unit 3: Psychosocial Concepts/Sexuality/Cultural

The nurse is teaching a patient newly diagnosed with type 1 diabetes mellitus about how to best manage his blood sugar. Which outcome in the patient's plan of care is associated with the cognitive domain of learning? The patient: 1) identifies signs and symptoms of hypoglycemia. 2) nods affirmatively with direct eye contact. 3) demonstrates fingerstick glucose monitoring. 4) independently self-administers insulin.

Correct Answer: 1 Cognitive behavior includes recall and comprehension, which is demonstrated by stating information, such as indicators of hypoglycemia. Nodding with eye contact is an action that exhibits the listener is dealing with the information with emotion (respect), which shows affective domain. Affective learning is the manner in which we deal with things emotionally, such as feelings, values, appreciation, enthusiasms, motivations, and attitudes. Willingness to hear and showing attention falls within the affective domain. Demonstration of skills depicts the psychomotor domain, such as performing a test to check blood sugar or injecting insulin. See page 856 in the textbook

Over which factor affecting self-concept does a school-age child have the most control? 1) Peer relationships 2) Family relationships 3) Socioeconomic status 4) Developmental level

Correct Answer: 1 Factors that affect self-concept but are out of the school-age child's control include family relationships, socioeconomic status, and developmental level. Peer relationships influence self-concept and are within the child's control because she can choose whether to remain in a relationship. A person cannot control the socioeconomic status into which she is born, although later in life one's choices can affect socioeconomic status. Nevertheless, larger forces impact socioeconomic status, so the individual has less control over that than over her peer relationships. See page 275 in the textbook

Years after being in a building that exploded, killing and injuring 10 people, a client is still having flashbacks and anxiety. These symptoms most likely represent: 1) post-traumatic stress disorder. 2) ego defense mechanisms. 3) crisis. 4) somatization.

Correct Answer: 1 Post-traumatic stress disorder (PTSD) is a specific response to a violent, traumatizing event, such as an earthquake or other natural disaster, or to physical or emotional abuse, such as rape, torture, or war experience. The victim, such as this client, experiences anxiety and flashbacks that may last for months or years. Ego defense mechanisms are unconscious mental mechanisms (e.g., rationalization, denial) that make a stressful situation more tolerable by decreasing the inner tension associated with the stressors. They are used to reduce anxiety. A crisis exists when (1) an event in a person's life drastically changes the person's routine and he perceives it as a threat to self, and (2) the person's usual coping methods are ineffective, resulting in high levels of anxiety and inability to function adequately. A crisis is usually sudden and unexpected (e.g., being in a building explosion); however, anxiety and flashbacks lasting for years are characteristic of PTSD. In somatization, anxiety and emotional turmoil are expressed in physical symptoms, loss of physical function, pain that changes location often, and depression. Complaints are vague and exaggerated. See page 259-261 in the textbook

A middle-aged man experienced the sudden death of his wife 2 weeks before his hospitalization. Along with the stress of hospitalization, you realize he is most likely experiencing which type of stressor? 1) External 2) Internal 3) Developmental 4) Physiological

Correct Answer: 1 The death of a family member is an example of an external stressor (although many of the responses are internal). A disease is an example of an internal stressor. Developmental stressors are those that can be predicted at various stages of a person's life. The death of a middle-aged spouse is not a predicted stressor at this stage in the patient's life. Physiological stressors are those that affect body structure or function. See page 249 in the textbook

Which of the following is the primary goal for the oldest-old? 1) Maximize function 2) Prevent falls 3) Promote good nutrition 4) Prevent heart disease

Correct Answer: 1 The goal of interventions for the oldest-old is to maximize function and prevent loss of function or disability, thus ensuring independence for as long as possible. Supportive environments and conditions that allow a person to function are vital. See page 216 in the textbook

An agnostic nurse is caring for a devoutly religious patient. The client says, "I am so frightened. Please say a prayer with me." The patient begins praying aloud. What should the nurse do? 1) Remain quietly beside the bed until the client finishes the prayer. 2) Walk quietly from the room while the client is praying. 3) Stop the client and say, "I am not comfortable with prayer. I will get someone to join you." 4) Stay during the prayer and say "Amen" at pauses and when the prayer is finished.

Correct Answer: 1 The nurse might choose to pray or not to; but the nurse must respect the client's dignity and provide spiritual support. Remaining at the bedside during prayer provides support for the client without compromising the nurse's beliefs. The nurse does not need to pray but merely should remain quiet and respectful while the client prays. Only if the client asks should the nurse say she is uncomfortable praying. Secretly exiting the room while the patient is praying is neither respectful nor honest. Participating in the prayer by interjecting and closing with "Amen" is also dishonest because the agnostic nurse does not believe in prayer. See page 350 in the textbook

A 17-year-old woman with Down syndrome is brought to the emergency department by her parents after an incident of sexual assault by her uncle. What would you do when providing care to her after the incident? Select all that apply. 1) Document pregnancy status with a urine or blood sample. 2) Advise parents to have her tested for STIs 1 week after the incident. 3) Administer the hepatitis B and HPV vaccines, as ordered. 4) Refer the victim to a sexual assault center for further information and counseling.

