: B Feedback A When severe anxiety is present, the person's thoughts are scattered and attention to learning is decreased. B With mild anxiety, the person is able to focus attention, and there is an increased capacity for learning. C When moderate anxiety is present, the person is only able to concentrate on one thing at a time and would not be asking questions. D The level of anxiety can be determined from the patient's behaviors.

24. A new mother says to the nurse, "It really hurts me to breastfeed. I think I should wean my baby." The nurse responds, "If I understand you, it hurts when you breastfeed. Tell me how and when it hurts." This response best represents which criterion of successful communication? a. Appropriateness b. Efficiency c. Feedback d. Flexibility

24. ANS: C Feedback A Appropriateness relates to whether the reply fits the circumstances and matches the message. B Efficiency means using simple, clear words that are timed at a pace suitable to the patient. C The nurse seeks to clarify the hurt before intervening further. D Flexibility means the message is based on the immediate situation and not preconceived expectations.

24. Which of the following represents an interdependent nursing action? a. Giving the patient an ordered medication b. Bathing the patient c. Inserting a Foley catheter d. Participating in a "code" (cardiac arrest response)

24. ANS: D Feedback A "Giving the patient an ordered medication" is a dependent nursing action. B "Bathing the patient" is an independent nursing action. C "Inserting a Foley catheter" is a dependent nursing action. D "Participating in a 'code' (cardiac arrest response)" is an example of an action that involves collaboration with other health care professionals before and during implementation. It requires a protocol.

25. When a co-worker tells the nurse, "I am not sure I will be able to give the right answers in the job interview," the nurse replies, "I know what you mean. Interviews have always been a problem for me, too." This response can be evaluated as lacking a. appropriateness. b. efficiency. c. feedback. d. flexibility.

25. ANS: A Feedback A Appropriateness relates to whether the reply fits the circumstances and matches the message. The nurse's response related to his own issue does not deal with the co-worker's issue, which should be the focus of the interaction. B Efficiency means using simple, clear words that are timed at a pace suitable to the patient. C Feedback means the nurse seeks to clarify what the patient has said and gain understanding. D Flexibility means the message is based on the immediate situation and not preconceived expectations.

25. The use of standardized plans of care for different patient populations has a. facilitated the use of critical paths as interdisciplinary plans of care. b. required the nurse to individualize the plan of care to the patient. c. eliminated the need for the nurse to develop a plan of care for an individual. d. increased the time the nurse has to document the plan of care.

25. ANS: B Feedback A Standardized plans of care are not always critical paths and/or interdisciplinary. B Although plans for frequent patient problems can be easily produced, the plan of care still may need to be modified to meet the needs of the patient. C The use of standardized plans of care has not eliminated the need for an individualized plan. D The use of the standardized plans of care has decreased the time required of the nurse to update and document the plan of care.

25. Nurses can best help patients deal with stress by a. helping patients eliminate all stress from their lives. b. helping patients communicate their stress better to friends and family. c. helping patients evaluate their lifestyles for areas of potential stress. d. intervening in the family system to reduce family stress.

25. ANS: C Feedback A It is not possible or desirable to eliminate all stress from one's life. B Having someone to talk to may be helpful in reducing stress, but problem solving and planning are more effective plans for management. C Nurses can assist patients to restructure the stressful aspects of their lives to reduce or minimize stress. D It is not reasonable to expect the nurse to solve the patient's problems.

26. When planning for patient teaching, the nurse is aware that which of the following factors create(s) a barrier to learning? a. Mild anxiety b. Pain and fatigue c. Family presence d. Patient autonomy

26. ANS: B Feedback A Mild anxiety can improve learning. B Pain and fatigue create barriers to learning. C Family presence does not necessarily impede learning. D Patient autonomy does not impede learning, and patient learning facilitates development of autonomy.

26. The nurse instructs the patient about incentive spirometry as preoperative teaching. Which phase of the nursing process does this illustrate? a. Assessment b. Planning c. Implementation d. Evaluation

26. ANS: C Feedback A The example in the question is an intervention, not an assessment. B The example in the question is an intervention, not a plan. C Implementation is the phase of the nursing process when interventions are carried out. D The example of incentive spirometry is not an evaluation.

26. A new mother says, "My baby is being kept in the nursery. I'm really worried about him. I'm also worried that the separation will interfere with breastfeeding." The most appropriate response by the nurse is, a. "Well, that's not my territory. You'll have to deal with the nursery staff about breastfeeding." b. "As a nurse on this unit, I can assure you that we will do all we can to help you." c. "I can see you're upset about this, but to be honest with you, I'm a new nurse here, and I'm not sure how I can help you." d. "I can see this is a problem for you. I will go to the nursery and see if I can get some answers for you."

26. ANS: D Feedback A Telling the mother that she will need to deal with the nursery staff does not address the concern of the mother. B Saying that the staff of the hospital will do all they can to help does not address the concern of the mother. C The nurse telling the mother that he is new and does not know how to help does not address the concern of the mother. D The nurse's response fits the circumstances and matches the mother's message of being concerned about the separation and breastfeeding.

27. Using simple, clear words to explain the details of a colonoscopy procedure shows sensitivity to which successful communication criterion? a. Appropriateness b. Efficiency c. Feedback d. Flexibility

27. ANS: B Feedback A Appropriateness relates to whether the reply fits the circumstances and matches the message. B Efficiency means using simple, clear words that are timed at a pace suitable to the patient. C Feedback means the nurse seeks to clarify what the patient has said and gain understanding. D Flexibility means the message is based on the immediate situation and not preconceived expectations.