Correct Answer: 1;2;3;4 The risk for sexually transmitted infections (STIs) is extremely high in cases of sexual assault. Not only should prophylactic treatment be given for STIs, such as gonorrhea or chlamydia, but you might also administer vaccines to prevent hepatitis B and human papillomavirus (HPV), as prescribed and according to your agency's policy. If there is a significant risk for HIV, prophylaxis may be prescribed within 72 hours of exposure. The victim should receive follow-up care 1 week after the event to assess for healing of injuries and presence of sexually transmitted infection. Female adolescents who have experienced a sexual assault should be offered emergency contraception, even if vaginal penetration cannot be determined with certainty. At the time of the evaluation, pregnancy status should be documented with either a blood or urine sample. Because of the long-term psychologic and emotional consequences of sexual assault, victims most often benefit from counseling. Consider referring the victim to a sexual assault center for support, counseling, and additional information. See page 1184 in the textbook

The nurse is caring for a patient whose primary language is Vietnamese. When working with the interpreter, the nurse should do which of the following? Select all that apply. 1) Make eye contact with the interpreter. 2) Speak a little more loudly than usual. 3) Use an interpreter who is socially compatible with the patient. 4) Try to find a family member to help interpret.

Correct Answer: 1;3 When choosing an interpreter, the nurse should use one who is socially compatible with the patient. The nurse should maintain eye contact with both the patient and interpreter. She should not speak loudly. It is best to not ask family members to interpret because of privacy issues. See page 332 in the textbook

Negative body image has been linked to an increased risk for which of the following? Select all that apply. 1) Sexually transmitted infections 2) Hypertension 3) Depression 4) Colon cancer

Correct Answer: 1;3 Sexually transmitted infections Depression A negative body image has been linked to (and therefore places a patient at risk for) depression, smoking among adolescents, unintended pregnancy, sexually transmitted infections, and HIV infection. Negative body image has not been directly linked to hypertension or colon cancer. See page 276 in the textbook

Which of the following is the best test of functional ability? 1) Geriatric Depression scale (GDS) 2) Katz Index of Independence in Activities of Daily Living 3) Client's heart rate after 2 minutes on a treadmill 4) Bone density scan to identify osteoporosis

Correct Answer: 2 Functional status is the ability to perform self-care and other activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The Katz Index of Independence in Activities of Daily Living allows you to rate a client's independence in bathing, dressing, toileting, transferring, continence, and feeding. The Geriatric Depression scale (GDS) is a 30-item questionnaire that screens for depression. Although depression and decreased bone density might indirectly affect functional ability, they are not good tests of functional ability because they do not necessarily result in loss of ability to perform ADLs. They do not screen for overall functional ability. See page 212 in the textbook

Which of the following questions would provide information about "O" in a HOPE assessment and "S" in a SPIRIT assessment? 1) Do you have any dietary restrictions or needs on religious holidays? 2) What is your religion or what church do you go to? 3) How comfortable are you with discussing spirituality? 4) Do you have an advance directive?

Correct Answer: 2 In the HOPE assessment "O" represents "organized religion." In the SPIRIT tool, "S" represents "spiritual/religious belief system." Dietary needs provide information about ritualized practices and restrictions ("R" in the SPIRIT tool; "E" in the HOPE approach). Asking about the patient's comfort with discussing spirituality addresses personal spirituality ("P" in the SPIRIT tool; "P" in the HOPE approach). Advance directives address terminal events planning ("T" in the SPIRIT tool; "E" in the HOPE approach). See page 346-347 in the textbook,

What type of disability is most common for noninstitutionalized persons in the United States? 1) Physical restriction 2) Mental illness 3) Sensory impairment 4) Self-care deficit

Correct Answer: 2 Many people with chronic illness and disability require assistance with activities of daily living, such as getting around the home, feeding, bathing, dressing, toileting, and getting in and out of a chair or bed. Among those with specific types of disabilities, the highest group was made up of people with mental disability (32.5%), and the lowest group comprised those with sensory disability (23.3%). Noninstitutionalized people who reported disability were unable to care for themselves (26.6%). And, 17.2% were people with physical disabilities. See page 307 in the textbook

Which of the following is a DSM category of sexual deviation for which a client might require mental health care? 1) Homosexuality 2) Voyeurism 3) Bisexuality 4) Transgenderism

Correct Answer: 2 The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) describes eight categories of sexual deviation or paraphilias: exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, and voyeurism. Homosexuality and bisexuality are forms of sexual orientation. A transgendered person is someone with a gender identification issue. See page 1182 in the textbook

During the admission assessment, a patient tells the nurse that he does not believe there is a God. The nurse should document his religious affiliation as: 1) Agnostic 2) Atheist 3) Sikhism 4) Rastafarianism

Correct Answer: 2 Those who actively deny the existence of God are known as atheists. Agnostics believe it is not possible to know whether or not God actually exists. Sikhism combines the teachings of Hinduism and Islamic Sufism (a mystical branch of Islam); they believe in the presence of one God, not multiple gods. Rastafarians follow the Old and New Testaments of the Bible and emphasize a deep love of God. See page 347 in the textbook

Which topic is most important to include when educating all clients about sexuality? 1) Contraception 2) Sexually transmitted infections (STIs) 3) Sexual orientation 4) Sexual identity

Correct Answer: 2 Sexually transmitted infections (STIs) STIs are among the most common infectious diseases in the United States today. More than 20 different STIs have been identified, and they affect millions of men and women in this country each year. In 2000, the Centers for Disease Control and Prevention (CDC) estimated 18.9 million new cases were reported. Educating on prevention is absolutely critical. See page 1195 in the textbook

In general, for young-old clients with no special problems, which of the following would you recommend for exercising? Select all that apply: 1) Walk 10 minutes a day and increase minutes and intensity slowly. 2) Perform muscle-strengthening activities on 2 or more days a week. 3) Participate in yoga and tai chi exercises. 4) See an exercise therapist for an exercise program.