27. The parents of a 4-year-old diabetic have become increasingly argumentative especially about whether the father helps enough with child care and housekeeping. He works two jobs which leaves little time to help his stay-at-home wife. Which nursing intervention is most appropriate for this family? a. Referring the parents to a marriage counselor b. Discussing with the parents the stresses they perceive in the situation c. Suggesting that the father give up one of his jobs d. Identifying a way to reallocate the child's diabetes care between the parents

27. ANS: B Feedback A It may be premature to refer the parents to a marriage counselor until the situation is assessed further. B Before changes are suggested and/or made, everyone involved should have identified what the perceived stressors are for all members of the family. C Suggesting that the father give up his part-time job may be premature until it is known what the stressors are, as well as determining whether the income is required to provide for the needs of the family. D The nurse should not be the one determining how to reallocate the child's care within the family. The decision rests with the parents.

27. In the nursing process, the evaluation phase is used to determine the a. value of the nursing intervention. b. accuracy of problem identification. c. the quality of the plan of care. d. degree of outcome achievement.

27. ANS: D Feedback A Evaluation does not measure the value of the intervention. B Evaluation does not measure the accuracy of problem identification. C While it is an indicator of the effectiveness of the plan of care, evaluation is far more than that. D The evaluation phase of the nursing process is used to evaluate patient progress related to goals and outcome achievement to determine whether a problem is resolved.

35. Within nurse-patient communication, the use of silence can a. block further therapeutic communication. b. allow the patient to not feel pressured to provide information. c. demonstrate trust. d. provide the nurse with an opportunity to complete the patient's care.

35. ANS: B Feedback A Using silence actually encourages communication because it allows the patient to organize his or her thoughts. B Using silence means allowing periods of quiet thought during the nurse-patient interaction when the patient does not feel pressure to provide conversation. C Using silence does not relate to trust. D Using silence is not a requirement for completing patient care.

28. A 4-year-old child is going to have an abdominal x-ray examination. The child asks, "Why do they have to do this? Will it hurt?" Which of the following is the most appropriate response by the nurse? a. "The doctor needs you to have the x-ray so she knows what is wrong with you." b. "You will go to the x-ray department so they can take pictures of your tummy to find out why you have a tummy ache. The bed you lie on may be cool, but you will have a blanket to keep you warm. The test will not hurt." c. "You will go downstairs on a stretcher. You will need to lie very still on a hard table while the x-ray machine goes over you. It will not take very long." d. "X-rays do not hurt. The machine takes a picture but will not touch you."

28. ANS: B Feedback A Telling the child that he will need an x-ray to determine what is wrong with him does not provide a clear explanation that addresses the child's concerns. B The nurse's response explains the procedure in clear and simple words that are suitable to a 4-year-old child. C Explaining the x-ray procedure in terms that may not be easy to understand for a 4-year-old does not provide a clear explanation that addresses the child's concerns. D Telling the child that x-rays do not hurt and that they take pictures does not provide a clear explanation that addresses the child's concerns.

28. A nurse reviewing a patient's care plan notes a goal of "Patient will ambulate 50 feet, three times in the hallway today." According to Bloom, what taxonomic category is this goal? a. Affective domain b. Physical domain c. Psychomotor domain d. Cognitive domain

28. ANS: C Feedback A The affective domain involves feelings, emotions, values, and attitudes. This goal is not in the affective domain. B Bloom's taxonomy does not include "physical" domain. C The psychomotor involves movement and motor skills. An ambulation goal would be part of this domain. D The cognitive domain includes knowledge and cognitive skills. Ambulating would not be part of the cognitive domain.

29. Which of the following examples illustrates the nurse's failure to use flexibility effectively in professional communication? a. Asking on the admission assessment, "You don't smoke, do you?" b. When updating a family member on a patient's condition stating, "Your wife's ABG report indicates significant hypoxia." c. Continuing to follow the agenda in a staff meeting when people are obviously upset by a recent death on the unit d. Requiring nurses to read back phone orders to physicians

29. ANS: C Feedback A "You don't smoke, do you?" is an example of value judgment. B This is an example of poor communication, because the message is not geared to the receiver's level of understanding. C Continuing to follow an established agenda when the emotional state of the group needs to be addressed indicates inflexibility on the part of the leader. D Requiring nurses to read back phone orders to physicians is an example of feedback.

3. What is the most important information the nurse should share with the patient during the orientation phase? a. Name, credentials, extent of responsibility b. Plan for the day, times the nurse will be unavailable, how to contact the nurse c. Nurse's name, physician's name, possible discharge date d. Plan for discharge, teaching needs, goals for the day

3. ANS: A Feedback A During the orientation phase the nurse shares his or her name, credentials, and extent of responsibilities. B Sharing information about the plan for the day, times the nurse will be unavailable and how to contact the nurse is not primary during the orientation phase. C Determining a discharge date would be the responsibility of the entire treatment team. D The nurse does not share the plan for discharge and teaching needs during the orientation phase.