Correct Answer: 2;3 Clients should perform moderate or high-intensity muscle-strengthening activities on 2 or more days a week. The weight-bearing and toning exercises should involve all major muscle groups. Muscle-strengthening activities can include use of exercise bands, handheld weights, digging, lifting and carrying as part of gardening, carrying groceries, and some yoga and tai chi exercises. Inactive older adults or those with a very low level of fitness should begin with 10 minutes of walking and increase minutes and intensity slowly with subsequent walks. Others should engage in 150 minutes a week of moderate-intensity aerobic exercise. Only those with chronic conditions may need to see an exercise therapist for help in making adaptations that allow them to exercise. See page 215, 216 in the textbook

Which of the following should you advise a frail older adult to do to slow the spiral of frailty? Select all that apply: 1) Participate in a fall-preventive moderate-intensive group exercise program. 2) Eat a balanced diet, including enough protein, fiber, and fluids. 3) Keep the mind active (e.g., by reading and socializing). 4) Walk, as tolerated, for aerobic fitness and joint flexibility.

Correct Answer: 2;3;4 Available research suggests that the frail elderly do not appear to benefit from fall-preventive moderate-intensity group exercise programs, although they have positive effects on older adults before frailty occurs. Maintaining good nutritional status is also thought to be important in preventing or delaying frailty (Bartali, Semba, Frongillo, et al., 2006). Keep the mind active by socializing, working puzzles, reading, or playing games (Frailty in older adults, 2006). Engage in daily physical activity to the extent possible: walking and weights to build aerobic fitness, build muscle, and improve joint stiffness and pain (Bartali, Semba, Frongillo, et al., 2006). See page 236 in the textbook

A patient of Mormon faith is admitted to the hospital with new onset diabetes mellitus. Based on his religious affiliation, which item(s) should the nurse be sure is replaced on the patient's dinner tray? Select all that apply. 1) Pork 2) Tea 3) Meat 4) Coffee

Correct Answer: 2;4 Tea Coffee Mormons follow a strict health code, known as the Word of Wisdom, which prohibits the consumption of tea, coffee, and alcohol. Orthodox and many conservative Jews avoid pork products. Most Hindus are lacto-vegetarians, which means they consume milk but not eggs. Buddhists, Hindus, some Rastafarians, and some Christians (on Fridays during Lent) do not consume meat. See page 342 in the textbook

When taking a cultural history, all of the following are important. Which one is most important in order to later plan for patient safety? 1) Obtain data directly from the patient. 2) Show empathy and respect; build rapport. 3) Ask about use of alternative medicine and folk remedies. 4) Ask open-ended questions when beginning the assessment.

Correct Answer: 3 Always ask patients about their use of alternative medicine and folk remedies so that their effects on traditional biomedical medications and treatments can be evaluated. Some remedies may interfere with traditional treatments; others can be dangerous. Many people use folk remedies, but they may be reluctant to tell you so because they fear ridicule or at least disapproval. It is best to obtain data directly from the client, but this includes all data, not just that contributing to safety. Empathy and respect help to build trust and encourage the patient to provide data; but this includes all kinds of data. Asking open-ended questions encourages patients to talk and therefore supply more of all types of data. See page 328, 331 in the textbook

NANDA has two nursing diagnoses for describing sexual problems: Ineffective Sexuality Patterns and Sexual Dysfunction. How would you determine which diagnosis to use on a client? 1) Use Ineffective Sexuality Patterns when the patient expresses concern about the ability to achieve his perceived sex role. 2) Use Ineffective Sexuality Patterns when the patient is seeking confirmation of desirability. 3) Use Sexual dysfunction when the patient is experiencing values conflicts in the area of sexuality. 4) Use Sexual Dysfunction when the patient expresses dissatisfaction with an actual change in sexual functioning (e.g., difficulty maintaining an erection).

Correct Answer: 4 There is much overlap between these two NANDA diagnoses; however, Sexual Dysfunction is the more specific diagnosis for physiological and performance problems. See page 1187 in the textbook

A client has been involved in an abusive relationship for more than 10 years. Her self-esteem is low. After an overnight stay in the hospital to be treated for cuts, bruises, a concussion, and a broken arm, she is tearful and shaky. She will not go to a shelter, even though she says she is afraid because "he said he will kill me if he ever sees me again." She admits, "I barely know my children are around; I just am so on edge all the time. I make them stay in their room. But I'm sure I can make this all better." Which stage of crisis does this situation represent? 1) Precrisis 2) Impact 3) Crisis 4) Adaptive

Correct Answer: 3 In the crisis phase, the person experiences a high level of anxiety and tries new ways of coping, such as withdrawal, rationalization, and projection—and in this case, denial. The person recognizes the problem but denies it is out of control (e.g., she states she is afraid, but she says, "I can make this all better."). In the impact phase, the person may be anxious and confused and have trouble organizing her life; she feels the stress, but minimizes its severity—this patient does not minimize; she admits she is stressed (e.g., "on edge all the time," "afraid"). The precrisis stage would have occurred for this patient early in the relationship, when her usual coping strategies were being used, when she had no symptoms, and when she denied any stress. In the adaptive phase, the person redefines the threat and perceives the crisis in a realistic way. She begins to think rationally and does some positive problem solving, regains some self-esteem, and is able to begin socializing again. None of this is true for this patient. See page 259 in the textbook

Which of the following would be an abnormal assessment finding for an older adult that the nurse would document and report to the primary care provider? Decreased: 1) Reaction time 2) Short-term memory 3) Intellectual ability 4) Cognitive processing speed

Correct Answer: 3 There should be no loss of intellectual ability. An elderly person can learn, although learning takes longer. Reaction time slows as we age, and it is also normal to have a decline of short-term memory, although long-term memory loss is not as common. Cognitive processing speed declines with age. This includes slower computational skills and reduced speed for problem solving, but this does not imply that intellect is impaired. See page 208 in the textbook

When assessing an older adult patient, which of the following should the nurse recognize as a normal age-related change? Select all that apply: 1) Urinary incontinence ("dribbling") 2) Frequent loss of balance 3) Diminished acuity of near vision 4) A decline in short-term memory