3. Which of the following is a characteristic of an accomplished critical thinker? a. Inquisitiveness b. Narrow focus c. Unaffected by other arguments d. Quick decision making

3. ANS: A Feedback A The accomplished critical thinker needs to ask questions when things do not seem quite right. B The accomplished critical thinker thinks broadly, considering all possibilities. C The accomplished critical thinker considers all information and all arguments before deciding on a course of action. D The accomplished critical thinker considers the facts, fits them into known patterns, considers all aspects of the problem, and makes decisions based on knowledge, not on instinct.

3. Which statement about acute illness is true? a. Most people with acute illness develop chronic illness. b. Most people with acute illness return to their previous level of wellness. c. All people with an acute illness need medical care. d. Acute illnesses are usually catastrophic in nature.

3. ANS: B Feedback A Some people do go on to develop a chronic illness after an acute one, but unless there are complications, most people with acute illness return to their previous level of wellness. B Most people with acute illness return to their previous level of wellness. C Many acute illnesses do not require medical intervention. D While some acute illnesses are catastrophic in nature, not all acute illnesses are.

3. Which of the following are characteristic of compassion fatigue? (Select all that apply.) a. Increased energy b. Burnout c. Being prone to accidents d. Poor judgment e. Increased interest in reflection

3. ANS: B, C, D Feedback Correct Loss of physical energy, burnout, accident proneness, emotional breakdowns, apathy, indifference, poor judgment, and disinterest in introspection are all signs of compassion fatigue. Incorrect Increased energy and increased interest in reflection are not signs of compassion fatigue.

Which factors contribute to threatening the current and future supply of nurses? (Select all that apply.) a. The number of qualified applicants has decreased. b. Seventy-five percent of current faculty may retire over the next decade. c. Overall numbers of applicants to doctoral programs has decreased. d. Faculty vacancies are having an impact on large numbers of schools. e. More men are entering nursing and choosing faculty positions.

3. ANS: B, D Feedback Correct It is projected that as many as 75% of current faculty will retire by 2019. This will impact large numbers of schools and can limit enrollment. Incorrect The number of qualified applicants has increased, but more than 30,000 applicants were turned away from bachelor's degree programs for "lack of capacity." More men are entering nursing, which should help increase recruitment of other men into the field. More male faculty could also help recruitment of men into nursing. There is continued demand for doctoral education in nursing.

3. The nurse is admitting a patient for surgery. The patient is twisting a handkerchief over and over while saying, "I'm going to have a little mole removed. I'm not worried. The surgery will take only an hour, and then I will go home. I've never been sick a day in my life, so I'll be fine." The nurse finds the following during her physical assessment: blood pressure is 150/90; temperature is 98.6° F; pulse is 88 beats per minute; respiration is 20 breaths per minute; black, brown, and red pigmented pea-sized raised area on her shoulder. Which of the above information would be considered subjective data? (Select all that apply.) a. Pigmented mole on shoulder b. "I'm not worried... I'll be fine." c. Patient is anxious. d. Heart rate is increased. e. "The surgery will take only an hour and then I will go home."

3. ANS: B, E Feedback Correct "I'm not worried... I'll be fine" and "The surgery will take only an hour and then I will go home" are statements made by the patient describing feelings or events. Incorrect "Pigmented mole on shoulder" is a conclusion based on objective data. "Patient is anxious" is incorrect because this is a conclusion the nurse might make based on the subjective and objective data. "Heart rate is increased" is incorrect because this is a conclusion the nurse might make based on objective data.

3. The Goldmark Report focused on what aspect of nursing? a. Consistency in length of nursing education programs b. Consistency in theory content across diploma programs c. Desirability of establishing schools of nursing within academic settings d. Increasing numbers of physicians teaching in nursing programs

3. ANS: C Feedback A Consistency in length of programs was not an issue. B Content was not the issue. C The Goldmark Report focused on clinical learning experiences of students, hospital control of schools of nursing, desirability of establishing schools of nursing in universities, lack of funding for nursing education, and lack of qualified faculty. D Nursing curriculum with instruction by physicians was not encouraged.

30. The nurse plans to teach a patient about the care of her mastectomy site. The nurse finds the patient crying. The best response by the nurse is, a. "It is time to discuss how to care for the surgical site." b. "You seem upset. You should start looking forward to going home and being a wife and mother again." c. "I see you are upset. Is there something on your mind you'd like to talk about?" d. "Dr. Abrams said you can go home tomorrow, and we need to talk about the care of your surgical site."

30. ANS: C Feedback A This statement follows the established agenda and does not respond to the emotional state of the patient. B This statement follows the established agenda and does not respond to the emotional state of the patient. C The nurse's response demonstrates flexibility. The response identifies the emotional state of the patient and requires deviation from the established agenda. D This statement follows the established agenda and does not respond to the emotional state of the patient.

31. The patient says to the nurse, "The staff treats me like I'm a child. Everyone tells me what to do. No one ever asks my opinion. After all, it is my body." Which response by the nurse indicates active listening? a. "Well, you're sick. Don't you think you should let us take care of you?" b. "I don't think I can help you with this. This is a personal matter between you and the rest of the staff." c. "It makes you angry not to be included in your health care decisions. Let's talk about how you can vent your anger appropriately." d. "Let me see if I understand. It bothers you not to be recognized for your abilities to handle your life. I can discuss this with the staff if you wish so that everyone involves you in planning your care."

31. ANS: D Feedback A This statement indicates a lack of interest in what the patient was saying and is paternalistic. B This statement indicates a lack of interest in what the patient was saying and an unwillingness to help the patient. C This statement shows an assumption by the nurse that should be verified. D The nurse's response recognizes the patient's feelings and concerns. The nurse verifies the patient's feelings and suggests an action which gives the patient the desired control.

32. In which of the following examples is the nurse demonstrating empathy for the postoperative mastectomy patient? a. "With today's advanced reconstruction techniques, you'll quickly forget you ever had surgery." b. "You'll be back to your busy routine sooner than you think." c. "This must be a very difficult time for you." d. "I know how you feel; I also had breast cancer."

32. ANS: C Feedback A Saying "With today's advanced reconstruction techniques, you'll quickly forget you ever had surgery" discounts the patient's feelings and is false reassurance. B The nurse is making an assumption that the patient wants to return to a busy routine. This is false reassurance based on a faulty assumption about the patient. C The nurse acknowledges the patient's feelings and uses an open-ended statement to encourage the patient to verbalize further. D The nurse should never assume to know how the patient feels. The focus should be on the patient, not the nurse. The nurse's experience is not germane to the nurse-patient relationship.

33. Which of the following demonstrates giving information versus opinion? a. "Mrs. Khan, let's practice together the breathing techniques you learned in Lamaze classes. That will help us to work together more effectively later when your labor is stronger." b. "You learned breathing techniques in Lamaze classes. I really believe the breathing techniques make labor easier." c. "Mrs. Khan, have you been practicing the breathing techniques you learned? It is very important to practice if you wish to use them effectively in labor." d. "Using breathing techniques in labor is really to your benefit because you feel in control."

33. ANS: A Feedback A Saying "Mrs. Khan, let's practice together the breathing techniques you learned in Lamaze classes. That will help us to work together more effectively later when your labor is stronger" does not offer an opinion. B Saying "You learned breathing techniques in Lamaze classes. I really believe the breathing techniques make labor easier" offers the nurse's opinion regarding the breathing techniques. C Saying "Mrs. Khan, have you been practicing the breathing techniques you learned? It is very important to practice if you wish to use them effectively in labor" offers the nurse's opinion regarding the breathing techniques. D Saying "Using breathing techniques in labor is really to your benefit because you feel in control" offers the nurse's opinion regarding the breathing techniques.

34. How would a nurse's use of the technique of reflection help a person? a. Showing an awareness of the person's feelings b. Causing the person to answer more fully than yes or no c. Showing knowledge the person is not expected to know d. Encouraging the person to think through problems for himself or herself

34. ANS: D Feedback A Reflection may involve the person becoming aware of his or her feelings but does not require the nurse's awareness. B Reflection is not related to the answers provided by the patient. C Reflection is related to the insight the person gains, not information provided to him or her. D Reflection implies respect for the patient and his or her ability to solve his or her problems.

36. A patient states, "The harder I try to get along with my son, the more I feel he just wants to be left alone," and the nurse responds, "I guess parents have to expect these problems as children get older." The nurse's response is an example of a communication breakdown known as a. failing to see the uniqueness of the individual. b. failing to recognize levels of meaning. c. using value statements d. failing to clarify unclear messages.

36. ANS: A Feedback A The nurse's response has put the patient into a group, parents, and therefore does not respond to the patient as a unique individual. B There is no meaning under the surface content in the patient's remark. C There are no value statements in the nurse's response. D The patient's remark was not unclear.

37. A patient states, "The thing that scares me the most about surgery is the spinal anesthesia. I'm afraid it'll leave me paralyzed," and the nurse responds, "Everything will be fine. The anesthesiologists are very skilled in administering spinal anesthesia." The nurse's response is an example of a communication breakdown known as a. failing to see the uniqueness of the individual. b. failing to recognize levels of meaning. c. using value statements. d. using false assurance.

37. ANS: D Feedback A The nurse does not fail to respond to the patient as a unique individual. B The nurse does not fail to take into account the meaning under the surface content. C The nurse does not use value statements. D The nurse offers false assurance.

38. Collaboration in health care settings involves a. professionals respected for their unique knowledge and abilities. b. professionals educated in a collaborative model of education. c. recognition of individual professional accomplishments. d. a multitiered system hierarchy.

38. ANS: A Feedback A Collaboration implies working jointly with other professionals, all of whom are respected for their unique knowledge and skills in the situation. B Currently most professionals are not educated in a collaborative model of education, although they are expected to work in collaboration. C In collaboration the accomplishments of the total group are recognized, not individuals. D Collaboration implies that everyone on the interdisciplinary team can make valuable contributions.

39. Collaboration among health care professionals most importantly results in a. the development of esprit de corps. b. benefits to the organization alone. c. positive patient outcomes. d. maintenance of employee satisfaction.

39. ANS: C Feedback A Although esprit de corps develops, the ultimate result is for positive patient outcomes. B Collaboration benefits the individuals involved, as well as the organization. C Making the most of collaborative opportunities enhances positive patient outcomes. D Employee satisfaction is greater with more collaboration, but the ultimate value of collaboration is positive patient outcomes.

4. What is the primary difference between acute illness and chronic illness? a. In acute illness, symptoms begin suddenly, progress quickly, and subside quickly. b. In acute illness, symptoms begin suddenly, progress gradually, and do not subside. c. In chronic illness, symptoms begin gradually, progress suddenly, and subside quickly. d. In chronic illness, symptoms begin suddenly, require ongoing management, and subside quickly.