Correct Answer: 3;4 Diminished acuity of near vision A decline in short-term memory Urinary incontinence is not the result of usual age-related changes. It may signal a urinary tract infection, a prostate problem, excessive urogenital drying, or the need for in-home assistance. Frequent falls or loss of balance are not the result of normal age-related changes but could signal a neuropathology such as Parkinson's disease or early symptoms of dementia and should be reported to a health-care provider. With aging, the lens of the eye thickens and there is increased glare sensitivity and decreased visual acuity. Reaction time slows in older adults, and short-term memory declines; it takes longer to respond to a stimulus, and it takes more time to process incoming information. However, there is no loss of intelligence as a person ages. See page 208, 209 in the textbook

For a client who is experiencing multiple stressors, which of the following interventions could a nurse use without special training? 1) Biofeedback 2) Therapeutic touch 3) Acupuncture 4) Visualization

Correct Answer: 4 A nurse can provide visualization or guided imagery to complement the effects of relaxation techniques. Biofeedback, therapeutic touch, and acupuncture all require special training. See page 267 in the textbook

When teaching nursing students about how to provide culturally sensitive care to a diverse group of patients, which teaching strategy is most likely to promote affective learning? 1) Demonstration 2) Computer-assisted instruction 3) Concept mapping 4) Role-modeling

Correct Answer: 4 Affective learning involves changes in feelings, beliefs, attitudes, and values. It is considered the "feeling domain." Strategies for promoting affective learning include role-modeling, panel discussion, support group, one-to-one instruction, audiovisual materials, and possibly printed materials. Strategies for cognitive learning include concept mapping, panel discussion, and computer-assisted instruction. Strategies for psychomotor learning include demonstration, simulation, audiovisual materials, and printed materials. See page 872 in the textbook

A nurse is admitting a 75-year-old patient to the nursing unit, accompanied by his son. Using a life span approach to care, which of the following is essential for the nurse to do? 1) Increase the room temperature. 2) Speak slowly and use short sentences. 3) Direct admission questions to the patient's son. 4) Ask the patient if he has had any falls in the past year.

Correct Answer: 4 Falls are a major source of morbidity in hospitalized patients. On admission, nurse should ask all older adults (age 65 and older) if they have had any falls in the past year. Although it is true that some older adults may like a warm temperature, this is not universally true; it would need to be assessed for each individual. Speaking slowly and using short sentences is recommended for patients with learning or hearing disabilities; however, the nurse cannot assume that all older adults have either of these. The best assessment data usually are obtained from the patient. The nurse should interview other family members only if the patient is not communicating clearly; the nurse has not yet assessed that in this scenario. See page 239 in the textbook

While admitting a patient with a particular religious heritage, the nurse comments to another nurse, "This is going to be a pain. This kind of patient always has a million family members in and out, and they're always so noisy and demanding." This illustrates: 1) Discrimination 2) Sexism 3) Ethnocentrism 4) Prejudice

Correct Answer: 4 Prejudice refers to negative attitudes toward other people, which are based on faulty and rigid stereotypes about race, gender, sexual orientation, and so on. Discrimination refers to behavioral manifestations of prejudice; the nurse is not discriminating because she has not yet taken any action. Sexism is the assumption that members of one sex are superior to those of the other sex; there is no mention of gender in the scenario. Ethnocentrism is a positive bias toward one's own culture, believing that their beliefs and values are right and those of other cultures are wrong or at least bizarre. It is broader than prejudice and is not directed toward a specific cultural group. See page 327 in the textbook

What is the term for a person who feels a personal identity as the opposite gender for which he or she was born? 1) Transvestite 2) Intersexual 3) Homosexual 4) Transsexual

Correct Answer: 4 Transgendered (or "differently gendered") is a broad term used to describe people whose gender identity differs in some way from their apparent biological gender. A transsexual is a person who identifies his or her own self image as the opposite gender of birth. This is also referred to as a gender identity disorder. Intersexed people are born with ambiguous sexual organs. For example, the person may have female internal organs (ovaries, a uterus), but an external penis. An older term for this is hermaphrodite. A homosexual person is one whose focus of sexual attraction is those of the same gender. A cross-dresser (or transvestite) is a person who occasionally or frequently wears the clothing characteristic of the opposite sex, particularly the undergarments, as a form of sexual expression. See page 1174 in the textbook

According to developmental norms, at what age does the greatest increase in height occur? 1) 1 to 3 years 2) 4 to 5 years 3) 6 to 11 years 4) 12 to 18 years

Correct Answer: 4 Twelve- to 18-year-old females grow 2 to 8 inches, and males grow 4 to 12 inches. Growth is about 3 inches for children during years 1 to 3 and 4 to 5. Growth is about 2 inches during the sixth and up to the 12th year. See page 181, 182 in the textbook

The nurse is evaluating a patient's responses to interventions to promote her self-esteem. The patient has a nursing diagnosis of Chronic Low Self-Esteem. The patient is moderately overweight. Which of the following statements by the patient provides the most direct evidence of positive self-esteem? 1) "I've always been a little overweight, even as a child." 2) "When I look in the mirror, I can see that I've lost a little weight." 3) "My husband says he likes me at this weight." 4) "I've done a good job sticking to my diet this week."

Correct Answer: 4 When talking about her diet, the patient uses an evaluative word ("good") to indicate a positive feeling about herself. "I've always been overweight" states a fact but gives no clue as to how the patient feels about it. A person who knows she has "lost a little weight" may or may not have good self-esteem and could be in a state of denial. Even though the patient's husband says he likes her weight, she may not believe him and might not have good self-esteem. Also, that statement describes how someone else evaluates the patient, not how she evaluates herself. See page 285, 286 in the textbook

The nurse provides instructions to a parent about what to anticipate during her son's adolescence. Which comment by the parent indicates she understands the instructions? 1) "I know his peers will have more of an influence than I will." 2) "I'm relieved he will finally be able to make good decisions." 3) "I'm sure he will be less inclined to do things with his friends." 4) "I'm glad his growth will slow; the food bills have been huge."

Correct answer: 1 "I know his peers will have more of an influence than I will." Adolescents develop their own personal identity, and they do this by decreasing the attachment to their parents and developing close relationships with peers. The adolescent still lacks common sense and can have poor judgment. Adolescents have a strong need to feel part of a group. There is a growth spurt for both sexes during adolescence. See page 182 in the textbook

A young mother of a 1-month-old infant says to the nurse, "My baby can't roll over or sit up. He can raise his head though, and he looks at me when I talk to him. Is anything wrong?" How should the nurse respond? 1) "No. Babies don't usually roll over until they are about 5 months old." 2) "Probably not. But we can do a Denver Developmental Screening Test to be certain." 3) "Probably not. If he doesn't fall over when you sit him up, he is developing normally." 4) "I don't think so, but we can have the physician examine him to be sure."

Correct answer: 1 "No. Babies don't usually roll over until they are about 5 months old." Development proceeds in a proximodistal pattern, beginning at the center of the body and moving outward. For example, the infant first begins to focus her eyes, then lifts her head, and later pushes up and rolls over (by about 5 months of age). There is no need to use time and money administering a Denver Developmental Screening Test (DDST); what the mother describes is certainly normal, and the nurse is qualified to make that judgment. Normally, a baby will roll over before she sits alone; it would be very unusual for a 1-month-old to do either. Also, because of proximodistal development, the infant will probably (but not always) roll over before he sits alone. The nurse does not need the physician to answer this mother's question about normal infant development. See page 171 in the textbook, BASIC NURSING

__________________ is defined as a loss of interest or pleasure in previously enjoyed activities. 1) Anhedonia 2) Anxiety 3) Depression 4) Ambivalence

Correct answer: 1 Anhedonia Anhedonia is defined as a loss of interest or pleasure in previously enjoyed activities. It is one of the symptoms of depression. Anxiety is defined as a nonspecific mental feeling of uneasiness or apprehension caused by perception of threat to self. Depression is a prolonged feeling of sadness; it is associated with affective symptoms such as denial of feelings, anger, anxiety, guilt, helplessness, hopelessness, and sadness, as well as some physical symptoms, such as constipation. Ambivalence is a feeling of uncertainty or mental conflict about something or is the presence of two opposing ideas or emotions at the same time. See page 289 in the textbook

For which behavior should the nurse observe when assessing the family's ineffective pattern for coping with stress of illness and hospitalization of a family member? 1) Avoiding coming to the hospital to visit family member 2) Arranging a family meeting to discuss plan for care 3) Seeking professional counseling for conflict resolution 4) Scheduling respite care to take a break from caregiving

Correct answer: 1 Avoiding coming to the hospital to visit family member For inpatients, notice who is visiting. Family members who are not coping well may avoid coming to visit the patient, so this may be an indicator of who is coping and who is not. Family meetings are beneficial for determining mutual goals and intervention strategies for caring for an ill family member. Ineffective coping can trigger family abuse or neglect and dysfunctional family relationships. Professional counseling is commonly necessary for families dealing with complex or stressful issues related to illness and hospitalization. Arranging for respite care is a healthy option to ease the burden of the caregiver role and ease stress when a family member is ill or hospitalized. See page 310 in the textbook

Which nursing intervention is specific for promoting positive body image? 1) Encourage the client to be active and focus on healthy eating. 2) Discuss boundaries, expectations, and management defined by lifestyle and family networks. 3) Monitor for and discourage self-doubt and self-criticism. 4) Use positive and reaffirming language when speaking with the patient.

Correct answer: 1 Encourage the client to be active and focus on healthy eating. Encouraging the client to be active and focus on healthy eating is a nursing intervention that promotes positive body image. Discussing boundaries, expectations, and management defined by lifestyle and family networks facilitates role enhancement. Monitoring for and discouraging self-doubt and using positive and reaffirming language promote self-esteem. See page 286 in the textbook

Which core issue of spirituality includes a patient's basic human need for achievement? 1) Hope 2) Faith 3) Love 4) Forgiveness

Correct answer: 1 Hope Hope includes the basic human needs to achieve, create, and make something of one's life. Faith addresses our ongoing effort to make sense of our life and our purpose for being. With the aspect of love, we extend our love to others with hope of receiving love. Forgiveness is not a core issue of spirituality. See page 240 in the textbook, BASIC NURSING

The nurse is responsible for setting up special equipment (e.g., oxygen, suction). Aside from that, which of the following procedures can the nurse delegate in its entirety to nursing assistive personnel (NAP)? 1) Preparing a room for a newly admitted patient 2) Admitting a patient to a hospital unit 3) Transferring a patient to a long-term care facility 4) Discharging a patient to home

Correct answer: 1 Preparing a room for a newly admitted patient As a general rule, the nurse can delegate to an NAP the tasks of setting up a room for a patient being admitted to the unit, except for setting up and regulating special equipment such as oxygen and suction. Admissions, transfers, and discharges all involve patient assessment, teaching, and interdisciplinary communication that the NAP cannot do. See page 233 in the textbook

The nurse working in a hospital with a diverse population strives to offer culturally sensitive care. What nursing action would be most appropriate? 1) Act as if familiar with cultural practices or values even if uncertain. 2) Allow patient to include cultural practices in plan of care unless harmful. 3) Use common, slang phrases as they are familiar to many people. 4) Incorporate humor into interactions with patients to put them at ease.