4. ANS: A Feedback A Acute illness is defined as severe symptoms that appear suddenly, progress steadily, and subside quickly. B Chronic illness symptoms progress gradually and generally do not subside. C Chronic illness symptoms progress gradually and generally do not subside. D Chronic illness symptoms begin gradually.

4. Several methods have been developed to assist nurses in organizing patient data. They include (Select all that apply.) a. Henderson's 14 nursing problems. b. Gordon's 11 functional health patterns. c. Nightingale's ecological framework. d. Abdellah's 21 nursing problems.

4. ANS: A, B, D Feedback Correct Henderson's 14 nursing problems, Gordon's 11 functional health patterns, and Abdellah's 21 nursing problems help sort patient data into categories. Incorrect Nightingale did not provide a method of organizing patient data.

Over the last two decades a number of organizations issued reports identifying changes needed in nursing education to prepare nurses for practice in the twenty-first century. Which of the following suggestions were included in these reports? (Select all that apply.) a. Recruitment of students and faculty to reflect the multicultural nature of society b. More focus on knowledge and skills to care for acutely ill individuals c. Increased informatics training to improve access to information d. Limiting discussion of the quality improvement measures in the health care system e. Curricula emphasizing interdisciplinary teamwork and collaboration

4. ANS: A, C, E Feedback Correct The changes "recruitment of students and faculty to reflect the multicultural nature of society," "increased informatics training to improve access to information" and "curricula emphasizing interdisciplinary teamwork and collaboration" were made in several nursing reports and in the 2003 Institute of Medicine report. Incorrect The reports stated that there should be increased focus on chronic illness and that a quality improvement process of the health care system must be included in the education of health care providers.

4. Which of the following statements describes the purpose of the nursing process? a. Process of documentation designed to decrease liability b. Process designed to maximize reimbursement potential c. A sophisticated time-management strategy d. Process used to identify and solve patient problems

4. ANS: D Feedback A Although proper documentation is part of the nursing process, it is a problem-solving process, not a documentation process. B The nursing process is not used with reimbursement potential in mind. C The nursing process is not a time-management strategy. D The purpose of the nursing process is to identify and solve patient problems.

4. Which American university opened the first nursing school as a separate department within the university? a. Harvard b. Teachers College c. Columbia d. Yale

4. ANS: D Feedback A Harvard was not the first American university to open a nursing school as its own department. B Teachers College was not the first American university to open a nursing school as its own department. C Columbia was not the first American university to open a nursing school as its own department. D In 1924, Yale University was the first American university to open a school of nursing as its own department.

4. One of the most important outcomes of the orientation phase of the nurse-patient relationship is the development of mutual a. communication. b. understanding. c. acceptance. d. trust.

4. ANS: D Feedback A The entire relationship requires excellent communication, not just the orientation phase. B All phases of the therapeutic relationship require understanding. C All phases require nonjudgmental acceptance. D The purpose of the orientation phase is to establish trust.

5. A patient with diabetes who refuses to change eating patterns may be in which stage of adjustment? a. Denial and disbelief b. Irritability and anger c. Attempting to gain control d. Acceptance and participation

5. ANS: A Feedback A Denial and disbelief is the first stage in adjustment to an illness. It is characterized by belief that the symptoms do not really represent illness and will go away. B Irritability and anger are characteristics of the second stage of illness acceptance. It is characterized by anger at the body for not functioning properly or by anger displaced onto others. C The person in the "attempting to gain control" stage usually seeks help and knowledge as ways to gain control. D The "acceptance and participation" stage occurs when the patient is ready to participate in decisions about treatment.

5. Developing sound clinical judgment is a professional responsibility of the nurse. Which statements indicate behaviors that improve clinical judgment? (Select all that apply.) a. "I always assess before acting and make changes as needed." b. "I work the shifts I am assigned." c. "I look for research findings to support my nursing actions." d. "I believe that every patient deserves my very best efforts." e. "I have read the professional nursing standards."

5. ANS: A, C, D, E Feedback Correct "I always assess before acting and make changes as needed," "I look for research findings to support my nursing actions," "I believe that every patient deserves my very best efforts," and "I have read the professional nursing standards" are behaviors that demonstrate the use of resources and the nursing process to give the patient quality care. These activities facilitate the development of clinical judgment. Incorrect The nurse is not taking opportunities to extend herself or himself and potentially learn from other situations. This would not show sound clinical judgment.

5. Which behaviors help patients develop trust in the nurse? a. Answering questions with authority b. Sharing personal information to indicate openness c. Conveying acceptance of the patient and a nonjudgmental attitude d. Meeting with the patient spontaneously because that indicates caring

5. ANS: C Feedback A Although answering questions as fully as possible and admitting the limits of knowledge facilitates trust, answering questions with authority implying that this is the entire answer does not help develop trust. B The sharing of personal information does not help develop trust. C Accepting the patient's thoughts and feelings without judgment helps develop trust in the nurse. D Meeting at designated times helps the patient develop trust that the nurse will follow through with what is promised.

5. Which of the following recommendations resulting from the 1934 study Nursing Schools Today and Tomorrow still has relevance today? a. Nursing students should be trained on the job. b. Nursing students should be used to staff hospitals on the weekends. c. Nurses should be highly educated. d. Nurses with highly developed instincts do not require standards of practice.