Correct answer: 2 Find ways to incorporate the client's current healthcare practices and beliefs into the plan of care unless there is potential for harm. When the nurse is unfamiliar with the patient and family's cultural practices, she should admit lack of knowledge, seek clarification, and express willingness to learn. She should not fake it. The nurse should avoid using slang expressions because they can take on different meanings in different cultures. Slang can lead to miscommunication and offensive messages. Avoid using humor; jokes often do not translate well because of subtle meaning changes. See page 863 in the textbook, BASIC NURSING

Which statement by the patient demonstrates that she is identifying too closely with her disease? 1) "Because I have high blood pressure, I need to watch my salt intake." 2) "Now that I have had chemotherapy, I can't go anywhere; too many germs." 3) "I have to watch my fluid intake so my lungs don't fill up with fluid again." 4) "I try to exercise at least 3 times a week to avoid further bone loss."

Correct answer: 2 "Now that I have had chemotherapy, I can't go anywhere; too many germs." The patient who states "Now that I have had chemotherapy, I can't go anywhere" is identifying too closely with her disease. Although she must avoid crowds, she can still venture out of the house. Her response shows that she is placing too many limitations on herself because of the disease. The other options demonstrate patients who are realistically following restrictions brought on by their diseases. See page 276 in the textbook

A patient is prescribed a low-sodium, low-fat diet. How can the nurse best ensure that the patient follows the prescribed diet during hospitalization? 1) Make sure dietary services sends a low-sodium, low-fat meal tray. 2) Arrange for meals that accommodate his cultural dietary practices and specified diet. 3) Ask the patient's family to bring in foods from home he typically eats. 4) Sit with the patient while he eats to make sure he consumes the prescribed diet.

Correct answer: 2 Arrange for meals that accommodate his cultural dietary practices and specified diet. The nurse can help ensure that the patient consumes the prescribed diet by requesting a culturally appropriate meal tray for the patient. Patients are more likely to follow the prescribed diet when it contains foods that they prefer. Simply providing a tray that is low in fat and sodium does not take into consideration his cultural preferences. The family can provide foods for the patient after they have been instructed about the diet. Sitting with the patient while he eats does not ensure that the patient will follow the diet, and it fosters dependence. See page 332, 333 in the textbook, BASIC NURSING

A nurse strives to teach a spouse how to monitor a patient's blood pressure. Which teaching method is best? 1) Provide the patient and spouse with written instruction about how to obtain blood pressure. 2) Demonstrate the technique for taking blood pressure, and then request a return demonstration. 3) Schedule the spouse for a class about high blood pressure, including monitoring technique. 4) Provide the spouse with a patient education brochure about blood pressure monitoring.

Correct answer: 2 Demonstrate the technique for taking blood pressure, and then request a return demonstration. The best way to teach a psychomotor skill, such as obtaining blood pressure, is through demonstration and return demonstration. Cognitive learning, which includes storage and recall of information, is most often taught through lecture and print and audiovisual materials. See page 871 in the textbook

You are caring for a young adult who frequently complains of feeling nervous. The patient asks you to explain the difference between fear and anxiety. Your best response is: 1) "Fear is an emotional response, whereas anxiety is a physical response to stress." 2) "Fear is a form of anxiety that forms related to an anticipated event." 3) "Unlike anxiety, fear is a cognitive response, usually with an identifiable source." 4) "Unlike anxiety, fear results from a psychological conflict about a previous decision or action."

Correct answer: 3 "Unlike anxiety, fear is a cognitive response, usually with an identifiable source." Fear is a cognitive response, whereas anxiety is an emotional response. Fear is related to a present event; whereas anxiety is related to an anticipated event. Fear can result from a physical or a psychological event; anxiety results from psychological conflict rather than a physical threat. The source of fear is usually identifiable. See page 256 in the textbook, BASIC NURSING

A long-term care facility has started a program to increase the cultural competence of its employees. When notified of this, a nurse thinks to himself, "I don't have time for this nonsense. I already know all I need to about culture, and I don't really like taking care of so many different kinds of people anyway." This most clearly illustrates the nurse's lack of cultural: 1) Awareness 2) Desire 3) Exposure 4) Knowledge

Correct answer: 2 Desire Cultural desire is the wish to be culturally competent. This nurse clearly does not want to improve in that area. He seems to be aware of his personal biases ("I don't like taking care of different kinds of people . . ."). Exposure refers to the actual face-to-face encounters with patients from diverse cultural backgrounds. This scenario does not state clearly whether this nurse has had many encounters, but nothing in the scenario indicates that he is lacking in encounters. Apparently he has had enough encounters to develop a negative bias. Cultural knowledge refers to principles and theories. There is nothing in this scenario to indicate that the nurse lacks cultural knowledge, although it is not beyond the realm of possibility. The question asks, though, not what is possible, but what the nurse's thinking "most clearly illustrates." See page 327 in the textbook, BASIC NURSING

Which of the following is the most prevalent major health problem for young adults? 1) Cancer 2) Obesity 3) Eating disorders 4) Cardiovascular disease

Correct answer: 2 Obesity Obesity has increased drastically in adults. Of course, some cancers do occur in young adults; however, cancer and cardiovascular disease become major concerns in middle adulthood. Eating disorders are a problem more typical of adolescence. They are not widespread in adults. They may occur in young adults but are not as prevalent as obesity. See page 188 in the textbook

Life transitions that young adults experience as they mature are most typically perceived as: 1) An opportunity for independence 2) Occurring in a predictable order. 3) Creating a low-risk-taking generation 4) A time of unchanged family dynamics

Correct answer: 2 Occurring in a predictable order. Young adulthood is a time of transitions that occur in various sequences, such as leaving home, finishing school, obtaining employment, getting married, and serving military duty. Not every young adult will experience these milestones in the same sequence, nor will they cope with them in the same manner. The autonomy achieved in young adulthood can sometimes result in risky behavior that is characteristic of adolescence when adult children feel that they are now "outside the family microscope" and have the freedom to do whatever they want. Risks to family health during this period relate to the children's living on their own for the first time. Whether the young adult permanently leaves the home or transiently returns to the nest, the family dynamics change in one way or another. Roles and communication patterns evolve during this time, based on the developmental demands of adulthood for self-reliance. See page 305 in the textbook

What is the most important reason for a nurse to remain calm, greet the patient by name, and introduce herself to a new patient, even when the nurse is upset by something else that has happened? 1) The nurse will work more efficiently if she is not upset. 2) These actions help to establish a trusting relationship. 3) Hospital policies prohibit nurses from showing emotion in a patient's presence. 4) If the nurse is upset, she may not recall all the assessments she needs to make.