5. ANS: C Feedback A Nurses should be highly educated in a university setting. B Students should not be used to staff hospitals. C The study made five recommendations: nursing education should be established within higher education; nurses should be highly educated; students should not be used to staff hospitals; standards of practice should be established; and students should meet minimal qualifications for graduation. D Standards of practice should be established.

5. Which of the following is considered subjective data in information gathering from the patient? a. Pulse and blood pressure measurements b. ECG pattern c. Diaphoresis d. Pain

5. ANS: D Feedback A Pulse rate and blood pressure measurements are signs or objective data that can be confirmed by observation. B The ECG pattern is objective data. C Diaphoresis is objective data. D Subjective data are the patient's perceptions, sometimes called "symptoms."

6. The earliest type of formal nursing education program was the a. diploma program. b. associate degree program. c. bachelor's degree program. d. grandfathered acceptance as registered nurse (RN).

6. ANS: A Feedback A Diploma programs of nursing began in the late 1800s and were the earliest form of nursing education. B Associate nursing degree programs began in 1952. C Bachelor's degree programs began in 1909 but became commonplace only in the mid-1900s. D Nurses are not grandfathered into licensure.

6. A patient states, "I am so upset that I need a knee replacement. I should have done those exercises that the physical therapist told me to do years ago." In which stage of illness is the patient? a. Disbelief and denial b. Irritability and anger c. Attempting to gain control d. Depression and despair

6. ANS: B Feedback A The person in the "disbelief and denial" stage believes that the symptoms do not really represent illness and will go away. B Irritability and anger is the second stage of illness acceptance. It is characterized by anger at the body for not functioning properly or by anger at self or others. C The person in the "attempting to gain control" stage usually seeks help and knowledge as ways to gain control. D At the "depression and despair" stage, the patient may experience many losses, and depression is the response.

6. The nurse says to a newly diagnosed diabetic patient, "I will be working with you during your 3-day stay to help you practice insulin injections and to review your new diet. I'm wondering if we could find a time of day to begin the teaching sessions that is good for us." This conversation would occur in which phase of the nurse-patient relationship? a. Acquaintance phase b. Orientation phase c. Working phase d. Termination phase

6. ANS: B Feedback A The phases of the nurse-patient relationship do not include an acquaintance phase. B During the orientation phase the time frame of the relationship is established, the problems to be worked on are identified, and a time to meet is established. C The working phase is when the nurse and patient address the problems. D The termination phase is when the relationship is ending.

6. A nursing student is complaining about writing care plans. Which response by the faculty is best to help the student see the importance of this activity? a. "Using the nursing process will help nurses get reimbursement for their services." b. "You need a written plan of care so everyone is on the same page as you are." c. "The nursing process is a way to systematically think about and use patient data." d. "Most state nurse practice acts require them, so you need to learn how to do them."

6. ANS: C Feedback A Demonstrating use of the nursing process may be important in obtaining reimbursement, but it is not the primary reason for using the nursing process (and writing care plans). B Having a detailed plan that other nurses can follow is important, but it is not the primary reason for using the nursing process (and writing care plans). C Writing care plans teaches students to use the nursing process, which is a systematic way of thinking about and processing patient data. D State nurse practice acts do require that nurses demonstrate the use of the nursing process, but this statement does not describe why the process itself is important.

7. Which of the following suggests that a successful contract has been established between the nurse and patient in the orientation phase of the nurse-patient relationship? a. Patient has agreed to learn to change his colostomy bag. b. Patient ambulates in the hall without assistance. c. Patient allows the nurse to inject his daily insulin. d. Patient asks the charge nurse to verify that the staff nurse's teaching is correct.

7. ANS: A Feedback A The successful completion of a planned intervention signifies the successful establishment of the therapeutic relationship. B The patient is acting independently of the nurse's instructions. C The patient is not moving toward goals of independence. D Trust has not been established.

7. A patient states, "I do not understand why I keep getting these headaches. I have seen a nurse practitioner and two specialists. I have taken several medications, but the headaches keep coming back." In which stage of illness is the patient? a. Disbelief and denial b. Irritability and anger c. Attempting to gain control d. Acceptance and participation

7. ANS: C Feedback A The person in the first stage believes that the symptoms do not really represent illness and will go away. B At the second stage the person is angry at the body for not functioning properly or displaces anger onto self or others. C Attempting to gain control is the third stage in adjustment to an illness. The person in this stage usually seeks help and knowledge as ways to gain control. D The fifth stage occurs when the patient is ready to participate in decisions about treatment.

7. Which of the following is considered objective data obtained from the patient? a. "I can't catch my breath." b. Patient expresses concern about missing work. c. Patient nods, indicating an affirmative answer to a question. d. Blood pressure is 110/70 at 8 PM.

7. ANS: D Feedback A A patient's expression of a problem is subjective data. B The patient expressing concern about missing work is an inference based on what a patient has said. C "Patient nods, indicating an affirmative answer to a question" is interpretation of a movement. D Objective data are measurable and observable.

7. The single most important reason for the decline in the number of hospital-based diploma programs was a. shift in hospital occupancy from acute care to home care. b. increase in hospital-based medical residency programs competing for educational dollars. c. beginning of associate degree programs that were shorter in length. d. diploma education's position outside the mainstream of higher education.