Correct answer: 2 These actions help establish a trusting relationship. Greeting the patient by name and introducing yourself helps to build a trusting relationship at the first patient contact. The disruptions of illness and transition to the hospital are stressful for patients. A trusting relationship helps relieve their anxiety and preserve the energy needed for healing. The nurse might work more efficiently if she is not upset, but that is not the most important reason. It is not likely a policy would prohibit nurses to appropriately show emotions to a patient, although it would be inappropriate to do so in the situation described in this question. However, even if there were such a policy, that is not the most important reason. It is true that if the nurse is upset, she might not recall the contents of an admission assessment; however, there is almost always a structured data collection form for admission assessments, so recall is not an issue. See page 231-233 in the textbook

Which statement about families is true? 1) Family wellness can be promoted by addressing primarily individual concerns. 2) Wellness of each family member is critical to the health of the family unit. 3) An external individual best teaches health beliefs to the family. 4) Family coping has little influence on the care of a hospitalized patient.

Correct answer: 2 Wellness of each family member is critical to the health of the family unit. Family wellness can be promoted by addressing both individual and family concerns. The family teaches health beliefs, values, and behaviors to its individual members. How families cope with everyday life situations and hospitalization can influence the effectiveness of care. See page 308 in the textbook

How might the nurse improve health literacy between patients and healthcare providers? 1) Ask patients simple yes or no questions. 2) Speak with passive voice instead of active. 3) Avoid medical jargon and technical terms. 4) Provide information printed in English.

Correct answer: 3 Health literacy is the ability to understand basic health information and services needed to make appropriate healthcare decisions. A gap in health literacy results when a healthcare provider uses terminology that is unfamiliar or misunderstood by the patient, thus resulting in an unintended message or lack of meaningful information. Therefore, healthcare providers should avoid unnecessary medical jargon and technical terms. Speak using common words, short sentences, and structuring sentences with active rather than passive voice. To be sure the patient understands your questions clearly, ask questions that involve "how" and "what" rather than "yes" and "no." Patients with limited language proficiency might use words of agreement "yes" or disagreement "no" simply because of reduced vocabulary and poor understanding of the question. Do not assume that a client who smiles, nods, and says "yes" really understands what you are teaching. The client may be embarrassed to ask questions or may feel that it will embarrass you. An interpreter might help communication when language is the barrier. See page 862-863 in the textbook, BASIC NURSING

Which of the following patients demonstrates successful adaptation to a stressor? 1) A man who discovers a testicular lump and avoids seeing a physician 2) A woman who gives up a job she loves because it is stressful to her 3) A mother who finds easier ways to care for her child who is in a wheelchair 4) An adolescent who continues a relationship with an abusive boyfriend

Correct answer: 3 A mother who finds easier ways to care for her child who is in a wheelchair The mother who finds more efficient ways to care for her child in a wheelchair demonstrates adaptation to a stressor. The man who discovers a testicular lump and is too fearful to notify the physician is avoiding the stressor. The woman who gives up her job is altering or avoiding the stressor. The adolescent who continues a relationship with an abusive boyfriend is still trying to adapt to the stressor. See page 251 in the textbook

Which of the following is a common, normal emotional response to a stressor? 1) Depression 2) Fear 3) Anxiety 4) Panic

Correct answer: 3 Anxiety Anxiety is a common emotional response to a stressor. Depression is a prolonged feeling of sadness. Fear is a specific, cognitive response to a known threat. Panic is an unreasonable and irrational response to a stressor. See page 277 in the textbook

Which health conditions would be considered acute illness? A patient with: 1) Diabetes mellitus 2) AIDS 3) Appendicitis 4) Multiple sclerosis

Correct answer: 3 Appendicitis Appendicitis is an acute illness; diabetes mellitus, AIDS, and multiple sclerosis are chronic illnesses. See page 229 in the textbook, BASIC NURSING

When do people typically begin to increase awareness of the compelling reality of death? Select all that apply. 1) Adolescence 2) Young adulthood 3) Middle age 4) Older adulthood

Correct answer: 3 Middle age During middle age, even without a life-threatening illness, people typically become more aware of the reality of death—that one's life is limited. See page 227 in the textbook

You are caring for a healthy 28-year-old man with a fractured tibia (bone in the lower leg). The patient has asked you to place his penis in the urinal and hold it while he voids. You should: 1) assist the patient as he has requested. 2) immediately leave the room. 3) tell him his behavior is inappropriate. 4) report him to your supervisor.

Correct answer: 3 tell him his behavior is inappropriate. The patient's request is unnecessary and should be considered a request for sexual stimulation. If you believe a client is demonstrating inappropriate sexual behaviors, immediately tell the client that his behavior is inappropriate. If this is unsuccessful, you may need to inform your supervisor or request a change in assignment. See page 1196 in the textbook

A patient remarks to the nurse, "What's the point of going through all these medical treatments. They make me feel so bad, and I will never be well anyway." What is the most helpful action for the nurse to take? 1) Explore with the patient what has triggered his emotions. 2) Treat the patient with dignity and respect. 3) Pray with the patient in a private setting. 4) Assist the patient to identify areas of hope in life.