7. ANS: D Feedback A The increase in complexity of health care led to the need for more advanced educational preparation for nurses. B Although it became more difficult for hospitals to fund diploma programs, this was not the most important reason for their decline. C The advent of associate degree programs led to the decline in diploma programs, because associate degree programs are located in academic settings. D The movement of nursing education into the educational mainstream, that is, colleges and universities, was responsible for the rapid decrease in diploma programs.

Which of the following is a primary reason for the initial slow growth of bachelor's degree nursing programs in the United States? a. Belief that hands-on training received in hospital-based diploma programs was superior to the theoretical-focused content in bachelor's degree programs b. Belief that hospital-based diploma programs were more scientifically based c. Belief that students prepared in hospital-based diploma programs were more compassionate caregivers d. Belief that hospital-based education programs facilitated career mobility

8. ANS: A Feedback A There was a great deal of acceptance of the hands-on teaching received in diploma programs. B Bachelor's degree programs are more theoretically focused. C There is no difference in perception of caring between the programs. D Bachelor's degree education facilitates career mobility.

8. A newly diagnosed diabetic patient states "I have very definite likes and dislikes when it comes to food. Am I going to have to eat only certain foods, or will I have some choice?" The nurse responds, "Why don't you give me a list of your likes and dislikes? I will consult with the dietitian about how to include your preferences and still come up with a good diet for you." What phase of the nurse-patient relationship is this? a. Relationship phase b. Orientation phase c. Working phase d. Termination phase

8. ANS: C Feedback A The phases of the nurse-patient relationship do not include a relationship phase. B The orientation phase is when the relationship is established, the problems to be worked on are identified, and a time to meet is established. C The working phase is when the nurse and patient address the problems that have been identified. D The termination phase is when the relationship is ending.

8. The nurse observes a patient lying rigidly in bed and taking shallow breaths. The patient reports a pain score of 4 out of 5 and says, "My leg hurts." The nurse determines that the objective and subjective data are a. incongruent and require more assessment. b. insufficient to make any conclusions. c. congruent and support that the patient is in pain. d. unclear; the nurse needs to talk to the patient's family for more information.

8. ANS: C Feedback A The statement and behaviors observed indicate that the patient is experiencing pain. B One can make a conclusion because there is sufficient information available. C The patient states he/she is in pain and the rigid positioning and shallow breathing are behaviors found when individuals experience pain. D The subjective nature of pain requires obtaining the information from the patient if at all possible. The family can be an excellent source of information if the patient is unable to cooperate with the nurse's assessment.

8. A patient states, "There is no hope. They're going to keep me here until I die. Can't you give me my medication more often? I'm going to die anyway." In which stage of illness is this patient? a. Disbelief and denial b. Irritability and anger c. Attempting to gain control d. Depression and grief

8. ANS: D Feedback A The person in the first stage believes that the symptoms do not really represent illness and will go away. B At the second stage the person is angry at the body for not functioning properly or displaces anger onto self or others. C The person in the third stage usually seeks help and knowledge as ways to gain control. D Depression and grief is the fourth stage in the adjustment to an illness. The person at this stage may experience many losses, and depression is the response.

9. A nursing student asks, "Why do I have to go to clinical in obstetrics when I know I'll never work with women and children?" In which stage of Cohen's model of professional socialization is this student? a. Stage I: Unilateral dependence b. Stage II: Negativity/independence c. Stage III: Dependence/mutuality d. Stage IV: Interdependence

9. ANS: B Feedback A Students in stage I rely on external controls and teachers. B In stage II, students begin to question authority figures and overestimate their ability to care for complex patients. C Students develop better critical thinking skills in stage III. D In stage IV, students learn to make decisions in collaboration with each other.

9. A patient demonstrates obvious regression in ability to perform self-care during the working phase. Which response by the nurse is most appropriate? a. Frustration because the patient does not appear to be motivated to achieve goals b. Persistence in demonstrating the importance of achieving goals c. Patience and understanding because regression is a defense mechanism d. Ignoring it because the nurse realizes the patient is exhibiting childlike behavior

9. ANS: C Feedback A The nurse needs to show patience and maturity, not frustration. B Regression may be a necessary defense mechanism against stress, and the nurse needs patience during this time. C Patience and understanding are necessary because the patient's progress toward goal achievement may not be smooth. Regression is a defense mechanism that may precede positive outcomes. D Understanding of regression is needed during this time.

9. A nurse is admitting a non-English speaking patient to the hospital unit. Which is the best method of obtaining data from the patient? a. Asking the other family members to help interpret b. Performing a physical examination on the patient c. Interviewing the patient using a professional interpreter d. Attempting to obtain past medical records for this patient

9. ANS: C Feedback A While tempting, the nurse should not use family members to interpret. They may insert cultural biases, may be embarrassed to translate certain topics, or may misunderstand the nurse's question. Professional interpreters must be used. B A physical examination yields important data, but the patient interview is the primary method of obtaining information. The nurse needs to use an interpreter to gain this information from the patient. C A professional interpreter has been trained to convey medical information without cultural biases and in an objective fashion. D Past medical records may provide useful information but obtaining them does not replace the need to conduct a patient interview with the assistance of a professional interpreter.

9. The 1948 Brown Report recommended which of the following? a. Limit enrollment of men and minorities in nursing programs. b. Students admitted to nursing programs should not be required to meet admission requirements of the university. c. Schools of nursing should be associated with teaching hospitals. d. Schools of nursing should be located in institutions of higher learning.