Correct answer: 4 The patient is demonstrating Hopelessness. All of the responses would be appropriate under certain circumstances, but helping the patient identify areas of hope in life most directly addresses Hopelessness. The nurse does not need to explore the trigger for the patient's emotions—he has said that it is the treatments and the lack of hope for returning to wellness. All patients should be treated with dignity and respect; however, this alone would not address Hopelessness. The nurse should pray with the patient only after first learning whether this would be helpful to the patient; in this scenario, that information is not available. See page 350 in the textbook, BASIC NURSING

The structural-functional theory views the family as: 1) A system in interaction with other systems 2) A unit of interacting personalities 3) Evolving through developmental stages 4) A social system with focus on outcomes

Correct answer: 4 A social system with focus on outcomes A central issue of structural-functional theory is how well the family maintains and meets the needs of the individuals, the family as a whole, and society. This theory is focused on the outcome of how those needs are or are not met. General systems theory focuses on interactions between systems and the changes that result from these interactions. Developmental theory focuses on the life cycle of families. This framework depicts normative stages of family development. The major emphasis of the family interactional theory is on the family personalities, the interaction and communication between family members, their roles and power, family coping, and relationships with other people outside the direct family unit. See page 302 in the textbook

The nurse is planning to discuss the psychosocial challenges of middle adulthood with a community group. Which of the following should be included in the discussion? 1) There is an unavoidable decline in health in middle adulthood. 2) There are significant age-related body changes that affect health. 3) Work is more challenging because the productive years have passed. 4) Along with raising children there is often the concern of aging parents.

Correct answer: 4 Along with raising children there is often the concern of aging parents. Middle adults often have competing demands of raising children and caring for aging parents along with the demands of the job. There is not a noticeable decline in health, although energy levels may decline. There are some age-related changes (loss of skin turgor, muscle tone, etc.), but they are not as significant as during older adulthood, and as a rule they do not affect health. During middle adulthood, a person is usually at the peak of his career, but it is also the peak of creativity. See page 190 in the textbook

The nurse is developing a care plan for a patient admitted to the intensive care unit with upper gastrointestinal bleeding. Which intervention by the nurse may help the family cope with the emergent hospitalization? 1) Assessing family relationships 2) Carefully observing verbal and nonverbal communication 3) Monitoring for signs of stress 4) Keeping the family informed of the patient's progress

Correct answer: 4 Keeping the family informed of the patient's progress Keeping the family informed of the patient's progress may help the family cope with the emergent hospitalization of their loved one. Assessing family relationships, observing verbal and nonverbal communication, and monitoring for signs of stress are ways the nurse assesses the family's strategies for coping with a stressful situation. They are actually assessments, not interventions; and although they would provide information for the nurse, they would not help the family to cope. See page 301 in the textbook

Why is patient education important in today's healthcare environment? 1) Primarily it is offered to increase patient confidence for self-care. 2) Nurses do patient teaching to transfer responsibility for care to patients. 3) Patient education contributes to rising healthcare costs. 4) More healthcare is delivered in the home and outpatient settings.

Correct answer: 4 More healthcare is delivered in the home and outpatient settings. With shorter hospital stays and complex care increasingly being given in homes and the community, teaching is essential to protect patient well-being and safety in the outpatient environment. The primary goal of patient education is to increase the knowledge and skills needed for quality self-care or for providers delivering care in the outpatient setting. Although patients often feel more confident in the home care they will perform after receiving patient education, the primary objective is to facilitate healing and prevent complications. Patients participate in healthcare decisions. Patients have a responsibility for their own health and the care needed to prevent illness, maintain health, treat disease, and evaluate the response to medical treatment. The cost of healthcare is rising. Patient education can help to decrease the overall cost of healthcare and prevent complications leading to rehospitalization. See page 854 in the textbook

Which intervention by the nurse best indicates that she values a Native American patient's beliefs and indigenous healthcare system? 1) Incorporating Native American practices into care based on consultation with a cultural resource book 2) Explaining the values and beliefs of the traditional healthcare system to the patient so that the patient understands what is occurring 3) Contacting a Native American resource group for information about the culture 4) Planning how to incorporate traditional practices and beliefs through discussion with the patient

Correct answer: 4 Planning how to incorporate traditional practices and beliefs through discussion with the patient "Incorporating traditional practices and beliefs . . ." is the only answer that indicates that the nurse has assessed to determine what the patient's beliefs actually are. When consulting a cultural resource book or a Native American resource group for information, the nurse would be assuming that the patient's wishes will conform to her cultural group. By explaining the traditional healthcare system, the nurse would not even be attempting to deal with the patient's beliefs but would be trying to convince the patient that the mainstream way is preferred. See page 332 in the textbook

Each patient develops unique patterns of coping with anxiety, called _____________________, which the patient uses both consciously and unconsciously to relieve anxiety.

Defense mechanisms Each person develops unique patterns of coping with anxiety, called defense mechanisms, which are used consciously or unconsciously to relieve the anxiety. See page 277 in the textbook

A 28-year-old client underwent surgery for testicular cancer. Which factor might increase the client's recovery time? 1) Drinking a glass of red wine daily 2) The client's developmental stage 3) Exercising three times a week 4) History of tobacco use

History of tobacco use A history of tobacco use increases recovery time from other illnesses, injury, and surgery. Drinking a glass of red wine each day can reduce the risk of heart disease and slow bone loss. Studies support the benefit of moderate physical activity in reducing the risk of chronic disease. Because this client is young, his developmental stage would not be a factor in increasing recovery time; advanced age might be a factor. See page 225 in the textbook