9. ANS: D Feedback A The Brown Report recommended that more men and minorities be recruited into nursing. B The Brown Report recommendations did not address admission requirements of universities. C The Brown Report recommended moving nursing education into academic settings. D The Brown Report recommended that schools of nursing be moved to institutions of higher learning.

_ 9. A patient states, "I have knowledge about my diet and how to do my insulin injections, so I can get on with my life." In which stage of illness is this patient? a. Disbelief and denial b. Irritability and anger c. Attempting to gain control d. Acceptance and participation

9. ANS: D Feedback A The person in the first stage believes that the symptoms do not really represent illness and will go away. B At the second stage the person is angry at the body for not functioning properly or displaces anger onto self or others. C The person in the third stage usually seeks help and knowledge as ways to gain control. D Acceptance and participation is the final stage in the adjustment to an illness. A person in this stage is ready to participate in decisions about treatment.

Which early nursing theorist recognized therapeutic milieu, assessment skills, and a unique body of knowledge in her definition of nursing? a.Dorothea Orem b.Virginia Henderson c.Hildegard Peplau d.Florence Nightingale

ANS: D A. Orem was known for her self-care theory. B.Henderson was best known for her definition of nursing as assisting the sick to do those things that they would do for themselves if they were able and for her list of 14 patient problems. C. Peplau is known for her theory of therapeutic nurse-patient relationships. D.Nightingale was the first nurse to realize the importance of environment and assessment skills and that nursing care should be delivered by a professional nurse with a unique body of knowledge, not a layperson.

8. A nursing student says to the clinical faculty, "I know I will be able to care for this patient given your directions." In which stage of Cohen's model of professional socialization is this student? a. Stage I: Unilateral dependence b. Stage II: Negativity/independence c. Stage III: Dependence/mutuality d. Stage IV: Interdependence

Ans. A A In stage I, students rely on external controls and teachers, absorbing information given by the faculty. B In stage II, students begin to question authority figures versus accepting the patient assignment without questioning. C The student has developed better critical thinking skills at stage III. D In stage IV, the student has learned to make decisions in collaboration with others.

Which of the following is an example of Orem's self-care theory? a. Assuring proper fresh air and ventilation b. Demonstrating good handwashing techniques c. Assisting a disoriented patient with a bath d. Performing a visual screening exam

Ans. C A Proper ventilation was described by Nightingale. B Good handwashing was described by Nightingale. C Providing adequate patient hygiene is described in Orem's theory of nursing as providing assistance to a person because of the person's inabilities for self-care. D Preventive services are not addressed in Orem's theory.

7. Which of the following is an example of informal socialization into a profession? a. Nurses discussing a patient care issue in the presence of other nurses b. Taking an extra class for an elective c. Performing your first physical assessment in a client d. Teaching a patient about warfarin (Coumadin)

Ans: A A Informal socialization into the role of a nurse occurs when the student learns from the nurse in an informal, unplanned way. B Taking an extra class for an elective is an example of formal, planned education. C Performing your first physical assessment in a client is part of the formal learning process. D Teaching a patient about Coumadin is part of a planned clinical experience and therefore falls under the category of formal socialization.

2. Which early nursing theorist defined nursing in interpersonal terms by stating that nursing is a significant, therapeutic, and interpersonal process? a. Virginia Henderson b.Hildegard Peplau c.Martha Rogers d.Dorothea Orem

Ans: B A. Henderson's definition of nursing did not focus on the interpersonal relationship. B. Peplau defined nursing in interpersonal terms. C. Rogers is known for including nursing process in her definition of nursing. D.Orem is known for her theory on self-care.

6. Which of the following is an example of formal socialization into the profession of nursing? a. Unplanned observation of a nurse comforting a child after a painful procedure b. Hearing two nurses discussing how to organize patient care more effectively c. Starting an intravenous (IV) line in the simulation laboratory under faculty guidance d. Participating in a student nurses' association meeting

Ans: C A "Unplanned observation of a nurse comforting a child after a painful procedure" is an example of an incidental learning experience. B "Hearing two nurses discussing how to organize the care of a patient more effectively" is an example of an incidental learning experience. C Formal socialization includes planned activities to gain knowledge and skills needed by the nurse. D "Participating in a student nurses' association meeting" is an example of an incidental learning experience.

4. Which of the following is an example of Henderson's definition of nursing? a. Performing a hearing screening in preschool children b. Interacting with depressed men to learn new strategies for reducing their symptoms c. Setting goals for weight loss with a patient d. Teaching a person with frequent constipation about high-fiber foods

Ans: D A Henderson's definition does not speak to preventive services. B Henderson's definition does not focus on interpersonal relationship. C Goal setting is part of King's definition of nursing, not Henderson's. D Henderson's definition states that "the unique function of the nurse is to assist the individual . . . in the performance of those activities contributing to health . . . that he would perform unaided if he had the necessary . . . knowledge."

5. The legal definition of nursing for any particular state can be found in the a. state legislature's official newsletter. b. state board of nursing's bylaws. c. governor's official papers. d. state's nurse practice act.

Ans: D A The legal definition of nursing is not found in the state legislature's official newsletter. B The state board of nursing administers the nurse practice act of that state, and its bylaws govern its internal functioning. C The governor's office does not determine the legal definition of nursing. D Each state's nurse practice act contains the legal definition of nursing for a particular state.